1
|
O’Brien-Kelly J, Moore D, O’Leary I, O’Connor T, Moore Z, Patton D, Nugent L. Development and impact of a tailored eHealth resource on fibromyalgia patient's self-management and self-efficacy: A mixed methods approach. Br J Pain 2024; 18:292-307. [PMID: 38751562 PMCID: PMC11092935 DOI: 10.1177/20494637231221647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Aim To develop an eHealth resource to support fibromyalgia patients and explore it for usability and impact on their self-management and self-efficacy. Background Fibromyalgia is a complex, non-progressive chronic condition characterised by a bewildering array of symptoms for patients to self-manage. International guidelines recommend patients receive illness-specific information once diagnosed to promote self-management and improve health-related quality of life. Design A 3-phase mixed methods exploratory sequential design. Methods Qualitative interviews explored the information and self-management needs of fibromyalgia patients attending a large tertiary hospital in Dublin. Identified themes together with an extensive review of the literature of interventions proven to be impactful by patients with fibromyalgia were utilised in the design and development of the eHealth resource. The resource was tested for usability and impact using pre and post-intervention outcomes measures. Results Patient interviews highlighted a lack of easy accessible evidenced information to support self-management implicating the urgent need for a practical solution through development of a tailored eHealth resource. Six themes emerged for inclusion; illness knowledge, primary symptoms, treatment options, self-management strategies, practical support and reliable resources. Forty-five patients who tested the site for usability and impact demonstrated a statistically significant improvement in self-efficacy after 4 weeks access with a medium positive effect size. Patients with the most severe fibromyalgia impact scores pre-intervention demonstrated the most improvement after 4 weeks. Patients gave the resource a System Usability Score A rating, highly recommending it for fellow patients diagnosed with fibromyalgia. Conclusions The study demonstrated how the development of a novel eHealth resource positively impacted fibromyalgia patients' self-efficacy to cope with this debilitating condition. Impact This study suggests that access to eHealth can positively impact patients self-efficacy, has the potential to be a template for eHealth development in other chronic conditions, supporting advanced nurse practitioners working in chronic disease management.
Collapse
Affiliation(s)
- Joanne O’Brien-Kelly
- Department of Pain Management, Beaumont Hospital, Dublin, Ireland
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - David Moore
- Department of Pain Management, Beaumont Hospital, Dublin, Ireland
| | - Ian O’Leary
- Multimedia Cork Institute of Technology, Cork, Ireland
| | - Tom O’Connor
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Linda Nugent
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| |
Collapse
|
2
|
Crow JA, Joseph V, Miao G, Goodin BR, Sibille KT, Cardoso J, Bartley EJ, Staud R, Fillingim RB, Booker SQ. A domain-oriented approach to characterizing movement-evoked pain. Pain Rep 2024; 9:e1158. [PMID: 38646659 PMCID: PMC11029970 DOI: 10.1097/pr9.0000000000001158] [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: 08/25/2023] [Revised: 02/04/2024] [Accepted: 02/20/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Movement-evoked pain (MEP) impacts a substantial proportion of US adults living with chronic pain. Evidence suggests that MEP is influenced by numerous biopsychosocial factors and mediated by mechanisms differing from those of spontaneous pain. However, both characteristic and mechanistic knowledge of MEP remain limited, hindering effective diagnosis and treatment. Objectives We asked (1) can chronic pain, functional, psychosocial, and behavioral measures be grouped into descriptive domains that characterize MEP? and (2) what relationships exist between biopsychosocial factors across multiple domains of MEP? Methods We formed 6 characteristic domains from 46 MEP-related variables in a secondary analysis of data from 178 individuals (aged 45-85 years) with knee pain. Ratings of pain during 3 functional activities (ie, Balance, Walking, Chair Stand) were used as primary MEP variables. Pearson correlations were calculated to show linear relationships between all individual domain variables. Relationships between variables were further investigated through weighted correlation network analysis. Results We observed a unique combination of pain characteristics associated with MEP apart from general pain. Notably, minutes doing physical activity were inversely associated with multiple variables within 4 of the 6 domains. Weighted correlation network analysis largely supported our classification of MEP domains. Additional interdomain relationships were observed, with the strongest existing between MEP, Mechanical Pain, and Multiple Pain Characteristics and Symptoms. Additional relationships were observed both within and between other domains of the network. Conclusion Our analyses bolster fundamental understanding of MEP by identifying relevant mechanistic domains and elucidating biopsychosocial and interdomain relationships.
Collapse
Affiliation(s)
- Joshua A. Crow
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Verlin Joseph
- College of Population Health, The University of New Mexico, Albuquerque, NM, USA
| | - Guanhong Miao
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Burel R. Goodin
- Department of Anesthesiology, School of Medicine, Washington University, St. Louis, MO, USA
| | - Kimberly T. Sibille
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Josue Cardoso
- The Pennsylvania State University, University Park, PA, USA
| | - Emily J. Bartley
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- Department of Rheumatology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B. Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Staja Q. Booker
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| |
Collapse
|
3
|
Lind M, Koch MK, Bluck S. Nursing students' empathic communication: Role in recognizing and treating chronic pain patients. Patient Educ Couns 2024; 123:108236. [PMID: 38452687 DOI: 10.1016/j.pec.2024.108236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE A substantial body of research supports what many nurses know from experience: empathy is at the heart of providing quality care. The major objective of this study was to identify unique mechanisms through which higher empathy translates into greater intentions to treat patients in pain employing novel methodology. METHODS Using an ecologically-valid scenario methodology, student nurses (N = 156) reviewed the narrative of a patient in chronic pain. They completed standard, valid measures of empathy toward the patient, perception of the patient's pain, and intention to provide pain-relieving treatment. Nursing student's personality traits were assessed and perception of patients' age and sex were experimentally manipulated. RESULTS Empathy was associated with higher intention to treat the patient in chronic pain irrespective of patients' age or sex. A moderated-mediation analysis confirmed that nursing students with higher empathy perceived the patient in the scenario as being in greater pain. This was correspondingly associated with higher intention to provide treatment. Nursing students' trait Extraversion was a moderator. CONCLUSION Empathy not only improves rapport between patients and providers but is related to intentions to provide pain-relieving treatment. PRACTICE IMPLICATIONS The clinical and educational importance of empathy in patient-provider relationships are discussed.
Collapse
Affiliation(s)
- Majse Lind
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark.
| | - Mary Kate Koch
- Department of Psychology, University of Florida, Gainesville, USA
| | - Susan Bluck
- Department of Psychology, University of Florida, Gainesville, USA
| |
Collapse
|
4
|
Overmann L, Schleip R, Anheyer D, Michalak J. Effectiveness of myofascial release for adults with chronic neck pain: a meta-analysis. Physiotherapy 2024; 123:56-68. [PMID: 38290198 DOI: 10.1016/j.physio.2023.12.002] [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: 02/06/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Every second human will experience a phase of neck pain in their lifetime and a high rate of chronicity exists. Because of the complexity and multiple influencing factors, chronic pain conditions are associated with a long treatment and diagnostic process. This leads to a prolonged healing process and high costs. OBJECTIVE To evaluate the effect of myofascial release on the variables of pain and range of motion in patients with chronic neck pain. METHOD Selection criteria were set to create a search algorithm for a systematic search in the databases: PubMed, Google Scholar, EBM Reviews, Medline, CINAHL, PEDro, and Science Direct. The risk of bias and the methodological quality was analyzed with the PEDro scale. RESULT Ten randomized controlled trials, with 549 participants met the eligibility criteria. The methodological quality was ranked from good to excellent. The myofascial release showed a significant difference in pain (p = 0.03), rotation to the right (p = 0.05), and lateral flexion to the right (p = 0.04), compared to other treatment methods. No significant effect was found for improvements in pressure pain threshold. CONCLUSION Modest effects are observed in pain reduction, suggesting potential benefits of myofascial release in managing chronic neck pain. Further research with standardized protocols and direct comparisons to established therapies is crucial for a comprehensive understanding of myofascial release efficacy. CONTRIBUTION OF THE PAPER What does the meta-analysis add to the current literature.
Collapse
Affiliation(s)
- Lea Overmann
- Department of Psychology, University of Witten-Herdecke, Germany.
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University Munich, Germany
| | - Dennis Anheyer
- Department of Psychology, University of Witten-Herdecke, Germany
| | | |
Collapse
|
5
|
Sean M, Coulombe-Lévêque A, Nadeau W, Charest AC, Martel M, Léonard G, Tétreault P. Counting your chickens before they hatch: improvements in an untreated chronic pain population, beyond regression to the mean and the placebo effect. Pain Rep 2024; 9:e1157. [PMID: 38689593 PMCID: PMC11057814 DOI: 10.1097/pr9.0000000000001157] [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: 09/12/2023] [Revised: 01/22/2024] [Accepted: 02/20/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Isolating the effect of an intervention from the natural course and fluctuations of a condition is a challenge in any clinical trial, particularly in the field of pain. Regression to the mean (RTM) may explain some of these observed fluctuations. Objectives In this paper, we describe and quantify the natural trajectory of questionnaire scores over time, based on initial scores. Methods Twenty-seven untreated chronic low back pain patients and 25 healthy controls took part in this observational study, wherein they were asked to complete an array of questionnaires commonly used in pain studies during each of 3 visits (V1, V2, V3) at the 2-month interval. Scores at V1 were classified into 3 subgroups (extremely high, normal, and extremely low), based on z-scores. The average delta (∆ = V2 - V1) was calculated for each subgroup, for each questionnaire, to describe the evolution of scores over time based on initial scores. This analysis was repeated with the data for V2 and V3. Results Our results show that high initial scores were widely followed by more average scores, while low initial scores tended to be followed by similar (low) scores. Conclusion These trajectories cannot be attributable to RTM alone because of their asymmetry, nor to the placebo effect as they occurred in the absence of any intervention. However, they could be the result of an Effect of Care, wherein participants had meaningful improvements simply from taking part in a study. The improvement observed in patients with high initial scores should be carefully taken into account when interpreting results from clinical trials.
Collapse
Affiliation(s)
- Monica Sean
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Anesthesiology, Sherbrooke, QC, Canada
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Alexia Coulombe-Lévêque
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- School of Rehabilitation, Sherbrooke, QC, Canada
- Research Centre on Aging, Sherbrooke, QC, Canada
| | - William Nadeau
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Anne-Catherine Charest
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marylie Martel
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Guillaume Léonard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- School of Rehabilitation, Sherbrooke, QC, Canada
- Research Centre on Aging, Sherbrooke, QC, Canada
| | - Pascal Tétreault
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Anesthesiology, Sherbrooke, QC, Canada
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada
- Department of Nuclear Medicine and Radiobiology, Sherbrooke, QC, Canada
| |
Collapse
|
6
|
Nobili S, Micheli L, Lucarini E, Toti A, Ghelardini C, Di Cesare Mannelli L. Ultramicronized N-palmitoylethanolamine associated with analgesics: Effects against persistent pain. Pharmacol Ther 2024; 258:108649. [PMID: 38615798 DOI: 10.1016/j.pharmthera.2024.108649] [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: 10/02/2023] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
Current epidemiological data estimate that one in five people suffers from chronic pain with considerable impairment of health-related quality of life. The pharmacological treatment is based on first- and second-line analgesic drugs, including COX-2 selective and nonselective nonsteroidal anti-inflammatory drugs, paracetamol, antidepressants, anti-seizure drugs and opioids, that are characterized by important side effects. N-palmitoylethanolamine (PEA) is a body's own fatty-acid ethanolamide belonging to the family of autacoid local injury antagonist amides. The anti-inflammatory and pain-relieving properties of PEA have been recognized for decades and prompted to depict its role in the endogenous mechanisms of pain control. Together with its relative abundance in food sources, this opened the way to the use of PEA as a pain-relieving nutritional intervention. Naïve PEA is a large particle size lipid molecule with low solubility and bioavailability. Reducing particle size is a useful method to increase surface area, thereby improving dissolution rate and bioavailability accordingly. Micron-size formulations of PEA (e.g., ultramicronized and co-(ultra)micronized) have shown higher oral efficacy compared to naïve PEA. In particular, ultramicronized PEA has been shown to efficiently cross the intestinal wall and, more importantly, the blood-brain and blood-spinal cord barrier. Several preclinical and clinical studies have shown the efficacy, safety and tolerability of ultramicronized PEA. This narrative review summarizes the available pharmacokinetic/pharmacodynamic data on ultramicronized PEA and focuses to its contribution to pain control, in particular as 'add-on' nutritional intervention. Data showing the ability of ultramicronized PEA to limit opioid side effects, including the development of tolerance, have also been reviewed.
Collapse
Affiliation(s)
- Stefania Nobili
- Department of Neuroscience, Psychology, Drug Research and Child Health - NEUROFARBA - Pharmacology and Toxicology Section, University of Florence, Florence, Italy.
| | - Laura Micheli
- Department of Neuroscience, Psychology, Drug Research and Child Health - NEUROFARBA - Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Elena Lucarini
- Department of Neuroscience, Psychology, Drug Research and Child Health - NEUROFARBA - Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Alessandra Toti
- Department of Neuroscience, Psychology, Drug Research and Child Health - NEUROFARBA - Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Carla Ghelardini
- Department of Neuroscience, Psychology, Drug Research and Child Health - NEUROFARBA - Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Lorenzo Di Cesare Mannelli
- Department of Neuroscience, Psychology, Drug Research and Child Health - NEUROFARBA - Pharmacology and Toxicology Section, University of Florence, Florence, Italy.
| |
Collapse
|
7
|
Vieira WF, Coelho DRA, Litwiler ST, McEachern KM, Clancy JA, Morales-Quezada L, Cassano P. Neuropathic pain, mood, and stress-related disorders: A literature review of comorbidity and co-pathogenesis. Neurosci Biobehav Rev 2024; 161:105673. [PMID: 38614452 DOI: 10.1016/j.neubiorev.2024.105673] [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: 01/30/2024] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
Neuropathic pain can be caused by multiple factors, and its prevalence can reach 10% of the global population. It is becoming increasingly evident that limited or short-lasting response to treatments for neuropathic pain is associated with psychological factors, which include psychiatric comorbidities known to affect quality of life. It is estimated that 60% of patients with neuropathic pain also experience depression, anxiety, and stress symptoms. Altered mood, including stress, can be a consequence of several painful conditions but can also favor pain chronicization when preexisting. Despite the apparent tight connection between clinical pain and mood/stress disorders, the exact physiological mechanisms remain unclear. This review aims to provide an overview of state-of-the-art research on the mechanisms of pain related to the pathophysiology of depression, anxiety, and stress disorders.
Collapse
Affiliation(s)
- Willians Fernando Vieira
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital (MGH), Boston, USA; Department of Psychiatry, Harvard Medical School (HMS), Boston, USA; Department of Anatomy, Institute of Biomedical Sciences (ICB), University of São Paulo (USP), São Paulo, Brazil.
| | - David Richer Araujo Coelho
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital (MGH), Boston, USA; Department of Psychiatry, Harvard Medical School (HMS), Boston, USA; Harvard T. H. Chan School of Public Health (HSPH), Boston, USA
| | - Scott Thomas Litwiler
- Center for Computational and Integrative Biology (CCIB), Massachusetts General Hospital (MGH), Boston, USA
| | - Kayla Marie McEachern
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital (MGH), Boston, USA
| | - Julie A Clancy
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital (MGH), Boston, USA
| | - Leon Morales-Quezada
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, USA
| | - Paolo Cassano
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital (MGH), Boston, USA; Department of Psychiatry, Harvard Medical School (HMS), Boston, USA
| |
Collapse
|
8
|
Kraft KVL, Backmund T, Eberhart L, Schubert AK, Dinges HC, Hagen MK, Gehling M. Does opioid therapy enhance quality of life in patients suffering from chronic non-malignant pain? A systematic review and meta-analysis. Br J Pain 2024; 18:227-242. [PMID: 38751560 PMCID: PMC11092930 DOI: 10.1177/20494637231216352] [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] [Indexed: 05/18/2024] Open
Abstract
Background and objective Chronic pain is associated with a poor health-related quality of life (HRQL). Whereas the prescription rate of opioids increased during the last decades, their use in chronic non-malignant pain remains unclear. However, there is currently no clinical consensus or evidence-based guidelines that consider the long-term effects of opioid therapy on HRQL in patients with chronic non-cancer pain. This systematic review aims to address the question of whether opioid therapy improves HRQL in patients with chronic non-malignant pain and provide some guidance to practitioners. Databases and data treatment PubMed, EMBASE and CENTRAL were searched in June 2020 for double-blind, randomized trials (RCTs), comparing opioid therapy to placebo and assessed a HRQL questionnaire. The review comprises a qualitative vote counting approach and a meta-analysis of the Short Form Health Survey (SF-36), EQ-5D questionnaire and the pain interference scale of the Brief pain inventory (BPI). Results 35 RCTs were included, of which the majority reported a positive effect of opioids for the EQ-5D, the BPI and the physical component score (PCS) of the SF-36 compared to placebo. The meta-analysis of the PCS showed a mean difference of 1.82 [confidence interval: 1.32, 2.32], the meta-analysis of the EQ-5D proved a significant advantage of 0.06 [0.00, 0.12]. In the qualitative analysis of the mental component score (MCS) of the SF-36, no positive or negative trend was seen. No significant differences were seen in the MCS (MD: 0.65 [-0.43, 1.73]). A slightly higher premature dropout rate was found in the opioid group (risk difference: 0.04 [0.00, 0.07], p = .07). The body of evidence is graded as low to medium. Conclusion Opioids have a statistically significant, but small and clinical not relevant effect on the physical dimensions of HRQL, whereas there is no effect on mental dimensions of HRQL in patients with chronic non-malignant pain during the initial months of treatment. In clinical practice, opioid prescriptions for chronic non-cancer pain should be individually assessed as their broad efficacy in improving quality of life is not confirmed. The duration of opioid treatment should be determined carefully, as this review primarily focuses on the initial months of therapy.
Collapse
Affiliation(s)
- Karl V. L. Kraft
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Teresa Backmund
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Leopold Eberhart
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Ann-Kristin Schubert
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Hanns-Christian Dinges
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Maria K. Hagen
- Department of Physics and Material Sciences Center, Philipps-University Marburg, Marburg, Germany
| | | |
Collapse
|
9
|
Skidmore N, Ryan CG, Mankelow J, Martin D. Acceptability and feasibility of virtual reality to promote health literacy in primary care from the health professional's view: A qualitative study. Patient Educ Couns 2024; 123:108179. [PMID: 38367303 DOI: 10.1016/j.pec.2024.108179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/12/2023] [Accepted: 01/26/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The development of health literacy is important in the management of chronic pain and virtual reality may be an effective medium for its development. This study aims to understand the usability and acceptability of a virtual reality-based pain education system for the facilitation of health literacy. METHODS Semi-structured interviews were conducted with health professionals who had used a VR-based pain education system within their clinical practice, to explore perceptions of feasibility. Data collection and analyses were informed by the Unified Theory of Acceptance and Use of Technology and the Integrated Model of Health Literacy. RESULTS From 10 participants, the VR-based system was considered feasible in providing immersive experiential learning which addressed patient understanding and health-related communication. CONCLUSION VR appears to be perceived as an acceptable and feasible technology to support the development of health literacy in people with chronic pain. Its largest perceived benefit was its capacity to provide an immersive and entertaining alternative to conventional methods of pain education. PRACTICE IMPLICATIONS Virtual reality is considered as a feasible method of facilitating patient understanding and health-related communication related to chronic pain. Feasibility of such a tool relies clinically on time available, social expectations of VR, and the role of immersive and experiential learning within the management of chronic pain.
Collapse
Affiliation(s)
- Nathan Skidmore
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom.
| | - Cormac G Ryan
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom
| | - Jagjit Mankelow
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom
| | - Denis Martin
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom; NIHR Applied Research Collaboration for the North East and Cumbria, United Kingdom
| |
Collapse
|
10
|
Cornwall N, Woodcock C, Ashworth J, Harrisson SA, Dikomitis L, White S, Helliwell T, Hodgson E, Knaggs R, Pincus T, Santer M, Mallen CD, Jinks C. Acceptability of a proposed practice pharmacist-led review for opioid-treated patients with persistent pain: A qualitative study to inform intervention development. Br J Pain 2024; 18:274-291. [PMID: 38751561 PMCID: PMC11092934 DOI: 10.1177/20494637231221688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Introduction Regular review of patients prescribed opioids for persistent non-cancer pain (PCNP) is recommended but not routinely undertaken. The PROMPPT (Proactive clinical Review of patients taking Opioid Medicines long-term for persistent Pain led by clinical Pharmacists in primary care Teams) research programme aims to develop and test a pharmacist-led pain review (PROMPPT) to reduce inappropriate opioid use for persistent pain in primary care. This study explored the acceptability of the proposed PROMPPT review to inform early intervention development. Methods Interviews (n = 15) and an online discussion forum (n = 31) with patients prescribed opioids for PCNP and interviews with pharmacists (n = 13), explored acceptability of a proposed PROMPPT review. A prototype PROMPPT review was then tested and refined through 3 iterative cycles of in-practice testing (IPT) (n = 3 practices, n = 3 practice pharmacists, n = 13 patients). Drawing on the Theoretical Framework of Acceptability (TFA), a framework was generated (including a priori TFA constructs) allowing for deductive and inductive thematic analysis to identify aspects of prospective and experienced acceptability. Results Patients felt uncertain about practice pharmacists delivering the proposed PROMPPT review leading to development of content for the invitation letter for IPT (introducing the pharmacist and outlining the aim of the review). After IPT, patients felt that pharmacists were suited to the role as they were knowledgeable and qualified. Pharmacists felt that the proposed reviews would be challenging. Although challenges were experienced during delivery of PROMPPT reviews, pharmacists found that they became easier to deliver with time, practise and experience. Recommendations for optimisations after IPT included development of the training to include examples of challenging consultations. Conclusions Uptake of new healthcare interventions is influenced by perceptions of acceptability. Exploring prospective and experienced acceptability at multiple time points during early intervention development, led to mini-optimisations of the prototype PROMPPT review ahead of a non-randomised feasibility study.
Collapse
Affiliation(s)
| | | | - Julie Ashworth
- School of Medicine, Keele University, Keele, UK
- Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Stoke on Trent, UK
| | - Sarah A Harrisson
- School of Medicine, Keele University, Keele, UK
- Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Stoke on Trent, UK
| | - Lisa Dikomitis
- Centre for Health Services Studies and Kent and Medway Medical School, University of Kent, Canterbury, UK
| | - Simon White
- School of Pharmacy and Bioengineering, Keele University, Keele, Staffordshire, UK
| | - Toby Helliwell
- School of Medicine, Keele University, Keele, UK
- Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Stoke on Trent, UK
| | | | - Roger Knaggs
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Clinical Sciences Building, City Hospital, Nottingham, UK
- UK & Primary Integrated Community Services, Nottingham, UK
| | - Tamar Pincus
- Department of Psychology, University of Southampton, Southampton, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Christian D Mallen
- School of Medicine, Keele University, Keele, UK
- Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Stoke on Trent, UK
| | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - on behalf of the PROMPPT team
- School of Medicine, Keele University, Keele, UK
- Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Stoke on Trent, UK
- Centre for Health Services Studies and Kent and Medway Medical School, University of Kent, Canterbury, UK
- School of Pharmacy and Bioengineering, Keele University, Keele, Staffordshire, UK
- Leek Health Centre, Leek, UK
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Clinical Sciences Building, City Hospital, Nottingham, UK
- UK & Primary Integrated Community Services, Nottingham, UK
- Department of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, University of Southampton, Southampton, UK
| |
Collapse
|
11
|
Schepis TS, Rogers AH, Munoz L, Zvolensky MJ. Indirect effects of emotion regulation in the relationship between pain and cannabis use in adults 18-64 years. Addict Behav 2024; 153:107983. [PMID: 38367507 DOI: 10.1016/j.addbeh.2024.107983] [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: 11/06/2023] [Revised: 01/19/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Individuals with chronic pain often receive prescription opioid medication, and they may use cannabis to treat pain as well, although the risks of cannabis-opioid co-use are significant. This study aimed to investigate whether two transdiagnostic factors, emotion regulation and distress tolerance, had significant indirect effects in the relationship between pain and cannabis use in adults with chronic pain and an opioid prescription. METHODS Participants (n = 450; mean age = 38.6 ± 11.09) were recruited using Qualtrics panel service and were 75 % female and 79 % White, non-Hispanic. Participants completed a 30-minute self-report survey capturing three-month cannabis use, the Difficulties in Emotional Regulation Scale (DERS), and the Distress Tolerance Scale (DTS). The Graded Pain Scale (GCPS) assessed pain severity/intensity and disability. Analyses used the SPSS PROCESS macro, with both single (i.e., one transdiagnostic factor) and parallel indirect effects (i.e., both the DERS and DTS) examined. RESULTS There were statistically significant indirect effects for both the DERS and DTS in the relationship between pain intensity or disability and three-month cannabis use in single factor models. In the parallel indirect effect model, only the DERS was statistically significant (intensity indirect effect coefficient = 0.0195 % confidence interval [95 %CI] = 0.0065, 0.390; disability indirect effect coefficient = 0.0147, 95 %CI = 0.0055, 0.0274). CONCLUSIONS When examining parallel indirect effects, only emotional regulation and not distress tolerance mediated the relationship between chronic pain and cannabis use among those with an opioid prescription. Clinically, interventions aimed at improving emotional regulation in individuals with chronic pain can help limit cannabis and opioid co-use.
Collapse
Affiliation(s)
- Ty S Schepis
- Department of Psychology, Texas State University, USA; Translational Health Research Center, Texas State University, USA; Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan, USA.
| | - Andrew H Rogers
- Department of Psychology, University of Houston, USA; Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA; Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA, USA
| | - Liliana Munoz
- Department of Psychology, Texas State University, USA
| | - Michael J Zvolensky
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, USA; HEALTH Institute, University of Houston, USA
| |
Collapse
|
12
|
Wang W, Zheng WQ, Du X, Chen SC, Chen YH, Ma QY, Wang H, Gao S, Tan R, Zhang HT, Zhou YM, Zhang FF. Chronic pain exacerbates memory impairment and pathology of Aβ and tau by upregulating IL-1β and p-65 signaling in a mouse model of Alzheimer's disease. Brain Res 2024; 1832:148843. [PMID: 38430996 DOI: 10.1016/j.brainres.2024.148843] [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: 12/14/2023] [Revised: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Chronic pain is linked to cognitive impairment; however, the underlying mechanisms remain unclear. In the present study, we examined these mechanisms in a well-established mouse model of Alzheimer's disease (AD). METHODS Neuropathic pain was modeled in 5-month-old transgenic APPswe/PS1dE9 (APP/PS1) mice by partial ligation of the sciatic nerve on the left side, and chronic inflammatory pain was modeled in another group of APP/PS1 mice by injecting them with complete Freund's adjuvant on the plantar surface of the left hind paw. Six weeks after molding, the animals were tested to assess pain threshold (von Frey filament), learning, memory (novel object recognition, Morris water maze, Y-maze, and passive avoidance), and depression-like symptoms (sucrose preference, tail suspension, and forced swimming). After behavioral testing, mice were sacrificed and the levels of p65, amyloid-β (residues 1-42) and phospho-tau in the hippocampus and cerebral cortex were assayed using western blotting, while interleukin (IL)-1β levels were measured by enzyme-linked immunosorbent assay. RESULTS Animals subjected to either type of chronic pain showed lower pain thresholds, more severe deficits in learning and memory, and stronger depression-like symptoms than the corresponding control animals. Either type of chronic pain was associated with upregulation of p65, amyloid-β (1-42), and IL-1β in the hippocampus and cerebral cortex, as well as higher levels of phosphorylated tau. CONCLUSIONS Chronic pain may exacerbate cognitive deficits and depression-like symptoms in APP/PS1 mice by worsening pathology related to amyloid-β and tau and by upregulating signaling involving IL-1β and p65.
Collapse
Affiliation(s)
- Wei Wang
- Institute of Pharmacology, Pharmacy College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Wen-Qing Zheng
- Institute of Pharmacology, Pharmacy College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China; Department of Pharmacy, the Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Xian Du
- Tai'an Municipal Hospital, Tai'an, China
| | - Shi-Cai Chen
- Institute of Pharmacology, Pharmacy College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Yan-Han Chen
- Institute of Pharmacology, Pharmacy College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Qing-Yang Ma
- Institute of Pharmacology, Pharmacy College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Hao Wang
- Institute of Pharmacology, Pharmacy College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Shan Gao
- Institute of Pharmacology, Pharmacy College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Rui Tan
- Institute of Pharmacology, Pharmacy College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Han-Ting Zhang
- Institute of Pharmacology, Pharmacy College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Yan-Meng Zhou
- Institute of Pharmacology, Pharmacy College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China.
| | - Fang-Fang Zhang
- Institute of Pharmacology, Pharmacy College, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China.
| |
Collapse
|
13
|
Salazar-Méndez J, Cuyul-Vásquez I, Ponce-Fuentes F, Guzmán-Muñoz E, Núñez-Cortés R, Huysmans E, Lluch-Girbés E, Viscay-Sanhueza N, Fuentes J. Pain neuroscience education for patients with chronic pain: A scoping review from teaching-learning strategies, educational level, and cultural perspective. Patient Educ Couns 2024; 123:108201. [PMID: 38387389 DOI: 10.1016/j.pec.2024.108201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE (1) To identify the characteristics of PNE programs in terms of teaching-learning strategies, session modality, content delivery format, number of sessions, total minutes and instructional support material used in patients with chronic musculoskeletal pain, (2) to describe PNE adaptations for patients with different educational levels or cultural backgrounds, and (3) to describe the influence of the patient's educational level or cultural background on the effects of PNE. METHODS The PRISMA guideline for scoping reviews was followed. Nine databases were systematically searched up to July 8, 2023. Articles that examined clinical or psychosocial variables in adults with chronic musculoskeletal pain who received PNE were included. RESULTS Seventy-one articles were included. Studies found benefits of PNE through passive/active teaching-learning strategies with group/individual sessions. However, PNE programs presented great heterogeneity and adaptations to PNE were poorly reported. Most studies did not consider educational level and culture in the effects of PNE. CONCLUSIONS Despite the large number of studies on PNE and increased interest in this intervention, the educational level and culture are poorly reported in the studies. PRACTICAL IMPLICATIONS It is recommended to use passive and/or active teaching-learning strategies provided in individual and/or group formats considering the patient's educational level and culture.
Collapse
Affiliation(s)
| | - Iván Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Chile; Facultad de las Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
| | - Felipe Ponce-Fuentes
- Escuela de Kinesiología, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Temuco, Chile
| | - Eduardo Guzmán-Muñoz
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile; Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels 1090, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels 1090, Belgium; Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Enrique Lluch-Girbés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels 1090, Belgium
| | | | - Jorge Fuentes
- Clinical Research Lab, Department of Physical Therapy, Catholic University of Maule, Chile; Faculty of Rehab Medicine, University of Alberta, Edmonton, Canada.
| |
Collapse
|
14
|
Eastwood F, Godfrey E. The efficacy, acceptability and safety of acceptance and commitment therapy for fibromyalgia - a systematic review and meta-analysis. Br J Pain 2024; 18:243-256. [PMID: 38751564 PMCID: PMC11092929 DOI: 10.1177/20494637231221451] [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] [Indexed: 05/18/2024] Open
Abstract
Background Fibromyalgia (FM) is a chronic pain disorder characterised by widespread pain, fatigue and cognitive symptoms. Acceptance and commitment therapy (ACT) aims to improve psychological flexibility and has been found to be beneficial in treating chronic pain; however, there are few studies evaluating its efficacy in treating FM. Aim This systematic review and meta-analysis evaluated the efficacy of acceptance and commitment therapy in patients with fibromyalgia. Methods PubMed, Embase and PsychInfo databases were searched. Randomised Controlled Trials (RCTs) were eligible for inclusion if participants had FM, and the intervention was based on the ACT framework/model, and not combined with any other active therapy; any non-ACT control was accepted. A meta-analysis was performed, with the primary outcomes pain acceptance (chronic pain acceptance questionnaire, CPAQ), health-related quality of life (fibromyalgia impact questionnaire, FIQ), attrition rate and frequency of adverse events, and the secondary outcomes pain intensity, disability, depression, anxiety, and fatigue. Results Six RCTs, with a total of 384, mostly-female, participants were included, with ACT being delivered online, in a group setting, or one-to-one. ACT was superior to controls in improving FIQ score at post-intervention (SMD -1.05, 95% CI -2.02, -0.09) and follow-up (SMD -1.43, 95% CI -2.17, -0.69) and CPAQ post-intervention (SMD 1.05, 95% CI 0.61, 1.49) and at follow-up (SMD 0.95, 95% CI 0.40, 1.49). Attrition was below 20% in 4/6 studies and no adverse events were reported as attributable to ACT. All secondary outcomes showed large-to-moderate pooled effect estimates post-intervention, indicating improvement in anxiety, depression, pain and disability. Fatigue also improved, with a large negative effect. Conclusions The results suggest ACT improved outcomes in patients with FM: there was an overall improvement in all outcomes post-intervention, with most maintained at follow-up. This review was, however, limited by the small body of evidence and differing methodologies of included studies.
Collapse
Affiliation(s)
- Florence Eastwood
- Department of Psychology, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Mid and South Essex NHS Foundation Trust, Chelmsford, UK
| | - Emma Godfrey
- Department of Psychology, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Population Health Sciences, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| |
Collapse
|
15
|
Bernardo C, Hoon E, Gonzalez-Chica DA, Frank O, Black-Tiong S, Stocks N. Management of physical and psychological trauma resulting from motor vehicle crashes in Australian general practice: a mixed-methods approach. BMC Prim Care 2024; 25:167. [PMID: 38755534 PMCID: PMC11100075 DOI: 10.1186/s12875-024-02421-5] [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] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND In Australia, motor vehicle crashes (MVC)-related health data are available from insurance claims and hospitals but not from primary care settings. This study aimed to identify the frequency of MVC-related consultations in Australian general practices, explore the pharmacological management of health conditions related to those crashes, and investigate general practitioners' (GPs) perceived barriers and enablers in managing these patients. METHODS Mixed-methods study. The quantitative component explored annual MVC-related consultation rates over seven years, the frequency of chronic pain, depression, anxiety or sleep issues after MVC, and management with opioids, antidepressants, anxiolytics or sedatives in a sample of 1,438,864 patients aged 16 + years attending 402 Australian general practices (MedicineInsight). Subsequently, we used content analysis of 81 GPs' qualitative responses to an online survey that included some of our quantitative findings to explore their experiences and attitudes to managing patients after MVC. RESULTS MVC-related consultation rates remained stable between 2012 and 2018 at around 9.0 per 10,000 consultations. In 2017/2018 compared to their peers, those experiencing a MVC had a higher frequency of chronic pain (48% vs. 26%), depression/anxiety (20% vs. 13%) and sleep issues (7% vs. 4%). In general, medications were prescribed more after MVC. Opioid prescribing was much higher among patients after MVC than their peers, whether they consulted for chronic pain (23.8% 95%CI 21.6;26.0 vs. 15.2%, 95%CI 14.5;15.8 in 2017/2018, respectively) or not (15.8%, 95%CI 13.9;17.6 vs. 6.7%, 95% CI 6.4;7.0 in 2017/2018). Qualitative analyses identified a lack of guidelines, local referral pathways and decision frameworks as critical barriers for GPs to manage patients after MVC. GPs also expressed interest in having better access to management tools for specific MVC-related consequences (e.g., whiplash/seatbelt injuries, acute/chronic pain management, mental health issues). CONCLUSION Chronic pain, mental health issues and the prescription of opioids were more frequent among patients experiencing MVC. This reinforces the relevance of appropriate management to limit the physical and psychological impact of MVC. GPs identified a lack of available resources (e.g. education, checklists and management support tools) for managing MVC-related consequences, and the need for local referral pathways and specific guidelines to escalate treatments.
Collapse
Affiliation(s)
- Carla Bernardo
- Adelaide Medical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 817.01, Adelaide, SA, 5000, Australia.
| | - Elizabeth Hoon
- Adelaide Medical School, School of Public Health, The University of Adelaide, 115 Grenfell St, Level 8, Room 818.01, Adelaide, SA, 5000, Australia
| | - David Alejandro Gonzalez-Chica
- Adelaide Medical School, Adelaide Rural Clinical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 811C.02, Adelaide, SA, 5000, Australia
| | - Oliver Frank
- Adelaide Medical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 817.09, Adelaide, SA, 5000, Australia
| | - Sean Black-Tiong
- Adelaide Medical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 817, Adelaide, SA, 5000, Australia
| | - Nigel Stocks
- Adelaide Medical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 823.01, Adelaide, SA, 5000, Australia
| |
Collapse
|
16
|
Rey Chaves CE, Ramírez-Giraldo C, Isaza-Restrepo A, Conde Monroy D, González-Tamayo J, Ayala D, Moreno Matson MC, Navarro-Alean J. Postoperative pain in transabdominal preperitoneal laparoscopic hernia repair with staple fixation versus self-fixation mesh. Heliyon 2024; 10:e30033. [PMID: 38707324 PMCID: PMC11066375 DOI: 10.1016/j.heliyon.2024.e30033] [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: 10/04/2023] [Revised: 04/11/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background The mesh fixation method is one of the multiple factors associated with chronic postoperative pain in inguinal hernia surgery. The aim of this study is to evaluate postoperative pain associated with the two available fixation strategies (staple fixation versus self-fixating mesh) used in our field. Methods We designed an observational study with retrospective cohorts to analyze postoperative pain in patients who underwent a laparoscopic transabdominal preperitoneal inguinal hernia repair with a self-fixating mesh or staple fixation, which are the two available techniques in our field. A total of 296 patients who met the inclusion criteria were included between January 2014 and October 2021. Results The evaluated patients' median age was 66.0 (interquartile range (IQR): 20.75) years and were predominantly male (70.13 %). The proportion of participants with chronic pain was 3.20 % in the staple fixation group and 0 % in the self-fixating mesh group, with no statistically significant differences. On the other hand, recurrency in the staple fixation group was 2.28 % versus 3.90 % in the self-fixating mesh group, without statistically significant differences. Conclusions Self-fixating meshes have a trend towards smaller proportion of chronic pain and similar proportions of recurrence; therefore, they seem to be the best fixation method between the two mechanisms that are available in our field to prevent postoperative chronic pain.
Collapse
Affiliation(s)
| | - Camilo Ramírez-Giraldo
- Hospital Universitario Mayor - Méderi. Bogotá, Colombia
- Universidad del Rosario. Bogotá, Colombia
| | - Andrés Isaza-Restrepo
- Hospital Universitario Mayor - Méderi. Bogotá, Colombia
- Universidad del Rosario. Bogotá, Colombia
| | - Danny Conde Monroy
- Hospital Universitario Mayor - Méderi. Bogotá, Colombia
- Universidad del Rosario. Bogotá, Colombia
| | | | | | | | - Jorge Navarro-Alean
- Hospital Universitario Mayor - Méderi. Bogotá, Colombia
- Universidad del Rosario. Bogotá, Colombia
| |
Collapse
|
17
|
Zetterberg H, Zhao X, Bergbom S, Golovchanova N, Flink I, Boersma K. Understanding Work Ability in Employees with Pain and Stress-Related Ill-Health: An Explorative Network Analysis of Individual Characteristics and Psychosocial Work Environment. J Occup Rehabil 2024:10.1007/s10926-024-10200-3. [PMID: 38743130 DOI: 10.1007/s10926-024-10200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE There is a wide range of individual and work environment factors that influence work ability among workers with pain and stress-related ill-health. The multiple interactions and overlap between these factors are insufficiently understood, and a network approach could mitigate limitations of previous research. This pilot study aimed to explore interactions between individual characteristics and psychosocial work environment and potential links to long-term work ability. METHODS Prospective data from a prevention project was used. Individuals (N = 147) with pain and/or stress-related ill-health (95% women) at public sector workplaces filled out baseline questionnaires about a collection of individual and work environment factors, which were used for constructing undirected networks. The model was run in three subsamples of workplaces. Finally, a separate model was established with work ability at 6-month follow-up as outcome variable. A shortest pathway analysis was calculated to identify mediators of work ability. RESULTS Symptom catastrophizing and perceived stress were the most influential factors in all network models. Symptom catastrophizing and pain-disability risk were found to mediate the relation between perceived stress and long-term work ability. Further, demand-control-support factors were interrelated, and patterns of interaction differed between different types of workplaces. CONCLUSION The findings support the importance of individual factors, specifically symptom catastrophizing in an individual's coping with pain or stress-problems and its influence on long-term work ability. Catastrophizing might play a role in stress-related disorders which should be further investigated. Individual and work environment factors interact and vary across context, which needs to be taken into consideration to prevent pain and stress-related ill-health at work.
Collapse
Affiliation(s)
- Hedvig Zetterberg
- The Center for Health and Medical Psychology, School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden.
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Xiang Zhao
- The Center for Health and Medical Psychology, School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
- Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Sofia Bergbom
- The Center for Health and Medical Psychology, School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - Nadezhda Golovchanova
- The Center for Health and Medical Psychology, School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - Ida Flink
- The Center for Health and Medical Psychology, School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Katja Boersma
- The Center for Health and Medical Psychology, School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
18
|
Todd AR, Tracy MF, Hall SF, Herrmann AA, Chrenka EA, Hanson LR. Improving Access to Yoga for Chronic Pain in a Spanish-Speaking Community: A Quality Improvement Initiative. Pain Manag Nurs 2024:S1524-9042(24)00139-5. [PMID: 38735818 DOI: 10.1016/j.pmn.2024.03.018] [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: 04/26/2023] [Revised: 02/20/2024] [Accepted: 03/25/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND The recent increase in opioid misuse and overdose among the Hispanic population signifies the need for an initiative to increase efforts in pain management in the Hispanic population. Yoga is an evidence-based therapeutic intervention that is effective for several pain-associated disorders. However, in the United States, it is primarily taught in English and not always accessible. This quality improvement (QI) project aimed to assess the outcome of implementing a yoga program on pain and quality of life in the Hispanic population. METHODS Twenty Spanish-speaking community center members participated in a linguistically-tailored yoga program over the course of 10 weeks that included educational, demonstration, and practice videos. Outcome measures of the QI program included changes in pain interference, physical function, opioid medication use, the overall impression of change in pain, satisfaction with the program, and the likelihood of continuation of yoga practice. RESULTS Data collected from participants (n = 16) after the 10-week period indicated that nearly 60% experienced an improvement in their overall impression of change in pain; their reported likelihood of continuation of yoga practice at home or another location were 6.8 and 7.4, respectively, on a 10-point scale. While pain interference was unaffected, there was an improvement in markers of physical function, including a two-fold improvement in general activity without limitations. The mean average intensity of pain decreased by 33%. CONCLUSION The use of a linguistically-tailored yoga program improved self-reported overall pain, physical function, average intensity of pain, and initiated an interest in participants in utilizing yoga practice for self-management of pain. This QI project provides results that can be used for further implementation initiatives at other sites and consideration of use in diverse populations.
Collapse
Affiliation(s)
| | | | - Sara F Hall
- HealthPartners Neuroscience Center, Saint Paul, Minnesota; Regions Hospital, Saint Paul, Minnesota
| | - Amanda A Herrmann
- HealthPartners Neuroscience Center, Saint Paul, Minnesota; HealthPartners Institute, Minneapolis, Minnesota
| | | | - Leah R Hanson
- HealthPartners Neuroscience Center, Saint Paul, Minnesota; HealthPartners Institute, Minneapolis, Minnesota
| |
Collapse
|
19
|
Gupta A, Han D, Norwood SM. H-Wave ® Device Stimulation for Chronic Neck Pain: A Patient-Reported Outcome Measures (PROMs) Study. Pain Ther 2024:10.1007/s40122-024-00609-2. [PMID: 38733549 DOI: 10.1007/s40122-024-00609-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Chronic neck pain (cNP) is one of the leading causes of disability worldwide, often being refractory to conventional forms of treatment. Various forms of electrical stimulation have been proposed to decrease pain and improve function. Patient-reported outcome measures (PROMs) for treatment of cNP have rarely been published. METHODS An independent retrospective statistical analysis of PROMs data for users of H-Wave® device stimulation (HWDS), prospectively collected by the device manufacturer over a 4-year period, was conducted. Final surveys for 34,192 pain management patients were filtered for pain chronicity limited to 3-24 months and device use of 22-365 days, resulting in 11,503 patients with "all diagnoses"; this number was further reduced to 1482 patients with cNP, sprain, or strain. RESULTS Neck pain was reduced by 3.13 points (0-10 pain scale), with significant (≥ 20%) relief in 86.6%. Function/activities of daily living (ADL) improved in 96.19%, while improved work performance was reported in 84.76%. Medication use decreased or stopped in 65.42% and sleep improved in 60.39%. Over 95% reported having expectations met or exceeded, service satisfaction, and confidence in device use, while no adverse events were reported. Subgroup analyses found positive benefit associations with longer duration of device use. CONCLUSION Near-equivalent outcomes were self-reported by cNP HWDS patients as for (previously published) chronic low back pain (cLBP) patients. HWDS provided effective and safe cNP relief, improvements in function and ADL, along with additional benefits including decreased medication use, better sleep, and improved work performance.
Collapse
Affiliation(s)
- Ashim Gupta
- Future Biologics, Lawrenceville, GA, 30043, USA.
- Regenerative Orthopaedics, Noida, UP, 201301, India.
| | - David Han
- Department of Management Science and Statistics, University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | | |
Collapse
|
20
|
Sim L, Fahrenkamp A, Geske JR, Lebow J, Thilges H, Peterson CB, Matthews A, Harbeck-Weber C. Screening for eating disorders in adolescents with chronic pain: the Eating Attitudes Test-16-Chronic Pain. J Eat Disord 2024; 12:56. [PMID: 38730431 PMCID: PMC11084020 DOI: 10.1186/s40337-024-01014-y] [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] [Received: 01/05/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Few measures have been validated to screen for eating disorders (ED) in youth with chronic pain. We conducted confirmatory (CFA) of two established factor structures of the Eating Attitudes Test-26 (EAT-26) in a sample of youth with chronic pain attending an intensive interdisciplinary pain treatment (IIPT) program and examined the validity of the best-fitting model in predicting ED diagnoses in this sample. METHODS Participants were 880 adolescents (M age = 16.1, SD = 2.1) consecutively admitted into an IIPT program who completed the EAT-26 upon admission. CFA was conducted and in the case of inadequate fit, EFA was planned to identify alternative models. Factors of the best-fitting model were included in a logistic regression analysis to predict ED diagnoses. RESULTS The TLIs (0.70; 0.90), RMSEAs (0.09; 0.07) and CFIs (0.73; 0.92) suggested poor fit of one model and adequate of the second model. Goodness of fit indices from EFA (TLI:0.85, RMSEA:0.06) did not outperform the fit of the second CFA. As such, the second model was retained with the exception of one factor. The items loaded onto a 16-item, five factor model: Fear of Getting Fat, Social Pressure to Gain Weight, Eating-Related Control, Eating-Related Guilt and Food Preoccupation. Based on chart review, 19.1% of the participants were diagnosed with an eating disorder. Logistic regression analyses indicated the new 16-item measure and Fear of Getting Fat, significantly predicted an ED diagnosis that did not include avoidant restrictive food intake disorder (ARFID) and Social Pressure to Gain Weight significantly predicted a diagnosis of ARFID. CONCLUSIONS An alternative 16-item, 5-factor structure of the EAT-26 should be considered in screening for EDs with youth with chronic pain.
Collapse
Affiliation(s)
- Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Amy Fahrenkamp
- Pain, Palliative Care, and Integrative Medicine Department, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Jennifer R Geske
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jocelyn Lebow
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Hope Thilges
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Abigail Matthews
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
| | - Cynthia Harbeck-Weber
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
| |
Collapse
|
21
|
Goree JH, Grant SA, Dickerson DM, Ilfeld BM, Eshraghi Y, Vaid S, Valimahomed AK, Shah JR, Smith GL, Finneran JJ, Shah NN, Guirguis MN, Eckmann MS, Antony AB, Ohlendorf BJ, Gupta M, Gilbert JE, Wongsarnpigoon A, Boggs JW. Randomized Placebo-Controlled Trial of 60-Day Percutaneous Peripheral Nerve Stimulation Treatment Indicates Relief of Persistent Postoperative Pain, and Improved Function After Knee Replacement. Neuromodulation 2024:S1094-7159(24)00064-3. [PMID: 38739062 DOI: 10.1016/j.neurom.2024.03.001] [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: 12/26/2023] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Total knee arthroplasty (TKA) is an effective surgery for end-stage knee osteoarthritis, but chronic postoperative pain and reduced function affect up to 20% of patients who undergo such surgery. There are limited treatment options, but percutaneous peripheral nerve stimulation (PNS) is a promising nonopioid treatment option for chronic, persistent postoperative pain. The objective of the present study was to evaluate the effect of a 60-day percutaneous PNS treatment in a multicenter, randomized, double-blind, placebo-controlled trial for treating persistent postoperative pain after TKA. MATERIALS AND METHODS Patients with postoperative pain after knee replacement were screened for this postmarket, institutional review board-approved, prospectively registered (NCT04341948) trial. Subjects were randomized to receive either active PNS or placebo (sham) stimulation. Subjects and a designated evaluator were blinded to group assignments. Subjects in both groups underwent ultrasound-guided placement of percutaneous fine-wire coiled leads targeting the femoral and sciatic nerves on the leg with postoperative pain. Leads were indwelling for eight weeks, and the primary efficacy outcome compared the proportion of subjects in each group reporting ≥50% reduction in average pain relative to baseline during weeks five to eight. Functional outcomes (6-minute walk test; 6MWT and Western Ontario and McMaster Universities Osteoarthritis Index) and quality of life (Patient Global Impression of Change) also were evaluated at end of treatment (EOT). RESULTS A greater proportion of subjects in the PNS groups (60%; 12/20) than in the placebo (sham) group (24%; 5/21) responded with ≥50% pain relief relative to baseline (p = 0.028) during the primary endpoint (weeks 5-8). Subjects in the PNS group also walked a significantly greater distance at EOT than did those in the placebo (sham) group (6MWT; +47% vs -9% change from baseline; p = 0.048, n = 18 vs n = 20 completed the test, respectively). Prospective follow-up to 12 months is ongoing. CONCLUSIONS This study provides evidence that percutaneous PNS decreases persistent pain, which leads to improved functional outcomes after TKA at EOT.
Collapse
Affiliation(s)
- Johnathan H Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Stuart A Grant
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - David M Dickerson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Endeavor Health, Evanston, IL, USA; The University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Yashar Eshraghi
- Department of Anesthesiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Sandeep Vaid
- Better Health Clinical Research, Newnan, GA, USA
| | | | - Jarna R Shah
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G Lawson Smith
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - John J Finneran
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Nirav N Shah
- Department of Anesthesiology, Critical Care, and Pain Medicine, Endeavor Health, Evanston, IL, USA; The University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Maged N Guirguis
- Department of Anesthesiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Maxim S Eckmann
- Department of Anesthesiology, University of Texas San Antonio, San Antonio, TX, USA
| | | | - Brian J Ohlendorf
- Department of Anesthesiology, Duke University Hospital, Durham, NC, USA
| | - Mayank Gupta
- Neuroscience Research Center, Overland Park, KS, USA
| | | | | | | |
Collapse
|
22
|
Ahmed S, Visca R, Gogovor A, Eilayyan O, Finlayson R, Valois MF, Ware MA. Implementation of an integrated primary care prevention and management program for chronic low back pain (LBP): patient-reported outcomes and predictors of pain interference after six months. BMC Health Serv Res 2024; 24:611. [PMID: 38725037 PMCID: PMC11083802 DOI: 10.1186/s12913-024-11031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Integrated primary care programs for patients living with chronic pain which are accessible, interdisciplinary, and patient-centered are needed for preventing chronicity and improving outcomes. Evaluation of the implementation and impact of such programs supports further development of primary care chronic pain management. This study examined patient-reported outcomes among individuals with low back pain (LBP) receiving care in a novel interdisciplinary primary care program. METHODS Patients were referred by primary care physicians in four regions of Quebec, Canada, and eligible patients received an evidence-based interdisciplinary pain management program over a six-month period. Patients were screened for risk of chronicity. Patient-reported outcome measures of pain interference and intensity, physical function, depression, and anxiety were evaluated at regular intervals over the six-month follow-up. A multilevel regression analysis was performed to evaluate the association between patient characteristics at baseline, including risk of chronicity, and change in pain outcomes. RESULTS Four hundred and sixty-four individuals (mean age 55.4y, 63% female) completed the program. The majority (≥ 60%) experienced a clinically meaningful improvement in pain intensity and interference at six months. Patients with moderate (71%) or high risk (81%) of chronicity showed greater improvement in pain interference than those with low risk (51%). Significant predictors of improvement in pain interference included a higher risk of chronicity, younger age, female sex, and lower baseline disability. CONCLUSION The outcomes of this novel LBP program will inform wider implementation considerations by identifying key components for further effectiveness, sustainability, and scale-up of the program.
Collapse
Affiliation(s)
- Sara Ahmed
- Faculty of Medicine, School of Physical & Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
- Faculty of Medicine, Family Medicine, McGill University, 5858, Chemin de La Côte-Des-Neiges 3 Floor, Montreal, QC, H3S 1Z1, Canada.
- Faculty of Medicine, Family Medicine and Emergency Medicine, Université Laval, Montreal, QC, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Lethbridge Layton Mackay Rehabilitation, CIUSSS West-Central Montreal, Montreal, QC, Canada.
- Research Institute of the McGill University Health Center, Clinical Epidemiology, Montreal, QC, Canada.
| | - Regina Visca
- Faculty of Medicine, Family Medicine, McGill University, 5858, Chemin de La Côte-Des-Neiges 3 Floor, Montreal, QC, H3S 1Z1, Canada
- Centre of Expertise in Chronic Pain of the Réseau Universitaire Intégré de Santé Et Services Sociaux McGill, 1650 Cedar Ave., Montreal, QC, H3G 1A4, Canada
- Alan Edwards Pain Management Unit of the McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Amede Gogovor
- Faculty of Medicine, Family Medicine and Emergency Medicine, Université Laval, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Owis Eilayyan
- Faculty of Applied Medical Sciences, Physical Therapy Department, Al-Ahliyya Amman University, Amman, Jordan
| | - Roderick Finlayson
- Alan Edwards Pain Management Unit of the McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | | | - Mark A Ware
- Faculty of Medicine, Family Medicine, McGill University, 5858, Chemin de La Côte-Des-Neiges 3 Floor, Montreal, QC, H3S 1Z1, Canada
- Alan Edwards Pain Management Unit of the McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| |
Collapse
|
23
|
Tsai SE, Yang SF, Wang YH, Yeh CB. Association between gabapentin use and risk of dementia in adults with chronic pain: A nested case-control study. J Affect Disord 2024; 358:S0165-0327(24)00749-3. [PMID: 38729220 DOI: 10.1016/j.jad.2024.05.031] [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] [Received: 12/05/2023] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
STUDY OBJECTIVE To explore the association between gabapentin use and the risk of dementia in patients with chronic pain, considering the rising concerns of dementia in an aging population and the potential cognitive impacts of chronic pain management. DESIGN A nested case-control study utilizing data from a longitudinal health insurance database. SETTING The study is based on a longitudinal health insurance database spanning 2000-2019 in Taiwan. PATIENTS A total of 201,492 patients aged 50 years and older diagnosed with chronic pain between 2001 and 2017 were included. The study focused on individuals with chronic pain, excluding those diagnosed with dementia a year before or after their chronic pain diagnosis. INTERVENTION Analysis of gabapentin prescription history was conducted, considering the cumulative dose from the chronic pain diagnosis date to the dementia diagnosis date or equivalent period for controls. MEASUREMENT Data included demographics, gabapentin prescription history, and comorbidities. Logistic regression was used to estimate odds ratios for dementia risk. MAIN RESULTS No significant difference in the risk of dementia was found between low and high cumulative doses of gabapentin. The adjusted odds ratio for dementia risk associated with gabapentin use was 0.91 (95 % C.I. 0.83-1.01), indicating no substantial increase in risk. CONCLUSION Long-term Gabapentin therapy for chronic pain is not associated with a differential risk of dementia across dosage levels, irrespective of age or gender. Further study into its potential cognitive impacts is essential.
Collapse
Affiliation(s)
- Sheng-En Tsai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Anesthesiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chao-Bin Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
24
|
Knox S, Offiah I, Hashim H. Evaluation of Central Sensitisation in Bladder Pain Syndrome: A Systematic Review. Int Urogynecol J 2024:10.1007/s00192-024-05793-5. [PMID: 38713239 DOI: 10.1007/s00192-024-05793-5] [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: 10/17/2023] [Accepted: 03/27/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder pain syndrome (BPS) is a debilitating condition characterised by exaggerated bladder sensations and altered bladder function. It is still unknown whether the condition is a peripheral sensory problem or due to abnormal central sensory processing as seen in central sensitisation. This systematic review, which followed a published and Prospective Register of Systematic Reviews-registered protocol (CRD42021229962), is aimed at establishing the scope of central sensitisation in patients with BPS to aid optimal management and treatment. METHODS Four databases were searched, and appraisal of the identified studies was conducted by two independent reviewers based on eligibility criteria: patients with BPS being investigated for central sensitisation with or without comparison of controls, English-language articles, full text and publication in a peer-reviewed journal. The Methodological Index for non-Randomised Studies was used to determine study quality. We identified 763 papers in total, with 15 studies included in the final analysis. All studies were observational and had a low risk of bias. Measures included in the evaluation of CS were questionnaires, urodynamics, and quantitative sensory testing methods. RESULTS There was evidence of central sensitisation in patients with BPS in all papers evaluated (15 out of 15). In addition, more significant central sensitisation correlated with severe disease presentation (3 out of 3 papers) and concomitant chronic pain conditions (5 out of 5 papers). CONCLUSIONS Central sensitisation plays an integral role in BPS patient pathology. Many secondary measures are used to evaluate this condition. Stratification of patients based on their pathology (peripheral, central or a combination of the two) will aid in implementing an individualised management strategy.
Collapse
Affiliation(s)
- S Knox
- Department of Obstetrics and Gynaecology, Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ, UK.
| | - I Offiah
- North Bristol NHS Trust, Bristol, UK
| | - H Hashim
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| |
Collapse
|
25
|
Beckers P, Belo Do Nascimento I, Charlier M, Desmet N, Massie A, Hermans E. Implication of system x c- in neuroinflammation during the onset and maintenance of neuropathic pain. J Neuroinflammation 2024; 21:117. [PMID: 38715127 PMCID: PMC11077843 DOI: 10.1186/s12974-024-03112-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Despite the high prevalence of neuropathic pain, treating this neurological disease remains challenging, given the limited efficacy and numerous side effects associated with current therapies. The complexity in patient management is largely attributed to an incomplete understanding of the underlying pathological mechanisms. Central sensitization, that refers to the adaptation of the central nervous system to persistent inflammation and heightened excitatory transmission within pain pathways, stands as a significant contributor to persistent pain. Considering the role of the cystine/glutamate exchanger (also designated as system xc-) in modulating glutamate transmission and in supporting neuroinflammatory responses, we investigated the contribution of this exchanger in the development of neuropathic pain. METHODS We examined the implication of system xc- by evaluating changes in the expression/activity of this exchanger in the dorsal spinal cord of mice after unilateral partial sciatic nerve ligation. In this surgical model of neuropathic pain, we also examined the consequence of the genetic suppression of system xc- (using mice lacking the system xc- specific subunit xCT) or its pharmacological manipulation (using the pharmacological inhibitor sulfasalazine) on the pain-associated behavioral responses. Finally, we assessed the glial activation and the inflammatory response in the spinal cord by measuring mRNA and protein levels of GFAP and selected M1 and M2 microglial markers. RESULTS The sciatic nerve lesion was found to upregulate system xc- at the spinal level. The genetic deletion of xCT attenuated both the amplitude and the duration of the pain sensitization after nerve surgery, as evidenced by reduced responses to mechanical and thermal stimuli, and this was accompanied by reduced glial activation. Consistently, pharmacological inhibition of system xc- had an analgesic effect in lesioned mice. CONCLUSION Together, these observations provide evidence for a role of system xc- in the biochemical processes underlying central sensitization. We propose that the reduced hypersensitivity observed in the transgenic mice lacking xCT or in sulfasalazine-treated mice is mediated by a reduced gliosis in the lumbar spinal cord and/or a shift in microglial M1/M2 polarization towards an anti-inflammatory phenotype in the absence of system xc-. These findings suggest that drugs targeting system xc- could contribute to prevent or reduce neuropathic pain.
Collapse
Affiliation(s)
- Pauline Beckers
- Institute of Neuroscience, Group of Neuropharmacology, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 53 (B1.53.01), Brussels, 1200, Belgium
| | - Inês Belo Do Nascimento
- Institute of Neuroscience, Group of Neuropharmacology, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 53 (B1.53.01), Brussels, 1200, Belgium
| | - Mathilde Charlier
- Institute of Neuroscience, Group of Neuropharmacology, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 53 (B1.53.01), Brussels, 1200, Belgium
| | - Nathalie Desmet
- Institute of Neuroscience, Group of Neuropharmacology, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 53 (B1.53.01), Brussels, 1200, Belgium
| | - Ann Massie
- Neuro-Aging & Viro-Immunotherapy, Center for Neurosciences, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
| | - Emmanuel Hermans
- Institute of Neuroscience, Group of Neuropharmacology, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 53 (B1.53.01), Brussels, 1200, Belgium.
| |
Collapse
|
26
|
Goldenberg DL. How to understand the overlap of long COVID, chronic fatigue syndrome/myalgic encephalomyelitis, fibromyalgia and irritable bowel syndromes. Semin Arthritis Rheum 2024; 67:152455. [PMID: 38761526 DOI: 10.1016/j.semarthrit.2024.152455] [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: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/18/2024] [Indexed: 05/20/2024]
Abstract
Long COVID should be limited to patients with multiple, persistent symptoms not related to well-defined organ damage. Once redefined, a focused review of long COVID demonstrates striking similarity to chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), fibromyalgia (FM) and irritable bowel syndrome (IBS). Research in long COVID has revealed similar findings to those noted in CFS/ME and FM, characterized by central nervous system organ dysfunction. Long COVID, like CFS/ME, FM and IBS, is best understood as a bidirectional mind-body, neuroimmune illness.
Collapse
Affiliation(s)
- Don L Goldenberg
- Emeritus Professor of Medicine, Tufts University School of Medicine, United States; Adjunct Faculty, Departments of Medicine and Nursing, Oregon Health Sciences University, United States.
| |
Collapse
|
27
|
Olayinka O, Alemu BT, Nkemjika S, Barry DT. Nationwide Assessment of Chronic Pain among Hospitalized Individuals with Co-occurring Post Traumatic Stress Disorder and Substance Use Disorder in the United States. J Dual Diagn 2024:1-10. [PMID: 38704860 DOI: 10.1080/15504263.2024.2347489] [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: 05/07/2024]
Abstract
Objective: Chronic pain (CP) is independently associated with substance use disorders (SUD) and posttraumatic stress disorder (PTSD). However, little is known about factors associated with CP among patients with co-occurring PTSD and SUD. Patterns of hospital resource usage should also be explored further. Methods: Using the 2019 National Inpatient Sample (NIS), we identified 216,125 hospital discharges with co-occurring diagnoses of PTSD and SUD in 2019 and examined their association with CP. Multivariable logistic regression models were used to identify factors associated with an increased likelihood of CP in this cohort. Results: Among those with co-occurring PTSD and SUD (N = 216,125), 35,450 had associated CP, a prevalence of 164.02 cases per 1,000 discharges (95% CI [160.54, 167.52]). Individuals aged 55-64 with co-occurring PTSD and SUD were approximately 7.2 times more likely to experience CP, compared to those aged 16-24 (OR = 7.2; 95% CI [6.09, 8.60]). Being in the CP group was associated with 50% increased odds of insomnia and obesity (OR = 1.5; 95% CI [1.12, 2.03] and OR = 1.5; 95% CI [1.38, 1.55], respectively), 30% increased odds of anxiety (OR = 1.3; 95% CI [1.24, 1.38]), 20% increased odds of attention deficit disorder (ADD;OR = 1.2; 95% CI [1.12, 1.38]) and 10% increased odds of depression (OR = 1.1; 95% CI [1.01, 1.14]). Compared with females, being male was associated with slightly decreased odds of CP (OR = 0.9; 95% CI [0.84, 0.94]). Conclusions: Among hospitalized Americans with co-occurring PTSD and SUD, advanced age, being female, and the presence other mental health disorders were associated with an increased risk of CP. Providers treating co-occurring PTSD/SUD should evaluate for and consider evidence-based management of CP if present.
Collapse
Affiliation(s)
- Olaniyi Olayinka
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Brook T Alemu
- Health Sciences Program, School of Health Sciences, Western Carolina University, Cullowhee, North Carolina, USA
| | - Stanley Nkemjika
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Declan T Barry
- The APT Foundation, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
28
|
Reynders A, Anissa Jhumka Z, Gaillard S, Mantilleri A, Malapert P, Magalon K, Etzerodt A, Salio C, Ugolini S, Castets F, Saurin AJ, Serino M, Hoeffel G, Moqrich A. Gut microbiota promotes pain chronicity in Myosin1A deficient male mice. Brain Behav Immun 2024; 119:S0889-1591(24)00397-0. [PMID: 38710336 DOI: 10.1016/j.bbi.2024.05.010] [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] [Received: 08/11/2023] [Revised: 04/23/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024] Open
Abstract
Chronic pain is a heavily debilitating condition and a huge socio-economic burden, with no efficient treatment. Over the past decade, the gut microbiota has emerged as an important regulator of nervous system's health and disease states. Yet, its contribution to the pathogenesis of chronic somatic pain remains poorly documented. Here, we report that male but not female mice lacking Myosin1a (KO) raised under single genotype housing conditions (KO-SGH) are predisposed to develop chronic pain in response to a peripheral tissue injury. We further underscore the potential of MYO1A loss-of-function to alter the composition of the gut microbiota and uncover a functional connection between the vulnerability to chronic pain and the dysbiotic gut microbiota of KO-SGH males. As such, parental antibiotic treatment modifies gut microbiota composition and completely rescues the injury-induced pain chronicity in male KO-SGH offspring. Furthermore, in KO-SGH males, this dysbiosis is accompanied by a transcriptomic activation signature in the dorsal root ganglia (DRG) macrophage compartment, in response to tissue injury. We identify CD206+CD163- and CD206+CD163+ as the main subsets of DRG resident macrophages and show that both are long-lived and self-maintained and exhibit the capacity to monitor the vasculature. Consistently, in vivo depletion of DRG macrophages rescues KO-SGH males from injury-induced chronic pain underscoring a deleterious role for DRG macrophages in a Myo1a-loss-of function context. Together, our findings reveal gene-sex-microbiota interactions in determining the predisposition to injury-induced chronic pain and point-out DRG macrophages as potential effector cells.
Collapse
Affiliation(s)
- Ana Reynders
- Aix-Marseille-Université, CNRS, Institut de Biologie du Développement de Marseille, Marseille, France.
| | - Z Anissa Jhumka
- Aix-Marseille-Université, CNRS, Institut de Biologie du Développement de Marseille, Marseille, France
| | | | - Annabelle Mantilleri
- Aix-Marseille-Université, CNRS, Institut de Biologie du Développement de Marseille, Marseille, France
| | - Pascale Malapert
- Aix-Marseille-Université, CNRS, Institut de Biologie du Développement de Marseille, Marseille, France
| | - Karine Magalon
- Aix-Marseille-Université, CNRS, Institut de Biologie du Développement de Marseille, Marseille, France
| | - Anders Etzerodt
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Chiara Salio
- Department of Veterinary Sciences, University of Turin, Grugliasco, TO, Italy
| | - Sophie Ugolini
- Aix-Marseille-Université, CNRS, INSER, Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | - Francis Castets
- Aix-Marseille-Université, CNRS, Institut de Biologie du Développement de Marseille, Marseille, France
| | - Andrew J Saurin
- Aix-Marseille-Université, CNRS, Institut de Biologie du Développement de Marseille, Marseille, France
| | - Matteo Serino
- Institut de Recherche en Santé Digestive, Université de Toulouse-Paul Sabatier, INSERM, INRAe, ENVT, UPS, Toulouse, France
| | - Guillaume Hoeffel
- Aix-Marseille-Université, CNRS, INSER, Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | - Aziz Moqrich
- Aix-Marseille-Université, CNRS, Institut de Biologie du Développement de Marseille, Marseille, France.
| |
Collapse
|
29
|
Rodríguez MN, Colgan DD, Leyde S, Pike K, Merrill JO, Price CJ. Trauma exposure across the lifespan among individuals engaged in treatment with medication for opioid use disorder: differences by gender, PTSD status, and chronic pain. Subst Abuse Treat Prev Policy 2024; 19:25. [PMID: 38702783 PMCID: PMC11067259 DOI: 10.1186/s13011-024-00608-8] [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: 12/13/2023] [Accepted: 04/22/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND There is little study of lifetime trauma exposure among individuals engaged in medication treatment for opioid use disorder (MOUD). A multisite study provided the opportunity to examine the prevalence of lifetime trauma and differences by gender, PTSD status, and chronic pain. METHODS A cross-sectional study examined baseline data from participants (N = 303) enrolled in a randomized controlled trial of a mind-body intervention as an adjunct to MOUD. All participants were stabilized on MOUD. Measures included the Trauma Life Events Questionnaire (TLEQ), the Brief Pain Inventory (BPI), and the Posttraumatic Stress Disorder Checklist (PCL-5). Analyses involved descriptive statistics, independent sample t-tests, and linear and logistic regression. RESULTS Participants were self-identified as women (n = 157), men (n = 144), and non-binary (n = 2). Fifty-seven percent (n = 172) self-reported chronic pain, and 41% (n = 124) scored above the screening cut-off for PTSD. Women reported significantly more intimate partner violence (85%) vs 73%) and adult sexual assault (57% vs 13%), while men reported more physical assault (81% vs 61%) and witnessing trauma (66% vs 48%). Men and women experienced substantial childhood physical abuse, witnessed intimate partner violence as children, and reported an equivalent exposure to accidents as adults. The number of traumatic events predicted PTSD symptom severity and PTSD diagnostic status. Participants with chronic pain, compared to those without chronic pain, had significantly more traumatic events in childhood (85% vs 75%). CONCLUSION The study found a high prevalence of lifetime trauma among people in MOUD. Results highlight the need for comprehensive assessment and mental health services to address trauma among those in MOUD treatment. TRIAL REGISTRATION NCT04082637.
Collapse
Affiliation(s)
- Monique N Rodríguez
- Department of Individual, Family, and Community Education, University of New Mexico USA, Simpson Hall MSC053042, 502 Campus, Blvd, Albuquerque, NM, 87131, USA
| | - Dana D Colgan
- Department of Neurology, Oregon Health and Science University USA, 3818 SW Sam Jackson Parkway, Portland, OR, 97229, USA
- Helfgott Research Center, National University of Natural Medicine USA, Portland, USA
| | - Sarah Leyde
- School of Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Kenneth Pike
- Department of Child Family and Population Health Nursing, University of Washington USA, Seattle, USA
| | - Joseph O Merrill
- School of Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Cynthia J Price
- Department of Biobehavioral Nursing and Health Informatics, University of WA, Seattle, USA.
| |
Collapse
|
30
|
Uchida R, Mukai Y, Amano T, Sakimura K, Itoi K, Yamanaka A, Minami M. Chronic pain enhances excitability of corticotropin-releasing factor-expressing neurons in the oval part of the bed nucleus of the stria terminalis. Mol Brain 2024; 17:22. [PMID: 38702738 PMCID: PMC11071157 DOI: 10.1186/s13041-024-01094-6] [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: 02/29/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
We previously reported that enhanced corticotropin-releasing factor (CRF) signaling in the bed nucleus of the stria terminalis (BNST) caused the aversive responses during acute pain and suppressed the brain reward system during chronic pain. However, it remains to be examined whether chronic pain alters the excitability of CRF neurons in the BNST. In this study we investigated the chronic pain-induced changes in excitability of CRF-expressing neurons in the oval part of the BNST (ovBNSTCRF neurons) by whole-cell patch-clamp electrophysiology. CRF-Cre; Ai14 mice were used to visualize CRF neurons by tdTomato. Electrophysiological recordings from brain slices prepared from a mouse model of neuropathic pain revealed that rheobase and firing threshold were significantly decreased in the chronic pain group compared with the sham-operated control group. Firing rate of the chronic pain group was higher than that of the control group. These data indicate that chronic pain elevated neuronal excitability of ovBNSTCRF neurons.
Collapse
Affiliation(s)
- Ryoko Uchida
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Hokkaido University, Sapporo, 060-0812, Japan
| | - Yasutaka Mukai
- Department of Neuroscience II, Research Institute of Environmental Medicine, Nagoya University, Nagoya, 464-8601, Aichi, Japan
- Department of Cellular Pharmacology, Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
- Postdoctoral Research Fellow, Japan Society for the Promotion of Science, Tokyo, 102-0083, Japan
| | - Taiju Amano
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Hokkaido University, Sapporo, 060-0812, Japan
| | - Kenji Sakimura
- Department of Animal Model Development, Brain Research Institute, Niigata University, Niigata, 951-8585, Japan
| | - Keiichi Itoi
- Department of Nursing, Tohoku Fukushi University, Sendai, 981-8522, Japan
| | - Akihiro Yamanaka
- Department of Neuroscience II, Research Institute of Environmental Medicine, Nagoya University, Nagoya, 464-8601, Aichi, Japan
- Chinese Institute for Brain Research, Beijing, 102206, China
- Division of Brain Sciences, Institute for Advanced Medical Research, Keio University School of Medicine, Shinjuku, Tokyo, 160-8582, Japan
- National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, 444-8585, Aichi, Japan
| | - Masabumi Minami
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Hokkaido University, Sapporo, 060-0812, Japan.
| |
Collapse
|
31
|
Guzzi G, Della Torre A, Bruni A, Lavano A, Bosco V, Garofalo E, La Torre D, Longhini F. Anatomo-physiological basis and applied techniques of electrical neuromodulation in chronic pain. J Anesth Analg Crit Care 2024; 4:29. [PMID: 38698460 PMCID: PMC11064427 DOI: 10.1186/s44158-024-00167-1] [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: 02/28/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Abstract
Chronic pain, a complex and debilitating condition, poses a significant challenge to both patients and healthcare providers worldwide. Conventional pharmacological interventions often prove inadequate in delivering satisfactory relief while carrying the risks of addiction and adverse reactions. In recent years, electric neuromodulation emerged as a promising alternative in chronic pain management. This method entails the precise administration of electrical stimulation to specific nerves or regions within the central nervous system to regulate pain signals. Through mechanisms that include the alteration of neural activity and the release of endogenous pain-relieving substances, electric neuromodulation can effectively alleviate pain and improve patients' quality of life. Several modalities of electric neuromodulation, with a different grade of invasiveness, provide tailored strategies to tackle various forms and origins of chronic pain. Through an exploration of the anatomical and physiological pathways of chronic pain, encompassing neurotransmitter involvement, this narrative review offers insights into electrical therapies' mechanisms of action, clinical utility, and future perspectives in chronic pain management.
Collapse
Affiliation(s)
- Giusy Guzzi
- Neurosurgery Department, "R. Dulbecco" Hospital, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Attilio Della Torre
- Neurosurgery Department, "R. Dulbecco" Hospital, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, "R. Dulbecco" Univesity Hospital, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Catanzaro, 88100, Italy
| | - Angelo Lavano
- Neurosurgery Department, "R. Dulbecco" Hospital, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Vincenzo Bosco
- Anesthesia and Intensive Care Unit, "R. Dulbecco" Univesity Hospital, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Catanzaro, 88100, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care Unit, "R. Dulbecco" Univesity Hospital, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Catanzaro, 88100, Italy
| | - Domenico La Torre
- Neurosurgery Department, "R. Dulbecco" Hospital, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, "R. Dulbecco" Univesity Hospital, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Catanzaro, 88100, Italy.
| |
Collapse
|
32
|
Jinnouchi H, Kiyama M, Kitamura A, Matsudaira K, Kakihana H, Hayama-Terada M, Muraki I, Honda E, Okada T, Yamagishi K, Imano H, Iso H. Medical and exercise consultation use for low back and knee pain among cardiovascular mass screening population: A cross-sectional study. Prev Med Rep 2024; 41:102684. [PMID: 38533393 PMCID: PMC10963857 DOI: 10.1016/j.pmedr.2024.102684] [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: 07/14/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
Low back and knee pain, as major symptoms and early signs of osteoarthritis, have restricted healthy life expectancy, and numerous guidelines have recommended therapeutic exercise as the first-line treatment for chronic pain. Proportions of medical and exercise consultation use for those pain have been unclear, and these may change in the future. We performed a cross-sectional study of 2,954 persons aged over 30 years in 2017 as a part of the Circulatory Risk in Communities Study. A generalized linear model with logit link and 11-year age-group moving averages were used to estimate sex- and age-specific average proportions of lifetime pain, chronic pain, and dysfunctional chronic pain of the low back and knee, and history of medical and exercise consultation use. The medical consultation use increased in the order of lifetime pain, chronic pain, and dysfunctional chronic pain, reaching 69.1 % [65.2, 72.8] in women and 74.9 % [70.3, 79.0] in men for chronic low back pain, and 70.3 % [66.1, 74.2] in women and 55.6 % [49.3, 61.7] in men for chronic knee pain. On the other hand, the exercise consultation use accounted for 36.5 % [32.6, 40.6] in women and 28.8 % [24.4, 33.5] in men for chronic low back pain, and 40.8 % [36.5, 45.2] in women and 20.6 % [16.0, 26.0] in men for chronic knee pain. This survey revealed the differences in the multilayer proportions of medical and exercise consultation use for low back and knee pain in the cardiovascular mass screening, suggesting exercise consultation was less often provided compared to medical consultation.
Collapse
Affiliation(s)
- Hiroshige Jinnouchi
- Department of Hygiene and Public Health, Nippon Medical School, 1-25-16 Nezu, Bunkyo-ku, Tokyo 113-0031, Japan
- Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
- Osaka Center for Cancer and Cardiovascular Disease Prevention, 1-6-107 Morinomiya, Joto-ku, Osaka 536-8588, Japan
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention, 1-6-107 Morinomiya, Joto-ku, Osaka 536-8588, Japan
| | - Akihiko Kitamura
- Yao City Public Health Center, 1-2-5 Shimizu-cho, Yao, Osaka 581-0006, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hironobu Kakihana
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, 518 Arise, Ikawadani-cho, Nishi-ku, Kobe 651-2180 Japan
| | - Mina Hayama-Terada
- Yao City Public Health Center, 1-2-5 Shimizu-cho, Yao, Osaka 581-0006, Japan
| | - Isao Muraki
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Eiko Honda
- Osaka Center for Cancer and Cardiovascular Disease Prevention, 1-6-107 Morinomiya, Joto-ku, Osaka 536-8588, Japan
| | - Takeo Okada
- Osaka Center for Cancer and Cardiovascular Disease Prevention, 1-6-107 Morinomiya, Joto-ku, Osaka 536-8588, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hironori Imano
- Osaka Center for Cancer and Cardiovascular Disease Prevention, 1-6-107 Morinomiya, Joto-ku, Osaka 536-8588, Japan
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan
| | - Hiroyasu Iso
- Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
- Osaka Center for Cancer and Cardiovascular Disease Prevention, 1-6-107 Morinomiya, Joto-ku, Osaka 536-8588, Japan
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| |
Collapse
|
33
|
Nance M, Stetsiv K, McNamara IA, Carpenter RW, Hepp J. Acute, Chronic, and Everyday Physical Pain in Borderline Personality Disorder. Curr Psychiatry Rep 2024; 26:240-248. [PMID: 38598062 PMCID: PMC11082044 DOI: 10.1007/s11920-024-01498-0] [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] [Accepted: 03/13/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE OF REVIEW Physical pain is an underrecognized area of dysregulation among those with borderline personality disorder (BPD). Disturbances are observed within the experience of acute, chronic, and everyday physical pain experiences for people with BPD. We aimed to synthesize research findings on multiple areas of dysregulation in BPD in order to highlight potential mechanisms underlying the association between BPD and physical pain dysregulation. RECENT FINDINGS Potential biological mechanisms include altered neural responses to painful stimuli within cognitive-affective regions of the brain, as well as potentially low basal levels of endogenous opioids. Emotion dysregulation broadly mediates dysregulation of physical pain. Certain psychological experiences may attenuate acute physical pain, such as dissociation, whereas others, such as negative affect, may exacerbate it. Social challenges between patients with BPD and healthcare providers may hinder appropriate treatment of chronic pain. Dysregulated physical pain is common in BPD and important in shaping health outcomes including elevated BPD symptoms, chronic pain conditions, and risk for problematic substance use.
Collapse
Affiliation(s)
- Melissa Nance
- Department of Psychological Sciences, University of Missouri, St. Louis, St. Louis, USA
| | - Khrystyna Stetsiv
- Department of Psychological Sciences, University of Missouri, St. Louis, St. Louis, USA
| | - Ian A McNamara
- Department of Psychological Sciences, University of Missouri, St. Louis, St. Louis, USA
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri, St. Louis, St. Louis, USA
| | - Johanna Hepp
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, J5, 68159, Mannheim, Germany.
| |
Collapse
|
34
|
Rajan J, Gaur GS, Shanmugavel K, S A. Relation between heart rate variability and spectral analysis of electroencephalogram in chronic neuropathic pain patients. Korean J Physiol Pharmacol 2024; 28:253-264. [PMID: 38682173 PMCID: PMC11058544 DOI: 10.4196/kjpp.2024.28.3.253] [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: 10/16/2023] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 05/01/2024]
Abstract
Chronic neuropathic pain (CNP) is a complex condition often arising from neural maladaptation after nerve injury. Understanding CNP complications involves the intricate interplay between brain-heart dynamics, assessed through quantitative electroencephalogram (qEEG) and heart rate variability (HRV). However, insights into their interaction in chronic pain are limited. Resting EEG and simultaneous electrocardiogram (lead II) of the participants were recorded for qEEG and HRV analysis. Correlations between HRV and qEEG parameters were calculated and compared with age, sex, and body mass index (BMI)-matched controls. CNP patients showed reduced HRV and significant increases in qEEG power spectral densities within delta, theta, and beta frequency ranges. A positive correlation was found between low frequency/ high frequency (LF/HF) ratio in HRV analysis and theta, alpha, and beta frequency bands in qEEG among CNP patients. However, no significant correlation was observed between parasympathetic indices and theta, beta bands in qEEG within CNP group, unlike age, sex, and BMI-matched healthy controls. CNP patients display significant HRV reductions and distinctive qEEG patterns. While healthy controls exhibit significant correlations between parasympathetic HRV parameters and qEEG spectral densities, these relationships are diminished or absent in CNP individuals. LF/HF ratio, reflecting sympathovagal balance, correlates significantly with qEEG frequency bands (theta, alpha, beta), illuminating autonomic dysregulation in CNP. These findings emphasize the intricate brain-heart interplay in chronic pain, warranting further exploration.
Collapse
Affiliation(s)
- John Rajan
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Girwar Singh Gaur
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Karthik Shanmugavel
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Adinarayanan S
- Department of Anesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| |
Collapse
|
35
|
Medrano-de-la-Fuente R, Hernando-Garijo I, Mingo-Gómez MT, Jiménez-Del-Barrio S, Hernández-Lázaro H, Ceballos-Laita L. Is adding dry needling to a standard care protocol beneficial in patients with chronic neck pain? A randomized placebo-controlled trial. Complement Ther Clin Pract 2024; 55:101842. [PMID: 38364664 DOI: 10.1016/j.ctcp.2024.101842] [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: 11/03/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE To evaluate the short-term effects of adding a dry needling therapy to a standard care protocol based on education, exercise and electrotherapy, compared to a sham procedure and to a standard care protocol in isolation in patients with chronic neck pain. MATERIAL AND METHODS A randomized placebo-controlled trial was performed. The participants in the dry needling group received a standard care protocol based on patient education, therapeutic exercise and electrotherapy, as well as two sessions of dry needling in the upper trapezius, levator scapulae, and/or sternocleidomastoid muscles. The participants in the sham dry needling group received the same standard care protocol and two sessions of sham dry needling. The participants in the control group received the same standard care protocol. The outcomes measured were pain intensity, pressure pain threshold, neck disability, range of movement, activation of deep cervical flexor muscles, kinesiophobia, pain catastrophizing, anxiety, and depression. RESULTS No significant group by time interactions were found for any of the outcome variables except for lower cervical spine range of movement (F = 3.79; p = 0.030). CONCLUSION The addition of two sessions of dry needling in the superficial neck muscles to a standard protocol did not yield superior results compared to either the standard care alone or the standard care plus sham dry needling in patients with chronic neck pain in any outcome except for cervical range of movement.
Collapse
Affiliation(s)
- Ricardo Medrano-de-la-Fuente
- Faculty of Health Sciences, University of Valladolid, C/ Universidad, 42004, Soria, Spain; Clinical Research in Health Sciences Group, University of Valladolid, C/ Universidad, 42004, Soria, Spain
| | - Ignacio Hernando-Garijo
- Faculty of Health Sciences, University of Valladolid, C/ Universidad, 42004, Soria, Spain; Clinical Research in Health Sciences Group, University of Valladolid, C/ Universidad, 42004, Soria, Spain
| | - María Teresa Mingo-Gómez
- Faculty of Health Sciences, University of Valladolid, C/ Universidad, 42004, Soria, Spain; Clinical Research in Health Sciences Group, University of Valladolid, C/ Universidad, 42004, Soria, Spain
| | - Sandra Jiménez-Del-Barrio
- Faculty of Health Sciences, University of Valladolid, C/ Universidad, 42004, Soria, Spain; Clinical Research in Health Sciences Group, University of Valladolid, C/ Universidad, 42004, Soria, Spain.
| | - Héctor Hernández-Lázaro
- Faculty of Health Sciences, University of Valladolid, C/ Universidad, 42004, Soria, Spain; Clinical Research in Health Sciences Group, University of Valladolid, C/ Universidad, 42004, Soria, Spain
| | - Luis Ceballos-Laita
- Faculty of Health Sciences, University of Valladolid, C/ Universidad, 42004, Soria, Spain; Clinical Research in Health Sciences Group, University of Valladolid, C/ Universidad, 42004, Soria, Spain
| |
Collapse
|
36
|
Valdes-Hernandez PA, Johnson AJ, Montesino-Goicolea S, Laffitte Nodarse C, Bashyam V, Davatzikos C, Fillingim RB, Cruz-Almeida Y. Accelerated Brain Aging Mediates the Association Between Psychological Profiles and Clinical Pain in Knee Osteoarthritis. J Pain 2024; 25:104423. [PMID: 37952863 DOI: 10.1016/j.jpain.2023.11.006] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/12/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
Chronic pain is driven by factors across the biopsychosocial spectrum. Previously, we demonstrated that magnetic resonance images (MRI)-based brain-predicted age differences (brain-PAD: brain-predicted age minus chronological age) were significantly associated with pain severity in individuals with chronic knee pain. We also previously identified four distinct, replicable, multidimensional psychological profiles significantly associated with clinical pain. The brain aging-psychological characteristics interface in persons with chronic pain promises elucidating factors contributing to their poor health outcomes, yet this relationship is barely understood. That is why we examined the interplay between the psychological profiles in participants having chronic knee pain impacting function, brain-PAD, and clinical pain severity. Controlling for demographics and MRI scanner, we compared the brain-PAD among psychological profiles at baseline (n = 164) and over two years (n = 90). We also explored whether profile-related differences in pain severity were mediated by brain-PAD. Brain-PAD differed significantly between profiles (ANOVA's omnibus test, P = .039). Specifically, participants in the profile 3 group (high negative/low positive emotions) had an average brain-PAD ∼4 years higher than those in profile- (low somatic reactivity), with P = .047, Bonferroni-corrected, and than those in profile 2 (high coping), with P = .027, uncorrected. Repeated measures ANOVA revealed no significant change in profile-related brain-PAD differences over time, but there was a significant decrease in brain-PAD for profile 4 (high optimism/high positive affect), with P = .045. Moreover, profile-related differences in pain severity at baseline were partly explained by brain-PAD differences between profile 3 and 1, or 2; but brain-PAD did not significantly mediate the influence of variations in profiles on changes in pain severity over time. PERSPECTIVE: Accelerated brain aging could underlie the psychological-pain relationship, and psychological characteristics may predispose individuals with chronic knee pain to worse health outcomes via neuropsychological processes.
Collapse
Affiliation(s)
- Pedro A Valdes-Hernandez
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Alisa J Johnson
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Soamy Montesino-Goicolea
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Chavier Laffitte Nodarse
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Vishnu Bashyam
- Center for Biomedical Image Computing & Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Artificial Intelligence in Biomedical Imaging Lab (AIBIL), Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christos Davatzikos
- Center for Biomedical Image Computing & Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, Florida; Department of Neuroscience, College of Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
37
|
Mundal I, Schei J, Lydersen S, Thomsen PH, Nøvik TS, Kvitland LR. Prevalence of chronic and multisite pain in adolescents and young adults with ADHD: a comparative study between clinical and general population samples (the HUNT study). Eur Child Adolesc Psychiatry 2024; 33:1433-1442. [PMID: 37386203 PMCID: PMC11098922 DOI: 10.1007/s00787-023-02249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and chronic pain are prevalent and associated. We examined the prevalence and distribution of chronic pain in adolescents and young adults with ADHD using 9-years longitudinal data (from T1:2009-2011 to T3:2018-2019) with three time points from a clinical health survey compared to two age-matched reference population-based samples. Mixed-effect logistic regression and binary linear regression were used to estimate the probability for chronic and multisite pain at each time point and to compare the prevalence of chronic pain with the reference populations. The prevalence of chronic and multisite pain was high in those with ADHD, especially in female young adults, with highly prevalent chronic pain at 9 years of follow-up (75.9%) compared to 45.7% in females in the reference population. The probability of having pain was only statistically significant for chronic pain in males at 3 years of follow-up (41.9%, p = 0.021). Those with ADHD were at higher risk of reporting single-site and multisite pain compared to the general population at all measurement points. Longitudinal studies should be tailored to further understand the complex sex differences of comorbid chronic pain and ADHD in adolescents, exploring predictive factors of pain assessing long-term associations with bodyweight, psychiatric comorbidities, and possible mechanisms of stimulant use effects on pain.
Collapse
Affiliation(s)
- Ingunn Mundal
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- Department of Health and Social Sciences, Molde University College, Molde, Norway.
- Kristiansund Community Mental Health Centre, Division of Psychiatry, Møre and Romsdal Hospital Trust, Kristiansund, Norway.
| | - Jorun Schei
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Per Hove Thomsen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark
| | - Torunn Stene Nøvik
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Levi R Kvitland
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs University Hospital, Trondheim, Norway
| |
Collapse
|
38
|
Abstract
Conor Hamilton examines the key components healthcare practitioners should consider when using transanal irrigation.
Collapse
Affiliation(s)
- Conor Hamilton
- Lecturer (Nursing), School of Nursing and Midwifery, Queen's University Belfast
| |
Collapse
|
39
|
Ruiz Romero MV, Lobato Parra E, Porrúa Del Saz A, Martínez Monrobé MB, Pereira Delgado CM, Gómez Hernández MB. [Management of chronic non-oncologic pain by multicomponent programs using non-pharmacologic therapies: A systematic review of the literature]. J Healthc Qual Res 2024; 39:168-187. [PMID: 38556371 DOI: 10.1016/j.jhqr.2024.02.004] [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: 12/20/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/02/2024]
Abstract
Chronic pain is a public health problem suffered by 20% of the world's population. Pharmacological approaches are insufficient, so a multi-therapeutic approach that also includes non-pharmacological therapies (psychological therapies, meditation, physical exercise, healthy habits, etc.) is proposed. The aim of this review was to review the existing scientific evidence on the effect of multicomponent programs with non-pharmacological therapies in people with chronic non-oncologic pain. To this end, a search for scientific articles was carried out in three databases (PubMed, Web of Science and PsycINFO) and 17 articles were selected, following the PRISMA recommendations. The patients who participated in these programs were mostly women, aged 18 to 80years, working or on sick leave due to pain, with secondary education or less and married. The most frequent pain was musculoskeletal, mainly low back pain. All the articles studied the effectiveness of two or more therapies, highlighting psychological therapies, physical exercise and education. Positive results were obtained in the reduction of different variables such as pain, pain catastrophizing, anxiety and depression, in addition to improving functionality and quality of life. It has also been shown that patients' prior expectations regarding the intervention influence its effectiveness. Although throughout the review there was great heterogeneity in the interventions, in the evaluation methods and in the results themselves, it can be concluded that multicomponent programs show positive results in the management of chronic pain, and should therefore be incorporated as a routine therapeutic treatment.
Collapse
Affiliation(s)
- M V Ruiz Romero
- Unidad de Calidad e Investigación, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España; Universidad Internacional de Valencia, Valencia, España
| | - E Lobato Parra
- Unidad de Calidad e Investigación, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España.
| | - A Porrúa Del Saz
- Servicio de Rehabilitación, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - M B Martínez Monrobé
- Unidad de Psicología, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - C M Pereira Delgado
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - M B Gómez Hernández
- Servicio de Rehabilitación, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| |
Collapse
|
40
|
Khan MA, Koh RGL, Rashidiani S, Liu T, Tucci V, Kumbhare D, Doyle TE. Cracking the Chronic Pain code: A scoping review of Artificial Intelligence in Chronic Pain research. Artif Intell Med 2024; 151:102849. [PMID: 38574636 DOI: 10.1016/j.artmed.2024.102849] [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: 06/23/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE The aim of this review is to identify gaps and provide a direction for future research in the utilization of Artificial Intelligence (AI) in chronic pain (CP) management. METHODS A comprehensive literature search was conducted using various databases, including Ovid MEDLINE, Web of Science Core Collection, IEEE Xplore, and ACM Digital Library. The search was limited to studies on AI in CP research, focusing on diagnosis, prognosis, clinical decision support, self-management, and rehabilitation. The studies were evaluated based on predefined inclusion criteria, including the reporting quality of AI algorithms used. RESULTS After the screening process, 60 studies were reviewed, highlighting AI's effectiveness in diagnosing and classifying CP while revealing gaps in the attention given to treatment and rehabilitation. It was found that the most commonly used algorithms in CP research were support vector machines, logistic regression and random forest classifiers. The review also pointed out that attention to CP mechanisms is negligible despite being the most effective way to treat CP. CONCLUSION The review concludes that to achieve more effective outcomes in CP management, future research should prioritize identifying CP mechanisms, CP management, and rehabilitation while leveraging a wider range of algorithms and architectures. SIGNIFICANCE This review highlights the potential of AI in improving the management of CP, which is a significant personal and economic burden affecting more than 30% of the world's population. The identified gaps and future research directions provide valuable insights to researchers and practitioners in the field, with the potential to improve healthcare utilization.
Collapse
Affiliation(s)
- Md Asif Khan
- Department of Electrical and Computer Engineering at McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Ryan G L Koh
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON M5G 2A2, Canada
| | - Sajjad Rashidiani
- Department of Electrical and Computer Engineering at McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Theodore Liu
- Department of Electrical and Computer Engineering at McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Victoria Tucci
- Faculty of Health Sciences at McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Dinesh Kumbhare
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON M5G 2A2, Canada
| | - Thomas E Doyle
- Department of Electrical and Computer Engineering at McMaster University, Hamilton, ON L8S 4K1, Canada.
| |
Collapse
|
41
|
Spector AL, Quinn KG, Cruz-Almeida Y, Fillingim RB. Chronic Pain Among Middle-Aged and Older Adults in the United States: The Role of Everyday Discrimination and Racial/Ethnic Identity. J Pain 2024; 25:104439. [PMID: 38065467 PMCID: PMC11058034 DOI: 10.1016/j.jpain.2023.11.022] [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] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 04/14/2024]
Abstract
Chronic pain disproportionately affects middle-aged and older adults in the United States. Everyday discrimination is associated with worse pain outcomes and is more prevalent among adults from racial/ethnic minoritized groups. Yet, there is limited evidence on relationships between everyday discrimination and chronic pain among middle-aged and older adults, as well as how discrimination and racial/ethnic identity may interact to influence this relationship. We used the 2018 Health and Retirement study to evaluate associations between exposure to everyday discrimination and odds to experience any, severe, and high-impact chronic pain among 5,314 Hispanic, non-Hispanic Black, and non-Hispanic White adults over the age of 50. Logistic regression was used to evaluate the main and interaction effects of everyday discrimination on the odds of chronic pain (any, severe, and high-impact) across racial/ethnic groups. Results showed that Hispanic and non-Hispanic Black middle-aged and older adults had a higher, unadjusted prevalence of severe and high-impact chronic pain and reported more exposure to everyday discrimination compared to non-Hispanic White middle-aged and older adults. In fully adjusted models, exposure to everyday discrimination predicted higher odds to experience each type of chronic pain. In addition, study findings showed that exposure to everyday discrimination significantly raised pain risk among Hispanic and non-Hispanic White, but not non-Hispanic Black, middle-aged, and older adults. Findings underscore the influential role of everyday discrimination on the chronic pain experiences of middle-aged and older adults, as well as differential effects across racial/ethnic groups. PERSPECTIVE: Using national data, we examined associations between discrimination and chronic pain among middle-aged and older adults, including interactions between discrimination and race/ethnicity. Exposure to discrimination predicted a higher chronic pain burden, overall. Differential effects within racial/ethnic groups underscored a need for more nuanced investigations into pain disparities among this population.
Collapse
Affiliation(s)
- Antoinette L. Spector
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Katherine G. Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
42
|
Ma R, Romano E, Ashworth M, Smith TO, Vancampfort D, Scott W, Gaughran F, Stewart R, Stubbs B. The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review. J Pain 2024; 25:104421. [PMID: 37952860 DOI: 10.1016/j.jpain.2023.11.004] [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] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
Chronic pain (CP) and mental illness (MI) are leading causes of years lived with disability and commonly co-occur. However, it remains unclear if available interventions are effective in improving pain outcomes in patients with co-existing CP and MI. This systematic review synthesised evidence for the effectiveness of interventions to improve pain outcomes for people with comorbid CP and clinically diagnosed MI. Ten electronic databases were searched from inception until May 2023. Randomised controlled trials (RCTs) were included if they evaluated interventions for CP-related outcomes among people with comorbid CP and clinically diagnosed MI. Pain-related and mental health outcomes were reported as primary and secondary outcomes, respectively. 26 RCTs (2,311 participants) were included. Four trials evaluated the effectiveness of cognitive-behavioural therapy, 6 mindfulness-based interventions, 1 interpersonal psychotherapy, 5 body-based interventions, 5 multi-component interventions, and 5 examined pharmacological-based interventions. Overall, there was considerable heterogeneity in sample characteristics and interventions, and included studies were generally of poor quality with insufficient trial details being reported. Despite the inconsistency in results, preliminary evidence suggests interventions demonstrating a positive effect on CP may include cognitive-behavioural therapy for patients with depression (with a small to medium effect size) and multi-component intervention for people with substance use disorders (with a small effect size). Despite the high occurrence/burden of CP and MI, there is a relative paucity of RCTs investigating interventions and none in people with severe MI. More rigorously designed RCTs are needed to further support our findings. PERSPECTIVE: This systematic review presents current evidence evaluating interventions for CP-related and MH outcomes for people with comorbid CP and clinically diagnosed MI. Our findings could potentially help clinicians identify the most effective treatments to manage these symptoms for this vulnerable patient group.
Collapse
Affiliation(s)
- Ruimin Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Eugenia Romano
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Mark Ashworth
- Department of Population Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Toby O Smith
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Physiotherapy and Psychomotor Therapy Unit, University Psychiatric Centre KU Leuven, Kortenberg, Belgium
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; INPUT Pain Management Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK; Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| |
Collapse
|
43
|
Cavalcante AFL, Holanda JSCB, Passos JOS, Pereira de Oliveira JM, Morya E, Okano AH, Bikson M, Pegado R. Anodal tDCS over the motor cortex improves pain but not physical function in chronic chikungunya arthritis: Randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101826. [PMID: 38479250 DOI: 10.1016/j.rehab.2024.101826] [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: 03/22/2023] [Revised: 12/08/2023] [Accepted: 12/26/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND Chikungunya virus (CHIKV) is a globally prevalent pathogen, with outbreaks occurring in tropical regions. Chronic pain is the main symptom reported and is associated with decreased mobility and disability. Transcranial direct current stimulation (tDCS) is emerging as a new therapeutic tool for chronic arthralgia. OBJECTIVE To evaluate the effectiveness of 10 consecutive sessions of anodal tDCS on pain (primary outcome) in participants with chronic CHIKV arthralgia. Secondary outcomes included functional status, quality of life, and mood. METHODS In this randomized, double-blind, placebo-controlled trial, 30 participants with chronic CHIKV arthralgia were randomly assigned to receive either active (n = 15) or sham (n = 15) tDCS. The active group received 10 consecutive sessions of tDCS over M1 using the C3/Fp2 montage (2 mA for 20 min). Visual analog scale of pain (VAS), health assessment questionnaire (HAQ), short-form 36 health survey (SF-36), pain catastrophizing scale, Hamilton anxiety scale (HAS), timed up and go (TUG) test, lumbar dynamometry, 30-s arm curl and 2-min step test were assessed at baseline, day 10 and at 2 follow-up visits. RESULTS There was a significant interaction between group and time on pain (p = 0.03; effect size 95 % CI 0.9 (-1.67 to -0.16), with a significant time interaction (p = 0.0001). There was no interaction between time and group for the 2-minute step test (p = 0.18), but the groups differed significantly at day 10 (p = 0.01), first follow-up (p = 0.01) and second follow-up (p = 0.03). HAQ and SF-36 improved but not significantly. There was no significant improvement in mental health, and physical tests. CONCLUSION tDCS appears to be a promising intervention for reducing pain in participants with chronic CHIKV arthralgia, although further research is needed to confirm these findings and explore potential long-term benefits. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC): RBR-245rh7.
Collapse
Affiliation(s)
- Antônio Felipe Lopes Cavalcante
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal 59078-970, Brazil
| | - Joanna Sacha Cunha Brito Holanda
- Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal 59078-970, Brazil
| | - João Octávio Sales Passos
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal 59078-970, Brazil
| | - Joyce Maria Pereira de Oliveira
- Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal 59078-970, Brazil
| | - Edgard Morya
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Alberto Santos Dumont Avenue, 1.560, Macaíba 59280-000, Brazil
| | - Alexandre H Okano
- Center of Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo, São Paulo, Alameda da Universidade, Bairro Anchieta 09606-045, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of The City University of New York, 160 Convent Avenue, New York, NY 10031, USA
| | - Rodrigo Pegado
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal 59078-970, Brazil; Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal 59078-970, Brazil.
| |
Collapse
|
44
|
Ortega PM, Scholtz S, O'Donnell K, Hakky S, Purkayastha S, Tsironis C, Moorthy K, Aggarwal R, Ahmed AR. Risk Factors for Chronic Abdominal Pain After RYGB: Are Patients Adequately Selected Beforehand? Obes Surg 2024; 34:1748-1755. [PMID: 38575742 DOI: 10.1007/s11695-024-07193-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Chronic abdominal pain after RYGB is a known issue. Identifying the potential patient-related and modifiable risk factors might contribute to diminish the risk for this undesirable outcome. METHODS A single-center retrospective cohort study with prospective data collection was conducted with inclusion of all patients who underwent RYGB surgery between 2015 and 2021. Data from the NBSR and medical records were used. Patients with chronic abdominal pain were defined when pain lasting or recurring for more than 3 to 6 months. RESULTS Six hundred sixty-four patients who underwent RYGB surgery were included with a median follow-up of 60.5 months. Forty-nine patients (7.3%) presented with chronic abdominal pain. Postoperative complications (OR 13.376, p = 0.020) and diagnosis of depression (OR 1.971, p = 0.037) were associated with developing abdominal pain. On the other hand, ex-smokers (OR 0.222, p = 0.040) and older age (0.959, p = 0.004) presented as protective factors. CONCLUSION Postoperative complications and diagnosis of depression are risk factors for chronic pain after RYGB. The role of the bariatric MDT remains crucial to select these patients adequately beforehand.
Collapse
Affiliation(s)
- Patricia M Ortega
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
| | - Samantha Scholtz
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
- West London NHS Trust, Southall, UK
| | - Karen O'Donnell
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Sherif Hakky
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Sanjay Purkayastha
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Christos Tsironis
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Krishna Moorthy
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, London, W2 1NY, UK
| | - Ravi Aggarwal
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, London, W2 1NY, UK
| | - Ahmed R Ahmed
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, London, W2 1NY, UK
| |
Collapse
|
45
|
Shaban M, Shaban MM, Zaky ME, Alanazi MA, Ramadan OME, Ebied EMAES, Ghoneim NIA, Ali SI. Divine resilience: Unveiling the impact of religious coping mechanisms on pain endurance in arab older adults battling chronic pain. Geriatr Nurs 2024; 57:199-207. [PMID: 38696877 DOI: 10.1016/j.gerinurse.2024.04.022] [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: 12/12/2023] [Revised: 04/13/2024] [Accepted: 04/19/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Chronic pain diminishes the quality of life for many Older Adults individuals. Identifying effective coping methods to enhance pain resilience is imperative as populations age. Older Adults commonly use religious faith and spiritual practices to endure pain, yet little research has explored their impact on pain tolerance. METHODS This cross-sectional study examined relationships between positive/negative religious coping styles and pain endurance in 200 Arab elders with chronic pain. Participants completed the Brief Arab Religious Coping Scale, Numeric Pain Rating Scale, WHOQOL-BREF, and demographic/medical history questionnaires. RESULTS Quantitative analysis demonstrated significant positive associations between positive religious reappraisal and active spiritual coping with higher self-reported pain endurance (p<.05). Negative religious coping styles lacked meaningful relationships with pain tolerance. Multiple regression confirmed the unique effects of reappraisal and spiritual practice on improving pain resilience, controlling for covariates. CONCLUSIONS Outcomes align with perspectives highlighting multidimensional neurocognitive, emotional, and psychosocial pain relief from religious coping. Findings underscore integrating positive faith-based resources in biopsychosocial paradigms for Older Adult's pain management. Additional research should investigate causal pathways and contextual factors influencing religious coping effects on diverse Older Adult subgroups.
Collapse
Affiliation(s)
- Mostafa Shaban
- Geriatric Nursing Department, Faculty of Nursing, Cairo University, Cairo 11562, Egypt.
| | - Marwa Mamdouh Shaban
- Community Health Nursing Department, Faculty of Nursing, Cairo University, Cairo 11562, Egypt
| | | | | | | | | | - Nagwa Ibrahim Abbas Ghoneim
- Lecturer of Critical Care and Emergency Nursing, Faculty of Nursing, Tanta University, Gharbia 31527, Egypt; Assist prof, Nursing Department, Applied Medical Sciences College, University of Hafr Al Batin, Al Jamiah, Hafar Al Batin 39524, Saudi Arabia
| | - Sayed Ibrahim Ali
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Hofuf 31982, Al-Ahsa, Saudi Arabia; Educational Psychology Department, College of Education, Helwan University, Cairo, Egypt
| |
Collapse
|
46
|
Mathew J, Adhia DB, Hall M, De Ridder D, Mani R. EEG-Based Cortical Alterations in Individuals With Chronic Knee Pain Secondary to Osteoarthritis: A Cross-sectional Investigation. J Pain 2024; 25:104429. [PMID: 37989404 DOI: 10.1016/j.jpain.2023.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/05/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
Chronic painful knee osteoarthritis (OA) is a disabling physical health condition. Alterations in brain responses to arthritic changes in the knee may explain persistent pain. This study investigated source localized, resting-state electroencephalography activity and functional connectivity in people with knee OA, compared to healthy controls. Adults aged 44 to 85 years with knee OA (n = 37) and healthy control (n = 39) were recruited. Resting-state electroencephalography was collected for 10 minutes and decomposed into infraslow frequency (ISF) to gamma frequency bands. Standard low-resolution electromagnetic brain tomography statistical nonparametric maps were conducted, current densities of regions of interest were compared between groups and correlation analyses were performed between electroencephalography (EEG) measures and clinical pain and functional outcomes in the knee OA group. Standard low-resolution electromagnetic brain tomography nonparametric maps revealed higher (P = .006) gamma band activity over the right insula (RIns) in the knee OA group. A significant (P < .0001) reduction in ISF band activity at the pregenual anterior cingulate cortex, whereas higher theta, alpha, beta, and gamma band activity at the dorsal anterior cingulate cortex, pregenual anterior cingulate cortex, the somatosensory cortex, and RIns in the knee OA group were identified. ISF activity of the dorsal anterior cingulate cortex was positively correlated with pain measures and psychological distress scores. Theta and alpha activity of RIns were negatively correlated with pain interference. In conclusion, aberrations in infraslow and faster frequency EEG oscillations at sensory discriminative, motivational-affective, and descending inhibitory cortical regions were demonstrated in people with chronic painful knee OA. Moreover, EEG oscillations were correlated with pain and functional outcome measures. PERSPECTIVE: This study confirms alterations in the rsEEG oscillations and its relationship with pain experience in people with knee OA. The study provides potential cortical targets and the EEG frequency bands for neuromodulatory interventions for managing chronic pain experience in knee OA.
Collapse
Affiliation(s)
- Jerin Mathew
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand; Department of Anatomy, School of Biomedical Sciences, University of Otago, New Zealand; Pain@Otago Research Theme, University of Otago, New Zealand
| | - Divya B Adhia
- Pain@Otago Research Theme, University of Otago, New Zealand; Division of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
| | - Matthew Hall
- Division of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
| | - Dirk De Ridder
- Pain@Otago Research Theme, University of Otago, New Zealand; Division of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand; Pain@Otago Research Theme, University of Otago, New Zealand
| |
Collapse
|
47
|
Kastanias P, Wang W, Robinson S, Mackenzie K, Wnuk SM. Predictors of Chronic Pain 6 Months and 1 Year After Bariatric Surgery. Obes Surg 2024; 34:1786-1792. [PMID: 38564171 DOI: 10.1007/s11695-024-07201-9] [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: 09/29/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Obesity and chronic pain (CP) represent serious, interrelated global public health concerns that have a profound impact on individuals and society. Bariatric surgery is increasing in popularity and has been proven safe and efficacious, providing long-term weight loss and improvements in many obesity-related co-morbidities. A decrease in CP is often a motivation for bariatric surgery. The purpose of this study was to investigate the changes in CP postoperatively and to examine the relationship between psychosocial measures and pain. METHODS A total of 155 adult bariatric surgery patients were recruited and completed self-report measures for CP severity and interference, neuropathic pain, anxiety, depression, emotion regulation and perceived social support at three timepoints preoperative and 6 and 12 months postoperative. RESULTS Pain significantly decreased between preoperative and postoperative timepoints, and preoperative pain was the most significant predictor of postoperative pain. Preoperative CP was correlated with anxiety (p < 0.05) and depression (p < 0.01) at 6 months postoperatively and perceived social support (p < 0.01) at 1 year postoperatively. However, regression analyses with psychological variables were not significant. CONCLUSION CP decreases after bariatric surgery, but further research with larger sample sizes is needed to establish whether psychosocial characteristics impact this outcome.
Collapse
Affiliation(s)
- Patti Kastanias
- Bariatric Program, University Health Network, MP4-305, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada.
| | - Wei Wang
- Bariatric Program, University Health Network, MP4-305, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Sandra Robinson
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Karyn Mackenzie
- Kingston General Hospital, 76 Stuart St., Kingston, ON, K7L 2V7, Canada
| | - Susan M Wnuk
- Bariatric Program, University Health Network, MP4-305, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
| |
Collapse
|
48
|
Spinella S, McCarthy R. Buprenorphine for Pain: A Narrative Review and Practical Applications. Am J Med 2024; 137:406-413. [PMID: 38340973 DOI: 10.1016/j.amjmed.2024.01.022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
Chronic noncancer pain affects about 20% of US adults and can significantly affect function and quality of life. Current guidelines recommend multimodal pain control. Despite risks associated with long-term opioid therapy, opioids are commonly prescribed. Buprenorphine is a partial opioid agonist with an improved safety profile compared to full agonists. Some formulations are approved for chronic pain and others for opioid use disorder. Buprenorphine is an option for patients who use chronic daily opioids for pain. This review summarizes the literature on buprenorphine's efficacy and safety for chronic pain and provides recommendations to generalists on initiation, titration, and monitoring of buprenorphine-based pain treatment. We also discuss a communication approach when considering buprenorphine for pain.
Collapse
Affiliation(s)
- Sara Spinella
- Department of Medicine, University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System, Pittsburgh, Pa.
| | | |
Collapse
|
49
|
Castillo-Rangel C, Gallardo-García ES, Fadanelli-Sánchez F, Hernández-Peña VS, Trujillo-Ramírez AM, López-Gómez EDC, García LI, Iñiguez-Luna MI, Martínez-Bretón P, Ramírez-Rodríguez R, Ordoñez-Granja J, Trujillo-Aboite MG, Marín G. Minimally Invasive Treatment of Facet Osteoarthritis Pain in Spine: A Clinical Approach Evaluating Cryotherapy. World Neurosurg 2024; 185:e741-e749. [PMID: 38423456 DOI: 10.1016/j.wneu.2024.02.122] [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: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Chronic pain management remains a challenging aspect of neurosurgical care, with facet arthrosis being a significant contributor to the global burden of low back pain. This study evaluates the effectiveness of cryotherapy as a minimally invasive treatment for patients with facet arthrosis. By focusing on reducing drug dependency and pain intensity, the research aims to contribute to the evolving field of pain management techniques, offering an alternative to traditional pain management strategies. METHODS Through a retrospective longitudinal analysis of patients with facet osteoarthritis treated via cryotherapy between 2013 and 2023, we evaluated the impact on medication usage and pain levels, utilizing the Visual Analog Scale for pre- and posttreatment comparisons. RESULTS The study encompassed 118 subjects, revealing significant pain alleviation, with Visual Analog Scale scores plummeting from 9.0 initially to 2.0 after treatment. Additionally, 67 patients (56.78%) reported decreased medication consumption. These outcomes underscore cryotherapy's potential as a pivotal tool in chronic pain management. CONCLUSIONS The findings illuminate cryotherapy's efficacy in diminishing pain and curtailing medication dependency among patients with facet arthrosis. This study reaffirms cryotherapy's role in pain management and propels the discourse on nontraditional therapeutic avenues, highlighting the urgent need for personalized and innovative treatment frameworks.
Collapse
Affiliation(s)
- Carlos Castillo-Rangel
- Department of Neurosurgery, "Hospital Regional 1◦ de Octubre", Institute of Social Security and Services for State Workers (ISSSTE), Mexico City, Mexico
| | | | | | | | - Alex Missael Trujillo-Ramírez
- Faculty of Medicine campus Cd. Mendoza, Universidad Veracruzana, Camerino Z Mendoza, Veracruz, Mexico; Faculty of Medicine, Universidad Veracruzana, Veracruz, Mexico
| | | | - Luis I García
- Department of Biophysics, Brain Research Institute, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | | | | | | | - Jaime Ordoñez-Granja
- Department of Neurosurgery, "Hospital Regional 1◦ de Octubre", Institute of Social Security and Services for State Workers (ISSSTE), Mexico City, Mexico
| | | | - Gerardo Marín
- Neural Dynamics and Modulation Lab, Cleveland Clinic, Cleveland, Ohio, USA.
| |
Collapse
|
50
|
Kawi J, Yeh CH, Grant L, Huang X, Wu H, Hua C, Christo P. Retention, adherence, and acceptability testing of a digital health intervention in a 3-group randomized controlled trial for chronic musculoskeletal pain. Complement Ther Med 2024; 81:103030. [PMID: 38437926 DOI: 10.1016/j.ctim.2024.103030] [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: 07/13/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES Evaluate a digital health intervention using Auricular Point Acupressure (APA) for chronic musculoskeletal pain in terms of participant retention, adherence, acceptability, and satisfaction. Chronic musculoskeletal pain is a global concern and there are persistent challenges in pain management. Despite the value of digital health interventions, these interventions need to be fully evaluated for feasibility. METHODS We conducted a 3-group, longitudinal, randomized controlled trial (RCT). After Institutional Review Board approval, we posted recruitment flyers in a university, healthcare clinics, and community settings. Participants were randomized into an in-person + app group (n = 8), virtual + app group (n = 7), and a wait-list, education-enhanced control group (n = 8), evaluating our outcomes using standard feasibility measures. The 4-week intervention consisted of virtual sessions, telecommunications, and our APA app, followed by a 3-month follow-up. RESULTS Data from 22 participants were subsequently analyzed (95.7%). All app participants adhered to the study protocol and used APA at the minimum recommended frequency and duration. The virtual + app group used APA more during the intervention and follow-up periods. All app participants found the intervention to be acceptable and at least 80% overall were satisfied with APA at the 3-month follow-up. There were no adverse events reported. CONCLUSIONS Our digital health intervention was found to be acceptable and sustainable; participants adhered to and were satisfied with the intervention providing support for a larger RCT. CLINICAL TRIAL #: NCT05020470.
Collapse
Affiliation(s)
- Jennifer Kawi
- University of Nevada, Las Vegas, School of Nursing, 4505 S Maryland Parkway, Las Vegas, NV 89154-3018, USA.
| | - Chao Hsing Yeh
- University of Texas Health Science Center at Houston, Cizik School of Nursing, 6901 Bertner Ave, Houston, TX 77030, USA
| | - Lauren Grant
- University of Nevada, Las Vegas, Kirk Kerkorian School of Medicine, 625 Shadow Ln, Las Vegas, NV 89106, USA
| | - Xinran Huang
- University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA
| | - Hulin Wu
- University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA
| | - Chunyan Hua
- University of Nevada, Las Vegas, William F. Harrah College of Hospitality, 4505 S Maryland Pkwy, Las Vegas, NV 89154, USA
| | - Paul Christo
- Johns Hopkins University, School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| |
Collapse
|