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Sharma S, Pathak A, Parker R, Costa LOP, Ghai B, Igwesi-Chidobe C, Janwantanakul P, de Jesus-Moraleida FR, Chala MB, Pourahmadi M, Briggs AM, Gorgon E, Ardern CL, Khan KM, McAuley JH. How low back pain is managed-a mixed methods study in 32 countries. Part 2 of Low Back Pain in Low- and Middle-Income Countries Series. J Orthop Sports Phys Ther 2024:1-42. [PMID: 38602844 DOI: 10.2519/jospt.2024.12406] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND: The Lancet Series of Low Back Pain (LBP) highlighted the lack of LBP data from low- and middle-income countries (LMICs). The study aimed to describe (1) what LBP care is currently delivered in LMICs, and (2) how that care is delivered. METHODS: An online mixed-methods study. A Consortium for LBP in LMICs (n=65) was developed with an expert panel of leading LBP researchers (>2 publications on LBP) and multidisciplinary clinicians and patient partners with five years of clinical/lived LBP experience in LMICs. Quantitative data were analyzed using descriptive statistics. Two researchers independently analyzed qualitative data using deductive and inductive coding and developed a thematic framework. FINDINGS: Forty-seven (85%) of 55 invited panel members representing 32 LMICs completed the survey (38% women; 62% men). The panel included clinicians (34%), researchers (28%), educators (6%), and patient partners (4%). Pharmacotherapies and electrophysiological agents were the most used LBP treatments. The Thematic Framework comprised of eight themes: (1) Self-management is ubiquitous; (2) Medicines are the cornerstone; (3) Traditional therapies have a place; (4) Society plays an important role; (5) Imaging use is very common; (6) Reliance on passive approaches; (7) Social determinants influence LBP care pathway; and (8) Health systems are ill-prepared to address LBP burden. INTERPRETATION: LBP care in LMICs did not consistently align with the best available evidence. Findings will help research prioritization in LMICs and guide global LBP clinical guidelines. FUNDING: The lead author's Fellowship was supported by the International Association for the Study of Pain.
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Affiliation(s)
- Saurab Sharma
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney
| | - Anupa Pathak
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health sciences, University of Cape Town, South Africa
| | | | - Babita Ghai
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chinonso Igwesi-Chidobe
- Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
- School of Allied Health Professions and Midwifery, Faculty of Health Studies, the University of Bradford, United Kingdom
| | - Prawit Janwantanakul
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | - Mulugeta Bayisa Chala
- Department of Physiotherapy, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
- The Gray Centre for Mobility and Activity, Parkwood Institute, St. Joseph's Health Care London, ON, Canada
| | - Mohammadreza Pourahmadi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Andrew M Briggs
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Edward Gorgon
- College of Allied Medical Professions, University of the Philippines Manila, Manila, Philippines
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Clare L Ardern
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Karim M Khan
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis, Vancouver, BC, Canada
| | - James H McAuley
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney
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Robinson-Papp J, Lawrence S, Wadley A, Scott W, George MC, Josh J, O'Brien KK, Price C, Uebelacker L, Edelman EJ, Evangeli M, Goodin BR, Harding R, Nkhoma K, Parker R, Sabin C, Slawek D, Tsui JI, Merlin JS. Priorities for HIV and chronic pain research: results from a survey of individuals with lived experience. AIDS Care 2024:1-11. [PMID: 38588701 DOI: 10.1080/09540121.2024.2334358] [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: 10/18/2023] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
The Global Task Force on Chronic Pain in HIV published seven research priorities in the field of HIV-associated chronic pain in 2019: (1) causes; (2) management; (3) treatment individualization and integration with addiction treatment; (4) mental and social health factors; (5) prevalence; (6) treatment cost effectiveness; and (7) prevention. The current study used a web-based survey to determine whether the research topics were aligned with the priorities of adults with lived experiences of HIV and chronic pain. We also collected information about respondents' own pain and treatment experiences. We received 311 survey responses from mostly US-based respondents. Most respondents reported longstanding, moderate to severe, multisite pain, commonly accompanied by symptoms of anxiety and/or depression. The median number of pain treatments tried was 10 (IQR = 8, 13), with medications and exercise being the most common modalities, and opioids being viewed as the most helpful. Over 80% of respondents considered all research topics either "extremely important" or "very important". Research topic #2, which focused on optimizing management of pain in people with HIV, was accorded the greatest importance by respondents. These findings suggest good alignment between the priorities of researchers and US-based people with lived experience of HIV-associated chronic pain.
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Affiliation(s)
| | - Steven Lawrence
- Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, New York, NY, USA
| | - Antonia Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- INPUT Pain Unit, Guy's & St Thomas' NHS Foundation Trust
| | | | - Jo Josh
- British HIV Association (BHIVA), London, UK
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto
- Rehabilitation Sciences Institute (RSI), University of Toronto
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health University of Toronto, Toronto, Canada
| | - Collen Price
- Canadian HIV/AIDS and Chronic Pain Society, Ottawa, Canada
| | | | | | - Michael Evangeli
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Burel R Goodin
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Caroline Sabin
- Institute for Global Health, University College London, London, UK
| | - Deepika Slawek
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Judith I Tsui
- University of Washington School of Medicine, Seattle, WA, USA
| | - Jessica S Merlin
- CHAllenges in Managing and Preventing Pain (CHAMPP) Clinical Research Center, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh
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Mardon AK, Chalmers KJ, Heathcote LC, Curtis LA, Freedman L, Malani R, Parker R, Neumann PB, Moseley GL, Leake HB. "I wish I knew then what I know now" - pain science education concepts important for female persistent pelvic pain: a reflexive thematic analysis. Pain 2024:00006396-990000000-00547. [PMID: 38452219 DOI: 10.1097/j.pain.0000000000003205] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/18/2024] [Indexed: 03/09/2024]
Abstract
ABSTRACT Pain science education (PSE) provides people with an understanding of "how pain works" grounded in the biopsychosocial model of pain; it has been demonstrated to improve outcomes in musculoskeletal pain conditions. Preliminary evidence suggests PSE may be effective for female individuals with persistent pelvic pain, but how the content of PSE needs to be modified for this group remains to be determined. A reflexive thematic analysis of qualitative data was performed to identify PSE concepts that female individuals with persistent pelvic pain consider important and why. Twenty individual, semistructured interviews were conducted with adult females who had engaged with PSE and had self-identified as having "improved" pelvic pain. Most participants had been diagnosed with endometriosis (n = 16). Four themes were generated capturing PSE concepts considered important by female individuals with "improved" pelvic pain: (1) "A sensitised nervous system leads to overprotective pain" validated their pelvic pain as being real; (2) "Pain does not have to mean the body is damaged (although sometimes it does)" provided reassurance that pelvic pain does not mean their condition is worsening; (3) "How I think, feel, and 'see' my pain can make it worse" enabled participants to find optimal ways to manage their pain; and (4) "I can change my pain… slowly" provided hope that pelvic pain can improve and empowered them to pursue pain improvement as a viable goal. This study generated 4 PSE learning concepts that were important to female individuals with improved pelvic pain and may be incorporated into PSE curricula for female individuals with pelvic pain.
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Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - K Jane Chalmers
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Lauren C Heathcote
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lee-Anne Curtis
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | | | - Rinkle Malani
- MGM School of Physiotherapy, Aurangabad, A Constituent Unit of MGMIHS, Maharashtra, India
| | - Romy Parker
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Patricia B Neumann
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Hayley B Leake
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
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Limakatso K, Tucker J, Banda L, Robertson C, Parker R. The profile of people undergoing lower limb amputations at Groote Schuur Hospital. Afr J Disabil 2024; 13:1152. [PMID: 38445074 PMCID: PMC10912944 DOI: 10.4102/ajod.v13i0.1152] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/23/2023] [Indexed: 03/07/2024] Open
Abstract
Background The annual incidence of lower limb amputations (LLA) at Groote Schuur Hospital is rising gradually. However, little is known about the sociodemographic and clinical profiles of people undergoing these limb amputations. Objectives To collect and analyse data to describe the sociodemographic, health and amputation profiles of people who have undergone LLA at Groote Schuur Hospital. Method A descriptive retrospective chart review was conducted using a sample of 107 participants who had undergone LLA at Groote Schuur Hospital between January 2019 and July 2020. A customised assessment tool was used to extract data on the sociodemographic, health and amputation profiles of patients who had LLA. Data were analysed descriptively. Results Sixty per cent of the patients who had undergone LLA at Groote Schuur Hospital were women. Most of the patients were over the age of 60 years and had not completed school and were pensioners or unemployed, with very low income and multiple co-morbidities including poorly controlled diabetes. Conclusions Complications because of uncontrolled diabetes were the primary indication for LLAs at Groote Schuur Hospital. Therefore, health literacy projects are indicated to address chronic diseases of lifestyle, which, in turn, may reduce the overall burden of LLA, particularly on the South African under-resourced healthcare system. Contribution The results of this study may help us identify key factors that predispose patients to LLAs. Consequently, this may help us identify key areas for prevention and better management of diseases that can result in complications that indicate the need for amputation.
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Affiliation(s)
- Katleho Limakatso
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jenna Tucker
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lennie Banda
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Cheyne Robertson
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Limakatso K, Ndhlovu F, Usenbo A, Rayamajhi S, Kloppers C, Parker R. The prevalence and risk factors for phantom limb pain: a cross-sectional survey. BMC Neurol 2024; 24:57. [PMID: 38321380 PMCID: PMC10845739 DOI: 10.1186/s12883-024-03547-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND We previously performed a systematic review and meta-analysis which revealed a Phantom Limb Pain (PLP) prevalence estimate of 64% [95% CI: 60.01-68.1]. The prevalence estimates varied significantly between developed and developing countries. Remarkably, there is limited evidence on the prevalence of PLP and associated risk factors in African populations. METHODS Adults who had undergone limb amputations between January 2018 and October 2022 were recruited from healthcare facilities in the Western and Eastern Cape Provinces. We excluded individuals with auditory or speech impairments that hindered clear communication via telephone. Data on the prevalence and risk factors for PLP were collected telephonically from consenting and eligible participants. The prevalence of PLP was expressed as a percentage with a 95% confidence interval. The associations between PLP and risk factors for PLP were tested using univariate and multivariable logistic regression analyses. The strength of association was calculated using the Odds Ratio where association was confirmed. RESULTS The overall PLP prevalence was 71.73% [95% CI: 65.45-77.46]. Persistent pre-operative pain, residual limb pain, and non-painful phantom limb sensations were identified as risk factors for PLP. CONCLUSION This study revealed a high prevalence of PLP. The use of effective treatments targeting pre-amputation pain may yield more effective and targeted pre-amputation care, leading to improved quality of life after amputation.
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Affiliation(s)
- Katleho Limakatso
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Neural Prosthetics and Pain Research Unit, Bionics Institute, 384-388 Albert St, East Melbourne, East Melbourne, 3002, Australia
| | - F Ndhlovu
- Department of Anaesthesiology, Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - A Usenbo
- Department of Anaesthesiology, Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - S Rayamajhi
- Department of Acute Care Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - C Kloppers
- Department of Acute Care Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - R Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, D23 Groote Schuur Hospital, Faculty of Health Sciences, Anzio Rd, Observatory, Cape Town, 7925, South Africa.
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Shabangu N, Thebe T, Casey M, Wesselmann U, Parker R. Chronic pain in female breast cancer survivors - prevalence, characteristics and contributing factors: a cross-sectional pilot study. BMC Womens Health 2023; 23:613. [PMID: 37974174 PMCID: PMC10655434 DOI: 10.1186/s12905-023-02766-6] [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: 03/02/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND While the global incidence of breast cancer is increasing, there is also an increase in the numbers of breast cancer survivors and in survival duration, as early detection programs are implemented, and treatments are optimized. Breast cancer survivors in several countries commonly struggle with a range of symptoms (fatigue, insomnia, depression) with 25-80% of survivors suffering from chronic pain. There is a paucity of literature reporting on breast cancer survivors in South Africa. In this pilot study we aimed to determine the prevalence of chronic pain in female breast cancer survivors attending the breast oncology clinic. METHODS A cross-sectional survey was conducted of all breast cancer survivors attending the Groote Schuur Hospital Breast Unit during one month in 2019. 44 female breast cancer survivors (median age 60.5y) completed a sociodemographic questionnaire, the Brief Pain Inventory, Pain Catastrophizing Scale and measures for neuropathic pain (DN4), health related quality of life (HRQoL; EQ-5d-3 L), physical activity (IPAQ), depression and anxiety (PHQ4), and screening questions to evaluate sleep, happiness and perceived discrimination in the language of their choice. RESULTS The prevalence of chronic pain (pain on most days for more than three months) was 59% (95%CI 44-72), a significantly higher number than the 18,3% prevalence of chronic pain reported by South African adults. 39% of the women were classified as having neuropathic pain. The median pain severity score was 3.75 (IQR = 2.75-5) and the median pain interference with function score was 4 (IQR = 2.9-5.4). The women were experiencing pain in a median of 2 different body sites (IQR = 1-3). The women with pain were more likely to be unemployed or receiving a disability grant, had significantly worse HRQoL, and significantly worse scores for risk of depression and anxiety. CONCLUSION The results of this pilot study suggest that chronic pain may be a significant burden for South African breast cancer survivors. Routine screening for chronic pain in breast cancer survivors is recommended with a larger study indicated to explore this issue further.
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Affiliation(s)
- Nelisiwe Shabangu
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital. Cape Town, Cape Town, South Africa
| | - Tselane Thebe
- Department of Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Michelle Casey
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital. Cape Town, Cape Town, South Africa
| | - Ursula Wesselmann
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Department of Neurology, Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital. Cape Town, Cape Town, South Africa.
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Van Der Walt J, Parker R. LSD and psilocybin for chronic nociplastic pain: A narrative review of the literature supporting the use of classic psychedelic agents in chronic pain. S Afr Med J 2023; 113:22-26. [PMID: 38525640 DOI: 10.7196/samj.2023.v113i11.814] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Indexed: 03/26/2024] Open
Abstract
Healthcare providers face the challenging task of managing patients who suffer from chronic nociplastic pain conditions. Pain is a multidimensional experience, and the current approach to managing people in chronic pain often fails to meet the needs of these patients. Novel ways of treating people who suffer from chronic nociplastic pain with classic psychedelic agents may offer a new lens through which to approach their pain. Lysergic acid diethylamide (LSD) and psilocybin are both serotonergic agents with a long history of use in treating people with chronic pain and mental health disorders. The new wave of research into psychedelics for major depressive disorder provides an opportunity to investigate and understand the potential for incorporating these drugs into chronic pain management pathways. This narrative review presents healthcare workers with a framework to understand the method of action of these drugs in chronic nociplastic pain pathways and a brief history into their use. We conducted an online search using Pubmed with keywords 'chronic pain' AND/OR 'psilocybin' AND/OR 'lysergic acid diethylamide' AND/OR 'psychedelics' with no date limit applied. We identified further articles that contained information on the neuroscience of psychedelics and the serotonergic system using Google Scholar. During the final stages of writing the article, the latest publications on psychedelics and chronic pain in leading pain journals were again included to update the information.
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Affiliation(s)
- J Van Der Walt
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - R Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
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Fandim JV, Hinman RS, Øverås CK, Sharma S, Belton J, Oliveira VC, Dear BF, Parker R, Ghai B, Bennell KL, Ferreira P, Hartvigsen J, Saragiotto BT. One step at a time. Shaping consensus on research priorities and terminology in telehealth in musculoskeletal pain: an international modified e-Delphi study. BMC Musculoskelet Disord 2023; 24:783. [PMID: 37789304 PMCID: PMC10546725 DOI: 10.1186/s12891-023-06866-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/08/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Telehealth has emerged as an alternative model for treatment delivery and has become an important component of health service delivery. However, there is inconsistency in the use of terminologies and a lack of research priorities in telehealth in musculoskeletal pain. The purpose of this international, multidisciplinary expert panel assembled in a modified three-round e-Delphi survey is to achieve a consensus on research priorities and for the standard terminology for musculoskeletal pain telehealth practice. METHODS In this international modified e-Delphi survey, we invited an expert panel consisting of researchers, clinicians, consumer representatives, industry partners, healthcare managers, and policymakers to participate in a three-round e-Delphi. Expert panels were identified through the Expertscape website, PubMed database, social media, and a snowball approach. In Round 1, potential research priorities and terminologies were presented to panel members. Panel members rated the agreement of each research priority on a 5-point Likert scale and an 11-point numerical scale, and each terminology on a 5-point Likert scale for the "telehealth in musculoskeletal pain " field over rounds. At least 80% of the panel members were required to agree to be deemed a consensus. We analyzed the data descriptively and assessed the stability of the results using the Wilcoxon matched-pairs signed rank test. RESULTS We performed an international e-Delphi survey from February to August 2022. Of 694 invited people, 160 panel members participated in the first round, 133 in the second round (83% retention), and 134 in the third round (84% retention). Most of the panel members were researchers 76 (47%), clinicians 57 (36%), and consumer representatives 9 (6%) of both genders especially from Brazil 31 (19%), India 22 (14%), and Australia 19 (12%) in the first round. The panel identified fourteen telehealth research priorities spanned topics including the development of strategies using information and communication technology, telehealth implementation services, the effectiveness and cost-effectiveness of telehealth interventions, equity of telehealth interventions, qualitative research and eHealth literacy in musculoskeletal pain conditions from an initial list of 20 research priorities. The consensus was reached for "digital health" and "telehealth" as standard terminologies from an initial list of 37 terminologies. CONCLUSION An international, multidisciplinary expert consensus recommends that future research should consider the 14 research priorities for telehealth musculoskeletal pain reached. Additionally, the terms digital health and telehealth as the most appropriate terminologies to be used in musculoskeletal telehealth research. REGISTER Open Science Framework ( https://osf.io/tqmz2/ ).
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Affiliation(s)
- Junior V Fandim
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), Rua Cesário Galeno, 448, Tatuapé, CEP 03071-000, São Paulo, SP, Brasil.
| | - Rana S Hinman
- Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia
| | - Cecilie K Øverås
- Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Saurab Sharma
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Joletta Belton
- IASP Global Alliance of Partners for Pain Advocacy (GAPPA), Washington D.C, USA
| | - Vinícius C Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (UFVJM), Diamantina, MG, Brazil
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Macquarie Park, Australia
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Babita Ghai
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia
| | - Paulo Ferreira
- Faculty of Medicine and Health, The University of Sydney, Charles Perkins Centre, Sydney School of Health Sciences, Camperdown, NSW, Australia
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Bruno T Saragiotto
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), Rua Cesário Galeno, 448, Tatuapé, CEP 03071-000, São Paulo, SP, Brasil
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Bedwell GJ, Chikezie PC, Siboza FT, Mqadi L, Rice ASC, Kamerman PR, Parker R, Madden VJ. A Systematic Review and Meta-analysis of Non-pharmacological Methods to Manipulate Experimentally Induced Secondary Hypersensitivity. J Pain 2023; 24:1759-1797. [PMID: 37356604 DOI: 10.1016/j.jpain.2023.06.013] [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: 12/22/2022] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/27/2023]
Abstract
This systematic review and meta-analysis investigated the effects of non-pharmacological manipulations on experimentally induced secondary hypersensitivity in pain-free humans. We investigated the magnitude (change/difference in follow-up ratings from pre-manipulation ratings) of secondary hypersensitivity (primary outcome), and surface area of secondary hypersensitivity (secondary outcome), in 27 studies representing 847 participants. Risk of bias assessment concluded most studies (23 of 27) had an unclear or high risk of performance and detection bias. Further, 2 (of 27) studies had a high risk of measurement bias. Datasets were pooled by the method of manipulation and outcome. The magnitude of secondary hypersensitivity was decreased by diverting attention, anodal transcranial direct current stimulation, or emotional disclosure; increased by directing attention toward the induction site, nicotine deprivation, or negative suggestion; and unaffected by cathodal transcranial direct current stimulation or thermal change. Area of secondary hypersensitivity was decreased by anodal transcranial direct current stimulation, emotional disclosure, cognitive behavioral therapy, hyperbaric oxygen therapy, placebo analgesia, or spinal manipulation; increased by directing attention to the induction site, nicotine deprivation, or sleep disruption (in males only); and unaffected by cathodal transcranial direct current stimulation, thermal change, acupuncture, or electroacupuncture. Meta-analytical pooling was only appropriate for studies that used transcranial direct current stimulation or hyperbaric oxygen therapy, given the high clinical heterogeneity among the studies and unavailability of data. The evidence base for this question remains small. We discuss opportunities to improve methodological rigor including manipulation checks, structured blinding strategies, control conditions or time points, and public sharing of raw data. PERSPECTIVE: We described the effects of several non-pharmacological manipulations on experimentally induced secondary hypersensitivity in humans. By shedding light on the potential for non-pharmacological therapies to influence secondary hypersensitivity, it provides a foundation for the development and testing of targeted therapies for secondary hypersensitivity.
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Affiliation(s)
- Gillian J Bedwell
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Prince C Chikezie
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Felicia T Siboza
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Luyanduthando Mqadi
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa; HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Andrew S C Rice
- Pain Research Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Peter R Kamerman
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Victoria J Madden
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa; HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Merlin JS, Hamm M, de Abril Cameron F, Baker V, Brown DA, Cherry CL, Edelman EJ, Evangeli M, Harding R, Josh J, Kemp HI, Lichius C, Madden VJ, Nkhoma K, O'Brien KK, Parker R, Rice A, Robinson-Papp J, Sabin CA, Slawek D, Scott W, Tsui JI, Uebelacker LA, Wadley AL, Goodin BR. The Global Task Force for Chronic Pain in People with HIV (PWH): Developing a research agenda in an emerging field. AIDS Care 2023; 35:1215-1223. [PMID: 33745403 PMCID: PMC10758698 DOI: 10.1080/09540121.2021.1902936] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/01/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Chronic pain is a common comorbidity in people with HIV (PWH), with prevalence estimates of 25-85%. Research in this area is growing, but significant gaps remain. A Global Task Force of HIV experts was organized to brainstorm a scientific agenda and identify measurement domains critical to advancing research in this field. Experts were identified through literature searches and snowball sampling. Two online questionnaires were developed by Task Force members. Questionnaire 1 asked participants to identify knowledge gaps in the field of HIV and chronic pain and identify measurement domains in studies of chronic pain in PWH. Responses were ranked in order of importance in Questionnaire 2, which was followed by a group discussion. 29 experts completed Questionnaire 1, 25 completed Questionnaire 2, and 21 participated in the group. Many important clinical and research priorities emerged, including the need to examine etiologies of chronic pain in PWH. Pain-related measurement domains were discussed, with a primary focus on domains that could be assessed in a standardized manner across various cohorts that include PWH in different countries. We collaboratively identified clinical and research priorities, as well as gaps in standardization of measurement domains, that can be used to move the field forward.
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Affiliation(s)
- Jessica S Merlin
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Hamm
- Qualitative, Evaluation, and Stakeholder Engagement Research Services, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - F de Abril Cameron
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
- Qualitative, Evaluation, and Stakeholder Engagement Research Services, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - V Baker
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - D A Brown
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - C L Cherry
- Alfred Health, Monash University and Burnet Institute, Melbourne, Australia
- University of The Witwatersrand, Johannesburg, South Africa
| | - E J Edelman
- Yale Schools of Medicine and Public Health, New Haven, CT, USA
| | - M Evangeli
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - R Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - J Josh
- British HIV Association (BHIVA), London, UK
| | - H I Kemp
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - C Lichius
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - V J Madden
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - K Nkhoma
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - K K O'Brien
- Department of Physical Therapy, Rehabilitation Sciences Institute (RSI), Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada
| | - R Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - A Rice
- Department of Surgery & Cancer, Imperial College London, London, UK
| | | | - C A Sabin
- Institute for Global Health, University College London, London, UK
| | - D Slawek
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - W Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J I Tsui
- University of Washington School of Medicine, Seattle, WA, USA
| | - L A Uebelacker
- Brown University School of Medicine, Providence, RI, USA
| | - A L Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - B R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Limakatso K, Cashin AG, Williams S, Devonshire J, Parker R, McAuley JH. The Efficacy of Graded Motor Imagery and Its Components on Phantom Limb Pain and Disability: A Systematic Review and Meta-Analysis. Can J Pain 2023; 7:2188899. [PMID: 37214633 PMCID: PMC10193907 DOI: 10.1080/24740527.2023.2188899] [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: 11/08/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
Introduction Graded Motor Imagery (GMI) is a non-invasive and inexpensive therapy used to treat Phantom Limb Pain (PLP) by sequentially activating motor networks in such a way that movement and pain are unpaired. The objective of this systematic review was to critically appraise relevant data on the efficacy of GMI and its components for reducing PLP and disability in amputees. Methods We searched 11 electronic databases for controlled trials investigating GMI and its components in amputees with PLP from inception until February 2023. Two reviewers independently screened studies and extracted relevant data. Study-level data were entered using the inverse variance function of the Review Manager 5 and pooled with the random effects model. Results Eleven studies with varying risk of bias were eligible. No eligible study considered left/right judgement tasks in isolation. Studies showed no effect for imagined movements, but positive effects were seen for GMI [weighted mean difference: -21.29 (95%CI: -31.55, -11.02), I2= 0%] and mirror therapy [weighted mean difference: -8.55 (95%CI: -14.74, -2.35, I2= 61%]. A comparison of mirror therapy versus sham showed no difference [weighted mean difference: -4.43 (95%CI: -16.03, 7.16), I2= 51%]. Conclusion Our findings suggest that GMI and mirror therapy may be effective for reducing PLP. However, this conclusion was drawn from a limited body of evidence, and the certainty of the evidence was very low. Therefore, rigorous, high-quality trials are needed to address the gap in the literature and inform practice.
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Affiliation(s)
- Katleho Limakatso
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia
| | - Aidan G. Cashin
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia
| | - Sam Williams
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia
| | - Jack Devonshire
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia
| | - Romy Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - James H. McAuley
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia
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12
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Reardon C, Wadley A, Parker R. Context counts: Investigating pain management interventions in HIV-positive men living in a rural area. Afr J Prim Health Care Fam Med 2023; 15:e1-e11. [PMID: 37265161 DOI: 10.4102/phcfm.v15i1.3678] [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: 05/22/2022] [Revised: 11/04/2022] [Accepted: 02/19/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Pain remains a prevalent and burdensome complaint for people living with human immunodeficiency virus and/or aquired immunodeficiency syndrome (LWHA). Positive Living (PL), a multimodal pain intervention, reduced pain in female South Africans LWHA. We investigated the efficacy of the PL programme in South African males living with human immunodeficiency virus and/or acquired immunodeficiency syndrome (MLWA) in a rural community. AIM To determine the effects of a multimodal pain intervention in MLWHA. SETTING Various primary care clinics in Manguzi, Kwa-Zulu Natal, South Africa. METHODOLOGY Therapeutic relationship (TR) intervention alone or in combination with the PL programme were allocated to HIV-positive men between the ages of 18-40. Pain intensity and interference were the primary outcome measures. Secondary outcome measures included physical function, health-related quality of life, depressive symptoms and self-efficacy. RESULTS Forty-seven men (mean age 35 ± 3 years) were recruited with baseline mean pain severity of 5.02 (± 3.01) and pain interference of 4.6 (± 3.18). Nineteen men were allocated to the TR intervention alone, 28 were allocated to the TR intervention and PL programme. Attendance at the intervention sessions varied from 10% to 36%. No changes in any outcomes were recorded. CONCLUSION Poor attendance at the intervention and follow-up sessions make these results an unreliable reflection of the intervention. Contextual factors including internal migration and issues around employment were identified. These may influence healthcare utilisation for MLWHA living in rural settings.Contribution: Unmet healthcare needs of MLWHA in a rural community have been identified. If we are to 'leave no one behind', healthcare interventions should account for context and be 'rural-proofed'.
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Affiliation(s)
- Cameron Reardon
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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13
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Ernstzen DV, Parker R, Ras T, Von Pressentin K, Louw QA. Clinical recommendations for chronic musculoskeletal pain in South African primary health care. Afr J Prim Health Care Fam Med 2023; 15:e1-e12. [PMID: 37132561 PMCID: PMC10157417 DOI: 10.4102/phcfm.v15i1.3929] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Chronic musculoskeletal pain (CMSP) is prevalent globally and places a significant burden on individuals, healthcare systems and economies. Contextually appropriate clinical practice guidelines (CPGs) on CMSP are advocated to translate evidence into practice. AIM This study aimed to investigate the applicability and feasibility of evidence-based CPG recommendations for adults with CMSP in the primary health care (PHC) sector of South Africa (SA). SETTING The PHC sector in South Africa (SA). METHODS Consensus methodology was used, comprising two online Delphi rounds and a consensus meeting. A multidisciplinary panel of local healthcare professionals involved in CMSP management was purposefully sampled and invited to participate. The first Delphi survey considered 43 recommendations. In the consensus meeting, the results of the first Delphi round were discussed. The second Delphi round reconsidered the recommendations with no consensus. RESULTS Seventeen experts participated in the first Delphi round, 13 in the consensus meeting and 14 in the second Delphi round. In Delphi round two, 40 recommendations were endorsed, three were not endorsed and an additional recommendation was added. CONCLUSION A multidisciplinary panel endorsed 41 multimodal clinical recommendations as applicable and feasible for the PHC of adults with CMSP, in SA. Although certain recommendations were endorsed, they may not be readily implementable in SA because of context factors.Contribution: The study forms the basis of a model of care for contextually relevant PHC of CMSP. Future research should explore factors that could influence the uptake of the recommendations into practice to optimise chronic pain care in SA.
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Affiliation(s)
- Dawn V Ernstzen
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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14
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Nwaneri D, Ifebi E, Oviawe OO, Roberts R, Parker R, Rich E, Yoder A, Kempeneer J, Ibadin M. Effects of Integrated Vector Management in the Control of Malaria Infection: An Intervention Study in a Malaria Endemic Community in Nigeria. West Afr J Med 2023; 40:44-54. [PMID: 36716288] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND/AIM Malaria is a vector borne disease with high morbidity and mortality in endemic regions. In view to eliminating the disease, integrated vector and environmental hygiene practices have been advocated. There is paucity of studies on the effect of vector control measures on asymptomatic malaria infection which has been observed to be a reflection of malaria transmission. METHODS Longitudinal community-based intervention study carried out from October to December 2017. Study participants were 477 individuals living in 100 households selected by snow-balling sampling methods. Pre-intervention period included training of all heads of households on vector control methods. During the intervention period, each household received waste bins, two long lasting insecticide bed nets and had wire screen on their doors and windows; every household member was screened for malaria (antigen) using the pf rapid diagnostic test kits. Each household were monitored to ensure they comply with the environmental hygiene practices they were taught. Post-intervention malaria infection was obtained at 8 week being end of the intervention period. RESULTS Of the 100 households selected, 54.0% were from the lower social class, 45.0% middle class and only 1.0% upper class. Mean age [±] of the heads of the households was 37.1 ± 11.0 (range 16-68) years. There were 477 individuals recruited in the study from the 100 households; 234 (49.0%) females and 243 (51.0%) males; median age was 20.0 (range 1-100) years. Prevalence of malaria infection using mRDT during pre-intervention was 16.8% and an incidence of 1.3% post-intervention. There was 92.0% reduction in asymptomatic malaria infection showing marked reduction in malaria transmission in the study locale. CONCLUSION Some integrated vector control measures such as use of insecticide-treated net and sanitation were found effective methods for reducing malaria infection and transmission in endemic region.
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Affiliation(s)
- D Nwaneri
- Development of Child Health, University of Benin Teaching Hospital, P.M.B 1154, Benin City, Edo State, Nigeria
| | - E Ifebi
- Accident and Emergency Medicine, University of Benin Teaching Hospital, P.M.B 1154, Benin City, Edo State, Nigeria
| | - O O Oviawe
- Accident and Emergency Medicine, University of Benin Teaching Hospital, P.M.B 1154, Benin City, Edo State, Nigeria
| | - R Roberts
- Development Africa, Lagos, Dupe Oguntade St., Lekki Phase 1, Lagos State, Nigeria
| | - R Parker
- Development Africa, Lagos, Dupe Oguntade St., Lekki Phase 1, Lagos State, Nigeria
| | - E Rich
- Development Africa, Lagos, Dupe Oguntade St., Lekki Phase 1, Lagos State, Nigeria
| | - A Yoder
- Development Africa, Lagos, Dupe Oguntade St., Lekki Phase 1, Lagos State, Nigeria
| | - J Kempeneer
- Development Africa, Lagos, Dupe Oguntade St., Lekki Phase 1, Lagos State, Nigeria
| | - M Ibadin
- Development of Child Health, University of Benin Teaching Hospital, P.M.B 1154, Benin City, Edo State, Nigeria
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Shraim MA, Sluka KA, Sterling M, Arendt-Nielsen L, Argoff C, Bagraith KS, Baron R, Brisby H, Carr DB, Chimenti RL, Courtney CA, Curatolo M, Darnall BD, Ford JJ, Graven-Nielsen T, Kolski MC, Kosek E, Liebano RE, Merkle SL, Parker R, Reis FJJ, Smart K, Smeets RJEM, Svensson P, Thompson BL, Treede RD, Ushida T, Williamson OD, Hodges PW. Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a Delphi expert consensus study. Pain 2022; 163:1812-1828. [PMID: 35319501 PMCID: PMC9294075 DOI: 10.1097/j.pain.0000000000002577] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 09/09/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Classification of musculoskeletal pain based on underlying pain mechanisms (nociceptive, neuropathic, and nociplastic pain) is challenging. In the absence of a gold standard, verification of features that could aid in discrimination between these mechanisms in clinical practice and research depends on expert consensus. This Delphi expert consensus study aimed to: (1) identify features and assessment findings that are unique to a pain mechanism category or shared between no more than 2 categories and (2) develop a ranked list of candidate features that could potentially discriminate between pain mechanisms. A group of international experts were recruited based on their expertise in the field of pain. The Delphi process involved 2 rounds: round 1 assessed expert opinion on features that are unique to a pain mechanism category or shared between 2 (based on a 40% agreement threshold); and round 2 reviewed features that failed to reach consensus, evaluated additional features, and considered wording changes. Forty-nine international experts representing a wide range of disciplines participated. Consensus was reached for 196 of 292 features presented to the panel (clinical examination-134 features, quantitative sensory testing-34, imaging and diagnostic testing-14, and pain-type questionnaires-14). From the 196 features, consensus was reached for 76 features as unique to nociceptive (17), neuropathic (37), or nociplastic (22) pain mechanisms and 120 features as shared between pairs of pain mechanism categories (78 for neuropathic and nociplastic pain). This consensus study generated a list of potential candidate features that are likely to aid in discrimination between types of musculoskeletal pain.
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Affiliation(s)
- Muath A Shraim
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA, United States
| | - Michele Sterling
- The University of Queensland, RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Brisbane, QLD, Australia
| | - Lars Arendt-Nielsen
- Department Medical Gastroenterology Aalborg Hospital, Aalborg University CNAP School of Medicine, Denmark
| | | | - Karl S Bagraith
- Interdisciplinary Persistent Pain Centre, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology at Neurozentrum (House D), Kiel, Germany
| | - Helena Brisby
- Department of Orthopaedics, Institution of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel B Carr
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Carol A Courtney
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Michele Curatolo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Jon J Ford
- Discipline of Physiotherapy, School of Allied Health, Human Services & Sport, La Trobe University, Bundoora, VIC, Australia
| | - Thomas Graven-Nielsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
| | - Melissa C Kolski
- Feinberg School of Medicine, Shirley Ryan AbilityLab, Northwestern University, Chicago, IL, United States
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Richard E Liebano
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Physiotherapeutic Resources Laboratory/Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Shannon L Merkle
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa
| | - Felipe J J Reis
- Physical Therapy Department of Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Keith Smart
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- CIR Rehabilitation, Eindhoven, the Netherlands
| | - Peter Svensson
- Department of Dentistry and Oral Health, Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Bronwyn L Thompson
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Neurophysiology Mannheim Center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Takahiro Ushida
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Owen D Williamson
- School of Interactive Arts and Technology, Simon Fraser University, Surrey, BC, Canada
| | - Paul W Hodges
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD, Australia
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16
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Bedwell GJ, Louw C, Parker R, van den Broeke E, Vlaeyen JW, Moseley GL, Madden VJ. The influence of a manipulation of threat on experimentally-induced secondary hyperalgesia. PeerJ 2022; 10:e13512. [PMID: 35757170 PMCID: PMC9220919 DOI: 10.7717/peerj.13512] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/07/2022] [Indexed: 01/17/2023] Open
Abstract
Pain is thought to be influenced by the threat value of the particular context in which it occurs. However, the mechanisms by which a threat achieves this influence on pain are unclear. Here, we explore how threat influences experimentally-induced secondary hyperalgesia, which is thought to be a manifestation of central sensitization. We developed an experimental study to investigate the effect of a manipulation of threat on experimentally-induced secondary hyperalgesia in 26 healthy human adults (16 identifying as female; 10 as male). We induced secondary hyperalgesia at both forearms using high-frequency electrical stimulation. Prior to the induction, we used a previously successful method to manipulate threat of tissue damage at one forearm (threat site). The effect of the threat manipulation was determined by comparing participant-rated anxiety, perceived threat, and pain during the experimental induction of secondary hyperalgesia, between the threat and control sites. We hypothesized that the threat site would show greater secondary hyperalgesia (primary outcome) and greater surface area (secondary outcome) of induced secondary hyperalgesia than the control site. Despite a thorough piloting procedure to test the threat manipulation, our data showed no main effect of site on pain, anxiety, or threat ratings during high-frequency electrical stimulation. In the light of no difference in threat between sites, the primary and secondary hypotheses cannot be tested. We discuss reasons why we were unable to replicate the efficacy of this established threat manipulation in our sample, including: (1) competition between threats, (2) generalization of learned threat value, (3) safety cues, (4) trust, and requirements for participant safety, (5) sampling bias, (6) sample-specific habituation to threat, and (7) implausibility of (sham) skin examination and report. Better strategies to manipulate threat are required for further research on the mechanisms by which threat influences pain.
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Affiliation(s)
- Gillian J. Bedwell
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, Western Cape, South Africa,Pain Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Caron Louw
- Pain Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Romy Parker
- Pain Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Emanuel van den Broeke
- Institute of Neuroscience, Division Cognitive and Systems, UC Louvain, Brussels, Belgium
| | - Johan W. Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium,Experimental Health Psychology, University of Maastricht, Maastricht, Netherlands
| | | | - Victoria J. Madden
- Pain Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa,Research Group Health Psychology, KU Leuven, Leuven, Belgium,IIMPACT in Health, University of South Australia, Adelaide, Australia,Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
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Ernstzen D, Keet J, Louw KA, Park-Ross J, Pask L, Reardon C, Zway M, Parker R. "So, you must understand that that group changed everything": perspectives on a telehealth group intervention for individuals with chronic pain. BMC Musculoskelet Disord 2022; 23:538. [PMID: 35658929 PMCID: PMC9166594 DOI: 10.1186/s12891-022-05467-7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Patient Education Empowerment Programme (PEEP) is an interdisciplinary group intervention for people living with chronic pain. As a result of the COVID-19 pandemic, lockdown and restrictions on in-person group-based health care delivery in South Africa, PEEP was modified to a telehealth electronic format (ePEEP) and offered to patients on a waiting list at two interdisciplinary chronic pain clinics in Cape Town, South Africa. The purpose of this study was to explore the feasibility and acceptability of ePEEP through the perspectives of individuals with chronic pain who participated in ePEEP. METHODS: A qualitative, exploratory descriptive study was conducted. One month after completion of the 6-week ePEEP programme, individuals who participated, were recruited for the study. Data were collected through semi-structured interviews. Data analysis followed an iterative process of inductive content analysis. RESULTS: Six individuals, all women, consented and participated in the study. Three main themes emerged from the data. Theme one focussed on how ePEEP initiated a journey of personal development and discovery within the participants. In theme two, participants reflected on the importance and value of building peer and therapeutic relationships as part of ePEEP. In theme 3, participants shared that the online learning environment had features which influenced learning about pain in different ways. CONCLUSION ePEEP was found to be acceptable, feasible and valuable for the participants. ePEEP facilitated self-discovery, empowerment, relationship building and transformation in the participants, through experiential learning. Although barriers and facilitators to learning were present, both enhanced the learning experience. The positive reception of this telehealth initiative indicates potential for enhanced access to chronic pain management services in the South African setting.
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Affiliation(s)
- Dawn Ernstzen
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Janet Keet
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Kerry-Ann Louw
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Jocelyn Park-Ross
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Lorien Pask
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Cameron Reardon
- Division of Physiotherapy, Ukwanda Centre for Rural Health Stellenbosch University, Stellenbosch, South Africa
| | - Maia Zway
- Department of Anaesthesiology and Critical Care, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | - Romy Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.
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18
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Madden VJ, Msolo N, Mqadi L, Lesosky M, Bedwell GJ, Hutchinson MR, Peter JG, Parker R, Schrepf A, Edwards RR, Joska JA. Study protocol: an observational study of distress, immune function and persistent pain in HIV. BMJ Open 2022; 12:e059723. [PMID: 36691234 PMCID: PMC9171212 DOI: 10.1136/bmjopen-2021-059723] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/28/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Many people with HIV report both distress and pain. The relationship between distress and pain is bidirectional, but the mechanisms by which distress exacerbates pain are unclear. The inflammatory response to challenge (inflammatory reactivity, IR) may be a partial mediator, given that neuroimmune interactions provide a substrate for IR to also influence neurological reactivity and, thus, pain-related neural signalling. This prospective, observational, case-control study will characterise the relationships between distress, IR, pain-related signalling as captured by induced secondary hyperalgesia (SH), and pain, in people with HIV who report persistent pain (PP) (cases) or no pain (controls). METHODS AND ANALYSIS One hundred people with suppressed HIV, reporting either PP or no pain, will be assessed two or four times over 6 months. The primary outcomes are distress (Hopkins 25-item symptom checklist), IR (multiplex assay after LPS challenge), and PP (Brief Pain Inventory), assessed at the baseline timepoint, although each will also be assessed at follow-up time points. Induced SH will be assessed in a subsample of 60 participants (baseline timepoint only). To test the hypothesis that IR partly mediates the relationship between distress and pain, mediation analysis will use the baseline data from the PP group to estimate direct and indirect contributions of distress and IR to pain. To test the hypothesis that IR is positively associated with SH, data from the subsample will be analysed with generalised mixed effects models to estimate the association between IR and group membership, with SH as the dependent variable. ETHICS AND DISSEMINATION Information obtained from this study will be published in peer-reviewed journals and presented at scientific meetings. The study has been approved by the Human Research Ethics Committee of the University of Cape Town (approval number: 764/2019) and the City of Cape Town (ref: 24699). TRIAL REGISTRATION NUMBER NCT04757987.
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Affiliation(s)
- Victoria J Madden
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Ncumisa Msolo
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Luyanduthando Mqadi
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Gillian J Bedwell
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Mark R Hutchinson
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jonathan Grant Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, South Africa
- Allergy and Immunology Unit, University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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19
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van Vreede JJ, Parker R, van Nugteren J. A history of depression in patients attending a chronic pain management clinic in South Africa: A retrospective chart review. S Afr J Psychiatr 2022; 28:1673. [PMID: 35547102 PMCID: PMC9082265 DOI: 10.4102/sajpsychiatry.v28i0.1673] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/07/2022] [Indexed: 11/01/2022] Open
Abstract
Background: Chronic pain and depression are closely related conditions, which commonly exist as comorbid disorders. Understanding the prevalence of depression in patients presenting with chronic pain is vital for effective pain management.Aim: Our study aimed to establish the prevalence of a history of depression in patients presenting with chronic pain to a chronic pain management clinic at a tertiary academic hospital and to describe the characteristics of patients with both conditions.Setting: Groote Schuur Hospital, Chronic Pain Management Clinic, Cape Town, South Africa.Method: A retrospective review of 665 medical charts of consecutive patients accessing the clinic over a 7-year period was conducted. Baseline, patient-centred data were collected.Results: Of the 665 charts, 623 were analysed. The median age of patients was 53 years. The prevalence of depression in patients presenting with chronic pain was 32%, three times higher than the national life-time prevalence in South Africa. The majority (77%) of patients with chronic pain and depression were female (p 0.01). Overall, 51% of the patients assessed were unemployed with low levels of education. The majority of our study patients had received a tricyclic antidepressant at some time prior to presentation.Conclusion: The high prevalence of a history of depression in patients presenting with chronic pain in our study, emphasises the importance of looking for and understanding the interrelation of the physiological, psychiatric, psychological and socio-economic factors that are common to both depression and chronic pain. Pain relief alone is insufficient to ensure optimal rehabilitation of these patients and integrating the management of their depression should improve patient outcomes and overall well-being.
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Affiliation(s)
- Joseph J van Vreede
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Janieke van Nugteren
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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20
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Wadley AL, Parker R, Mukhuba VA, Ratshinanga A, Zwane Z, Kamerman PR. South African men and women living with HIV have similar distributions of pain sites. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 35144458 PMCID: PMC8832001 DOI: 10.4102/phcfm.v14i1.3114] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background No studies have investigated sex differences in the location and number of pain sites in people living with human immunodeficiency virus (HIV) (PLWH), despite evidence that women, in general, bear a greater burden of pain than men. Aim To determine sex differences in the location and number of pain sites, and whether there were demographic or disease-related differences in the number of pain sites. Setting South African tertiary hospital HIV clinics and a community healthcare centre Methods We conducted a retrospective analysis of records from South African PLWH who had pain. Results Of the 596 participant records, 19% were male (115/596) and the median number of pain sites for both sexes was 2 (interquartile range [IQR]: 1 to 3). Pain was most frequently experienced in the head (men: 12%, women: 38%), feet and ankles (men: 42%, women: 28%), abdomen (men = 19%, women = 28%) and chest (men = 20%, women = 20%). After correcting for multiple comparisons, males were less likely to experience headache than females (Fisher’s exact text, odds ratio [OR] = 0.23, 95% confidence interval [CI]: 0.12 – 0.42, p = 0.000). Pain at other body sites was experienced similarly between the sexes. There was no meaningful variation in the number of pain sites between the sexes (logistic regression, p = 0.157). Conclusion A similar location and number of pain sites were experienced by male and female South African PLWH. The locations of pain sites were different from previous reports, however, suggesting that research into pain in PLWH cannot necessarily be generalised across cultures.
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Affiliation(s)
- Antonia L Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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21
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Parker R, Bedwell GJ, Hodkinson P, Lourens A, Setshedi M. Managing acute abdominal pain in the emergency centre: Lessons from a patient's experience. Afr J Emerg Med 2021; 11:483-486. [PMID: 34815928 PMCID: PMC8593562 DOI: 10.1016/j.afjem.2021.06.006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/31/2021] [Accepted: 06/26/2021] [Indexed: 11/22/2022] Open
Abstract
Pain is one of the most common reasons people present to the emergency centre with 7-10% of presentations being due to acute abdominal pain. However, pain is also often neglected by clinicians in emergency centres. The well validated South African Triage Score (SATS) incorporates pain assessment in the prioritising of patients with the aim of guiding clinicians. Based on the SATS, severe pain (a score of ≥8 out of 10) should prompt the clinician to initiate treatment within 10 min of presentation, as unmanaged pain has multiple negative consequences, including poor outcomes of the acute incident with delayed healing and increased risk of developing chronic pain. In this commentary, we present a patient's experience when attending an emergency centre for acute abdominal pain, describe relevant pain mechanisms and highlight the stages where clinical management could have been optimised.
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Affiliation(s)
- Romy Parker
- Dept of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Gill J Bedwell
- Dept of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Peter Hodkinson
- Division of Emergency Medicine, Dept of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andrit Lourens
- Division of Emergency Medicine, Dept of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Paramedic Science, School of Nursing, Midwifery and Health, Faculty of Health and Life Sciences Coventry University, Coventry, United Kingdom
| | - Mashiko Setshedi
- Division of Gastroenterology, Dept of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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22
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Munsaka EF, Van Dyk D, Parker R. A retrospective audit of pain assessment and management post-caesarean section at New Somerset Hospital in Cape Town, South Africa. S Afr Fam Pract (2004) 2021; 63:e1-e6. [PMID: 34636591 PMCID: PMC8517764 DOI: 10.4102/safp.v63i1.5320] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/03/2022] Open
Abstract
Background The most common major surgical procedure performed worldwide is the caesarean section (CS). Effective pain management is a priority for women undergoing this procedure, to reduce the incidence of persistent pain (a risk factor for postpartum depression), as well as optimise maternal-neonatal bonding and the successful establishment of breastfeeding. Multimodal analgesia is the gold standard for post-CS analgesia. At present, no perioperative pain management protocols could be identified for the management of patients presenting for CS at regional hospitals in South Africa. This audit aimed to review the folders of patients who underwent CS, with particular reference to perioperative pain management guidelines for CS. Methods A descriptive, retrospective, cross-sectional audit was conducted. Three hundred folders (10% of the annual number of caesarean procedures performed) from New Somerset Hospital, a regional hospital in Cape Town, South Africa were reviewed. Results The women were a mean age of 30 years (standard deviation [s.d.]: 6.2). Median gravidity was 3 (interquartile range [IQR]: 2–3) and parity was 1 (IQR: 1–2); 52% had previously undergone a CS. In 93.3% cases, spinal anaesthesia was employed for CS. Pain assessment was poor, with only 55 (18%) patients having their pain assessed on the day of the operation. Analgesia was prescribed in over 98% of the patients, however, medication was only administered as prescribed in 32.6%. Non-steroidal anti-inflammatory drugs (NSAIDs) were prescribed in < 5% of cases. None of the patients received a patient-controlled analgesia (PCA), transversus abdominis plane (TAP) block, or wound infusion catheter as supplementary strategies. Conclusion Pain management for post-CS patient at this hospital is lacking. There is the need for the implementation of a structured assessment tool to improve administration of analgesics in these patients. In addition, the reasons for the omission of NSAIDs from the analgesia regimen requires investigation. Hospital requires post-CS pain protocols to guide management especially in resource-limited settings.
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Affiliation(s)
- Effraim F Munsaka
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town.
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23
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Majangara MBM, Limakatso K, Parker R. Patient satisfaction at the Chronic Pain Management Clinic at Groote Schuur Hospital. Southern African Journal of Anaesthesia and Analgesia 2021. [DOI: 10.36303/sajaa.2021.27.5.2508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- MBM Majangara
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town,
South Africa
| | - K Limakatso
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town,
South Africa
| | - R Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town,
South Africa
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24
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Lourens A, Parker R, Hodkinson P. Emergency care providers' perspectives of acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A qualitative study. Int Emerg Nurs 2021; 58:101042. [PMID: 34333334 DOI: 10.1016/j.ienj.2021.101042] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A growing body of evidence suggests that pain knowledge and management are poor, perhaps more so in the prehospital setting. The daily challenges that emergency care providers face in dealing with prehospital pain remain unclear. This study aimed to gain a deeper understanding of acute prehospital pain assessment and management in the Western Cape, South Africa. METHODS A series of focus group discussions, using a constructivist paradigm and qualitative content analysis were conducted. RESULTS The key themes emerging from six focus groups (total 25 emergency care providers) related to the difficulties of assessing pain in this setting, factors affecting clinical reasoning in this (hostile) setting, the realities of prehospital pain care for non-advanced life support practitioners, along with emergency departments' lack of understanding and appreciation of the prehospital environment, and participants' suggestions to improve pain practice. CONCLUSION Several barriers and enablers, some novel, to pain assessment and management in the South African prehospital setting were identified. Our findings provide valuable insight and understanding of the challenges related to pain care prehospital providers face, in other similar prehospital settings, but also to the global body of knowledge on prehospital barriers and enablers of pain assessment and management.
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Affiliation(s)
- Andrit Lourens
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, Western Cape, South Africa.
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town (UCT), Cape Town, Western Cape, South Africa.
| | - Peter Hodkinson
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, Western Cape, South Africa.
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25
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van den Bersselaar LR, Greven T, Bulger T, Voermans NC, van Petegem F, Schiemann AH, Parker R, Burling SM, Jungbluth H, Stowell KM, Kamsteeg EJ, Snoeck MMJ. RYR1 variant c.38T>G, p.Leu13Arg causes hypersensitivity of the ryanodine receptor-1 and is pathogenic for malignant hyperthermia. Br J Anaesth 2021; 127:e63-e65. [PMID: 34127251 DOI: 10.1016/j.bja.2021.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - T Greven
- Department of Anaesthesia, Nijmegen, the Netherlands
| | | | - N C Voermans
- Department of Anaesthesia, Nijmegen, the Netherlands
| | | | | | | | | | | | | | - E J Kamsteeg
- Department of Anaesthesia, Nijmegen, the Netherlands
| | - M M J Snoeck
- Department of Anaesthesia, Nijmegen, the Netherlands.
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26
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Parker R. Managing ethical issues in community-based adolescent self-harm research. ethical practice in an adolescent self-harm preventative intervention research project with pupils in secondary schools in wales. Eur Psychiatry 2021. [PMCID: PMC9480273 DOI: 10.1192/j.eurpsy.2021.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction Adolescent self-harm in Europe is a major public health challenge and shares a risk continuum with suicide. Recent research demonstrates a strong risk correlation with attempting suicide in the community-based adolescent self-harm population group, similar to research findings for populations in health setting-based research. In the UK increasing rates in hospital admissions represent the “tip of the iceberg” within the community, with potentially two thirds of the population group not accessing health services for support. This brings many health risks, including an increased suicide risk. Finding a solution to these issues requires a preventative intervention approach for young people, including community-based delivery to address service access barriers. Secondary schools are posited as key settings where this type of support could be delivered. But emerging UK research demonstrates challenges in completing adolescent self-harm research with young people in schools. Objectives This paper centres on a current adolescent self-harm preventative intervention research project in Cardiff University. It focuses on ethical research practice in community-based adolescent self-harm research. Methods This paper appraises some of the core ethical issues, challenges and their management in completing adolescent self-harm prevention intervention research in secondary school settings in Wales. It also provides an overview of the project’s innovative safety protocol design. Results This project was successful in managing the potential risks to the school-based adolescent research participants. Conclusions This work helps address some of the current research barriers to completing adolescent self-harm prevention intervention research in schools, to facilitate shared solutions to the urgent public health challenge of adolescent self-harm.
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27
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Limakatso K, Parker R. Treatment Recommendations for Phantom Limb Pain in People with Amputations: An Expert Consensus Delphi Study. PM R 2021; 13:1216-1226. [PMID: 33460508 PMCID: PMC8597012 DOI: 10.1002/pmrj.12556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 12/25/2022]
Abstract
Background Phantom limb pain (PLP) is common and often accompanied by serious suffering. Current systematic‐review evidence suggests that recommended treatments are no more effective than placebo for reducing PLP. Given the difficulty in conducting a meta‐analysis for nonpharmacological treatments and the weak evidence for pharmacological treatments for PLP, consensus on the first‐line management of PLP needs to be reached using alternative methods. Objective To reach expert consensus and make recommendations on the effective management of PLP. Design A three‐round Delphi design was used. Setting The study was conducted using e‐mail and Google survey tool as the main methods of communication and providing feedback. Participants The study included 27 clinicians and researchers from various health disciplines who are experts in PLP management. Method Data were collected using three sequential rounds of anonymous online questionnaires where experts proposed and ranked the treatments for PLP. A consensus was reached on the treatments that were endorsed by 50% or more of the experts. Results Thirty‐seven treatments were proposed for the management of PLP at the beginning of the study. Consensus was reached on seven treatments that were considered effective for managing PLP and on two treatments that were considered ineffective. Graded motor imagery, mirror therapy, amitriptyline, sensory discrimination training, and use of a functional prosthesis were endorsed by most experts because of the available backing scientific evidence and their reported efficacy in clinical practice. Cognitive behavioral therapy and virtual reality training were endorsed by most experts because of their reported efficacy in clinical practice despite indicating a dearth of scientific evidence to support their ranking. Citalopram and dorsal root ganglion pulsed radiofrequency were rejected owing to a lack of relevant scientific evidence. Conclusion The results of this study suggest that the nonpharmacological treatments endorsed in this study may have an important role in the management of PLP.
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Affiliation(s)
- Katleho Limakatso
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit Neuroscience Institute, University of Cape Town Cape Town South Africa
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit Neuroscience Institute, University of Cape Town Cape Town South Africa
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28
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Jackson K, Wadley AL, Parker R. Managing pain in HIV/AIDS: a therapeutic relationship is as effective as an exercise and education intervention for rural amaXhosa women in South Africa. BMC Public Health 2021; 21:302. [PMID: 33546647 PMCID: PMC7866667 DOI: 10.1186/s12889-021-10309-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 01/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background Pain is one of the most prevalent symptoms in people living with HIV/AIDS and is largely undermanaged. Both a peer-led exercise and education Positive Living programme (PL programme) and the PL programme workbook alone were previously found to be effective in reducing pain in urban amaXhosa Women Living With HIV/AIDS (WLWHA). A therapeutic relationship was hypothesised to have contributed to the efficacy of both interventions. The aim of the study was to determine the effectiveness of the PL programme and a therapeutic relationship, compared to a therapeutic relationship alone in managing pain amongst rural amaXhosa WLWHA on pain severity and pain interference, and secondary outcomes, symptoms of depression, health-related quality of life (HRQoL) and self-efficacy. Methods In this two-group, single-blind, pragmatic clinical trial with stratified convenience sampling, the PL programme and therapeutic relationship, was compared to a therapeutic relationship alone in rural amaXhosa WLWHA. The PL programme was a 6-week, peer-led intervention comprising education on living well with HIV, exercise and goal setting. The therapeutic relationship comprised follow-up appointments with a caring research assistant. Outcome measures included pain severity and interference (Brief Pain Inventory), depressive symptoms (Beck Depression Inventory), HRQoL (EuroQol 5-Dimensional outcome questionnaire) and self-efficacy (Self-efficacy for Managing Chronic Disease 6-Item Scale). Follow-up was conducted at 4, 8, 12, 24, and 48 weeks. Mixed model regression was used to test the effects of group, time, and group and time interactions of the interventions on outcome measures. Results Forty-nine rural amaXhosa WLWHA participated in the study: PL group n = 26; TR group n = 23. Both intervention groups were similarly effective in significantly reducing pain severity and interference and depressive symptoms, and increasing self-efficacy and HRQoL over the 48 weeks. A clinically important reduction in pain severity of 3.31 points occurred for the sample over the 48 weeks of the study. All of these clinical improvements were obtained despite low and suboptimal attendance for both interventions. Conclusions Providing a therapeutic relationship alone is sufficient for effective pain management amongst rural amaXhosa WLWHA. These findings support greater emphasis on demonstrating care and developing skills to enhance the therapeutic relationship in healthcare professionals working with rural amaXhosa WLWHA. Trial registration PACTR; PACTR201410000902600, 30th October 2014; https://pactr.samrc.ac.za. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10309-7.
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Affiliation(s)
- Kirsty Jackson
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.,Zithulele Hospital, Eastern Cape Department of Health, Mqanduli, South Africa
| | - Antonia L Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Romy Parker
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa. .,Pain Management Unit; Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town and Groote Schuur Hospital, Observatory, Cape Town, 7925, South Africa.
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Plenge U, Parker R, Davids S, Davies GL, Fullerton Z, Gray L, Groenewald P, Isaacs R, Kauta N, Louw FM, Mazibuko A, North DM, Nortje M, Nunes GM, Pebane N, Rajah C, Roos J, Ryan P, September WV, Shanahan H, Siebritz RE, Smit RW, Sombili S, Torborg A, van der Merwe JF, van der Westhuizen N, Biccard B. Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study. BMC Musculoskelet Disord 2020; 21:721. [PMID: 33153453 PMCID: PMC7643442 DOI: 10.1186/s12891-020-03752-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/28/2020] [Indexed: 12/26/2022] Open
Abstract
Background Encouraged by the widespread adoption of enhanced recovery protocols (ERPs) for elective total hip and knee arthroplasty (THA/TKA) in high-income countries, our nationwide multidisciplinary research group first performed a Delphi study to establish the framework for a unified ERP for THA/TKA in South Africa. The objectives of this second phase of changing practice were to document quality of patient recovery, record patient characteristics and audit standard perioperative practice. Methods From May to December 2018, nine South African public hospitals conducted a 10-week prospective observational study of patients undergoing THA/TKA. The primary outcome was ‘days alive and at home up to 30 days after surgery’ (DAH30) as a patient-centred measure of quality of recovery incorporating early death, hospital length of stay (LOS), discharge destination and readmission during the first 30 days after surgery. Preoperative patient characteristics and perioperative care were documented to audit practice. Results Twenty-one (10.1%) out of 207 enrolled patients had their surgery cancelled or postponed resulting in 186 study patients. No fatalities were recorded, median LOS was 4 (inter-quartile-range (IQR), 3–5) days and 30-day readmission rate was 3.8%, leading to a median DAH30 of 26 (25–27) days. Forty patients (21.5%) had pre-existing anaemia and 24 (12.9%) were morbidly obese. In the preoperative period, standard care involved assessment in an optimisation clinic, multidisciplinary education and full-body antiseptic wash for 67 (36.2%), 74 (40.0%) and 55 (30.1%) patients, respectively. On the first postoperative day, out-of-bed mobilisation was achieved by 69 (38.1%) patients while multimodal analgesic regimens (paracetamol and Non-Steroid-Anti-Inflammatory-Drugs) were administered to 29 patients (16.0%). Conclusion Quality of recovery measured by a median DAH30 of 26 days justifies performance of THA/TKA in South African public hospitals. That said, perioperative practice, including optimisation of modifiable risk factors, lacked standardisation suggesting that quality of patient care and postoperative recovery may improve with implementation of ERP principles. Notwithstanding the limited resources available, we anticipate that a change of practice for THA/TKA is feasible if ‘buy-in’ from the involved multidisciplinary units is obtained in the next phase of our nationwide ERP initiative. Trial registration The study was registered with ClinicalTrials.gov (NCT03540667).
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Affiliation(s)
- Ulla Plenge
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Rd, Observatory, Cape Town, Western Cape, 7925, South Africa.
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Rd, Observatory, Cape Town, Western Cape, 7925, South Africa
| | - Shamiela Davids
- Department of Physiotherapy, Mitchell's Plain Hospital, AZ Berman Drive, Mitchell's Plain, Cape Town, Western Cape, 7785, South Africa
| | - Gareth L Davies
- Department of Anaesthesia, Paarl Hospital, Hospital Street, Paarl, Western Cape, 7646, South Africa
| | - Zahnne Fullerton
- Department of Anaesthesia, Victoria Hospital, Alphen Hill Rd, Wynberg, Cape Town, Western Cape, 7800, South Africa
| | - Lindsay Gray
- Department of Physiotherapy, New Somerset Hospital, Portswood Rd, Greenpoint, Cape Town, Western Cape, 8051, South Africa
| | - Penelope Groenewald
- Department of Physiotherapy, Universitas Academic Hospital, University of the Free State, Logeman Str, Bloemfontein, Free State, 9301, South Africa
| | - Refqah Isaacs
- Department of Physiotherapy, Victoria Hospital, Alphen Hill Rd, Wynberg, Cape Town, Western Cape, 7800, South Africa
| | - Ntambue Kauta
- Department of Orthopaedic Surgery, Mitchell's Plain Hospital, AZ Berman Drive, Mitchell's Plain, Cape Town, Western Cape, 7785, South Africa
| | - Frederik M Louw
- Department of Orthopaedic Surgery, New Somerset Hospital, Portswood Rd, Greenpoint, Cape Town, Western Cape, 8051, South Africa
| | - Andile Mazibuko
- Department of Anaesthesia, Steve Biko Academic Hospital, University of Pretoria, Corner Malan and Steve Biko Str, Capital Park, Pretoria, Gauteng, 0001, South Africa
| | - David M North
- Department of Orthopaedic Surgery, Paarl Hospital, Hospital Street, Paarl, Western Cape, 7646, South Africa
| | - Marc Nortje
- Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Anzio Rd, Observatory, Cape Town, Western Cape, 7925, South Africa
| | - Glen M Nunes
- Department of Physiotherapy, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Vusi Mzimela Rd, Umkumbaan, Durban, KwaZulu-Natal, 4091, South Africa
| | - Neo Pebane
- Department of Physiotherapy, Steve Biko Academic Hospital, University of Pretoria, Corner Malan and Steve Biko Str, Capital Park, Pretoria, Gauteng, 0001, South Africa
| | - Chantal Rajah
- Department of Anaesthesia, Grey's Hospital, University of KwaZulu-Natal, Townbush Rd, Pietermaritzburg, KwaZulu-Natal, 3201, South Africa
| | - John Roos
- Department of Anaesthesia, Mitchell's Plain Hospital, AZ Berman Drive, Mitchell's Plain, Cape Town, Western Cape, 7785, South Africa
| | - Paul Ryan
- Department of Orthopaedic Surgery, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Vusi Mzimela Rd, Umkumbaan, Durban, KwaZulu-Natal, 4091, South Africa
| | - Winlecia V September
- Department of Physiotherapy, Paarl Hospital, Hospital Street, Paarl, Western Cape, 7646, South Africa
| | - Heidi Shanahan
- Department of Physiotherapy, Grey's Hospital, University of KwaZulu-Natal, Townbush Rd, Pietermaritzburg, KwaZulu-Natal, 3201, South Africa
| | - Ruth E Siebritz
- Department of Physiotherapy, Groote Schuur Hospital, University of Cape Town, Anzio Rd, Observatory, Cape Town, Western Cape, 7925, South Africa
| | - Rian W Smit
- Department of Orthopaedic Surgery, Grey's Hospital, University of KwaZulu-Natal, Townbush Rd, Pietermaritzburg, KwaZulu-Natal, 3201, South Africa
| | - Simon Sombili
- Department of Orthopaedic Surgery, Steve Biko Academic Hospital, University of Pretoria, Corner Malan and Steve Biko Str, Capital Park, Pretoria, Gauteng, 0001, South Africa
| | - Alexandra Torborg
- Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Vusi Mzimela Rd, Umkumbaan, Durban, KwaZulu-Natal, 4091, South Africa
| | - Johan F van der Merwe
- Department of Orthopaedic Surgery, Universitas Academic Hospital, University of the Free State, Logeman Str, Bloemfontein, Free State, 9301, South Africa
| | - Nico van der Westhuizen
- Department of Anaesthesia, Universitas Academic Hospital, University of the Free State, Logeman Str, Bloemfontein, Free State, 9301, South Africa
| | - Bruce Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Rd, Observatory, Cape Town, Western Cape, 7925, South Africa
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Beard B, Rettig R, Ryoo J, Parker R, Wang R, McLemore L, Attaluri V. Nonoperative Management versus Surgery in Patients with Complete Endoscopic Response to Neoadjuvant Therapy for Rectal Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Limakatso K, Bedwell GJ, Madden VJ, Parker R. The prevalence and risk factors for phantom limb pain in people with amputations: A systematic review and meta-analysis. PLoS One 2020; 15:e0240431. [PMID: 33052924 PMCID: PMC7556495 DOI: 10.1371/journal.pone.0240431] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 09/23/2020] [Indexed: 12/31/2022] Open
Abstract
Background Phantom limb pain (PLP)—pain felt in the amputated limb–is often accompanied by significant suffering. Estimates of the burden of PLP have provided conflicting data. To obtain a robust estimate of the burden of PLP, we gathered and critically appraised the literature on the prevalence and risk factors associated with PLP in people with limb amputations. Methods Articles published between 1980 and July 2019 were identified through a systematic search of the following electronic databases: MEDLINE/PubMed, PsycINFO, PsycArticles, Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Health Source: Nursing/Academic Edition, SCOPUS, Web of Science and Academic Search Premier. Grey literature was searched on databases for preprints. Two reviewers independently conducted the screening of articles, data extraction and risk of bias assessment. The meta-analyses were conducted using the random effects model. A statistically significant level for the analyses was set at p<0.05. Results The pooling of all studies demonstrated a prevalence estimate of 64% [95% CI: 60.01–68.05] with high heterogeneity [I2 = 95.95% (95% CI: 95.10–96.60)]. The prevalence of PLP was significantly lower in developing countries compared to developed countries [53.98% vs 66.55%; p = 0.03]. Persistent pre-operative pain, proximal site of amputation, stump pain, lower limb amputation and phantom sensations were identified as risk factors for PLP. Conclusion This systematic review and meta-analysis estimates that six of every 10 people with an amputation report PLP–a high and important prevalence of PLP. Healthcare professionals ought to be aware of the high rates of PLP and implement strategies to reduce PLP by addressing known risk factors, specifically those identified by the current study.
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Affiliation(s)
- Katleho Limakatso
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Gillian J. Bedwell
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Victoria J. Madden
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Mashanda-Tafaune B, Van Nugteren J, Parker R. Pain knowledge and attitudes of final-year medical students at the University of Cape Town: A cross-sectional survey. Afr J Prim Health Care Fam Med 2020; 12:e1-e6. [PMID: 32787409 PMCID: PMC7433251 DOI: 10.4102/phcfm.v12i1.2306] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 11/06/2022] Open
Abstract
Background Pain is the most common presenting complaint in patients visiting a healthcare facility. Healthcare professionals need adequate knowledge of pain to be able to manage it effectively. Aim The aim of this study was to determine the pain knowledge and attitudes of the 2018 final-year medical students at the University of Cape Town (UCT). Setting This study was conducted by the Department of Anaesthesia and Perioperative Medicine in the Faculty of Health Sciences, UCT, South Africa, with final-year medical students. Methods Unruh’s Modified Pain Knowledge and Attitudes (MPKA) questionnaire was utilised to collect data in a cross-sectional survey using an Internet-based electronic format. Results A total of 104 students out of 232 students in the class (44.8%) participated in the study. The total median score on the MPKA questionnaire was 46 (interquartile range [IQR] 44–50.5) out of 57, or 80.7% (IQR 77.2–88.6%). The participants performed worst in the section on the pharmacological management of pain with median scores of 6 (IQR 4–8) (55%) correct out of 11 questions. Conclusion Pain knowledge, especially with regard to the pharmacological aspects of pain management, has some important deficiencies in these final-year medical students. It appears that the undergraduate curriculum and teaching thereof would benefit from a review of the pain curriculum.
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Affiliation(s)
- Blessing Mashanda-Tafaune
- Department of Anesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town.
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Madden VJ, Parker R, Goodin BR. Chronic pain in people with HIV: a common comorbidity and threat to quality of life. Pain Manag 2020; 10:253-260. [PMID: 32484065 PMCID: PMC7421257 DOI: 10.2217/pmt-2020-0004] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/16/2020] [Indexed: 12/17/2022] Open
Abstract
Evidence indicates that over half of all people with HIV (PWH) will experience nonmalignant chronic pain throughout their lifetimes, with increasing prevalence as they age. Peripheral neuropathy resulting from the neurotoxic effects of HIV itself and the medications used to treat HIV were widely considered the primary cause of acute and chronic pain early on in the antiretroviral treatment era. However, recent studies suggest a predominance of non-neuropathic (e.g., musculoskeletal) pain in PWH with uncertain etiology. Chronic pain is often widespread in PWH, affecting multiple body locations. Additional research is needed to better understand contributors to chronic pain in PWH, which is likely to include biological (e.g., immune dysregulation), psychological (e.g., substance abuse) and social (e.g., stigma) factors.
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Affiliation(s)
- Victoria J Madden
- Department of Anaesthesia & Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Romy Parker
- Department of Anaesthesia & Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Burel R Goodin
- Author for correspondence: Tel.: +1 205 934 6536; Fax: +1 205 975 6110;
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Santillan MR, Savage K, Porter M, Parker R, Simon M, Kimball A. 430 Crohn's disease prevalence prior to and following hidradenitis suppurativa diagnosis. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Groenewald MB, van Nugteren J, Parker R. Are Groote Schuur Hospital anaesthesiologists burnt out? A cross-sectional study of prevalence and risk. South Afr J Anaesth Analg 2020. [DOI: 10.36303/sajaa.2020.26.3.2341] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Burnout and physician wellness are becoming increasingly topical. While some surveys have been performed with South African anaesthesiologists, these have been conducted in limited samples. While burnout is often measured, there is a paucity of research on contributory risk and protective factors.
Method: A contextual, prospective, cross-sectional study was conducted. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Areas of Worklife Survey (AWS) were used to assess burnout and contributory organisational risk factors amongst state-employed anaesthesiologists working at Groote Schuur Hospital.
Results: Out of a possible 127 members of staff (medical officers, registrars and consultants), 81 responded with 75 completing the full survey (59% response rate). Only 4% of respondents were classified as “burnt out”, defined as scoring high in all three domains of burnout: high emotional exhaustion and depersonalisation and low personal accomplishment. However, 67% of respondents scored high for at least one of the components of burnout, indicating the majority of the respondents are at risk for developing clinically significant burnout. The AWS showed that respondents found their workload inappropriate. However, responses for the categories of control, reward, community, fairness and values were all in the acceptable range.
Conclusion: While the overall rate of burnout was low, the majority of respondents were at risk for developing burnout. High perceived workload appeared to be a particular contributory factor. Protection against burnout in this group may be provided by a combination of few organisational risk factors together with feelings of personal accomplishment.
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Lourens A, Parker R, Hodkinson P. Prehospital acute traumatic pain assessment and management practices in the Western Cape, South Africa: a retrospective review. Int J Emerg Med 2020; 13:21. [PMID: 32370807 PMCID: PMC7201999 DOI: 10.1186/s12245-020-00278-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/07/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Trauma is a common aetiology of acute pain in the emergency setting, and traumatic injuries have been recognised as a global public health crisis leading to numerous deaths and disabilities. This study aimed to identify the prevalence of acute pain among high acuity trauma patients presenting to a public sector emergency medical service and to describe prehospital acute traumatic pain assessment and management practices amongst emergency care providers in the Western Cape Province, South Africa. METHODS A retrospective review of electronic patient care reports of trauma patients treated by the South African Western Cape Emergency Medical Services between January 1 and December 31, 2017 was conducted. Stratified random sampling was utilised to select 2401 trauma patients out of 24,575 that met the inclusion criteria. RESULTS Of the 2401 patients reviewed, 435 (18.1%) had a pain score recorded, of which 423 (97.2%) were experiencing pain. An additional 8.1% (n = 194) of patients had pain or tenderness mentioned in the working diagnosis but no pain score noted. Eighty-one (18.6%) patients experienced mild pain, 175 (40.2%) moderate pain and 167 (38.2%) severe pain. No association was found between a pain score recorded and age group (≤ 14 versus > 14 years) (p = 0.649) or gender (p = 0.139). Only 7.6% of patients with moderate-to-severe pain and 2.8% of all trauma patients received any form of analgesic medication. No association was found between the administration of analgesia and age group (≤ 14 versus > 14 years) (p = 0.151) or gender (p = 0.054). Patients were more likely to receive analgesia if they had a pain score recorded (p < 0.001), were managed by advanced life support practitioners (p < 0.001) or had severe pain (p = 0.001). CONCLUSION Acute trauma pain assessment and management practices in this prehospital cohort are less well established than reported elsewhere and whether this reflects emergency care training, institutional culture, scopes of practice or analgesic resources, requires further research. Emergency medical services need to monitor and promote quality pain care, enhance pain education and ensure that all levels of emergency care providers have access to analgesic medication approved for prehospital use. Clear and rational guidelines would enable better pain management by all cadres of providers, for all levels of pain.
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Affiliation(s)
- Andrit Lourens
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, South Africa.
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town (UCT), Cape Town, South Africa
| | - Peter Hodkinson
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, South Africa
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Kgokong D, Parker R. Physical activity in physiotherapy students: Levels of physical activity and perceived benefits and barriers to exercise. S Afr J Physiother 2020; 76:1399. [PMID: 32391443 PMCID: PMC7203537 DOI: 10.4102/sajp.v76i1.1399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/26/2020] [Indexed: 11/01/2022] Open
Abstract
Background Physiotherapists have been identified as key role players in health promotion, prevention and treatment of non-communicable diseases. Objectives The aim of this study is to describe the perceived benefits and barriers to exercise and their association with levels of physical activity (PA) in physiotherapy students attending university in the Western Cape province of South Africa. Method This study follows a quantitative, cross-sectional, survey design. Two hundred and ninety-six participants were recruited from three universities in the Western Cape. Participants completed a demographic questionnaire (DQ), Exercise Benefits and Barriers Scale (EBBS) and the International Physical Activity Questionnaire (IPAQ). Results Female students accounted for 83% of the sample. Out of the 296 participants, 58% lived off-campus and 65% were involved in sporting activities six hours per week. The median score on the EBBS was 136 (54-167) for all years. Responses with the highest agreement for perceived benefits were associated with physical performance. Alternatively, responses with the highest agreement for perceived barriers were associated with physical exertion. Only 37.5% students engaged in high PA. Conclusion Undergraduate physiotherapy students in the Western Cape across all three universities do not engage in adequate PA. In this group of students, benefits associated with high PA related to physical performance and barriers associated with low levels of PA related to physical exertion. Clinical implications Physiotherapists who do not practise what they preach are not effective role models and may not be effective in obtaining behaviour change through PA-related health promotion.
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Affiliation(s)
- Diana Kgokong
- Department of Physiotherapy, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
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Lourens A, Hodkinson P, Parker R. Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: a knowledge, attitudes and practices survey. BMC Emerg Med 2020; 20:31. [PMID: 32345230 PMCID: PMC7187518 DOI: 10.1186/s12873-020-00315-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 03/09/2020] [Indexed: 12/24/2022] Open
Abstract
Background Acute pain is frequently encountered in the prehospital setting, and therefore, a fundamental aspect of quality emergency care. Research has shown a positive association between healthcare providers’ knowledge of, and attitudes towards pain and pain management practices. This study aimed to describe the knowledge, attitudes, and practices of emergency care providers regarding acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa. The specific objectives were to, identify gaps in pain knowledge; assess attitudes regarding pain assessment and management; describe pain assessment and management behaviours and practices; and identify barriers to and enablers of pain care. Methods A web-based descriptive cross-sectional survey was conducted among emergency care providers of all qualifications, using a face-validated Knowledge, Attitudes and Practices of Pain survey. Results Responses of 100 participants were included in the analysis. The survey response rate could not be calculated. The mean age of respondents was 34.74 (SD 8.13) years and the mean years’ experience 10.02 (SD 6.47). Most respondents were male (69%), employed in the public/government sector (93%) as operational practitioners (85%) with 54% of respondents having attended medical education on pain care in the last 2 years. The mean percentage for knowledge and attitudes regarding pain among emergency care providers was 58.01% (SD 15.66) with gaps identified in various aspects of pain and pain care. Practitioners with higher qualifications, more years’ experience and those who did not attend medical education on pain, achieved higher scores. Alcohol and drug use by patients were the most selected barrier to pain care while the availability of higher qualified practitioners was the most selected enabler. When asked to record pain scores, practitioners were less inclined to assign scores which were self-reported by the patients in the case scenarios. The participant dropout rate was 35%. Conclusion Our results suggest that there is suboptimal knowledge and attitudes regarding pain among emergency care providers in the Western Cape, South Africa. Gaps in pain knowledge, attitudes and practices were identified. Some barriers and enablers of pain care in the South African prehospital setting were identified but further research is indicated.
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Affiliation(s)
- Andrit Lourens
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, South Africa.
| | - Peter Hodkinson
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, South Africa
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town (UCT), Cape Town, South Africa
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Reiné J, Rylance J, Ferreira DM, Pennington SH, Welters ID, Parker R, Morton B. The whole blood phagocytosis assay: a clinically relevant test of neutrophil function and dysfunction in community-acquired pneumonia. BMC Res Notes 2020; 13:203. [PMID: 32268927 PMCID: PMC7140487 DOI: 10.1186/s13104-020-05034-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/19/2020] [Indexed: 01/01/2023] Open
Abstract
Objective To refine and validate a neutrophil function assay with clinical relevance for patients with community-acquired pneumonia (CAP). Design Two phase cross-sectional study to standardise and refine the assay in blood from healthy volunteers and test neutrophil phagocytic function in hospital patients with CAP. Participants Phase one: Healthy adult volunteers (n = 30). Phase two: Critical care patients with severe CAP (n = 16), ward-level patients with moderate CAP (n = 15) and respiratory outpatients (no acute disease, n = 15). Results Our full standard operating procedure for the assay is provided. Patients with severe CAP had significantly decreased neutrophil function compared to moderate severity disease (median phagocytic index 2.8 vs. 18.0, p = 0.014). Moderate severity pneumonia neutrophil function was significantly higher than control samples (median 18.0 vs. 1.6, p = 0.015). There was no significant difference between critical care and control neutrophil function (median 2.8 vs. 1.6, p = 0.752). Conclusions Our whole blood neutrophil assay is simple, reproducible and clinically relevant. Changes in neutrophil function measured in this pneumonia cohort is in agreement with previous studies. The assay has potential to be used to identify individuals for clinical trials of immunomodulatory therapies, to risk-stratify patients with pneumonia, and to refine our understanding of ‘normal’ neutrophil function in infection.
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Affiliation(s)
- J Reiné
- Clinical Sciences Department, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK.
| | - J Rylance
- Clinical Sciences Department, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK.,Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. BOX 30096, Chichiri, Blantyre, Malawi
| | - D M Ferreira
- Clinical Sciences Department, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - S H Pennington
- Clinical Sciences Department, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - I D Welters
- Critical Care Department, Royal Liverpool University Hospital, Liverpool, UK
| | - R Parker
- Critical Care Department, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - B Morton
- Clinical Sciences Department, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK.,Critical Care Department, Aintree University Hospital NHS Foundation Trust, Liverpool, UK.,Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. BOX 30096, Chichiri, Blantyre, Malawi
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Abstract
Aim Major chest trauma is associated with significant morbidity and mortality. Management of patients with major chest trauma includes pain relief, ventilatory management, surgical fixation and early rehabilitation to improve both short- and long-term outcomes. Physiotherapy is widely considered an integral component of the multidisciplinary trauma team and aims to improve respiratory status and reduce the sequelae associated with immobility and reduced physical function. Despite this there is scarce evidence describing or investigating physiotherapy interventions and how these practices vary worldwide. The aim of this study was to ascertain the current physiotherapy management of patients having sustained major chest trauma and to investigate how such practices varied internationally. Methods A purpose designed online survey was administered to a group of experienced physiotherapists who work in the field of trauma. Results Response rate was 51% ( n = 49) and respondents represented all five continents. Respondents reported focussing on active coughing ( n = 46, 96%, r = 0.5, p = 0.98), body positioning ( n = 43, 94%, r = 0.7, p = 0.41), deep breathing exercises ( n = 44, 94%, r = 0.8, p = 0.66) and early mobilisation ( n = 47, 98%, r = 1, p = 0.64). Ambulation in hospital was reported to be common ( n = 46, 98%, r = 0.2, p = 0.99) but rehabilitation to address longer term sequelae following hospital discharge was reported to be rare ( n = 4, 8%). Conclusion This survey has highlighted those practices used by physiotherapists worldwide which aim to address the complications associated with major chest trauma. Having established global practice, the study provides a platform for future research investigating the efficacy of such interventions in improving both short- and long-term outcomes for patients following major chest injury.
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Affiliation(s)
- Heleen van Aswegen
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Julie Reeve
- Department of Physiotherapy, Auckland University of Technology, Auckland, New Zealand
| | - Lisa Beach
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Australia
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Monika Fagevik Olsèn
- Department of Physical Therapy, Sahlgrenska University Hospital and Gothenburg University, Gothenburg, Sweden
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Hendricks S, Hill H, Hollander SD, Lombard W, Parker R. Effects of foam rolling on performance and recovery: A systematic review of the literature to guide practitioners on the use of foam rolling. J Bodyw Mov Ther 2020; 24:151-174. [DOI: 10.1016/j.jbmt.2019.10.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022]
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Abstract
Background Pain is the most common reason for patients to seek help from a health care professional. In the past few decades, research has yielded gains in the Pain Sciences - multiple fields of scientific research that, when integrated, help to clarify what causes and influences human pain. Objectives In this article, we discuss the key areas in which the Pain Sciences have shifted the physiotherapy profession. Method A narrative review of the Pain Sciences literature was conducted. The review analyses how the Pain Sciences have influenced physiotherapy in several categories: assessment; clinical reasoning; treatment; research rigor and building the profile of the profession. Results Scientific research on pain has largely converged in support of three ‘game-changing’ concepts that have shifted the physiotherapy profession’s understanding and treatment of pain: (1) pain is not a signal originating from bodily tissues, (2) pain is not an accurate measure of tissue damage and (3) the plasticity of the nervous system means the nervous system itself is a viable target of treatment. These three concepts have influenced physiotherapy assessment and treatment approaches, and research design to consider pain mechanisms using patient-centred models. Conclusion The Pain Sciences have shifted physiotherapists’ assessment and treatment approaches and shifted the status of the physiotherapy profession. Ultimately the Pain Sciences have embedded interdisciplinary teams and expanded physiotherapy practice. Clinical implications We believe that the pain sciences should be embedded in undergraduate and postgraduate education and training of physiotherapists (including the three key concepts regarding pain) to benefit physiotherapists and their patients.
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Affiliation(s)
- Romy Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
| | - Victoria J Madden
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
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Limakatso K, Madden VJ, Manie S, Parker R. The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomised controlled trial. Physiotherapy 2020; 109:65-74. [PMID: 31992445 DOI: 10.1016/j.physio.2019.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/27/2018] [Revised: 04/10/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate whether graded motor imagery (GMI) is effective for reducing phantom limb pain (PLP) in people who have undergone limb amputations. DESIGN A single-blinded randomised, controlled trial. SETTING Physiotherapy out-patient departments in three secondary level hospitals in Cape Town, South Africa. PARTICIPANTS Twenty-one adults (≥18 years) who had undergone unilateral upper or lower limb amputations and had self-reported PLP persisting beyond three months. INTERVENTIONS A 6-week GMI programme was compared to routine physiotherapy. The study outcomes were evaluated at baseline, 6 weeks, 3 months and 6 months. OUTCOME MEASURES The pain severity scale of the Brief Pain Inventory (BPI) was used to assess the primary outcome - PLP. The pain interference scale of the BPI and the EuroQol EQ-5D-5L were used to assess the secondary outcomes - pain interference with function and health-related quality of life (HRQoL) respectively. RESULTS The participants in the experimental group had significantly greater improvements in pain than the control group at 6 weeks and 6 months. Further, the participants in the experimental group had significantly greater improvements than the control group in pain interference at all follow-up points. There was no between-group difference in HRQoL. CONCLUSION The results of the current study suggest that GMI is better than routine physiotherapy for reducing PLP. Based on the significant reduction in PLP and pain interference within the participants who received GMI, and the ease of application, GMI may be a viable treatment for treating PLP in people who have undergone limb amputations. CLINICAL TRIAL REGISTRATION NUMBER (PACTR201701001979279).
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Affiliation(s)
- Katleho Limakatso
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Victoria J Madden
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Shamila Manie
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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Prempeh AB, Duys R, de Vaal A, Parker R. Pain assessment and management: An audit of practice at a tertiary hospital. Health SA 2020; 25:1281. [PMID: 32161673 PMCID: PMC7059650 DOI: 10.4102/hsag.v25i0.1281] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 10/19/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In spite of advances in techniques and analgesics for pain management, pain remains a major health problem. Regular assessment and reassessment of pain using guidelines with measurable goals is essential for effective pain management in surgical wards. Unfortunately, no such guidelines exist in South Africa. To implement appropriate precepts for the South African context, the current practice must be understood. AIM The aim of this article was to evaluate pain assessment and management of patients in two surgical wards at a tertiary hospital in South Africa. SETTING The study was conducted within the Western Cape Province of South Africa in a government-funded tertiary academic institution. The patients at this hospital are generally from the low-income strata and live in resource-poor communities. METHODS A cross-sectional, retrospective medical record audit was conducted. The folders of all 215 patients admitted to a specific orthopaedic trauma and urogynaecological ward of a tertiary hospital in South Africa over a span of 1 month were targeted for review. Medical folders that were not available or had missing notes were excluded. Variables evaluated included the number of pain assessments recorded, pain assessor, assessment tool and management plan. RESULTS A total of 168 folders were available for review. Nearly half of the patients had no documented pain assessment. The Verbal Rating Scale was the predominant tool used, and assessments were mostly conducted by the ward doctor. Pain interventions appeared to be primarily based on the professional knowledge of the practitioner and were not evidence-based. CONCLUSION Pain assessment and management was a problem in the two wards reviewed, which is similar to the findings from studies referenced in this text. Health professionals must be empowered to manage pain adequately. An assessment tool that integrates the biopsychosocial factors that influence the pain experience should be routinely employed by a multidisciplinary team to facilitate goal-directed therapy.
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Affiliation(s)
- Agya B.A. Prempeh
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Rowan Duys
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Alma de Vaal
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Abstract
Synthetic peptides representing different areas of the CEA molecule were used as immunogens for the development of anti-CEA antibodies. Both polyclonal and monoclonal antibodies were generated using peptides composed of CEA amino acid positions 99–128 and 585–613, respectively. One MAb, designated CP4, generated using the CEA peptide 99–128, was chosen for a more detailed analysis of reactivity. MAb CP4 reacts in solid phase RIAs with CEA peptide 99–128 immunogen and purified native CEA. CP4 did not react with purified non- specific cross reacting antigen (NCA), even though there were two single amino acid differences between NCA and CEA in the 29 amino acid peptide. The affinity constants of CP4 for the CEA peptide 99–128 and native CEA are 4.07 × 109M−1and 5.75 × 108M−1, respectively. When CP4 was reacted with purified CEA in Western blotting experiments, the Mr 180,000 glycoprotein characteristic of CEA was detected, but CP4 reacted to various size entities in tumor cell extracts. The results of liquid competition RIAs showed that the epitope that MAb CP4 recognized on native CEA is not available for binding when CEA is in solution. Physical (adsorption to a solid matrix) or chemical (deglycosylation or formalin-fixation) alteration of CEA is required for binding of CP4 to CEA. MAb CP4 reacted approximately 1,000-fold greater to deglycosylated CEA than native CEA. Immunohistochemical studies using formalin-fixed paraffin-embedded tissue sections demonstrated that, among carcinomas, CP4 reacts selectively with colorectal carcinomas, while normal colon is negative. Although stomach carcinoma is negative, dysplastic lesions and areas of intestinal metaplasia are reactive. Two of 7 normal stomach tissues showed focal cytoplasmic reactivity of the surface epithelium. CP4, therefore, appears to react with an epitope with highly restricted expression in colorectal carcinoma. These studies demonstrate the complexities in dealing with an anti-peptide MAb with reactivity to an epitope which is accessible only under certain conditions.
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Affiliation(s)
- P Horan Hand
- Laboratory of Tumor Immunology and Biology, National Cancer Institute, Bethesda, MD
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Bhattacharjee D, Vracar S, Round RA, Nightingale PG, Williams JA, Gkoutos GV, Stratton IM, Parker R, Luzio SD, Webber J, Manley SE, Roberts GA, Ghosh S. Utility of HbA 1c assessment in people with diabetes awaiting liver transplantation. Diabet Med 2019; 36:1444-1452. [PMID: 30474191 PMCID: PMC6850030 DOI: 10.1111/dme.13870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 02/06/2023]
Abstract
AIMS To investigate the relationship between HbA1c and glucose in people with co-existing liver disease and diabetes awaiting transplant, and in those with diabetes but no liver disease. METHODS HbA1c and random plasma glucose data were collected for 125 people with diabetes without liver disease and for 29 people awaiting liver transplant with diabetes and cirrhosis. Cirrhosis was caused by non-alcoholic fatty liver disease, hepatitis C, alcoholic liver disease, hereditary haemochromatosis, polycystic liver/kidneys, cryptogenic/non-cirrhotic portal hypertension and α-1-antitrypsin-related disease. RESULTS The median (interquartile range) age of the diabetes with cirrhosis group was 55 (49-63) years compared to 60 (50-71) years (P=0.13) in the group without cirrhosis. In the diabetes with cirrhosis group there were 21 men (72%) compared with 86 men (69%) in the group with diabetes and no cirrhosis (P=0.82). Of the group with diabetes and cirrhosis, 27 people (93%) were of white European ethnicity, two (7%) were South Asian and none was of Afro-Caribbean/other ethnicity compared with 94 (75%), 16 (13%), 10 (8%)/5 (4%), respectively, in the group with diabetes and no cirrhosis (P=0.20). Median (interquartile range) HbA1c was 41 (32-56) mmol/mol [5.9 (5.1-7.3)%] vs 61 (52-70) mmol/mol [7.7 (6.9-8.6)%] (P<0.001), respectively, in the diabetes with cirrhosis group vs the diabetes without cirrhosis group. The glucose concentrations were 8.4 (7.0-11.2) mmol/l vs 7.3 (5.2-11.5) mmol/l (P=0.17). HbA1c was depressed by 20 mmol/mol (1.8%; P<0.001) in 28 participants with cirrhosis but elevated by 28 mmol/mol (2.6%) in the participant with α-1-antitrypsin disorder. Those with cirrhosis and depressed HbA1c had fewer larger erythrocytes, and higher red cell distribution width and reticulocyte count. This was reflected in the positive association of glucose with mean cell volume (r=0.39) and haemoglobin level (r=0.49) and the negative association for HbA1c (r=-0.28 and r=-0.26, respectively) in the diabetes group with cirrhosis. CONCLUSION HbA1c is not an appropriate test for blood glucose in people with cirrhosis and diabetes awaiting transplant as it reflects altered erythrocyte presentation.
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Affiliation(s)
| | - S. Vracar
- Medical SchoolUniversity of BirminghamBirminghamUK
| | - R. A. Round
- Clinical Laboratory ServicesUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Diabetes Translational Research GroupDiabetes CentreQueen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - P. G. Nightingale
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - J. A. Williams
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- College of Medical and Dental SciencesInstitute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
- Mammalian Genetics UnitMedical Research Council Harwell InstituteHarwellUK
| | - G. V. Gkoutos
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- College of Medical and Dental SciencesInstitute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
- MRC Health Data Research UK (HDR UK)BirminghamUK
- NIHR Experimental Cancer Medicine CentreBirminghamUK
- NIHR Surgical Reconstruction and Microbiology Research CentreBirminghamUK
- NIHR Biomedical Research CentreBirminghamUK
| | - I. M. Stratton
- Gloucestershire Retinal Research GroupGloucestershire Hospitals NHS Foundation TrustCheltenhamUK
| | - R. Parker
- Leeds Liver UnitSt James's University HospitalLeedsUK
| | - S. D. Luzio
- Diabetes Translational Research GroupDiabetes CentreQueen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Diabetes Research GroupSwansea UniversitySwansea
| | - J. Webber
- Diabetes Translational Research GroupDiabetes CentreQueen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - S. E. Manley
- Diabetes Translational Research GroupDiabetes CentreQueen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- College of Medical and Dental SciencesInstitute of Metabolism and Systems ResearchUniversity of BirminghamBirmingham
| | - G. A. Roberts
- Diabetes Translational Research GroupDiabetes CentreQueen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Diabetes Research GroupSwansea UniversitySwansea
- HRB‐Clinical Research Facility ‐ CorkUniversity College CorkCorkIreland
| | - S. Ghosh
- Diabetes Translational Research GroupDiabetes CentreQueen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
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Olwin B, Vogler T, Wheeler J, Parker R. I.8Reversible formation of TDP-43 assemblies during skeletal muscle regeneration. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jewer JK, Wong MJ, Bird SJ, Habib AS, Parker R, George RB. Supplemental peri‐operative intravenous crystalloids for postoperative nausea and vomiting: an abridged Cochrane systematic review. Anaesthesia 2019; 75:254-265. [DOI: 10.1111/anae.14857] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2019] [Indexed: 12/11/2022]
Affiliation(s)
- J. K. Jewer
- Department of Anesthesia, Pain Management and Perioperative Medicine Dalhousie University Halifax NS Canada
| | - M. J. Wong
- Department of Anesthesia, Pain Management and Perioperative Medicine Dalhousie University Halifax NS Canada
| | - S. J. Bird
- Department of Anesthesia, Pain Management and Perioperative Medicine Dalhousie University Halifax NS Canada
| | - A. S. Habib
- Duke University Medical Center Durham NC USA
| | - R. Parker
- W.K. Kellogg Health Sciences Library Dalhousie University Halifax NS Canada
| | - R. B. George
- Department of Anaesthesia and Perioperative Care University of California, San Francisco CA USA
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Gonzalez CE, Okunbor JI, Parker R, Owens MA, White DM, Merlin JS, Goodin BR. Pain-Specific Resilience in People Living With HIV and Chronic Pain: Beneficial Associations With Coping Strategies and Catastrophizing. Front Psychol 2019; 10:2046. [PMID: 31555190 PMCID: PMC6742745 DOI: 10.3389/fpsyg.2019.02046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/22/2019] [Indexed: 12/18/2022] Open
Abstract
Objective Chronic pain is increasingly recognized as a common and disabling problem for people living with HIV (PLWH). In a recent systematic review of psychosocial factors associated with chronic pain in PLWH, it was reported that very few studies to date have examined protective psychological factors that might help mitigate chronic pain for PLWH. The current study examined pain-specific resilience in relation to clinical and experimental pain, as well as pain coping in PLWH and chronic pain. Pain-specific resilience specifically refers to the ability to maintain relatively stable, healthy levels of psychological and physical functioning in the face of ongoing and persistent pain. Methods A total of 85 PLWH (mean CD4 = 643; 13% detectable viral load ≥200; 99% on antiretroviral therapy) who met criteria for chronic pain (>3 consecutive month’s duration) were enrolled. Medical records were reviewed to confirm clinical data. All participants provided sociodemographic information prior to completing the following validated measures: Pain Resilience Scale (PRS), Coping Strategies Questionnaire-Revised (CSQ-R), Center for Epidemiologic Studies – Depression Scale (CES-D), and the Brief Pain Inventory – Short Form (BPI-SF). They then completed a quantitative sensory testing battery designed to assess tolerance for painful heat and cold stimuli. Results In adjusted multiple regression models controlling for covariates, greater pain-specific resilience was significantly associated with less pain interference (p = 0.022) on the BPI-SF, less pain catastrophizing (p = 0.002), greater use of distraction (p = 0.027) and coping self-statements (p = 0.039) on the CSQ-R, as well as significantly greater heat pain tolerance (p = 0.009). Finally, results of a parallel multiple mediation model demonstrated that the effect of pain-specific resilience on heat pain tolerance was indirectly transmitted through less pain catastrophizing (95% confidence interval:0.0042 to 0.0354), but not use of distraction (95% confidence interval: −0.0140 to 0.0137) or coping self-statements (95% confidence interval: −0.0075 to 0.0255). Conclusion The findings suggest that pain-specific resilience may promote adaptation and positive coping in PLWH and chronic pain.
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Affiliation(s)
- Cesar E Gonzalez
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer I Okunbor
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Romy Parker
- Department of Anesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael A Owens
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dyan M White
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jessica S Merlin
- Department of Medicine, Divisions of General Internal Medicine and Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, United States
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
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Moabelo MLA, Parker R. Gabapentinoids for treatment of neuropathic pain: a medicines usage
evaluation at the Groote Schuur Hospital Chronic Pain Management Clinic. South Afr J Anaesth Analg 2019. [DOI: 10.36303/sajaa.2019.25.4.2253] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Neuropathic pain (NP), defined as pain caused by a lesion or disease of the somatosensory system, affects 6.9–10% of people worldwide. Pregabalin is currently recommended as a first line drug for NP in South Africa.
Methods: A cross-sectional, retrospective, descriptive medicines usage evaluation (MUE) of pregabalin at Groote Schuur Hospital (GSH) Chronic Pain Management Clinic for the year 2017 was conducted. A MUE using a standardised data collection form was performed on 100 randomly selected patient folders. Data was summarised using descriptive statistics.
Results: The majority of cases were women (76) with a mean age of 55.9 years (SD12.49). A diagnosis of NP was recorded in 58 folders and a “possible” diagnosis recorded in 7 folders. In 79 cases there was no mention of a tool/method used to diagnose NP. The most common condition diagnosed was chronic postsurgical pain with a neuropathic component (n = 16), followed by NP (n = 15). The most common initiating and current dose of pregabalin was 75 mg twice daily. In 56 patients, pregabalin was prescribed in conjunction with a tricyclic antidepressant (TCA) or selective noradrenaline reuptake inhibitor (SNRI). Patient education was documented as having taken place in 76 of cases.
Conclusions: Based on this MUE we recommend the use of screening tools for the diagnosis of neuropathic pain, and a focus on the initiating dose of pregabalin. The use of a standardised assessment document and the interdisciplinary team input at this clinic appears to optimise prescribing of pregabalin in line with practice guidelines.
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