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1.
Mansoor M. Aman R. Jason Yong Alan David Kaye Richard D. Urman 《Current pain and headache reports》2018,22(5):33
Purpose of Review
Fibromyalgia (FM) is the second most common rheumatologic pain disorder after osteoarthritis with a multisystem presentation. While the treatment of FM in a clinical setting incorporates both pharmacologic and non-pharmacologic modalities, the present investigation reviews evolving literature on cognitive behavioral and complementary medical therapies. The recent medical literature on FM was reviewed between 2012 and 2017 via MEDLINE and the Cochrane Central Registry of Controlled Trials, with an emphasis on randomized controlled trials, meta-analyses, and evidence-based treatment guidelines.Recent Findings
Cognitive behavioral therapy continues to play a significant role in the non-medical therapy of FM. It is especially helpful in high catastrophizing patients as evidenced by recent studies that note changes in the brain on functional magnetic resonance imaging. Mindfulness meditation can be helpful in improving pain symptoms and pain perception. No particular diet is found to have a meaningful impact in FM; however, various diets including low fermentable oligo- di –monosaccharides and polyols diet, gluten free, and hypocaloric may be helpful in ameliorating gastrointestinal distress in select patient populations. Current literature does not support the routine use of acupuncture for improving pain or quality of life in FM; however, given its benign side effect profile, it should not be discouraged.Summary
Goals for symptom management and pain control should be set early, and patient engagement remains critical in the management of this complex pain presentation. While low quality evidence exists for most non-pharmacologic treatment modalities for FM, CBT and mindfulness meditation show promise for future investigation.2.
Background
Parental reactions to their child’s pain can comprise cognitive-affective and behavioral responses. Dysfunctional responses like parental catastrophizing may lead to an aggravation of the child’s pain.Objectives
Aims of the online-based study were (1) to psychometrically evaluate existing questionnaires into cognitive-affective (Pain Catastrophizing Scale for Parents; PCS-P) and behavioral responses (Inventar zum schmerzbezogenen Elternverhalten; ISEV-E) within a sample of 105 healthy parents, and (2) to compare their responses to existing (inter)national clinical samples and to the reactions of 80 parents with self-reported chronic pain from the general population.Methods
The assessment of parental pain-related reactions was online-based.Results
While the factor structure of the ISEV-E could not be replicated, the three factors of the PCS-P could be replicated. Parental catastrophizing of the healthy parents was lower compared to clinical samples. Healthy parents did not differ from parents with chronic pain from the general population.Conclusion
The results offer a basis to grade parental catastrophizing, so that risk-groups can be identified.3.
Aims
Create an educational program in chronic pain (EPCP).Material and methods
We used a four-step process to create the EPCP tailored to patient’s needs.Results
Five groups of patients can benefit from the program annually. Based on their own assessment, patients stated that their knowledge of chronic pain improved between 2.8 to 24%. The satisfaction with the EPCP was 8.67/10.Conclusion
Our EPCP helps patients gain and maintain the skills they need to best manage their lives with a chronic pain.4.
Background
There is a dearth of research studies regarding the pain-related behavior of parents with children suffering from chronic pain. This study examined the pain-related reactions of mothers and fathers, analyzed changes in these reactions following the child’s inpatient interdisciplinary pain treatment and identified predictors for these changes.Method
Using validated questionnaires 40 mothers and 40 fathers of children suffering from chronic pain reported their pain-related responses and cognitive distortions at treatment commencement, immediately following therapy as well as at follow-up after 6 and 12 months.Results
At treatment commencement there were neither differences between maternal and paternal behavior nor in their reactions towards the sons and daughters. Immediately after treatment both parents showed increased distracting behavior and decreased solicitous behavior. Only the change in solicitous behavior showed long-term stability. The study identified the extent of parental catastrophizing at treatment commencement as well as changes in this reaction during treatment as predictors for reduction in solicitous behavior. The more parents reported catastrophizing thoughts at treatment commencement, the less they changed their solicitous behavior and strong changes in catastrophizing during treatment correlated with strong changes in solicitous reactions.Conclusion
Pain-related solicitous behavior can be modified by the interdisciplinary inpatient treatment of chronic pain in children and changes in solicitous behavior seem to be closely related to parental catastrophizing. This association should be considered when dealing with parents of children with chronic pain and also within the framework of future research projects.5.
Background
Pain, restriction of mobility and cognitive impairment are often present in old age and intensify each other.Objectives
Is there a relationship between mobility, pain, cognitive capacity, diagnoses and number of prescribed medication for residents of nursing homes?Methods
Subgroup analysis of the baseline data from an intervention study for optimization of the medication safety of 120 nursing home residents.Results
Pain was presumed in 77.8% of the residents. Persons with cognitive impairment were more frequently affected. The results of the observational and self-reported pain assessment in cognitively impaired patients did not agree for two-thirds of the cases. A correlation between prevalence of pain, pain intensity and mobility could only be shown for persons without cognitive impairment. Half of the persons were unable to walk; 80% of the residents with analgesics as a permanent medication were more restricted in their mobility.Conclusions
Cognitive impairment is associated with pain and reduced mobility, whereby self-rated pain did not concur with the observational pain assessment for two-thirds of the residents with cognitive impairment. This illustrates the difficulty of observational pain assessment.6.
Background
The subjective state of health with respect to pain and psyche was surveyed utilizing validated pain questionnaires in patients undergoing special pain therapy and represents the basis for targeted treatment measures.Objective
The purpose of this study was to investigate the possible distortion of answers due to social desirability of responses in chronic pain patients.Material and methods
During two survey periods assessing patient satisfaction using both anonymized and personalized questionnaires, the effects arising from socially desirable response patterns were analyzed. The sample consisted of chronic pain patients being treated in an inpatient therapy setting.Results
In both periods of observation no significant impact on the response behavior of chronic pain patients was found in personalized or anonymized questionnaires.Conclusion
The results of the study suggest that the responses of chronic pain patients with respect to their subjective state of health are not influenced by social desirability. Thus, scoring systems such as the German pain questionnaire will not be influenced by social desirability in chronic pain patients and can therefore be used as a part of diagnostics and therapy planning.7.
Purpose
The evidence for the effectiveness of psychological interventions for cancer patients is currently unclear. Acceptance and Commitment Therapy (ACT), which increases individual’s levels of psychological flexibility, may be more effective than other frameworks of psychological intervention, but good quality research is needed to inform adoption and implementation. This study explored the correlation between psychological flexibility and patient-reported outcomes to assess the viability of this intervention for cancer survivors.Methods
Recruitment was coordinated through a regional cancer centre. One hundred twenty-nine respondents completed a cross-sectional postal questionnaire. They were of mixed gender, diagnosis and cancer stage; a mean 61 years old; and a mean 207 days post-diagnosis. Self-report questionnaires assessed psychological flexibility, mood, anxiety, depression, stress, quality of life and benefit finding.Results
Psychological flexibility was a strong and consistent correlate of outcome; effects were maintained even when potentially confounding clinical and sociodemographic characteristics were controlled.Conclusions
Psychological flexibility can be modified through ACT-based interventions. Given the strong correlational evidence found in this study, it seems that such interventions might be useful for cancer survivors. High-quality and well-designed controlled trials are now needed to establish effectiveness.8.
Ali Alkan Zeynep Gulsum Guc Filiz Cay Senler Tugba Yavuzsen Handan Onur Mutlu Dogan Ebru Karci Arzu Yasar Elif Berna Koksoy Ozgur Tanriverdi Serdar Turhal Yuksel Urun Asiye Ozkan Dilsa Mizrak Hakan Akbulut 《Supportive care in cancer》2016,24(9):3747-3755
Purpose
Persistent postmastectomy pain syndrome (PMPS) is one of the most important disturbing symptoms. Posttraumatic stress disorder (PTSD) is an anxiety disorder which is characterized by reactions to reminders of the trauma that has been experienced. The purpose of this study is to evaluate the predictors of PMPS and PTSD in Turkish breast cancer survivors and the correlation between PMPS and PTSD.Method
The study is designed as a multicenter survey study. Breast cancer patients in remission were evaluated. Patients were evaluated with structured questionnaires to assess the PMPS and clinical parameters associated with it. The Turkish version of the posttraumatic stress disorder checklist—civilian version (PCL-C) was used.Results
Between February 2015 and October 2015, 614 breast cancer survivors in outpatient clinics were evaluated. The incidence of PMPS documented is 45.1 %. In the multivariate analysis low income, presence of PTSD and <46 months after surgery were associated with increased risk of PMPS. PTSD was documented in 75 %, and the mean PCL-C score was 32.4?±?11.1. PMPS and being married at the time of the evaluation were linked with PTSD.Conclusions
It is the first data about the association between PMPS and PTSD. The clinicians should be aware of PMPS and PTSD in breast cancer survivors.9.
Background
The in part promising, in part discrepant efficacy of psychological treatment of chronic musculoskeletal pain indicates a demand for interdisciplinary assessment and corresponding treatment structures with differentiated degrees of psychological and syndrome-specific specialization within a multimodal orthopedic context. Acceptance of pain and psychological flexibility are strongly related to physical impairments caused by pain.Objective
Goals are improved outcomes of medical and physical treatment measures as well as their flexible implementation in daily life through a differentially indicated psychological pain therapy focusing on pain acceptance and mindfulness.Methods
This study employed the “active not doing and generating inner silence” exercise from mindful-based pain therapy (“Achtsamkeitsbasierte Schmerztherapie”, ABST).Results
Pure observation of a problem without an attempt to solve it is unusual and strange. Prerequisites for such exercises are willingness to engage as well as courage and openness.Conclusion
A differentiated indication for clinical psychological treatment or psychotherapy of pain—a highly specialized form of psychological pain therapy—should be based on the diagnostic criterium of pain acceptance.10.
Background
Due to advances in oncological therapy options and increasing survival rates, the number of cancer patients with persistant pain, who are in need of analgesic therapy has increased. It has been proven that biopsychosocial mechanisms exist in patients with persistant non-cancer pain leading to chronification. Furthermore, addiction has been identified as a complication of analgesic therapy.Objective
Can the multidimensional model of chronic pain enhancement and chronification be used for patients with cancer pain, analogue to patients with non-cancer pain? Can addiction sydromes as a result of analgesic treatment be demonstrated?Material and methods
In this non-systematic review, a literature search was carried out for somatic and psychosocial chronification mechanisms in patients with cancer pain. Indications for potential addiction syndromes in cancer patients are demonstrated based on selected publications. A Medline search provided a number of relevant publications that are listed (see Supplementary Material).Results and discussion
Somatic chronification mechanisms, such as pain intensity, repetitive algesic stimuli, topical and demographic factors, are found both in persistant non-cancer pain and cancer pain. Cancer-induced peripheral and central sensitization mechanisms that can be due to underlying genetic variations, are specific for cancer pain. With regard to psychosocial determinants for pain chronification, both cancer and non-cancer patients show similar patterns. Furthermore, data from the literature support the existence of addiction in cancer patients.Conclusion
In order to optimize treatment more attention should be paid to the risk of chronification and addiction in cases of chronic persistant cancer pain.11.
12.
Background
Adequate pain management and palliative care structures are of significant importance in residential nursing homes. Whilst professional pain treatment and palliative care measures are frequently implemented for residents with oncological diseases, this is often not the case for residents with neurological disorders. Such a potential undertreatment is even more challenging when the means of interaction and communication with affected persons are aggravated by impairments in cognitive function.Objective
To examine differences in selected health care service characteristics between nursing home residents with Parkinson’s disease, Alzheimer’s disease and residents diagnosed with cancer.Material and methods
Secondary data analysis of residents’ survey and medical record data from 13 nursing homes as part of the study “Action Alliance Pain-free City Münster”.Results
Compared with residents with Parkinson’s disease and cancer, nursing home residents with Alzheimer’s disease exhibited significantly more severe impairment in cognitive function, less additional pain-associated diagnoses, shorter length of stay in nursing homes and more indications of pain.Conclusion
The generally high level of pain in all observed residents elucidates the principle necessity of adequate pain assessment and an interprofessional pain treatment. Furthermore, there seems to be a still unmet need for specifically adapted pain management strategies especially for the steadily increasing number of people with Parkinson’s disease and Alzheimer’s disease living in nursing homes. This should be a future high priority task for (nursing) practice and research against the background of the vulnerability of nursing home populations.13.
Background
In the context of improving perioperative pain management and shortening hospital stays, potent oral analgesics, such as slow release opioids, are gaining increasingly in importance.Objective
The aim of this study was to compare the use and effectiveness of different opioids in postoperative pain treatment in Germany.Materials and methods
Using data from the QUIPS database, the records of 5249 patients were evaluated. The total study population was divided into four groups: group 1 (10?mg oxycodone with or without naloxone 5?mg), group 2 (20?mg oxycodone with or without naloxone 10?mg), group 3 (piritramide) and group 4 (tramadol). Maximum pain intensity, pain-related interference with sleep and respiration, vomiting, postoperative fatigue, desire for more pain treatment and satisfaction with pain management were evaluated.Results and discussion
The differences in pain intensity were statistically significant between groups. Patients with piritramide reported more pain, more interference with sleep and respiration and more fatigue compared to those from the other groups. In the group with 10?mg oxycodone, the desire for additional pain medication was the lowest. Postoperative vomiting and satisfaction with pain management differed significantly between the four groups. Procedure-specific analysis has shown that differences between sub-groups were also significant following cholecystectomy and total knee arthroplasty.Conclusions
In summary, our findings suggest that postoperative pain treatment with slow release oral oxycodone does not show disadvantages compared to tramadol or piritramide with regard to pain-related impairments and opioid-induced side effects. This hypothesis needs to be further analyzed in controlled studies.14.
15.
Alexis R. Munoz Karen Kaiser Betina Yanez David Victorson Sofia F. Garcia Mallory A. Snyder John M. Salsman 《Supportive care in cancer》2016,24(12):4861-4870
Purpose
Young adult (YA) racial and ethnic minority survivors of cancer (diagnosed ages 18–39) experience significant disparities in health outcomes and survivorship compared to non-minorities of the same age. However, little is known about the survivorship experiences of this population. The purpose of this study is to explore the cancer experiences and health-related quality of life (HRQOL) among YA racial/ethnic minorities in an urban US city.Methods
Racial and ethnic minority YA cancer survivors (0 to 5 years posttreatment) were recruited from a comprehensive cancer center using a purposive sampling approach. Participants (n = 31) completed semi-structured interviews, the FACT-G (physical, emotional, social well-being) and the FACIT-Sp (spiritual well-being). Mixed methods data were evaluated using thematic analysis and analysis of covariance (ANCOVA).Results
The majority of survivors were women (65 %), single (52 %), and Hispanic (42 %). Across interviews, the most common themes were the following: “changes in perspective,” “emotional impacts,” “received support,” and “no psychosocial changes.” Other themes varied by racial/ethnic subgroups, including “treatment effects” (Hispanics), “behavior changes” (Blacks), and “appreciation for life” (Asians). ANCOVAs (controlling for gender and ECOG performance status scores) revealed that race/ethnicity had a significant main effect on emotional (P = 0.05), but not physical, social, or spiritual HRQOL (P > 0.05).Conclusions
Our findings suggest that minority YA cancer survivors report complex positive and negative experiences. In spite of poor health outcomes, survivors report experiencing growth and positive change due to cancer. Variations in experiences and HRQOL highlight the importance of assessing cultural background to tailor survivorship care among YA racial and ethnic minorities.16.
Background
Children and adolescents with severe hemophilia commonly suffer from acute and chronic pain as a consequence of hemophilia-related bleeding. Intervention-related pain also plays a major role. Despite its high prevalence in this patient group, hemophilia-related pain is not always adequately addressed and sufficiently treated.Objectives
This paper discusses how to improve pain management for children and adolescents (0–18 years) with hemophilia and which specific features in this population should influence decisions in pain management.Materials and methods
An expert panel discussed challenges in pain treatment in children and adolescents with hemophilia. Recommendations are based on evidence and clinical experience.Result
Pain management in children with hemophilia needs improvement. Children with hemophilia are at risk of developing chronic pain and of suffering traumatization due to insufficient pain management. Pain therapy can be challenging in these children as both their age and the underlying disease limit the options in particular in pain medication. The expert panel developed recommendations to improve pain management in children with hemophilia.17.
Youngki Cho Junghwa Do Sunyoung Jung Ohyun Kwon Jae Yong Jeon 《Supportive care in cancer》2016,24(5):2047-2057
Purpose
The aim of this study was to evaluate the effects of physical therapy (PT) combined with manual lymphatic drainage (MLD) on shoulder function, pain, lymphedema, visible cords, and quality of life (QOL) in breast cancer patients with axillary web syndrome (AWS).Methods
In this prospective, randomized trial, 41 breast cancer patients with visible and palpable cords on the arm and axilla and a numeric rating scale (NRS) pain score of >3 were randomly assigned to PT (3 times/week for 4 weeks; n?=?20) and PT combined with MLD (5 times/week for 4 weeks; PTMLD; n?=?21) groups. MLD was performed by a physical therapist and the patients themselves during week 1 and weeks 2–4, respectively. Arm volume, shoulder function (muscular strength; active range of motion; and disabilities of the arm, shoulder, and hand [DASH]); QOL (European Organization for Research and Treatment of Cancer Core and Breast Cancer‐Specific QOL questionnaires), and pain (NRS) were assessed at baseline and after 4 weeks of treatment.Results
QOL including functional and symptom aspects, shoulder flexor strength, DASH, and NRS scores were significantly improved in both groups after the 4-week intervention (P?<?0.05). NRS score and arm volume were significantly lower in the PTMLD group than in the PT group (P?<?0.05). Lymphedema was observed in the PT (n?=?6), but not PTMLD, group (P?<?0.05).Conclusions
PT improves shoulder function, pain, and QOL in breast cancer patients with AWS and combined with MLD decreases arm lymphedema.18.
K. Limbrecht-Ecklundt P. Werner H. C. Traue A. Al-Hamadi S. Walter 《Schmerz (Berlin, Germany)》2016,30(3):248-256
Background
The monitoring of facial expressions to assess pain intensity provides a way to determine the need for pain medication in patients who are not able to do so verbally.Objectives
In this study two methods for facial expression analysis – Facial Action Coding System (FACS) and electromyography (EMG) of the zygomaticus muscle and corrugator supercilii – were compared to verify the possibility of using EMG for pain monitoring.Material and methods
Eighty-seven subjects received painful heat stimuli via a thermode on the right forearm in two identical experimental sequences – with and without EMG recording.Results
With FACS, pain threshold and pain tolerance could be distinguished reliably. Multiple regression analyses indicated that some facial expressions had a predictive value. Correlations between FACS and pain intensity and EMG and pain intensity were high, indicating a closer relationship for EMG and increasing pain intensity. For EMG and FACS, a low correlation was observed, whereas EMG correlates much better with pain intensity.Conclusions
Results show that the facial expression analysis based on FACS represents a credible method to detect pain. Because of the expenditure of time and personal costs, FACS cannot be used properly until automatic systems work accurately. The use of EMG seems to be helpful in the meantime to enable continuous pain monitoring for patients with acute post-operative pain.19.
A. J. M. Beijers G. Vreugdenhil S. Oerlemans M. Eurelings M. C. Minnema C. M. Eeltink L. V. van de Poll-Franse F. Mols 《Supportive care in cancer》2016,24(6):2411-2420
Purpose
Chemotherapy-induced peripheral neuropathy (CIPN) may negatively influence multiple myeloma (MM) patients’ health-related quality of life (HRQOL). Dose modification is the only way to minimize CIPN. To measure CIPN in daily practice, the Indication for Common Toxicity Criteria (CTC) Grading of Peripheral Neuropathy Questionnaire (ICPNQ) was developed which can be completed within five minutes by the patient. The aims of this study were to (1) perform a psychometric evaluation of the ICPNQ and (2) examine the prevalence of CIPN and its influence on HRQOL in population-based MM patients.Methods
One hundred fifty-six MM patients, diagnosed between 2000 and 2014, completed the ICPNQ, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy 20 (EORTC QLQ-CIPN20), and EORTC QLQ-C30 (65 % response).Results
The psychometric analyses showed a Cronbach’s alpha of 0.84, 0.74, and 0.61 for, respectively, the sensory, motoric, and autonomic subscales of the ICPNQ. Test-retest reliability and construct validity were good for all subscales. Overall, 65 % of patients reported grade 2–3 neuropathy according to the ICPNQ. Patients with the highest CTC grades (grade 2 with neuropathic pain and grade 3 (38 %)) according to the ICPNQ reported significantly worse scores on all EORTC QLQ-CIPN20 subscales compared to patients with lower CTC grades (p ≤ 0.002). In addition, they reported statistically significant and clinically relevant worse HRQOL scores on almost all EORTC QLQ-C30 subscales.Conclusions
CIPN is a common side effect in MM patients, which has a negative impact on HRQOL. The ICPNQ is a valid instrument to distinguish the highest CIPN CTC grades from the lower CTC grades necessary to decide on dose modifications of chemotherapy in daily clinical practice.20.
Charles E. Heckler Sheila N. Garland Anita R. Peoples Michael L. Perlis Michelle Shayne Gary R. Morrow Charles Kamen Jenine Hoefler Joseph A. Roscoe 《Supportive care in cancer》2016,24(5):2059-2066