Telehealth versus In-Person Acceptance and Commitment Therapy for Chronic Pain: A Randomized Non-Inferiority Trial

The purpose of this randomized non-inferiority trial was to compare video-teleconferencing (VTC) versus in-person (IP) delivery of an 8-week Acceptance and Commitment Therapy (ACT) intervention among veterans with chronic pain (N = 128) at posttreatment and 6-month follow-up. The primary outcome was the pain interference subscale of the Brief Pain Inventory. Secondary outcomes included measures of pain severity, mental and physical health-related quality of life, pain acceptance, activity level, depression, pain-related anxiety, and sleep quality.

from The Journal of Pain http://www.jpain.org/article/S1526-5900(16)30292-9/fulltext?rss=yes
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Activation of the extracellular signal-regulated kinase in the amygdale modulates fentanyl-induced hypersensitivity in rats

Opioid-induced hyperalgesia (OIH) is one of the major problems associated with use of opioids in perioperative and chronic pain management. The mechanism underlying this paradoxical phenomenon needs to be fully elucidated. Laterocapsular division of central nucleus of amygdale (CeLC) has emerged as an important brain center for pain modulation, so we hypothesize that the activation of extracellular signal-regulated kinase (ERK) in CeLC may modulate OIH through strengthening synaptic transmission between neurons in CeLC.

from The Journal of Pain http://www.jpain.org/article/S1526-5900(16)30283-8/fulltext?rss=yes
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Pain Severity in Relation to the Final Menstrual Period in a Prospective Multiethnic Observational Cohort: Results from the Study of Women’s Health Across the Nation (SWAN)

The development of pain is common in midlife, resulting in increased healthcare utilization and costs. The aim of this study was to determine the longitudinal trajectory of overall bodily pain among women during the transition between the reproductive years and menopause. We conducted analyses on a community-based, longitudinal cohort of women enrolled in the Study of Women’s Health Across the Nation. One thousand four hundred and ninety-five women met inclusion criteria, including: 1) defined date of the final menstrual period (FMP) and 2) complete data on SF-36 bodily pain.

from The Journal of Pain http://www.jpain.org/article/S1526-5900(16)30282-6/fulltext?rss=yes
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Risk of pain medication misuse after spinal cord injury: The role of substance use, personality, and depression

Our purpose was to identify risk of pain medication misuse (PMM) among participants with spinal cord injury (SCI) by examining associations with multiple sets of risk factors including demographic and injury characteristics, pain experiences, frequency of pain medication use, substance use, personality, and depressive symptoms. Risk of PMM was defined by a cut-off score equal to or greater than 30 as measured by the Pain Medication Questionnaire (PMQ) and examined in 1,619 adults with traumatic SCI of at least 1-year duration who reported at least one painful condition and use of prescription pain medication using a cross-sectional design.

from The Journal of Pain http://www.jpain.org/article/S1526-5900(16)30281-4/fulltext?rss=yes
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Topical gabapentin gel alleviates allodynia and hyperalgesia in the chronic sciatic nerve constriction injury neuropathic pain model

Abstract

Background

Systemic gabapentin is a mainstay treatment for neuropathic pain though there are side-effects. Localized therapy may curtail such side-effects so a topical gabapentin dermal application was examined in the chronic constriction injury (CCI) model of neuropathic pain.

Methods

Partial denervation CCI was achieved by rat sciatic nerve ligation. Gabapentin gel (10% w/w) was applied three times daily on the ipsilateral or contralateral plantar surface of the hind-paw, whereas in a concurrent systemic study, gabapentin was intraperitoneally administered daily (75 mg/kg) for 30 days. Tests for static- and dynamic-mechano-allodynia [paw withdrawal threshold (PWT) to von Frey filament application and latency (PWL) to light brushing], cold-allodynia [paw withdrawal duration (PWD) to acetone], heat- (PWL and PWD) and mechano-hyperalgesia (PWD to pin prick) were utilized to assess pain, whereas effects on locomotion (open field) and motor balance (rotarod and footprint analysis) were measured on days 5–30 post surgery.

Results

Topical application of gabapentin gel ipsilaterally but not contralaterally alleviated CCI-induced static- (days 10–30) and dynamic-allodynia (days 15–30), suppressed cold-allodynia (days 10–30), heat- (days 15–30) and mechano-hyperalgesia (days 5–30) indicating a local action. Systemic gabapentin exhibited similar pain profiles but was associated with motor impairment. The gabapentin gel formulation afforded desirable neuropathic pain alleviating effects devoid of unwanted systemic side-effects.

Conclusions

These outcomes disclose an expedient pharmacological validation of the effectiveness of topical gabapentin gel against an extensive range of nociceptive stimulus modalities utilizing the CCI-induced neuropathic pain model. They also advocate further clinical studies on topical gabapentin with regard to certain neuropathic pain syndromes.

Significance

Systemic gabapentin neuropathic pain management carries side-effects ostensibly preventable by localized therapy. This study validates the effectiveness potential of a topical gabapentin gel against an extensive range of nociceptive stimulus modalities utilizing the chronic constriction injury-induced neuropathic pain model.

from European Journal of Pain http://ift.tt/2fAEVsh
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Medical specialists care and hospital costs for low back pain in the Netherlands

Abstract

Background

To examine the organization of medical specialist care and hospital costs for low back pain (LBP) in the Netherlands.

Methods

Aggregated health insurance claims data were provided on all diagnosis treatment combination (DTC) declarations for LBP patients first referred to the hospital in the 2nd half of 2008 and retrieved from Vektis, an organization that collects health insurance claims data. Data were available up to 1 January 2012. The data included patient characteristics, DTC-specific information including: neurology, neurosurgery, orthopaedic surgery, anaesthesiology and radiology.

Results

In total 80,652 LBP patients were referred to the hospital for the first time in the second half of 2008 accumulating to a total of 173,620 DTC's with total costs of €194 million. Of these patients, 56% were female and 61% aged above 50 years at first referral to the hospital. The average number of DTC's and costs per patient were 2.15 and €2410, respectively (during the follow-up period of 3.0–3.5 year). Moreover, 51% of the patients needed only one DTC; less than 10% of patients needed 5 DTC's. Following the DTC number, the share of consultations to the neurologist decreased, whereas that of the anaesthesiology specialism increased. The largest portion of costs was allocated to the anaesthesiology and neurosurgery specialisms.

Conclusions

In the Netherlands, LBP patients consult a variety of medical specialists, in particular, the neurology, hospital costs for LBP patients are expected to increase given the rising incidence. Optimal diagnosis and tailored treatment plans might result in reduced costs and improved patient outcomes.

Significance

Low back pain patients consult various specialists, with the majority first referred to the neurologist. More than half of the LBD patients require only one DTC and less than 10% needed five DTC's or more. The largest portion of the hospital costs for LBP patients is allocated to the anaesthesiology and neurosurgery specialisms.

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Do Patients With Chronic Low Back Pain Benefit From Early Intervention Regarding Absence From Work?: A Randomized, Controlled, Single-Center Pilot Study

Study Design. A randomized, controlled, single-center pilot study. Objective. The aim of this study was to investigate the feasibility of running a trial to explore if early intervention in individuals with chronic low back pain (CLBP) would lead to an early return to work (RTW) and reduce sick leave during 12 months of follow-up compared with patients on a 3-month waiting list. Summary of Background Data. Back pain is the reason for numerous absent days from work. In Norway, the government initiated a priority program, Earlier Return to Work (ERTW), to reduce work absences through early intervention. However, no proper evaluation has been performed on populations with CLBP. There is no consensus on how RTW should be measured. Only a few studies have examined how waiting time affects RTW. Methods. Fifty-eight patients were included in the study. The group with early intervention was examined within 2 weeks, and the group on the waiting list was examined after 12 weeks. The intervention was identical in both groups and consisted of an outpatient, intensive back school. The data were obtained by questionnaire after 3, 6, and 12 months. The primary outcome was absence from work. Results. The sample size in a full-scale study must comprise at least 382 patients on the basis of the assumptions in the pilot. In the pilot study, early intervention directly compared with an ordinary waiting list did not significantly affect the number of sick leave days after 12 months of follow-up. Conclusion. A prerequisite for launching a full-scale clinical trial is a redesign of the intervention, an improvement of procedures concerning inclusion and randomization, and finally a more precise definition of RTW. Level of Evidence: 3

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