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1.
Background
Interdisciplinary pain therapy is nowadays the state of the art for the treatment of chronic unspecific back pain. The aim of this article is to present the retrospective analysis of the data from a 1-week intensive outpatient multimodal interdisciplinary pain therapy group program for treatment of patients with chronic unspecific back pain.Design and methods
The questionnaire-based data from patients who attended the program were evaluated before as well as 3 and 12 months after finishing the program. The patients were questioned regarding parameters, such as pain severity, quality of life, pain-related disability, depression and pain acceptance.Results
On average a significant improvement of all parameters after 3 and 12 months could be demonstrated (excluding the domains “social” and “environment” in the context of quality of life).Discussion
Interestingly, the results showed a significant improvement of almost all evaluated parameters even after a period of 12 months (unfortunately only data for 41 patients were available). In our opinion this improvement is due to the special constellation of the presented program, which with 1 week is relatively short but very intensive with 34?h of treatment. In addition, the program is integrated into a long-term multimodal outpatient treatment, a concept in which the multimodal treatment is individually continued after the 1?week program. On the other hand, the results especially after 12 months have to be interpreted particularly in this context.2.
Background
Supplementary pain-related recommendations for the treatment of chronic pain in children and adolescents are an essential component of multimodal pain treatment. Studies are scarce regarding adherence to these recommendations and their effectiveness.Objective
The aim of this study was to evaluate patient adherence to pain-related recommendations and their effectiveness 12 months after initial presentation of children and adolescents with chronic pain to a pediatric outpatient pain clinic.Materials and methods
A total of 413 patients were assessed using a structured telephone interview. The assessment included pain characteristics during the last 4 weeks as well as information regarding the implementation of the pain-related recommendations and the effectiveness. Due to different recommendations given to migraine patients this subgroup was dealt with separately.Results
Patients reported significant improvements 12 months after the initial presentation and 29.5?% of the patients were pain free. Adherence levels and estimated effectiveness regarding recommendations, such as change of lifestyle, multimodal inpatient treatment and use of medication were high. Other recommendations, such as active relaxation and outpatient psychotherapy had low adherence levels and low estimated effectiveness. Migraine patients had a significantly higher adherence rate and estimated effectiveness regarding the recommendation use of medication than non-migraine patients.Conclusion
The adherence level as well as the estimated effectiveness regarding the majority of pain-related recommendations was high. Some recommendations had low adherence rates and low estimated effectiveness. These results can help to further improve the performance of outpatient clinics for children and adolescents with chronic pain.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.
Patricia A. Poulin Noriyeh Rahbari Rebecca Small Catherine E. Smyth Taylor Hatchard Brahm K. Solomon Xinni Song Cheryl A. Harris John Kowal Howard J. Nathan Keith G. Wilson 《Supportive care in cancer》2016,24(10):4167-4175
Purpose
This study aims to examine if mindfulness is associated with pain catastrophizing, depression, disability, and health-related quality of life (HRQOL) in cancer survivors with chronic neuropathic pain (CNP).Method
We conducted a cross-sectional survey with cancer survivors experiencing CNP. Participants (n?=?76) were men (24 %) and women (76 %) with an average age of 56.5 years (SD?=?9.4). Participants were at least 1 year post-treatment, with no evidence of cancer, and with symptoms of neuropathic pain for more than three months. Participants completed the Five Facets Mindfulness Questionnaire (FFMQ), along with measures of pain intensity, pain catastrophizing, pain interference, depression, and HRQOL.Results
Mindfulness was negatively correlated with pain intensity, pain catastrophizing, pain interference, and depression, and it was positively correlated with mental health-related HRQOL. Regression analyses demonstrated that mindfulness was a negative predictor of pain intensity and depression and a positive predictor of mental HRQOL after controlling for pain catastrophizing, age, and gender. The two mindfulness facets that were most consistently associated with better outcomes were non-judging and acting with awareness. Mindfulness significantly moderated the relationships between pain intensity and pain catastrophizing and between pain intensity and pain interference.Conclusion
It appears that mindfulness mitigates the impact of pain experiences in cancer survivors experiencing CNP post-treatment.Implications for cancer survivors
This study suggests that mindfulness is associated with better adjustment to CNP. This provides the foundation to explore whether mindfulness-based interventions improve quality of life among cancer survivors living with CNP.5.
Background
After having completed medical treatment cancer patients often suffer from pain that can impair the quality of life. While young adolescents and adults (AYA) with cancer have become the focus of research during recent years, literature on the prevalence, quality and relief of pain in AYA patients is lacking.Objective
This study investigated psychosocial data on pain experienced by AYA patients (e.g. prevalence, type, distress, anxiety and need for support) and the association with the quality of life.Material and methods
Standardized and validated questionnaires were used for assessing pain and quality of life in AYA patients defined as the patient group between 18 and 39 years. Calculated regression models were summarized in a pathway model.Results
Out of 117 AYA patients (66?% women) 45 (39?%) suffered from pain and of these 73?% felt impaired due to the pain, 58 (50?%) had a fear of pain and 21 (20?%) reported a need for support. The severity of pain had a negative influence on physical functioning (β = ?0.335) and health-related satisfaction (β = ?0.415). Regarding the quality of life, 105 patients (90?%) were overall satisfied with their life. Dissatisfaction was reported in the areas of occupation (39.34?%), ability to relax (36.31?%), physical performance (34.29?%), income (32.27?%) and partnership/sexuality (29.25?%).Conclusion
This study provides evidence that pain plays a relevant role for AYA patients after the end of medical treatment. A substantial proportion of AYA patients reported the need for support so that the question arises whether medical pain management is sufficient, particularly as pain was associated with impairment and strongly negatively associated with health-related satisfaction.6.
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.7.
Zarine S. Patel Lauren K. Hoffman Dawn C. Buse Amy S. Grinberg Ladan Afifi Steven R. Cohen Michelle A. Lowes Elizabeth K. Seng 《Current pain and headache reports》2017,21(12):49
Purpose of Review
Hidradenitis suppurativa (HS) is a chronic, painful dermatologic disease characterized by recurrent inflammatory nodules and abscesses of intertriginous areas such as the axilla and groin. People with HS suffer from greater pain and associated psychological comorbidities, including depression, anxiety, disability, and impairments in quality of life (QoL), compared to those with other dermatologic conditions. Our review focuses on the occurrence of pain and these relationships.Recent Findings
The existing literature indicates that acute and chronic pain, depression, anxiety, and disability all contribute to poor quality of life in individuals with HS. Despite the central role of pain and distress in the presentation of HS, few studies have empirically evaluated the impact of pain and gaps remain in the existing psychosocial literature. There are no formal guidelines for treating HS-specific pain or psychological comorbidities.Summary
The results of this review show a clear and pressing need to develop treatment recommendations and effective interventions for addressing acute and chronic pain, psychological comorbidities, disability, and impaired quality of life among people with HS. This review outlines a multidisciplinary approach to treating and managing pain and psychological comorbidities.8.
V. Vion-Genovese C. Maindet D. Gillet C. Boscapomi S. Heritier A. Gauchet C. Rigolet L. Benitez J.-P. Petrod J. Amiel M. Baudrant 《Douleur et Analgésie》2017,30(3):123-127
Introduction
Patients and care providers came up with the idea of an educational tool for patients with chronic painMethodology
The educational sessions were developed over a five-year period, with four meetings per year.Results
“Kit KAD” answers the problems faced by patients in pain in everyday life. The “Kit KAD” offers tools and session leaders and can be used by any team trained in PTE (patient therapeutic education).Conclusion
The “Kit KAD” group, assisted on methodology by the Eastern region UTEP (Transversal Patient therapeutic Education Unit), created an innovative educational tool for patients in chronic pain.9.
S. Kaske R. Lefering B. Bouillon M. Maegele A. Driessen C. Probst C. Simanski 《Schmerz (Berlin, Germany)》2016,30(3):273-278
Background and objectives
Trauma patients often suffer from persisting pain even years after injury, and data on long-term pain management is lacking. The aim of this study was to evaluate the frequency of persisting pain and health-related quality of life (HrQoL) among trauma victims 2 years after injury. Furthermore, the frequency of pain specialist consultation and the quality of outpatient pain management, including phamacological management, was assessed.Materials and methods
We analyzed prospectively collected data on severely injured adult patients treated between 2008–2011 at the Cologne Merheim Medical Center (CMMC)/Germany. Data included the ‘Polytrauma Outcome Profile’ and a standardized questionnaire on outpatient pain management. Exclusion criteria were death, inability to answer the questionnaire due to cognitive disabilities and lack of language knowledge.Results and conclusions
207/391 (53?%) data sets were available for analysis, presenting a typical trauma collective with injury severity of ISS 19, predominantly male and a mean age of 44 years. 2 years after trauma 59?% still reported that they suffered from severe persisting pain; 53?% of these patients were under pharmacological pain medication. Only 1/5 of the patients with severe persisting pain was treated by a pain specialist. Successful treatment options do exist; improvement of treatment is required.10.
S. Tafelski T. Beutlhauser F. Bellin E. Reuter T. Fritzsche C. West M. Schäfer 《Schmerz (Berlin, Germany)》2016,30(2):158-165
Background
Constipation is a common complication in patients with opioid therapy. Additionally, patient-related risk factors also contribute to the development of constipation and these factors have to be integrated into an individualized treatment plan.Objective
The aim of this study was to assess the incidence of constipation in patients with opioid therapy in an outpatient setting and to analyze the risk factors that contribute to the development of constipation.Material and methods
This retrospective cohort study was conducted in two university affiliated outpatient departments at the Charité hospital in Berlin. The trial included all consecutively treated patients with opioid therapy of at least 4 weeks duration. The study was conducted from January 2013 to August 2013. Constipation was defined according to the Rome III criteria.Results
Out of 1166 screened patients, altogether 171 patients were included with a median duration of opioid therapy of 5 years. The most common diagnoses were back pain, musculoskeletal pain and neuropathic pain. In 14?% of the treated patients symptoms of constipation were detected and another 35?% needed laxatives for symptom control resulting in an overall incidence of constipation of 49?%. The remaining 51?% of the patients did not use any laxatives and did not experience symptoms of constipation. Age and dosing of opioid therapy significantly increased the risk of consipation but duration of opioid therapy was not related to the incidence of constipation.Discussion
The incidence of constipation in this population remains high although a relevant number of patients were intermittently free of symptoms without using laxatives. An individualized therapy plan and patient education seem to be important elements to control opioid-associated constipation.11.
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.12.
Background
Palliative care is an approach that improves the quality of life of patients with incurable and progressive illnesses; therefore, in these situations physiotherapy can play an important role.Aim
This study was carried out to examine the integration and utilization of physiotherapy in palliative and hospice care services in Germany.Methods
A cross-sectional survey including all palliative care units, specialized outpatient palliative care teams and hospices in Germany (n = 680) in 2013 was carried out.Results
The response rate was 43.5?% (n = 296). Physiotherapy is predominantly applied in palliative care units (79?%) but rarely in hospices (38?%) and outpatient palliative care teams (30?%). A structured physiotherapeutic assessment is rarely carried out even on palliative care units (26?%). Positive effects of physiotherapy are especially described for symptoms, such as edema, pain, constipation and dyspnea.Conclusion
Despite its significant potential to relieve symptoms, physiotherapy is not systematically integrated into palliative care practice in Germany.13.
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.14.
Carlo Cattaneo Jaime Kulisevsky Viviana Tubazio Paola Castellani 《Advances in therapy》2018,35(4):515-522
Introduction
Chronic pain is an important yet overlooked non-motor symptom of Parkinson’s disease (PD), caused by an imbalance of the dopaminergic and glutamatergic systems. Safinamide has a multimodal mechanism of action, dopaminergic (reversible MAO-B inhibition) and non-dopaminergic (modulation of the abnormal glutamate release), that might be beneficial for both motor and non-motor symptoms.Objectives
To investigate the long-term (2-year) efficacy of safinamide on PD chronic pain and to confirm the positive effects observed after 6 months of treatment.Methods
This is a post hoc analysis of the data from the 2-year study 018, focused on the reduction of concomitant pain treatments and on the scores of pain-related items of the Parkinson’s disease quality of life questionnaire (PDQ-39).Results
Safinamide, compared with placebo, significantly improved the PDQ-39 items 37 (“painful cramps or spasm,” p?=?0.0074) and 39 (“unpleasantly hot or cold,” p?=?0.0209) and significantly reduced the number of concomitant pain treatments by 26.2% (p?=?0.005). A significantly greater proportion of patients in the safinamide group was not using pain drugs after 2 years of treatment (p?=?0.0478).Conclusions
The positive effects of safinamide on PD chronic pain were maintained in the long term. Further investigations are desirable to confirm their clinical relevance.Funding
Zambon SpA.15.
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.16.
Background
Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between postoperative recovery and health-related quality of life 30 days after discharge.Methods
A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale and the Quality of Recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between postoperative recovery and health-related quality of life.Results
Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). Health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. Recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).Conclusion
Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.17.
S. Dreßke 《Schmerz (Berlin, Germany)》2016,30(4):333-338
Background
Every professional segment has its own typical forms of stress, which for members result in patterns of bodily conception and interpretation of pain. The way individuals cope with these typical forms of pain reflects their social identity, social status and group membership. In this study pain was investigated from a sociological perspective as a medium contributing to socialization processes in stress collectives.Objectives
Cultural conceptions of headache and migraine were investigated in members of blue collar occupations, in service professions and patients in specialized medical pain care.Materials and methods
In this study 49 qualitative biographical interviews were conducted with patients suffering from headache and migraine. The study population included persons from the general outpatient population and patients recruited from specialized inpatient pain clinics.Results
Members of blue collar occupations with specific body-oriented, mechanical stress patterns and dominant masculine attitudes, perceived headache and migraine as atypical deviations, which are contextualized as body pain. Professionals in the service sector with specific communicative-emotional work patterns perceived headache and migraine as typical and accepted deviations. Both pain conceptions represent dominant body norms and social commitments in each group; however, in specialized pain care these everyday concepts are transformed by increasing expert knowledge resulting in medicalized life styles and in identity conceptions conforming to the medical imperative.Conclusion
The success of specialized treatment of headache depends to a certain extent on the ability of patients to impose a medically regulated life style on their significant others; however, this can conflict with the demands of everyday life.18.
Purpose of Review
Total knee arthroplasty traditionally has been associated with significant postoperative pain that can limit recovery and prolong hospital length of stay. Recently, however, due to financial pressures and an emphasis on improving patient satisfaction, many institutions are implementing outpatient and short-stay programs for patients undergoing this procedure. An effective perioperative anesthetic plan is an essential quality of a successful outpatient joint replacement program.Recent Findings
Improved technology and innovation has led to more effective and efficient strategies that contribute to a smoother and quicker postoperative course. The use of peripheral nerve blocks in conjunction with a variety of systemic analgesics has reduced post-operative pain compared to older modalities. Specifically, the adductor canal and IPACK blocks have become increasingly popular due to their analgesic efficacy and muscle sparing characteristics.Summary
Outpatient knee arthroplasty is becoming a reality with advancements in surgical pathways that incorporate these newer modalities with an emphasis on multidisciplinary coordination.19.
Elina Kyösti Tero I. Ala-Kokko Pasi Ohtonen Outi Peltoniemi Paula Rautiainen Janne Kataja Hanna Ebeling Janne H. Liisanantti 《Intensive care medicine》2018,44(9):1378-1387
Purpose
Long-term data are urgently needed in children after intensive care. The aim of this study was to measure health-related quality of life 6 years after intensive care in a paediatric intensive care population.Methods
This national, multicentre study enrolled all children and young people admitted to intensive care units (ICUs) in Finland in 2009 and 2010. The data concerning ICU stay were collected retrospectively from the ICU data registries and combined with prospective data from Paediatric Quality of Life Inventory (PedsQL 4.0) questionnaires, the generic 15D, 16D or 17D instrument, and data regarding children’s chronic diagnoses and need for healthcare support.Results
The questionnaires were answered by 1109 of 3682 living children and adolescents admitted to an ICU, response rate was 30.1%. Among the responders, 90 children (8.4%) had poor (under ??2?SD) PedsQL scores. Children with low scores had a higher rate of chronic diagnoses (94.4% vs. 47.6%), medication on a daily basis (78.7% vs. 29.4%) and a greater need for healthcare services (97.7% vs. 82.2%) than those with normal scores. Diagnoses associated with poor quality of life were asthma, epilepsy, cerebral palsy and other neurological diseases, chromosomal alterations, cancer and long-term pain. These children were mostly admitted electively, and less frequently on an emergency basis, but no other significant differences were found during the intensive care stay.Conclusions
The long-term quality of life after paediatric intensive care is good for the majority of children and young people, and it is dependent on the number of chronic diagnoses and the burden of the chronic disease, especially neurological diseases.20.