British Journal of Pain最新文献

Introduction: The study aimed to validate the effectiveness of Wrist and Ankle Acupuncture (WAA) in attenuating moderate to severe postoperative pain following Functional Endoscopic Sinus Surgery (FESS).

Methods: Participants were randomly allocated into a treatment group (n = 57) and a control group (n = 58). The treatment group underwent WAA treatment, while the control group received sham acupuncture treatment. The Numeric Rating Scale (NRS) was employed to assess postoperative pain. The sleep efficiency, the amount of rescue medication, and the adverse events were also evaluated for both groups.

Results: A significant immediate reduction in NRS scores was observed in the treatment group (p < .01). At 2, 4, 8, 22, and 24 h after first treatment, pain intensity decreased in the WAA group compared with the control group (p < .01). Moreover, the WAA group demonstrated superior sleep efficiency relative to the control group on the night after surgery (p < .01). And the mean number of rescue tablets used on the WAA group was obviously lower than the control group (p < .01). There were no serious adverse events in both groups, and all adverse events completely disappeared within 3 days.

Conclusion: WAA effectively alleviated postoperative discomfort associated with nasal packing subsequent to FESS and enhanced sleep quality during the postoperative night. The anatomical superficiality of the acupuncture points employed reduces the risk of adverse events while yielding effective analgesic results, thus validating its suitability for clinical application.

Background: Elective lumbar spine surgery is increasingly being implemented to treat patients with specific low back pain. However, approximately 30% of patients continue to have long-term pain and disability after surgery.

Objective: The aim of this study was to systematically review the literature on the effectiveness of pre-surgical rehabilitation (prehab) alone or in combination with usual care versus usual care on patient-oriented outcomes and health-related costs following elective lumbar spine surgery.

Data sources: Electronic databases from MEDLINE, CINAHL, EMBASE, and AMED were systematically searched from their inception to November 2022.

Study selection: Randomized controlled trials that examined adult (age >18 years) prehab programs and evaluated one or more outcomes of interest were included in this review.

Data extraction: In pairs, six reviewers independently conducted a risk-of-bias assessment and extracted outcome data from included studies, in accordance with the Template for Intervention Description and Replication (TIDieR). A meta-analysis was conducted when trials were homogeneous.

Data synthesis: A total of eight trials (n = 739 participants), reported in 13 different manuscripts, were eligible for inclusion. Exercise prehab interventions are superior to usual care for disability at 3-month (MD: -2.56, 95% CI -4.98 to -0.15), back pain at 6-month (MD: -6.65, 95% CI -13.25 to -0.05), and health-related costs (MD: €2572.8, 95% CI: €1963.0 to €3182.5). CBT prehab interventions seem to be superior to usual care for back pain at 3-month (MD: -7.3, 95% CI: -14.5 to -0.05). Individual trials showed that education prehab interventions may be superior to usual for back pain at 1-month post-operative (MD: 12.3, 95% CI: 0.9 to 23.7).

Limitations: Overall, the inclusion of heterogeneous trials (e.g., diagnosis, types of surgery, dosage, content, and duration of interventions) with small sample sizes leads to inconclusive and very low certainty of effect estimates.

Conclusion: The present systematic review has brought to light the dearth of high-quality evidence in support of prehab interventions for patients undergoing lumbar spine surgery. Given the uncertainty surrounding the results obtained from low-quality randomized controlled trials, it is currently not feasible to provide recommendations for clinical practice.

Background: Many pain clinics encourage/mandate attendance at introductory group pain education sessions. Despite high non-attendance rates, no studies have examined consumer-reported reasons for non-attendance. Purpose: The aim of this study was to better understand why consumers fail to attend their pain education session. Research Design and Study Sample: We attempted to contact all non-attendees of our South Australian tertiary pain unit's group pain education sessions from February-August 2020. Of the 23 we could reach, 10 completed semi-structured telephone interviews. Data Analysis: Audio-recordings were transcribed verbatim and subject to thematic content analysis. Results: 'Attendance barriers' themes highlighted the complex lives of non-attendees. Pain prevented them from leaving their house, deterred them from travel to, and sitting through, the entire session. Competing responsibilities including other medical appointments and comorbidities were commonly mentioned. Most explicitly stated their dislike for the group format. Other factors included fear of the unknown nature of the session, not wanting education, and wanting a doctor's appointment. Several participants expressed a distrust of medical professionals, and perceived the benefits of attending as not exceeding the perceived time, money and pain associated. Conclusions: Pain management may not be individuals' main priority and attendance may only occur when other personal issues are addressed. Significant non-attendance rates may be unavoidable. Providing additional session detail may reduce misconceptions and allay concerns. Educating referring GPs may assist consumers to make an informed decision regarding attending. Online sessions may address various barriers and prove a more cost-effective alternative.

Perspective: This article examines consumers' reasons for non-attendance at pre-clinic group education programs. Findings could be used by Pain Units to shape patient and GP communications regarding such programs, as well as program content and format, to improve patient acceptance and program attendance, and potentially engagement with self-management.

Background: Perioperative opioid stewardship programs are increasingly being introduced to guide responsible use around the time of surgery to reduce opioid-related harm to patients. However, patient experiences of perioperative opioid stewardship programs are underexplored.

Methods: We designed a mixed methods study to explore patients' experiences of perioperative opioid stewardship in the post-operative period following spine surgery. We performed evaluative action research, combining quality improvement and ethnographic methodologies. Our quantitative methods were retrospective medical record review and targeted survey research. Our qualitative methods were online focus groups. The quantitative data were analysed using descriptive statistics, chi-square, and rank sum testing. The focus group data underwent inductive thematic analysis.

Results: Our spine surgery cohort for the four-month study period included 101 patients. The median total discharge opioid dispensed was 75 mg [interquartile range 75-150 mg], with 30% of patients prescribed modified release opioids on discharge. A subset of patients (N = 14) participated in the online focus groups. The key themes that emerged from these sessions were (1) Supportive care delivery and rescue mechanisms were universally important to patient participants, providing great reassurance during their recovery; (2) Participants commonly believed opioid analgesia had an important role in recovery following spine surgery. Some patients were keen to dispose of surplus opioids whilst others intended to retain them; (3) Opioid analgesia access was variable, but established community prescriber relationships were important for post-discharge opioid re-prescription, and (4) The key future improvement suggestions included routine post-discharge contact and enhanced communication options back to the hospital if needed.

Discussion and conclusions: Our mixed methods approach provided rich insights into the pain and opioid analgesia experiences of patients following spine surgery. These insights are useful when seeking to optimise perioperative opioid stewardship programs including better meeting the needs of patient consumers. Limitations included potential response and selection bias for the online focus groups towards younger, higher socioeconomic status patients.

Psychedelic substances have shown preliminary efficacy for several neuropsychiatric disorders and are currently being investigated for chronic pain conditions. However, few studies have investigated outcomes of naturalistic psychedelic use among individuals with chronic pain, and none have assessed psychedelic-related changes in substance use patterns in this population. In a cross-sectional survey of adults who reported using psychedelics to self-treat a chronic pain condition (n = 466; 46.1% women), we investigated changed substance use patterns and self-reported outcomes on physical and mental health following use of a psychedelic. Most (86.3%; n = 391/453) indicated that they ceased or decreased use of one or more non-psychedelic substances "as a result of" psychedelic use, and 21.2% (n = 83/391) indicated that the decrease in use persisted for more than 26 weeks after psychedelic use. Alcohol (71.1%; n = 226/318) and prescription opioids (64.1%; n = 100/156) had the highest proportions for ceased/decreased use. Illicit opioids (27.8%; n = 22/79) and cannabis (21.5%; n = 78/362) had the highest proportions for increased/initiated use. In multivariate regression modeling, having a motivation to reduce one's substance use was positively associated with ceasing/decreasing substance use (p < .001). Perceptions of health outcomes following psychedelic use were broadly positive, and psilocybin was reported to be the most effective substance for both physical and mental health symptoms. Although limited by a cross-sectional study design, findings from this large sample merit future investigation into the benefits and risks of naturalistic psychedelic use among individuals with chronic pain.

Introduction: Social prescribing links patients to community groups and services to meet health needs; however, it is uncertain what the benefits and impacts of social prescribing are for people with chronic pain. The National Institute for Health and Care Excellence (NICE) undertook a systematic review to investigate the clinical and cost effectiveness of social interventions aimed at improving the quality of life of people with chronic pain; no relevant clinical studies comparing social interventions with standard care for chronic pain were found, though the inclusion criteria for studies was narrow.

Objectives: To undertake a rapid review of all types of research and policy on social prescribing for adults with chronic pain in the U.K. (i) to describe the characteristics of relevant research and (ii) to synthesise data on impact.

Methods: A two-stage rapid review was planned. Stage (i) scoped and categorised knowledge from a comprehensive representation of the literature. In stage (ii), we undertook a descriptive synthesis of quantitative data along with a thematic analysis of qualitative data identified by stage (i).

Results: Of 40 full-text records assessed for inclusion, three met the inclusion criteria from academic databases. An additional five records were found in grey literature. Six records reported quantitative findings suggesting that social prescribing reduced pain severity and discomfort, pain medication and clinical appointments; and improved quality of life and ability to manage health. Five records captured qualitative data from interviews, case studies and anecdotal quotes that suggested positive impact on health and wellbeing; and increased self-efficacy in social prescribers undertaking training on pain.

Conclusions: There is tentative evidence that social prescribing improves health and wellbeing outcomes in adults with chronic pain and that there is a need to upskill social prescribers in contemporary pain science education. Research on the routes to referral, outcomes and impacts is needed.

Perspective: Social prescribing is valued and may be of benefit for people with chronic pain. There is a need to further develop and evaluate social prescribing services for people with chronic pain to enhance holistic patient centered care.

Objectives: Validate the English version of the Self-C ompassion Scale S hort-F orm (SCS-SF) as a reliable measure in chronic pain. Explore self-compassion's relationship with pain-related outcomes.

Methods: A total of 240 chronic pain patients (at 6-months) and 256 community participants (at 12-months) completed two prospective survey studies. SCS-SF psychometric properties were evaluated through exploratory and confirmatory factor analyses (EFA and CFA), exploratory structural equation modelling (ESEM), test-retest reliability (Pearson's r) and internal consistency (Cronbach's α) in both samples. Convergent validity/clinical relevance was assessed in the chronic pain sample via univariate linear regressions between self-compassion and pain intensity, interference, catastrophizing, self-efficacy, anxiety and depression.

Results: The SCS-SF showed acceptable internal consistency in both samples (α > 0.70, range = 0.74-0.79), high test-retest reliability over 6-months in the pain sample (r = 0.81, p < .001) and sub-threshold over 12-months in the community (r = 0.59 p < .001). EFA revealed a two-factor model distinguishing compassionate and uncompassionate self-responding in both samples. CFA identified a one-factor and two-factor model in both samples, but it did not meet statistical thresholds. ESEM identified the best fit for the chronic pain group was for a two-factor model (RMSEA and SRMR < 0.08; CFI and TLI > 0.90), whereas no models met acceptable fit criteria in the community group. A two-bifactor Bayesian model had suitable fit in both groups. In the chronic pain sample, SCS-SF and compassionate self-responding negatively predicted pain intensity, interference, anxiety, depression, catastrophizing and positively predicted self-efficacy over 6-months. Uncompassionate self-responding positively predicted anxiety, depression, catastrophizing and negatively predicted self-efficacy but did not predict pain outcomes.

Discussion: The SCS-SF is a reliable and valid measure in chronic pain. Total and sub-factor scores appear to have distinct relationships with pain outcomes. Future research should consider self-compassion as a unitary and/or bifactorial (consisting of compassionate and uncompassionate self-responding) construct in chronic pain when measured using the SCS-SF.

Objectives: Waitlists for pain management services are often extensive, risking psychological and physical decline and patient non-engagement in treatment once accessed. Currently, for outpatient pain management, no standardised waiting list interventions exist, resulting in passive waiting. To arrest prospective wait-related decline(s), this study aimed to identify the barriers and facilitators to pain self-management while waiting, forming the foundation for a waitlist intervention development.

Design: An inductive qualitative approach was utilised to explore the barriers and drivers of pain self-management while waiting for chronic pain management.

Method: Semi-structured interviews, underpinned by the Theoretical Domains Framework and COM-B model, were conducted with people waiting for pain management services (N = 38). Interviews were audio-recorded, transcribed verbatim, and analysed via reflexive thematic analysis.

Results: The analysis demonstrated four thematised barriers and one facilitator: (1) Shunted Around the System (barrier); (2) The Information Gap (barrier); (3) Resisting Adaptation (barrier); (4) Losing Hope (barrier); and (5) Help Yourself or Lose Yourself (facilitator).

Conclusion: This study demonstrates the severe emotional and motivational impact of waiting, increasing treatment disengagement. The waitlist represents a prime opportunity for prehabilitation to protect wellbeing and optimise self-management engagement. Infrastructural and interpersonal barriers of poor communication and healthcare professional pain invalidation must be addressed to improve emotional wellbeing and motivation to engage with planned treatment. Enhancing self-efficacy, pain acceptance, self-compassion, and internal HLOC are fundamental to increasing pain self-management. These can all be met within a prehabilitation framework. This study is foundational for the development of psychological prehabilitation in outpatient chronic pain management.