Update in Pain Medicine (original) (raw)
Related papers
Pain, 2008
Chronic pain has been traditionally defined by pain duration, but this approach has limited empirical support; and does not account for chronic pain's multidimensionality. This study compared durationbased and prospective approaches to defining chronic pain in terms of their ability to predict future pain course and outcomes for primary care patients with three common pain conditions: back pain (n = 971), headache (n = 1078), or orofacial pain (n = 455). At baseline, their chronic pain was classified retrospectively based on Pain Days in the prior six months and prospectively with a prognostic Risk Score identifying patients with "possible" or "probable" chronic pain. The 0-28 Risk Score was based on pain intensity, pain-related activity limitations, depressive symptoms, number of pain sites, and Pain Days. Pain and behavioral outcomes were assessed at six-month follow-up, and long-term opioid use was assessed two to five years after baseline. Risk Score consistently predicted clinically significant pain at six months better than did Pain Days alone (Area under the Curve of 0.74-0.78 for Risk Score vs. 0.63-0.73 for Pain Days). Risk Score was a stronger predictor of future SF-36 Physical Function, pain-related worry, unemployment, and long-term opioid use than Pain Days alone. Thus, for these three common pain conditions, a prognostic Risk Score had better predictive validity for pain outcomes than did pain duration alone. However, chronic pain appears to be a continuum rather than a distinct class, because long-term pain outcomes are highly variable and inherently uncertain.
Pain, 2005
From a biopsychosocial perspective, assessing chronic pain's psychological impact should involve at minimum the measurement of pain severity, functional interference, and pain-related emotional burden. This article details the development of a brief instrument, the 15-item Profile of Chronic Pain: Screen (PCP:S), designed to address these three key elements in a national (US) sample of over 2400 individuals recruited via random digit dialing. Retest reliability, internal consistency, and preliminary validity were excellent. The scales also demonstrated minimal social desirability response bias. A series of confirmatory factor analyses on several distinct samples revealed a stable, 3-factor solution reflecting pain severity, interference, and emotional burden. Finally, national norms were developed by gender and three age groups. In view of its strong psychometric properties, the PCP:S has the potential to serve as a brief, cost-effective assessment tool for identifying individuals whose chronic pain merits more detailed psychosocial evaluation. q
Current Medical Research and Opinion, 2012
Objectives: This survey explores how physicians perceive chronic non-cancer pain, and examines their opinions on current treatment options. Methodology: The computer-based survey comprises a questionnaire that is completed by physicians, mostly at professional conferences and congresses, but also online. The focus is on pain specialists, primary care physicians and other specialists (such as neurologists and rheumatologists), to discover any differences in their approach to treating chronic non-cancer pain. Results: No common understanding existed of where severe pain starts on an 11-point Numeric Rating Scale. Overall, two-thirds of respondents aim for treatment to reduce pain intensity to an NRS score of 2-4, with primary care physicians tending to aim for lower scores. All three groups considered reduction of pain to be the most important treatment goal, followed by quality of life. Asked to rank the most important factors when choosing an analgesic agent to treat severe, chronic noncancer pain, respondents ranked efficacy first, tolerability second, and quality of life third. In each rank, more primary care physicians chose these options than in the specialist groups. More pain specialists used classical strong opioids often or very often-and for longer-than did physicians in the other two groups. Nausea/vomiting, bowel dysfunction and somnolence were ranked the first, second and third main reasons, respectively, for treatment failure with these agents. Over 90% of respondents used combination treatment rather than monotherapy to treat severe, chronic pain, but no fewer than 176 different combinations were cited. Conclusions: Pain reduction and improvement in quality of life are the most important treatment goals. Wide variation in treatment indicates that no single drug is particularly good for managing chronic pain, and suggests that current treatment is not evidence-based. Differences between the groups imply that first-line treatment is more cautious and conventional. The key limitations of this survey include its small sample size, informal implementation and lack of detail regarding the respondents surveyed.
The Journal of Pain, 2007
There are many types of pain assessments available to researchers conducting clinical trials, ranging from simple, single-item Visual Analog Scale (VAS) questions through extensive, multidimensional inventories. The primary question addressed in this survey of top-tier medical journals was: Which pain assessments are most commonly used in trials? Articles addressing chronic musculoskeletal pain in clinical trials were identified in seven major medical journals for the year 2003. A total of 50 studies (total original research articles reviewed: 1,476) met selection criteria, and from these we identified 28 types of pain assessments. Selected studies were classified according to the dimensions of pain assessed, the type of scale and descriptors/anchors used, and the reporting period specified. The most frequently used assessments were the single-item VAS scale and the Numeric Rating Scale (NRS); multidimensional inventories were used infrequently. There was considerable variability in the instructions patients received about the period to consider when evaluating their pain, and many studies provided only cursory information about their assessments in the methods. Overall, it appears that clinical trials utilize simple measures of pain and that there is no widely accepted standard for clinical pain assessment that would facilitate comparison of outcomes across trials.
A population-based survey of chronic pain and its treatment with prescription drugs
2011
Chronic pain is a common reason for medical visits, but prevalence estimates vary between studies and have rarely included drug treatment data. This study aimed to examine characteristics of chronic pain and its relation to demographic and health factors, and factors associated with treatment of pain with opioid analgesics. A chronic pain module was added to the 2007 Kansas Behavioral Risk Factor Surveillance System (response rate = 61%). Data on prevalence, duration, frequency, and severity of chronic pain, demographics, and health were collected from a representative sample of 4090 adults 18 years and older by telephone. Logistic regression was used to examine the association of both chronic pain and opioid use with demographic and health factors. Chronic pain was reported by 26.0% of the participants and was associated with activity limitations (adjusted odds ratio [AOR] = 3.6, 95% confidence interval [95% CI] 2.8-4.5), arthritis (AOR = 3.3, 95% CI 2.6-4.0), poor mental health (AOR = 2.0, 95% CI 1.4-2.8), poor overall health (AOR = 1.9; 95% CI 1.5-2.5), and obesity (AOR = 1.6; 95% CI 1.2-2.0). Of the 33.4% of people with pain who use prescription pain medication, 45.7% took opioids, including 36.7% of those with mild pain. Chronic pain affects a quarter of adults in Kansas and is associated with poor health. Opioid analgesics are the mainstay of prescribed pharmacotherapy in this group, even among those reporting mild pain.
Evidence-Based Strategies for Treatment and Referral of Chronic Pain in Primary Care
2018
Evidence-Based Strategies for Treatment and Referral of Chronic Pain in Primary Care Morgan Ann Bateman College of Nursing, BYU Master of Science Chronic pain is an ever present issue in the United States, with more people suffering from it than heart disease, cancer, and diabetes combined. Chronic pain is the most frequent complaint in primary care, and it poses significant challenges to both primary care providers (PCPs) and their patients. At the root of many of these challenges is the prescription and management of opioid prescription drugs used to treat chronic pain. Opiate misuse, abuse, and diversion are serious risks of opiate prescribing. Risk assessment tools are available to aid the PCP in determining the severity of risk for potential patient abuse, and include the Revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R), the Opioid Risk Tool (ORT), and the Brief Risk Questionnaire (BRQ). Patients who score “high” on these scales should be referred to pain...
European Journal of General Practice, 2006
Objectives: To evaluate the impact of using pain assessment scales on the management of musculoskeletal chronic pain. Methods: Cluster-randomized controlled multicentre trial in French general practice settings. Practices were randomized by region before patient recruitment. The inclusion concerned patients suffering from musculoskeletal chronic pain. General practitioners assigned to the scale group used two validated assessment instruments; those assigned to the control group cared for their patients according to their usual practice. The primary end-point was the level of relief obtained and the secondary changes in prescription of painkilling modalities. Results: A total of 155 general practitioners included 772 successive patients suffering from musculoskeletal chronic pain. The control group reported a mean level of relief of 50.7% compared with one of 41.1% in the scale group (pB/0.0001). In the intervention group, physicians decreased significantly their prescription of level two painkillers. Conclusions. In general practice, the use of pain assessment scales is not associated with greater pain relief. The lesser level of pain relief obtained in the scale group does provide evidence that using pain assessment scales does not enhance the relief of chronic pain in patients in primary care. Guidelines which recommend the systematic use of scales for the assessment and monitoring of chronic pain are not tailored to either the context or the patients encountered in the primary care setting.
A Longitudinal Analysis of Total Pain Scores for a Panel of Patients Treated by Pain Clinics
Health Services Research and Managerial Epidemiology
Background: There is a critical necessity to identify psychometric properties of the total pain score as a measurement of pain management effectiveness in the clinic. Purpose: In this article, we perform the analysis of the global pain scores from a panel of patients treated by 10 pain management physicians in a single group practice. Basic Procedures: The pain measurement consists of 4 pain subscales, namely physical pain, emotions, clinical outcome, and activities. A panel of 130 patients with 4 pain measurements is available to perform longitudinal analysis of the total pain scores. The analysis includes the following: (1) confirmatory factor analysis of the global pain scores with 4 related dimensions, (2) the stability of the pain scores between 2 clinical visits, (3) the change trajectories of pain scores in 4 waves of the pain measurement, and (4) the detection of physician variability in patients’ treatment outcomes measured by the reduction of total pain scores. Main Findin...
Pain, 2019
Normative data for chronic pain questionnaires are essential to the interpretation of aggregate scores on these questionnaires, for both clinical trials and clinical practice. In this study, we summarised data from 13,343 heterogeneous patients on several commonly used pain questionnaires that were routinely collected from 36 pain clinics in Australia and New Zealand as part of the electronic Persistent Pain Outcomes Collaboration (ePPOC) including the Brief Pain Inventory (BPI); the Depression Anxiety and Stress Scales (DASS); the Pain Self-Efficacy Questionnaire (PSEQ); and the Pain Catastrophizing Scale (PCS). The data are presented as summarised normative data, broken down by demographic (age, sex, work status, etc) and pain site/medical variables. The mean BPI severity score was 6.4 (moderate-severe), and mean interference score was 7.0. The mean DASS depression score was 20.2 (moderate-severe), mean DASS anxiety was 14.0 (moderate), and mean DASS stress was 21.0 (moderate). Th...