Chronic pain has a significant impact at both the individual and societal level.18,21,28 In addition to intensity and interference, psychosocial and behavioral contributors are critical for understanding the experience of pain and developing effective treatments.16,28 Pain catastrophizing (PC) has been recognized as an important and consistent psychosocial predictor of pain-related outcomes (e.g., pain intensity, disability, and psychological function).4,7,14,20,26,32,58,74,75,77
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Saturday, June 13, 2020
Clinician-patient movement synchrony mediates social group effects on interpersonal trust and perceived pain
Pain is a primary reason patients seek medical care and is a feature of a large number of clinical disorders. Pain is also an unfortunate consequence of many medical procedures that can become chronic and debilitating 65,98,99,117. Pain in post-operative and other contexts is associated with poor mental health, disability, and costs in work productivity and family relationships 2,3,7,18,25,51,105,142,145. Prevention and effective relief of acute pain may improve clinical outcomes, avoid clinical complications, save healthcare resources, and improve quality of life 36.
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Monday, June 8, 2020
Sunday, June 7, 2020
Opioid Use Trajectories after Thoracic Surgery among Veterans in the United States
Abstract
Background
Opioid use has increased to epidemic levels over the past decade within the United States, particularly among vulnerable populations. This retrospective study aimed to evaluate rates of prolonged opioid use in the Veteran population after thoracic surgery and identify specific risk clusters.
Methods
Veterans Administration data on patients who underwent thoracic surgery between January 1, 2006 and September 30, 2015 included preoperative opioid‐use information for stratification of patients to preoperative chronic opioid use (PCOU; nPCOU = 16,612) vs. patients without preoperative chronic opioid use (WPCOU; nWPCOU = 2,328). A Poisson regression model and prior literature were used to identify variables for use in a Latent Class Analysis (LCA) model for each stratum. Three‐cluster models were selected, and identified as “low”, “intermediate” and “high” risk groups.
Results
Cluster interpretations included: 1. Low‐risk: no psychiatric diagnoses, preoperative medication use, or preoperative chronic pain, 2. Intermediate risk: no psychiatric diagnoses, but had preoperative medication use and some preoperative chronic pain, and 3. High‐risk: psychiatric diagnoses, preoperative medication use and preoperative chronic pain. For the PCOU stratum, rates of prolonged opioid use 1 year after surgery were: 46.3%, 61.9% and 66.0%. For the WPCOU stratum, the observed rates were 4.7%, 8.3% and 9.2%.
Conclusions
Prolonged opioid use trajectories obviously differ by PCOU status, as well as preoperative psychosocial diagnoses, medication use and chronic pain. This is a first step in population‐level research to curb the rate of prolonged opioid use in Veterans following thoracic surgery.
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Saturday, June 6, 2020
Effects of neurofeedback in the management of chronic pain: A systematic review and meta‐analysis of clinical trials
Abstract
Background and Objective
Neurofeedback provides real‐time feedback about neurophysiological signals to patients, thereby encouraging modulation of pain‐associated brain activity. This review aims to evaluate the effectiveness and safety of neurofeedback in alleviating pain and pain‐associated symptoms in chronic pain patients.
Methods
MEDLINE, PUBMED, Web of Science and PsycINFO databases were searched using the strategy: (“Neurofeedback” OR “EEG Biofeedback” OR “fMRI Biofeedback”) AND (“Pain” or “Chronic Pain”). Clinical trials reporting changes in pain following electroencephalogram (EEG) or functional magnetic resonance imaging (fMRI) neurofeedback in chronic pain patients were included. Only Randomised‐controlled trials (RCT), non‐randomised controlled trials (NRCT) and case series were included. Effect size was pooled for all RCTs in a meta‐analysis.
Results
Twenty‐one studies were included. Reduction in pain following neurofeedback was reported by one high‐quality RCT, five of six NRCT or low‐quality RCT and thirteen of fourteen case‐series. Pain reduction reported by studies ranged from 6% to 82%, with ten studies reporting a clinically significant reduction in pain of >30%. The overall effect size was ‐0.76 (95% Confidence Interval ‐1.31 to ‐0.20). Studies were highly heterogenous [Q(df=5)=18.46, p<0.002, I2=73%]. Improvements in depression, anxiety, fatigue and sleep were also seen in some studies. Common side‐effects included headache, nausea and drowsiness. These generally did not lead to withdrawal of therapy except in one study.
Conclusions
Neurofeedback is a novel therapy with promising but largely low‐quality evidence supporting its use in chronic pain. Further high‐quality trials comparing different protocols is warranted to determine the most efficacious way to deliver neurofeedback.
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Effects of a person‐centred approach in a school setting for adolescents with chronic pain – The HOPE randomized controlled trial
Abstract
Background
Chronic pain among adolescents is common but effective interventions applicable in a school setting are rare. Person‐centred care (PCC) is a key factor in improving health by engaging people as partners in their own care.
Methods
In this randomized controlled trial, a total of 98 adolescents in secondary school or upper secondary school (aged 14−21 years) with chronic pain were randomly assigned to a PCC intervention or standard school health care. In the intervention group a pain management program, based on a PCC approach, comprising four face‐to‐face sessions with a school nurse over a period of five weeks was added to standard school health care. The main outcome measure was self‐efficacy in daily activities (SEDA scale) and rating scales for pain intensity and pain impact were used as secondary outcome measures.
Results
At the follow‐up, no significant differences were found between the groups in the SEDA scale (p=0.608) or in the rating scales for pain intensity (p=0.261) and pain impact (0.836). In the sub‐group analysis, a significant improvement in the SEDA scale was detected at the secondary school in favour of the PCC intervention group (p=0.021).
Conclusion
In this pain management program based on a PCC approach, we found no effect in the total sample, but the program showed promising results to improve self‐efficacy in daily activities among adolescents at secondary school.
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What high rates of physical and mental comorbidity remind us about fibromyalgia
Abstract
This journal recently published a paper by Sleurs et al., entitled "Comorbidities of self‐reported fibromyalgia in United‐States adults: A cross‐sectional study from The National Epidemiological Survey on Alcohol and Related Conditions (NESARC‐III). (Sleurs et al., 2020)” While its primary message is that persons reporting a physician diagnosis of fibromyalgia have very high rates of physical and mental comorbidities, this study provides other important information on the nature and validity of fibromyalgia and fibromyalgia diagnosis, as it is likely the most of the reported fibromyalgia patients in the study would not satisfy criteria for fibromyalgia.
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