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Varying definitions of long-term opioid therapy: examining prevalence, prescription patterns, and substance-related adverse outcomes. 阿片类药物长期治疗的不同定义:研究患病率、处方模式和与药物相关的不良后果。
IF 2.9 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1093/pm/pnae051
Patrick D Quinn, Olena Mazurenko, Richard Meraz, Zheng Chang, Toyya A Pujol, Adam T Hirsh, Arvid Sjölander, Kurt Kroenke, Brian M D'Onofrio
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引用次数: 0
How initial perceptions of the effectiveness of mind and body complementary and integrative health therapies influence long-term adherence in a pragmatic trial. 在一项实用性试验中,对身心互补和综合保健疗法有效性的初步认识如何影响长期坚持治疗的情况。
IF 2.9 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1093/pm/pnae070
Steven B Zeliadt, Scott Coggeshall, Xiaoyi Zhang, Ethan W Rosser, David E Reed Ii, A Rani Elwy, Barbara G Bokhour, Joy A Toyama, Stephanie L Taylor

Objective: Beliefs and perceptions about pain intervention effectiveness when initiating a therapy may influence long-term engagement. This study examines how early perceived effectiveness of complementary and integrative health therapies impacts long-term engagement in a pragmatic trial context.

Participants: Veterans with chronic musculoskeletal pain participating in a pragmatic trial of provider-delivered complementary and integrative health therapies (acupuncture, chiropractic care, or massage therapy) used alone compared to combining those therapies with self-care therapies (yoga, Tai Chi/Qigong, or meditation). This analysis focuses on 1713 participants using self-care therapies at baseline.

Setting: 18 Veterans Healthcare Administration Medical Facilities.

Design: Prospective cohort study.

Methods: Predictors of total self-care complementary and integrative health therapy sessions over a 6-month assessment period were assessed using linear regression to determine how strongly perceptions of initial therapy effectiveness was associated with total utilization. Perception of initial therapy effectiveness was assessed at study entry across four domains (pain, mental health, fatigue, and general well-being).

Results: In total, 56% (1032/1713) of Veterans reported a positive perceived effectiveness of their recent complementary and integrative health therapy use at study initiation. Older individuals and those using meditation were more likely to report early positive perceptions. Mean number of therapy sessions over the 6-month study was 11 (range 1 to 168). Early positive perceptions had a small effect on overall use, increasing mean sessions by 2.5 (1.3 to 3.6). Other factors such as recent physical therapy use and distance to primary care explained more variation in total utilization.

Conclusions: Pragmatic pain trials should examine factors associated with engagement across assigned treatment protocols, especially if any of the treatment protocols being tested are sensitive to long-term engagement.

目的:在开始接受治疗时,对疼痛干预效果的信念和看法可能会影响长期参与度。本研究探讨了在一项实用性试验中,早期感知的补充和综合健康疗法的有效性如何影响长期参与度:患有慢性肌肉骨骼疼痛的退伍军人,他们参加了由医疗服务提供者提供的补充和综合健康疗法(针灸、整脊或按摩疗法)单独使用与将这些疗法与自我保健疗法(瑜伽、太极/气功或冥想)相结合的实用性试验。本分析主要针对基线使用自我保健疗法的 1713 名参与者:18家退伍军人医疗保健管理局医疗机构:设计:前瞻性队列研究:在为期 6 个月的评估期间,采用线性回归法对自我保健补充疗法和综合保健疗法总疗程的预测因素进行评估,以确定对初始疗法有效性的认知与总利用率之间的关联程度。在研究开始时,对初始治疗效果的感知在四个领域(疼痛、心理健康、疲劳和总体健康)进行评估:总共有 56% 的退伍军人(1032/1713)在研究开始时对他们最近使用的补充和综合保健疗法的有效性有积极的认知。年长者和使用冥想疗法的退伍军人更有可能在早期报告积极的感知。在为期 6 个月的研究中,平均治疗次数为 11 次(1 至 168 次不等)。早期的积极认知对总体治疗次数的影响较小,平均治疗次数增加了 2.5 次(1.3 至 3.6 次)。其他因素,如最近使用物理治疗和距离初级医疗机构的远近,则可以解释总使用量的更多变化:结论:务实的疼痛试验应检查与指定治疗方案中参与度相关的因素,尤其是如果测试的治疗方案对长期参与度敏感的话。
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引用次数: 0
Analgesic effects of intraperitoneal lidocaine in adults undergoing surgery: a systematic review and meta-analysis with trial sequential analysis. 接受手术的成人腹腔内利多卡因的镇痛效果:系统综述与试验序列分析》。
IF 2.9 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1093/pm/pnae052
Ka Ting Ng, Wei En Lim, Wan Yi Teoh, Mohd Fitry Bin Zainal Abidin

Objective: The administration of local anesthesia in intraperitoneal space as part of the multi-modal analgesic regimen has shown to be effective in reducing postoperative pain. Recent studies demonstrated that intraperitoneal lidocaine may provide analgesic effects. Primary objective was to determine the impact of intraperitoneal lidocaine on postoperative pain scores at rest.

Design: We carried out a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Methods: Databases of MEDLINE, EMBASE, and CENTRAL were searched from their inception date until May 2023. Randomized clinical trials (RCT) comparing intraperitoneal lidocaine and placebo in adults undergoing surgery were included.

Results: Our systematic review included 24 RCTs (n = 1824). The intraperitoneal lidocaine group was significantly associated with lower postoperative pain scores at rest (MD, -0.87, 95% CI, -1.04 to -0.69) and at movement (MD, -0.50, 95% CI, -0.93 to -0.08) among adult patients after surgery. Its administration also significantly decreased morphine consumption (MD, -6.42 mg, 95% CI, -11.56 to -1.27) and lowered the incidence of needing analgesia (OR, 0.22, 95% CI, 0.14 to 0.35). Intraperitoneal lidocaine statistically reduced time to resume regular diet (MD, 0.16 days; 95% CI, -0.31 to -0.01) and lowered postoperative incidence of nausea and vomiting (OR, 0.54, 95% CI, 0.39 to 0.75).

Conclusions: In this review, our findings should be interpreted with caution. Future studies are warranted to determine the optimal dose of administering intraperitoneal lidocaine among adult patients undergoing surgery.

目的:作为多模式镇痛方案的一部分,腹腔内局部麻醉可有效减轻术后疼痛。最近的研究表明,腹腔内利多卡因可提供镇痛效果。主要目的是确定腹腔注射利多卡因对术后休息时疼痛评分的影响:我们根据系统综述和荟萃分析的首选报告项目(PRISMA)进行了系统综述和荟萃分析:方法:检索 MEDLINE、EMBASE 和 CENTRAL 数据库,检索时间从开始检索之日起至 2023 年 5 月。纳入的随机临床试验(RCT)对接受手术的成人腹腔注射利多卡因和安慰剂进行了比较:我们的系统性综述包括 24 项 RCT(n = 1,824)。腹腔注射利多卡因组显著降低了成年患者术后休息时(MD:-0.87,95% CI:-1.04 至 -0.69)和运动时(MD:-0.50,95% Cl:-0.93 至 -0.08)的疼痛评分。腹腔注射利多卡因还能明显减少吗啡用量(MD:-6.42 毫克,95% Cl:-11.56 至-1.27),降低需要镇痛的发生率(OR:0.22,95% Cl:0.14 至 0.35)。腹腔内利多卡因在统计学上缩短了恢复正常饮食的时间(MD:0.16 天;95% Cl:-0.31 至 -0.01),并降低了术后恶心和呕吐的发生率(OR:0.54,95% Cl:0.39 至 0.75):在本综述中,应谨慎解释我们的研究结果。结论:在这篇综述中,我们的研究结果应谨慎解读,今后有必要开展研究,以确定对接受手术的成年患者腹腔注射利多卡因的最佳剂量。
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引用次数: 0
Impact of the COVID-19 pandemic on participants in pragmatic clinical trials for chronic pain: implications for trial outcomes and beyond. COVID-19 大流行对慢性疼痛实用临床试验参与者的影响:对试验结果及其他方面的影响。
IF 2.9 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1093/pm/pnae060
John J Sellinger, Kathryn Gilstad-Hayden, Christina Lazar, Karen Seal, Natalie Purcell, Diana J Burgess, Steve Martino, Alicia Heapy, Diana Higgins, Marc I Rosen

Objective: The COVID-19 pandemic had profound effects on society, including those living with chronic pain. This study sought to examine pandemic impacts on individuals enrolled in pragmatic clinical trials focused on nonpharmacological treatments for chronic pain.

Methods: We evaluated responses to a questionnaire on COVID-19 impacts that had been administered to participants (n=2024) during study enrollment in 3 pragmatic clinical trials for chronic pain treatment. All trials were part of the National Institutes of Health (NIH)-Department of Veterans Affairs (VA)-Department of Defense (DOD) Pain Management Collaboratory. COVID-19-related impacts on access to health care, mental health, finances, ability to meet basic needs, and social support were assessed.

Results: Pandemic impacts were found in all domains assessed, including access to health care, mental and emotional health, ability to meet basic needs, finances, and social support. Impacts varied by demographic and clinical characteristics. The participants most negatively impacted by the pandemic were younger, Black or Latino, female, more educated, and unemployed and had screened positive for depression. No impact differences were found with regard to alcohol use disorder screenings or a prior history of COVID-19. Higher levels of pain were associated with worse pandemic impacts, and negative impacts declined over time.

Conclusions: Negative impacts of the pandemic on individuals living with chronic pain cut across aspects of life that are also central to effective pain management, including access to health care, social support, and mental and emotional health, with differential impacts found across key demographic and clinical factors. These findings should yield consideration of pandemic impacts in clinical practice and as moderating effects of treatment outcomes in clinical trials conducted during the pandemic.

目的:COVID-19 大流行对包括慢性疼痛患者在内的社会产生了深远影响。本研究旨在探讨大流行对参加以慢性疼痛非药物治疗为重点的实用临床试验的个人的影响:我们评估了参加 3 项慢性疼痛治疗实用临床试验的参与者(人数为 2024 人)对 COVID-19 影响调查问卷的答复。所有试验都是美国国立卫生研究院(NIH)-退伍军人事务部(VA)-国防部(DOD)疼痛管理合作项目的一部分。评估了 COVID-19 对获得医疗保健、心理健康、财务、满足基本需求的能力和社会支持的影响:结果:大流行对所有评估领域都产生了影响,包括获得医疗保健、精神和情绪健康、满足基本需求的能力、财务状况和社会支持。不同的人口和临床特征造成的影响也不尽相同。受大流行病负面影响最大的参与者年龄较轻、为黑人或拉丁裔、女性、受教育程度较高、失业且抑郁症筛查呈阳性。在酒精使用障碍筛查或 COVID-19 既往史方面没有发现影响差异。疼痛程度越高,大流行带来的影响越严重,而负面影响会随着时间的推移而减少:大流行对慢性疼痛患者的负面影响涉及生活的方方面面,这些方面也是有效控制疼痛的核心,包括获得医疗保健、社会支持以及心理和情感健康。这些发现应有助于在临床实践中考虑大流行病的影响,并在大流行病期间进行的临床试验中考虑其对治疗结果的调节作用。
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引用次数: 0
Initial development of a self-report survey on use of Nonpharmacological and Self-Care Approaches for Pain management (NSCAP). 关于使用非药物和自我护理方法治疗疼痛的自我报告调查 (NSCAP) 的初步开发。
IF 2.9 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1093/pm/pnae082
Sara N Edmond, Robert D Kerns, Mary Geda, Stephen L Luther, Robert R Edwards, Stephanie L Taylor, Marc I Rosen, Julie M Fritz, Christine M Goertz, Steven B Zeliadt, Karen H Seal
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引用次数: 0
Toward facilitating the collection and utilization of patient-reported outcomes in the Military Health System: Lessons learned from a pragmatic clinical trial on physical therapy management for low back pain. 促进收集和利用军事卫生系统中的患者报告结果:从腰背痛理疗管理实用临床试验中汲取的经验教训。
IF 2.9 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1093/pm/pnae059
Emma H Beisheim-Ryan, Brad D Hendershot, Timothy C Mauntel, Sara R Gorczynski, Ryan W Smith, Andrea Crunkhorn, Shawn Farrokhi, Christopher L Dearth
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引用次数: 0
Recommendations for monitoring adherence and fidelity in pragmatic trials based on experience in the Pain Management Collaboratory. 基于疼痛管理合作实验室的经验,对监测实用性试验中的依从性和忠实性的建议。
IF 2.9 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1093/pm/pnae080
James Dziura, Kathryn Gilstad-Hayden, Cynthia J Coffman, Cynthia R Long, Qilu Yu, Eugenia Buta, Scott Coggeshall, Mary Geda, Peter Peduzzi, Tassos C Kyriakides

Objective: Most pragmatic trials follow the PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) criteria. The criteria specify unobtrusive measurement of participants' protocol adherence and practitioners' intervention fidelity but suggest no special monitoring strategies to assure trial integrity. We present experience with adherence/fidelity monitoring in the Pain Management Collaboratory (PMC) and provide recommendations for their monitoring in pragmatic trials to preserve inferences of treatment comparisons.

Methods: In November 2021, we surveyed 10 of 11 originally funded PMC pragmatic trials to determine the extent to which adherence and fidelity data were being monitored.

Results: Of the 10 PMC trials, 8 track adherence/fidelity. The electronic health record is the most frequent source for monitoring adherence (7/10) and fidelity (5/10). Most adherence data are used to monitor participant engagement with the trial intervention (4/10) and are reviewed by study teams (8/10) and often with a data and safety monitoring board (DSMB) (5/10). Half of the trials (5/10) reported using fidelity data for feedback/training; such data are not shared with a DSMB (0/10). Only 2 of 10 trials reported having prespecified guidance or rules around adherence/fidelity (eg, stopping rules or thresholds for corrective action, such as retraining).

Conclusions: As a best practice for pragmatic trials, we recommend early and regular adherence/fidelity monitoring to determine whether intervention delivery is as intended. We propose a 2-stage process with thresholds for intervening and triggers for conducting a formal futility analysis if adherence and fidelity are not maintained. The level of monitoring should be unobtrusive for both participants and those delivering the intervention; resulting data should be reviewed by an independent DSMB.

目的:大多数实用性试验都遵循实用性连续解释指标摘要(PRECIS-2)标准。该标准规定对参与者的方案依从性和从业人员的干预忠实性进行非侵入性测量,但未提出确保试验完整性的特殊监测策略。我们介绍了疼痛管理协作组(PMC)在依从性/忠实性监测方面的经验,并就在实用性试验中如何对其进行监测以保持治疗比较的推论提出了建议:2021年11月,我们调查了11项最初获得资助的PMC实用性试验中的10项,以确定对依从性和忠诚度数据的监控程度:结果:在 10 项 PMC 试验中,有 8 项对依从性/忠诚度进行了跟踪。电子健康记录是监测依从性(7/10)和忠实性(5/10)的最常见来源。大多数依从性数据用于监测参与者参与试验干预的情况(4/10),并由研究团队(8/10)和数据与安全监测委员会(DSMB)(5/10)进行审查。半数试验(5/10)报告使用忠实度数据进行反馈/培训;这些数据未与 DSMB 共享(0/10)。10项试验中仅有2项试验报告了有关依从性/忠实性的预设指导或规则(如停止规则或纠正措施的阈值,如再培训):作为实用性试验的最佳实践,我们建议尽早定期对依从性/忠实性进行监测,以确定干预措施的实施是否符合预期。我们提出了一个两阶段的流程,其中包括干预的阈值以及在坚持性和忠实性未得到维持的情况下进行正式徒劳性分析的触发点。监测的程度应该对参与者和干预实施者都没有干扰;监测所得数据应由独立的 DSMB 进行审核。
{"title":"Recommendations for monitoring adherence and fidelity in pragmatic trials based on experience in the Pain Management Collaboratory.","authors":"James Dziura, Kathryn Gilstad-Hayden, Cynthia J Coffman, Cynthia R Long, Qilu Yu, Eugenia Buta, Scott Coggeshall, Mary Geda, Peter Peduzzi, Tassos C Kyriakides","doi":"10.1093/pm/pnae080","DOIUrl":"10.1093/pm/pnae080","url":null,"abstract":"<p><strong>Objective: </strong>Most pragmatic trials follow the PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) criteria. The criteria specify unobtrusive measurement of participants' protocol adherence and practitioners' intervention fidelity but suggest no special monitoring strategies to assure trial integrity. We present experience with adherence/fidelity monitoring in the Pain Management Collaboratory (PMC) and provide recommendations for their monitoring in pragmatic trials to preserve inferences of treatment comparisons.</p><p><strong>Methods: </strong>In November 2021, we surveyed 10 of 11 originally funded PMC pragmatic trials to determine the extent to which adherence and fidelity data were being monitored.</p><p><strong>Results: </strong>Of the 10 PMC trials, 8 track adherence/fidelity. The electronic health record is the most frequent source for monitoring adherence (7/10) and fidelity (5/10). Most adherence data are used to monitor participant engagement with the trial intervention (4/10) and are reviewed by study teams (8/10) and often with a data and safety monitoring board (DSMB) (5/10). Half of the trials (5/10) reported using fidelity data for feedback/training; such data are not shared with a DSMB (0/10). Only 2 of 10 trials reported having prespecified guidance or rules around adherence/fidelity (eg, stopping rules or thresholds for corrective action, such as retraining).</p><p><strong>Conclusions: </strong>As a best practice for pragmatic trials, we recommend early and regular adherence/fidelity monitoring to determine whether intervention delivery is as intended. We propose a 2-stage process with thresholds for intervening and triggers for conducting a formal futility analysis if adherence and fidelity are not maintained. The level of monitoring should be unobtrusive for both participants and those delivering the intervention; resulting data should be reviewed by an independent DSMB.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":"25 Supplement_1","pages":"S41-S48"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Can ultrasound-guided medial branch blocks be used to select patients for cervical facet joint radiofrequency neurotomy? A matched retrospective cohort validation study. 超声引导下的内侧支阻滞可用于选择颈椎面关节射频神经切除术的患者吗?- 一项匹配的回顾性队列验证研究。
IF 2.9 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1093/pm/pnae054
Robert Burnham, Rory Trow, James Trow, Ashley Smith, Taylor Burnham

Background: Medial branch blocks are used to select patients for cervical facet joint radiofrequency neurotomy (CRFN). Blocks are typically performed under fluoroscopic guidance (ie, fluoroscopy-guided blocks [FLBs]). The validity of ultrasound-guided blocks (USBs) is not well established. No prior research has compared cervical USB validity and FLB validity with CRFN outcome used as the criterion standard.

Objective: To evaluate cervical USB versus FLB validity with CRFN outcome used as the criterion standard.

Methods: Demographic and outcome data were extracted from the electronic medical records of 2 affiliated musculoskeletal pain management clinics for all patients between 2015 and 2023 inclusive who had cervical USB leading to CRFN. CRFN outcomes of each USB patient were compared with those of a matched FLB patient from the radiofrequency neurotomy (RFN) outcome database of the same clinics. Matching variables included patient age, sex, pain duration, diagnostic/prognostic block paradigm, and CRFN number. Each patient completed a numeric rating scale (NRS) pain score and Pain Disability Quality-of-Life Questionnaire (PDQQ) just before and 3 months after CRFN. At repeat CRFN, patients provided a retrospective estimate of the duration and average magnitude (percentage) of relief after the CRFN.

Results: USB and FLB groups were comprised of 27 patients (58 RFNs) and 38 patients (58 RFNs), respectively. Post-RFN NRS pain severity and PDQQ-Spine scores demonstrated comparable (P > .05) absolute improvements, proportion of patients achieving ≥50% improvement, and attainment of the minimum clinically important difference. Retrospective estimates of pain relief magnitude and duration were also comparable.

Conclusions: This study finds cervical USB and FLB to be comparably valid as defined by their ability to predict CRFN outcome. Within the limitations of operator competence, USB can be used to select patients for CRFN.

背景:内侧支阻滞用于选择颈椎面关节射频神经切断术(CRFN)的患者。阻滞通常在透视引导(FLB)下进行。超声引导下阻滞(USB)的有效性尚未得到充分证实。之前没有研究以 CRFN 结果为标准,比较颈椎 USB 与 FLB 的有效性:以 CRFN 结果为标准,评估宫颈 USB 与 FLB 的有效性:从两家附属 MSK 疼痛管理诊所的 EMR 中提取了 2015 年至 2023 年(含 2023 年)期间所有接受颈椎 USB 导致 CRFN 的患者的人口统计学和结果数据。将每位 USB 患者的 CRFN 结果与同一诊所 RFN 结果数据库中匹配的 FLB 患者进行比较。匹配变量包括患者的年龄、性别、疼痛持续时间、诊断/预后阻断范式和 CRFN 编号。每位患者在 CRFN 前和 CRFN 后 3 个月都填写了 NRS 疼痛评分和疼痛残疾生活质量问卷 (PDQQ)。在再次进行 CRFN 时,患者对 CRFN 后疼痛缓解的持续时间和平均程度(%)进行了回顾性评估:USB组和FLB组分别有27名患者(58个RFN)和38名患者(58个RFN)。RFN后NRS疼痛严重程度和PDQQ-S评分的绝对改善程度、改善程度≥50%的患者比例和达到MCID的比例相当(P>0.05)。对疼痛缓解程度和持续时间的回顾性估计也具有可比性:本研究发现,根据预测 CRFN 结果的能力,颈椎 USB 和 FLB 的有效性相当。在操作者能力有限的情况下,USB 可用于选择 CRFN 患者。
{"title":"Can ultrasound-guided medial branch blocks be used to select patients for cervical facet joint radiofrequency neurotomy? A matched retrospective cohort validation study.","authors":"Robert Burnham, Rory Trow, James Trow, Ashley Smith, Taylor Burnham","doi":"10.1093/pm/pnae054","DOIUrl":"10.1093/pm/pnae054","url":null,"abstract":"<p><strong>Background: </strong>Medial branch blocks are used to select patients for cervical facet joint radiofrequency neurotomy (CRFN). Blocks are typically performed under fluoroscopic guidance (ie, fluoroscopy-guided blocks [FLBs]). The validity of ultrasound-guided blocks (USBs) is not well established. No prior research has compared cervical USB validity and FLB validity with CRFN outcome used as the criterion standard.</p><p><strong>Objective: </strong>To evaluate cervical USB versus FLB validity with CRFN outcome used as the criterion standard.</p><p><strong>Methods: </strong>Demographic and outcome data were extracted from the electronic medical records of 2 affiliated musculoskeletal pain management clinics for all patients between 2015 and 2023 inclusive who had cervical USB leading to CRFN. CRFN outcomes of each USB patient were compared with those of a matched FLB patient from the radiofrequency neurotomy (RFN) outcome database of the same clinics. Matching variables included patient age, sex, pain duration, diagnostic/prognostic block paradigm, and CRFN number. Each patient completed a numeric rating scale (NRS) pain score and Pain Disability Quality-of-Life Questionnaire (PDQQ) just before and 3 months after CRFN. At repeat CRFN, patients provided a retrospective estimate of the duration and average magnitude (percentage) of relief after the CRFN.</p><p><strong>Results: </strong>USB and FLB groups were comprised of 27 patients (58 RFNs) and 38 patients (58 RFNs), respectively. Post-RFN NRS pain severity and PDQQ-Spine scores demonstrated comparable (P > .05) absolute improvements, proportion of patients achieving ≥50% improvement, and attainment of the minimum clinically important difference. Retrospective estimates of pain relief magnitude and duration were also comparable.</p><p><strong>Conclusions: </strong>This study finds cervical USB and FLB to be comparably valid as defined by their ability to predict CRFN outcome. Within the limitations of operator competence, USB can be used to select patients for CRFN.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"671-674"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141469918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Screening, brief intervention, and referral to treatment for pain management for veterans separating from military service: study protocol of a hybrid type 2 study testing implementation facilitation versus training-as-usual. 退伍老兵疼痛管理的筛查、简短干预和转诊治疗:混合型 2 类研究的研究方案,测试实施促进与常规培训的对比。
IF 2.9 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1093/pm/pnae062
John J Sellinger, Marc I Rosen, Christina M Lazar, Kathryn Gilstad-Hayden, James Dziura, Fang-Yong Li, Kristin Mattocks, Adrienne Weede, Michael Sullivan-Tibbs, Liam Rose, Gabriela Garcia Vassallo, Ajay Manhapra, Amos Turner, Dawne Vogt, Eva N Woodward, Christine W Hartmann, Sally G Haskell, Amir Mohammad, Steve Martino

Background: Veterans transitioning to civilian life often have chronic pain from service-related musculoskeletal disorders (MSD) with higher risk for substance misuse. Many seek VA (Department of Veterans Affairs) compensation for MSD. Use of Screening, Brief Intervention, and Referral to Treatment for Pain Management (SBIRT-PM) by VA Post-9/11 Military2VA (M2VA) case managers presents an opportunity to engage these veterans in VA pain care and address substance misuse. Implementation facilitation might help case managers use SBIRT-PM and engage veterans in services to improve outcomes.

Design: This study is a 2-cohort multisite cluster-randomized hybrid type 2 effectiveness-implementation trial. Within 2 separate cohorts of 14 VA sites each, sites will be allocated to receive an implementation strategy through the use of a constrained randomization procedure: virtual implementation facilitation or training-as-usual. Sites and M2VA case managers will receive the assigned implementation strategy to support use of SBIRT-PM. Recently discharged veterans (n = 1848) claiming service-connected MSD will be recruited, with case managers blind to veterans' study enrollment. The proportion of participants who receive any SBIRT-PM will be the primary implementation outcome. Veteran participants will complete baseline, 12-week, and 36-week assessments, irrespective of whether case managers conduct SBIRT-PM with them (intent-to-treat). Pain intensity and interference will be the primary clinical outcomes. The study emphasizes pragmatic over explanatory methodological features.

Summary: This pragmatic trial will examine implementation facilitation versus training-as-usual in implementing SBIRT-PM to promote veteran engagement in nonpharmacological pain services. Using innovative methods to train and support VA case managers in SBIRT-PM, study outcomes could have broad implications for case management systems of care across the VA.

背景:过渡到平民生活的退伍军人通常会因服役相关的肌肉骨骼疾病(MSD)而产生慢性疼痛,并有较高的药物滥用风险。许多人因 MSD 而寻求退伍军人事务部(VA)的补偿。退伍军人事务部 Post-9/11 Military2VA (M2VA) 案例经理使用疼痛管理筛查、简单干预和转介治疗(SBIRT-PM)为这些退伍军人参与退伍军人事务部疼痛护理和解决药物滥用问题提供了机会。实施促进工作可帮助病例管理人员使用 SBIRT-PM 并让退伍军人参与服务,从而改善治疗效果:本研究是一项 2 个队列的多地点分组随机混合 2 型有效性实施试验。在由 14 个退伍军人医疗机构组成的 2 个独立队列中,各医疗机构将通过受限随机程序被分配接受一种实施策略:虚拟实施促进或常规培训。医疗点和 M2VA 案例经理将接受指定的实施策略,以支持 SBIRT-PM 的使用。我们将招募最近退伍的退伍老兵(n = 1848),他们声称自己因服役而患上了 MSD,病例管理员对退伍老兵的研究注册情况一无所知。接受任何 SBIRT-PM 的参与者比例将是主要的实施结果。退伍军人参与者将完成基线、12 周和 36 周评估,无论病例管理员是否对其进行 SBIRT-PM(意向治疗)。疼痛强度和干扰将是主要的临床结果。该研究强调实用性而非解释性的方法论特征。摘要:这项实用性试验将研究在实施 SBIRT-PM 以促进退伍军人参与非药物止痛服务时,实施促进与常规培训的对比情况。利用创新方法对退伍军人事务部的病例管理人员进行 SBIRT-PM 培训和支持,研究结果可能会对整个退伍军人事务部的病例管理系统产生广泛影响。
{"title":"Screening, brief intervention, and referral to treatment for pain management for veterans separating from military service: study protocol of a hybrid type 2 study testing implementation facilitation versus training-as-usual.","authors":"John J Sellinger, Marc I Rosen, Christina M Lazar, Kathryn Gilstad-Hayden, James Dziura, Fang-Yong Li, Kristin Mattocks, Adrienne Weede, Michael Sullivan-Tibbs, Liam Rose, Gabriela Garcia Vassallo, Ajay Manhapra, Amos Turner, Dawne Vogt, Eva N Woodward, Christine W Hartmann, Sally G Haskell, Amir Mohammad, Steve Martino","doi":"10.1093/pm/pnae062","DOIUrl":"10.1093/pm/pnae062","url":null,"abstract":"<p><strong>Background: </strong>Veterans transitioning to civilian life often have chronic pain from service-related musculoskeletal disorders (MSD) with higher risk for substance misuse. Many seek VA (Department of Veterans Affairs) compensation for MSD. Use of Screening, Brief Intervention, and Referral to Treatment for Pain Management (SBIRT-PM) by VA Post-9/11 Military2VA (M2VA) case managers presents an opportunity to engage these veterans in VA pain care and address substance misuse. Implementation facilitation might help case managers use SBIRT-PM and engage veterans in services to improve outcomes.</p><p><strong>Design: </strong>This study is a 2-cohort multisite cluster-randomized hybrid type 2 effectiveness-implementation trial. Within 2 separate cohorts of 14 VA sites each, sites will be allocated to receive an implementation strategy through the use of a constrained randomization procedure: virtual implementation facilitation or training-as-usual. Sites and M2VA case managers will receive the assigned implementation strategy to support use of SBIRT-PM. Recently discharged veterans (n = 1848) claiming service-connected MSD will be recruited, with case managers blind to veterans' study enrollment. The proportion of participants who receive any SBIRT-PM will be the primary implementation outcome. Veteran participants will complete baseline, 12-week, and 36-week assessments, irrespective of whether case managers conduct SBIRT-PM with them (intent-to-treat). Pain intensity and interference will be the primary clinical outcomes. The study emphasizes pragmatic over explanatory methodological features.</p><p><strong>Summary: </strong>This pragmatic trial will examine implementation facilitation versus training-as-usual in implementing SBIRT-PM to promote veteran engagement in nonpharmacological pain services. Using innovative methods to train and support VA case managers in SBIRT-PM, study outcomes could have broad implications for case management systems of care across the VA.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":"25 Supplement_1","pages":"S99-S106"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neuropsychiatric drugs and a neurophysiological marker as predictors of health-related quality of life in patients with phantom limb pain. 预测幻肢痛患者健康相关生活质量的神经精神药物和神经生理标志物。
IF 2.9 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1093/pm/pnae053
Valton Costa, Kevin Pacheco-Barrios, Anna Carolyna Gianlorenço, Felipe Fregni

Objective: To explore the relationship between sociodemographic, clinical, and neurophysiological variables and health-related quality of life (HR-QOL) of patients with phantom limb pain (PLP).

Methods: This is a cross-sectional analysis of a previous clinical trial. Univariate and multivariate linear and logistic regression analyses were used to model the predictors of HR-QOL. We utilized a sequential modeling approach with increasing adjustment levels, controlling for age and sex, and other relevant clinical variables (time since amputation, level of amputation, and pain). HR-QOL was assessed by the SF-36 Health Survey and its 8 subdomains.

Results: We analyzed baseline data from 92 patients with lower-limb amputations. They were mostly male (63%), 45.2 ± 15.6 years, with a mean time since amputation of 82.7 ± 122.4 months, and an overall SF-36 score of 55.9 ± 21.5. We found an association between intracortical facilitation (ICF) in the affected hemisphere, gabapentin usage, and HR-QOL. ICF is a predictor of better HRQOL, whereas gabapentin usage was associated with a poorer HR-QOL, with the main model explaining 13.4% of the variance in the outcome. For the SF-36 subdomains, ICF was also a positive predictor for social functioning, bodily pain, and vitality, while medication usage was associated with lower scores in mental health, general health perception, bodily pain, and vitality.

Conclusion: We found firsthand 2 new independent predictors of HR-QOL in individuals with PLP, namely, the neurophysiological metric ICF and gabapentin usage. These results highlight the role of the motor cortex excitability in the HR-QOL and stress the need for treatments that favor the neuroplastic adaptation after amputation, for which ICF may be used as a possible marker.

摘要探讨幻肢痛患者的社会人口学、临床和神经生理学变量与健康相关生活质量(HR-QOL)之间的关系:这是对之前一项临床试验的横断面分析。我们使用单变量和多变量线性及逻辑回归分析来建立 HR-QOL 的预测模型。我们采用了一种顺序建模方法,调整水平不断提高,并控制了年龄、性别和其他相关临床变量(截肢后时间、截肢程度和疼痛)。HR-QOL通过SF-36健康调查及其八个子域进行评估:我们分析了 92 名下肢截肢患者的基线数据。他们大多为男性(63%),年龄(45.2±15.6)岁,截肢后的平均时间(82.7±122.4)个月,SF-36 总分(55.9±21.5)分。我们发现,受影响半球的皮层内促进(ICF)、加巴喷丁的使用和 HR-QOL 之间存在关联。ICF 可预测较好的 HRQOL,而使用加巴喷丁则与较差的 HR-QOL 相关,主模型可解释 13.4% 的结果变异。就 SF-36 子域而言,ICF 也是社会功能、身体疼痛和活力的积极预测因子,而使用药物则与心理健康、一般健康感知、身体疼痛和活力的低分相关:我们首次发现了两个新的独立预测因素,即神经电生理指标 ICF 和加巴喷丁的使用。这些结果凸显了运动皮层兴奋性在心率-质量-生活质量中的作用,并强调需要采取有利于截肢后神经可塑性适应的治疗方法,而 ICF 可作为一种可能的标记。
{"title":"Neuropsychiatric drugs and a neurophysiological marker as predictors of health-related quality of life in patients with phantom limb pain.","authors":"Valton Costa, Kevin Pacheco-Barrios, Anna Carolyna Gianlorenço, Felipe Fregni","doi":"10.1093/pm/pnae053","DOIUrl":"10.1093/pm/pnae053","url":null,"abstract":"<p><strong>Objective: </strong>To explore the relationship between sociodemographic, clinical, and neurophysiological variables and health-related quality of life (HR-QOL) of patients with phantom limb pain (PLP).</p><p><strong>Methods: </strong>This is a cross-sectional analysis of a previous clinical trial. Univariate and multivariate linear and logistic regression analyses were used to model the predictors of HR-QOL. We utilized a sequential modeling approach with increasing adjustment levels, controlling for age and sex, and other relevant clinical variables (time since amputation, level of amputation, and pain). HR-QOL was assessed by the SF-36 Health Survey and its 8 subdomains.</p><p><strong>Results: </strong>We analyzed baseline data from 92 patients with lower-limb amputations. They were mostly male (63%), 45.2 ± 15.6 years, with a mean time since amputation of 82.7 ± 122.4 months, and an overall SF-36 score of 55.9 ± 21.5. We found an association between intracortical facilitation (ICF) in the affected hemisphere, gabapentin usage, and HR-QOL. ICF is a predictor of better HRQOL, whereas gabapentin usage was associated with a poorer HR-QOL, with the main model explaining 13.4% of the variance in the outcome. For the SF-36 subdomains, ICF was also a positive predictor for social functioning, bodily pain, and vitality, while medication usage was associated with lower scores in mental health, general health perception, bodily pain, and vitality.</p><p><strong>Conclusion: </strong>We found firsthand 2 new independent predictors of HR-QOL in individuals with PLP, namely, the neurophysiological metric ICF and gabapentin usage. These results highlight the role of the motor cortex excitability in the HR-QOL and stress the need for treatments that favor the neuroplastic adaptation after amputation, for which ICF may be used as a possible marker.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"679-686"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Pain Medicine
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