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1.
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.2.
Ali Pourmand Steven Davis Alex Marchak Tess Whiteside Neal Sikka 《Current pain and headache reports》2018,22(8):53
Purpose of Review
To evaluate the use of virtual reality (VR) therapies as a clinical tool for the management of acute and chronic pain.Recent Findings
Recent articles support the hypothesis that VR therapies can effectively distract patients who suffer from chronic pain and from acute pain stimulated in trials. Clinical studies yield promising results in the application of VR therapies to a variety of acute and chronic pain conditions, including fibromyalgia, phantom limb pain, and regional specific pain from past injuries and illnesses.Summary
Current management techniques for acute and chronic pain, such as opioids and physical therapy, are often incomplete or ineffective. VR trials demonstrate a potential to redefine the approach to treating acute and chronic pain in the clinical setting. Patient immersion in interactive virtual reality provides distraction from painful stimuli and can decrease an individual’s perception of the pain. In this review, we discuss the use of VR to provide patient distraction from acute pain induced from electrical, thermal, and pressure conditions. We also discuss the application of VR technologies to treat various chronic pain conditions in both outpatient and inpatient settings.3.
Sebastiano Mercadante Paolo Marchetti Arturo Cuomo Augusto Caraceni Rocco Domenico Mediati Massimo Mammucari Silvia Natoli Marzia Lazzari Mario Dauri Mario Airoldi Giuseppe Azzarello Mauro Bandera Livio Blasi Giacomo Cartenì Bruno Chiurazzi Benedetta Veruska Pierpaola Costanzo Daniela Degiovanni Flavio Fusco Vittorio Guardamagna Vincenzo Iaffaioli Simeone Liguori Vito Lorusso Sergio Mameli Rodolfo Mattioli Teresita Mazzei Rita Maria Melotti Valentino Menardo Danilo Miotti Stefano Moroso Stefano De Santis Remo Orsetti Alfonso Papa Sergio Ricci Alessandro Fabrizio Sabato Elvira Scelzi Michele Sofia Giuseppe Tonini Federica Aielli Alessandro Valle On behalf of the IOPS MS study group 《Advances in therapy》2017,34(1):120-135
Introduction
An ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here.Methods
Thirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity.Results
Background pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids.Conclusions
These preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients’ satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients.Funding
Molteni Farmaceutici, Italy.4.
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.5.
C. G. Levenig M. I. Hasenbring J. Kleinert M. Kellmann 《Schmerz (Berlin, Germany)》2016,30(5):437-443
Background
Many factors seem to be causal for non-specific low back pain and are sometimes controversially discussed. Some years ago the concept of subjective body image attracted attention but due to the inconsistent use of terms and concepts it is difficult to classify publications in the literature. Studies confirmed a difference between the body images of patients with low back pain and healthy controls so that an inclusion of body image concepts could be relevant for causation and therapy.Objective
This article presents an overview of the current state of research on the association between body image and low back pain and with respect to the allocation of body image in psychosocial concepts of low back pain.Material and methods
Relevant studies on body image and low back pain were reviewed and are discussed with respect to the different use of terms and concepts of body image. Moreover, an approach for integration of the body image into current psychosocial concepts and therapy of low back pain is presented. Finally, it is discussed whether consideration of the body image could be of value in the therapy of low back pain.Results
Studies have shown that low back pain patients have a more negative body image compared to healthy controls. There is a lack of studies on clinical evidence for the application and effectiveness of interventions that influence the body image in low back pain.Conclusion
Further studies are necessary which include body image concepts as a possible psychosocial risk factor, in particular studies on the mechanism of body image procedures.6.
Ivan Urits Abra H. Shen Mark R. Jones Omar Viswanath Alan D. Kaye 《Current pain and headache reports》2018,22(2):10
Purpose of Review
Complex regional pain syndrome (CRPS) refers to a chronic pain condition that is characterized by progressively worsening spontaneous regional pain without dermatomal distribution. The symptomatology includes pain out of proportion in time and severity to the inciting event. The purpose of this review is to present the most current information concerning epidemiology, diagnosis, pathophysiology, and therapy for CRPS.Recent Findings
In recent years, discovery of pathophysiologic mechanisms of CRPS has led to significant strides in the understanding of the disease process.Summary
Continued elucidation of the underlying pathophysiological mechanisms will allow for the development of more targeted and effective evidence-based therapy protocols. Further large clinical trials are needed to investigate mechanisms and treatment of the disorder.7.
Purpose of Review
The purpose of this review is to evaluate and explain our current understanding of the clinical use of buprenorphine in the treatment of chronic pain.Recent Findings
There has been few high-quality, unbiased studies performed on the use of buprenorphine in the treatment of chronic pain.Summary
Buprenorphine is an effective and safe analgesic that is tolerated at least as well, if not better, than other opioids. Given its safety and mechanistic advantages, the authors believe there is an important role for buprenorphine in the treatment of chronic pain severe enough to warrant the use of an opioid analgesic. Though data is lacking for superiority in chronic pain states, the other advantages of the molecule make it the preferential first-line opioid for around-the-clock pain in our practice.8.
Purpose of Review
This review will consider forms of atypical facial and head pain in children and adolescents. A brief and general overview of typical head and facial pains and treatments will be offered. Moreover, atypical head and face pain will be discussed with treatment options.Recent Findings
The most recent literature including case reports will be evaluated; possible pathophysiological mechanisms, resulting disabilities, and family and social impact will be discussed.Summary
General indications for pharmacological treatment will be reviewed, when needed in more disabling cases. Also, non-pharmacological treatments that are especially suitable for this category of patients will be illustrated and discussed.9.
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.10.
Ken P. EhrhardtJr Susan M. Mothersele Andrew J. Brunk Jeremy B. Green Mark R. Jones Craig B. Billeaud Alan David Kaye 《Current pain and headache reports》2018,22(4):26
Purpose of Review
Chronic pain is a highly prevalent condition affecting millions of individuals.Recent Findings
In recent years, newer treatments have emerged that are changing the way clinicians treat pain pathogenesis, including novel nonopioid strategies. In this regard, spinal cord stimulation, the MILD procedure, and regenerative medicine have shown promise. This review summarizes recent literature on these three emerging treatment strategies.Summary
The results of this review suggest that under certain conditions, spinal cord stimulation, the MILD procedure, and regenerative medicine can be effective treatment modalities.11.
Background
Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes.Methods
The databases MEDLINE, PubMed, and PsycINFO were searched from March to June 2016 using the keywords “psychosocial screening”, “low back pain”, “sciatica” and “prognosis”, “athletes”. We included prospective studies conducted in patients with low back pain with and without radiation to the legs, aged ≥18 years and a follow-up of at least 3 months.Results
We identified 16 eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) demonstrated a sufficient early prediction of return to work and the STarT Back Screening Tool (SBT) revealed acceptable performance predicting pain-related impairment. The prediction of future pain was sufficient with the Risk Analysis of Back Pain Chronification (RISC-BP) and the Heidelberg Short Questionnaire (HKF).Conclusion
Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.12.
13.
Kathleen A. Puntillo Adeline Max Jean-Francois Timsit Stephane Ruckly Gerald Chanques Gemma Robleda Ferran Roche-Campo Jordi Mancebo Jigeeshu V. Divatia Marcio Soares Daniela C. Ionescu Ioana M. Grintescu Salvatore Maurizio Maggiore Katerina Rusinova Radoslaw Owczuk Ingrid Egerod Elizabeth D. E. Papathanassoglou Maria Kyranou Gavin M. Joynt Gaston Burghi Ross C. Freebairn Kwok M. Ho Anne Kaarlola Rik T. Gerritsen Jozef Kesecioglu Miroslav M. S. Sulaj Michelle Norrenberg Dominique D. Benoit Myriam S. G. Seha Akram Hennein Fernando J. Pereira Julie S. Benbenishty Fekri Abroug Andrew Aquilina Julia R. C. Monte Youzhong An Elie Azoulay 《Intensive care medicine》2018,44(9):1493-1501
Purpose
The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain.Methods
Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0–10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects.Results
A total of 4812 procedures were recorded (3851 patients, 192 ICUs, 28 countries). Pain distress scores were highest for endotracheal suctioning (ETS) and tracheal suctioning, chest tube removal (CTR), and wound drain removal (median [IQRs]?=?4 [1.6, 1.7]). Significant relative risks (RR) for a higher degree of pain distress included certain procedures: turning (RR?=?1.18), ETS (RR?=?1.45), tracheal suctioning (RR?=?1.38), CTR (RR?=?1.39), wound drain removal (RR?=?1.56), and arterial line insertion (RR?=?1.41); certain pain behaviors (RR?=?1.19–1.28); pre-procedural pain intensity (RR?=?1.15); and use of opioids (RR?=?1.15–1.22). Patient-related variables that significantly increased the odds of patients having higher procedural pain distress than pain intensity were pre-procedural pain intensity (odds ratio [OR]?=?1.05); pre-hospital anxiety (OR?=?1.76); receiving pethidine/meperidine (OR?=?4.11); or receiving haloperidol (OR?=?1.77) prior to the procedure.Conclusions
Procedural pain has both sensory and emotional dimensions. We found that, although procedural pain intensity (the sensory dimension) and distress (the emotional dimension) may closely covary, there are certain factors than can preferentially influence each of the dimensions. Clinicians are encouraged to appreciate the multidimensionality of pain when they perform procedures and use this knowledge to minimize the patient’s pain experience.14.
Nalini Vadivelu Alice M. Kai Gopal Kodumudi Dan Haddad Vijay Kodumudi Niketh Kuruvilla Alan David Kaye Richard D. Urman 《Current pain and headache reports》2018,22(4):25
Purpose of Review
In the present investigation, current literature on the relationship between substance abuse and pain is evaluated in order to improve clinical management and its implications on the increasingly challenging chronic pain and substance abuse epidemic. The relationship between substance abuse and chronic pain are evaluated, and this review provides recommendations on the management of this special patient population.Recent Findings
Currently, there are limited guidelines for prescribing opioids and other analgesics in the chronic pain population. As this field of practice continues to evolve, it is essential for clinicians to serve as the gatekeepers to monitor for misuse and safety. Multiple studies have indicated that illicit drug use and opioid abuse affect over 9% of patients. Although there are numerous reasons for seeking illicit drugs and abusing them, it is essential that clinicians identify factors which place certain patients at high risk and accordingly, to screen these patients in order to optimize their management.Summary
The high prevalence of patients with chronic pain who also screen positive for drug use emphasizes the importance and increasingly pressing need to evaluate and to manage chronic pain in this population.15.
Manuel Dómine Gómez Nieves Díaz Fernández Blanca Cantos Sánchez de Ibargüen Luis Zugazabeitia Olabarría Joaquina Martínez Lozano Raúl Poza de Celis Rafael Trujillo Vílchez Ignacio Peláez Fernández Jaume Capdevila Castillón Susana Traseira Lugilde Emilio Esteban González 《Advances in therapy》2017,34(1):136-147
Introduction
Bone metastasis is the most common cause of cancer-related pain, and metastatic bone pain (MBP) is not only severe but also progressive in many patients. The aim of this study was to investigate the association between pain management and performance status in patients with metastatic bone cancer in the Spanish clinical setting.Methods
A 3-month follow-up prospective, epidemiologic, multicenter study was conducted in 579 patients to assess the evolution of their performance, the impact of pain control on sleep and functionality, and the degree of pain control according to analgesic treatment.Results
In patients with MBP, Eastern Cooperative Oncology Group (ECOG) status (1.5 ± 0.7–1.3 ± 0.7 and 1.3 ± 0.8; p < 0.001) and pain (6.5 ± 1.4–2.8 ± 1.9 and 2.1 ± 1.9; p < 0.001) improved significantly from baseline to months 1 and 3, as did functionality and sleep, after a treatment change consisting of increasing the administration of opioids. Evolution of ECOG and pain were closely related. ECOG and pain outcomes were significantly more favorable in patients treated with opioids versus non-opioid treatment, and in patients who did not need rescue medication versus those who did.Conclusions
MBP is currently poorly managed in Spain. ECOG improvement is closely and directly related to pain management in MBP. Opioid treatment and a lack of requirements for rescue medication are associated with better ECOG and pain outcomes in MBP patients.Funding
Mundipharma Pharmaceuticals S.L.16.
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.17.
Background
We aimed to explore the existing use of pain assessment tools and guidelines, and develop understanding of the practical considerations required to facilitate their use within the nursing home, hospital and community settings.Methods
A self-administered web-based survey was conducted with nurses, health and social care workers with an interest in the assessment of pain in older adults with cognitive impairment. The survey was distributed to participants in Austria, Belgium, Denmark, Germany, The Netherlands, Switzerland and United Kingdom.Results
Only a minority of staff reported use of (inter-)national or local standards or specific pain assessment tools in daily practice. A range of tools were reported as being used, which varied across country. While participants generally reported that these pain assessment tools were easy/very easy to use, many participants reported that they were difficult to interpret. Assessment is generally performed whilst providing nursing care. This was highlighted in 70–80% of all participating countries. While many of these tools rely on facial expression of pain, facial expressions were considered to be the least useful in comparison to other items. Furthermore findings showed that nurses employed in long-term care settings did not feel that they were educated enough in pain assessment and management.Conclusion
Our findings suggest that pain education is required across all countries surveyed. This should include a focus on guidelines and standards for assessment and subsequent management of pain. Findings suggest that clinical staff find interpreting facial expressions in relation to pain more difficult.18.
Background
Increased pain sensitivity is characteristic for patients with chronic pain disorder with somatic and psychological factors (F45.41). Persistent stress can induce, sustain, and intensify pain sensitivity, thereby modulating pain perception. In this context, it would be favorable to investigate which psychosocial stressors are empirically linked to pain sensitivity.Objectives
The aim of this study was to examine the relationship between psychosocial stressors and pain sensitivity in a naturalistic sample of patients with chronic pain disorder with somatic and psychological factors (F45.41).Materials and methods
We assessed 166 patients with chronic pain disorder with somatic and psychological factors (F45.41) at entry into an inpatient pain clinic. Pain sensitivity was measured with a pain provocation test (Algopeg) at the middle finger and earlobe. Stressors assessed were exposure to war experiences, adverse childhood experiences, illness-related inability to work, relationship problems, and potentially life-threatening accidents. Correlation analyses and structural equation modeling were used to examine which stressors showed the strongest prediction of pain sensitivity.Results
Patients exhibited generally heightened pain sensitivity. Both exposure to war and illness-related inability to work showed significant bivariate correlations with pain sensitivity. In addition to age, they also predicted a further increase in pain sensitivity in the structural equation model.Conclusions
Bearing in mind the limitations of this cross-sectional study, these findings may contribute to a better understanding of the link between psychosocial stressors and pain sensitivity.19.
Background
Interdisciplinary pain treatment has been shown to be effective for children and adolescents with chronic pain, both in an outpatient and inpatient setting. Until now, the effectiveness has been analyzed with various outcome measures. Although it has only rarely been used for adolescents so far, Chronic Pain Grading (CPG) developed by Von Korff could be an appropriate general outcome measure.Objective
The study aims at prospectively investigating and comparing the therapy outcome one year after initial presentation for both outpatients and inpatients using the CPG.Materials and methods
Data of 258 adolescents were gathered at initial presentation and one year later and analyzed using the CPG. Changes from pretreatment to follow-up and predictors of good therapy outcome were investigated for the whole sample and separately for outpatients and inpatients.Results
Compared to inpatients, outpatients were characterized by a lower CPG both before and one year after initial presentation. Large effects were found both for outpatient and inpatient therapy regarding the improvement of the CPG. In outpatient therapy, boys were two times more likely to display therapy success.Conclusion
The study shows that the CPG is an appropriate outcome measure to display the long-term effectiveness of an inpatient and outpatient interdisciplinary pain treatment. The interdisciplinary pain treatment needs to be better tailored to girls to improve its effectiveness.20.