Pub Date : 2024-03-01DOI: 10.1177/20494637241237967
D. M. Aljohani, Patrice Forget
{"title":"Patient-centred approach in pain management: Solutions within reach?","authors":"D. M. Aljohani, Patrice Forget","doi":"10.1177/20494637241237967","DOIUrl":"https://doi.org/10.1177/20494637241237967","url":null,"abstract":"","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140089867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01Epub Date: 2023-09-05DOI: 10.1177/20494637231200324
Rémi Caron-Trahan, Anne-Eva Jusseaux, Maryse Aubin, Éloise Cardinal, Jennifer Aramideh, Moulay Idrissi, Nadia Godin, Mathieu Landry, Robert Urbanowicz, Pierre Rainville, Philippe Richebé, David Ogez
Background: Nearly a quarter of Canada's population suffers from chronic pain, a long-lasting medical condition marked by physical pain and psychological suffering. Opioids are the primary treatment for pain management in this condition; yet, this approach involves several undesirable side effects. In contrast to this established approach, non-pharmacological interventions, such as medical hypnosis, represent an efficient alternative for pain management in the context of chronic pain. HYlaDO is a self-hypnosis program designed to improve pain management for people with chronic pain. Purpose: This research aimed to evaluate the HYlaDO program based on the proof-of-concept level of the ORBIT model and investigated participants' subjective experience. Research design: Qualitative study. Study sample: Seventeen participants with chronic pain took part in this study. Data collection: We conducted individual semi-structured interviews with patients who had participated in HYlaDO to identify the three targets of desired change: pain, anxiety and autonomy in self-hypnosis practice. Results: Thematic analysis revealed that the practice of hetero-hypnosis and self-hypnosis decreased (i) pain and (ii) anxiety. Also, it (iii) indicated the development of an independent and beneficial self-hypnosis practice by having integrated the techniques taught. Conclusion: These results confirm that the established targets were reached and support further development, implementation and scaling up of this program. Consequently, we believe it is justified to move to the next step of program development.
{"title":"Practicing self-hypnosis to reduce chronic pain: A qualitative exploratory study of HYlaDO.","authors":"Rémi Caron-Trahan, Anne-Eva Jusseaux, Maryse Aubin, Éloise Cardinal, Jennifer Aramideh, Moulay Idrissi, Nadia Godin, Mathieu Landry, Robert Urbanowicz, Pierre Rainville, Philippe Richebé, David Ogez","doi":"10.1177/20494637231200324","DOIUrl":"10.1177/20494637231200324","url":null,"abstract":"<p><p><b>Background</b>: Nearly a quarter of Canada's population suffers from chronic pain, a long-lasting medical condition marked by physical pain and psychological suffering. Opioids are the primary treatment for pain management in this condition; yet, this approach involves several undesirable side effects. In contrast to this established approach, non-pharmacological interventions, such as medical hypnosis, represent an efficient alternative for pain management in the context of chronic pain. HYlaDO is a self-hypnosis program designed to improve pain management for people with chronic pain. <b>Purpose</b>: This research aimed to evaluate the HYlaDO program based on the proof-of-concept level of the ORBIT model and investigated participants' subjective experience. <b>Research design</b>: Qualitative study. <b>Study sample</b>: Seventeen participants with chronic pain took part in this study. <b>Data collection</b>: We conducted individual semi-structured interviews with patients who had participated in HYlaDO to identify the three targets of desired change: pain, anxiety and autonomy in self-hypnosis practice. <b>Results</b>: Thematic analysis revealed that the practice of hetero-hypnosis and self-hypnosis decreased (i) pain and (ii) anxiety. Also, it (iii) indicated the development of an independent and beneficial self-hypnosis practice by having integrated the techniques taught. <b>Conclusion</b>: These results confirm that the established targets were reached and support further development, implementation and scaling up of this program. Consequently, we believe it is justified to move to the next step of program development.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48188898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with inflammatory bowel disease (IBD) are often faced with distressing and confusing abdominal pain during remission. Some people respond adversely to healthcare professionals’ (HCPs) suggestions that this pain and related symptoms are due to secondary irritable bowel syndrome (IBS). Exploring how HCPs view, manage, and explain pain during quiescent disease may provide insights into how communication can be improved to increase understanding and mitigate negative responses. In-depth semi-structured interviews were conducted with 12 IBD-nurses ( n = 4) and gastroenterologists ( n = 8) working in the United Kingdom or the Netherlands. Reflexive thematic analysis was used to analyse interviews. Findings suggest that HCPs pay relatively little attention to pain when there is no underlying pathology and prefer to concentrate on objectifiable causes of symptoms and treating disease activity ( Theme 1: Focus on disease activity, not pain and associated symptoms). Explanations of abdominal pain and IBS-like symptoms during remission were not standardised ( Theme 2: Idiosyncratic and uncertain explanations for pain during remission). Processes of shared decision-making were outlined and shared sensemaking was reported as a strategy to enhance acceptance of IBS explanations ( Theme 3: Shared decision making versus shared sensemaking). Future work should focus on establishing how pain during remission may be best defined, when to diagnose IBS in the context of IBD, and how to explain both to patients. The formulation of standardised explanations is recommended as they might help HCPs to adopt practices of shared sensemaking and shared decision-making. Explanations should be adaptable to specific symptom presentations and different health literacy levels.
{"title":"Managing patients’ reports of abdominal pain and irritable bowel syndrome-like symptoms during quiescent inflammatory bowel disease: a role for shared sensemaking","authors":"Danielle Huisman, Felice Fernhout, Faye Moxham, Christine Norton, Kirsty Bannister, R. Moss‐Morris","doi":"10.1177/20494637241230807","DOIUrl":"https://doi.org/10.1177/20494637241230807","url":null,"abstract":"Patients with inflammatory bowel disease (IBD) are often faced with distressing and confusing abdominal pain during remission. Some people respond adversely to healthcare professionals’ (HCPs) suggestions that this pain and related symptoms are due to secondary irritable bowel syndrome (IBS). Exploring how HCPs view, manage, and explain pain during quiescent disease may provide insights into how communication can be improved to increase understanding and mitigate negative responses. In-depth semi-structured interviews were conducted with 12 IBD-nurses ( n = 4) and gastroenterologists ( n = 8) working in the United Kingdom or the Netherlands. Reflexive thematic analysis was used to analyse interviews. Findings suggest that HCPs pay relatively little attention to pain when there is no underlying pathology and prefer to concentrate on objectifiable causes of symptoms and treating disease activity ( Theme 1: Focus on disease activity, not pain and associated symptoms). Explanations of abdominal pain and IBS-like symptoms during remission were not standardised ( Theme 2: Idiosyncratic and uncertain explanations for pain during remission). Processes of shared decision-making were outlined and shared sensemaking was reported as a strategy to enhance acceptance of IBS explanations ( Theme 3: Shared decision making versus shared sensemaking). Future work should focus on establishing how pain during remission may be best defined, when to diagnose IBS in the context of IBD, and how to explain both to patients. The formulation of standardised explanations is recommended as they might help HCPs to adopt practices of shared sensemaking and shared decision-making. Explanations should be adaptable to specific symptom presentations and different health literacy levels.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140487109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-25DOI: 10.1177/20494637231208093
K. Greenfield, D. Schoth, Richard Hain, Simon Bailey, Christine Mott, Dilini Rajapakse, Emily Harrop, Kate Renton, Anna-Karenia Anderson, Bernie Carter, Margaret Johnson, C. Liossi
Breakthrough pain is common in life-limiting conditions and at end-of-life. Despite over 30 years of study, there is little consensus regarding the definition and characteristics of breakthrough pain. This study aims to update and expand a 2010 systematic review by Haugen and colleagues to identify (1) all definitions of breakthrough pain and (2) all descriptions and classifications of breakthrough pain reported by patients, caregivers, clinicians, and experts. This rapid systematic review followed the Cochrane Rapid Review Methods Group guidelines. A protocol is published on PROSPERO (CRD42019155583). CINAHL, MEDLINE, PsycINFO, and the Web of Science were searched for breakthrough pain terms from the inception dates of each database to 26th August 2022. We identified 65 studies that included data on breakthrough pain definitions, descriptions, or classifications from patients ( n = 30), clinicians ( n = 6), and experts ( n = 29), but none with data from caregivers. Most experts proposed that breakthrough pain was a sudden, severe, brief pain occurring in patients with adequately controlled mild-moderate background pain. However, definitions varied and there was no consensus. Pain characteristics were broadly similar across studies though temporal factors varied widely. Experts classified breakthrough pain into nociceptive, neuropathic, visceral, somatic, or mixed types. Patients with breakthrough pain commonly experienced depression, anxiety, and interference with daily life. Despite ongoing efforts, there is still no consensus on the definition of breakthrough pain. A compromise is needed on breakthrough pain nomenclature to collect reliable incidence and prevalence data and to inform further refinement of the construct.
{"title":"A rapid systematic review of breakthrough pain definitions and descriptions","authors":"K. Greenfield, D. Schoth, Richard Hain, Simon Bailey, Christine Mott, Dilini Rajapakse, Emily Harrop, Kate Renton, Anna-Karenia Anderson, Bernie Carter, Margaret Johnson, C. Liossi","doi":"10.1177/20494637231208093","DOIUrl":"https://doi.org/10.1177/20494637231208093","url":null,"abstract":"Breakthrough pain is common in life-limiting conditions and at end-of-life. Despite over 30 years of study, there is little consensus regarding the definition and characteristics of breakthrough pain. This study aims to update and expand a 2010 systematic review by Haugen and colleagues to identify (1) all definitions of breakthrough pain and (2) all descriptions and classifications of breakthrough pain reported by patients, caregivers, clinicians, and experts. This rapid systematic review followed the Cochrane Rapid Review Methods Group guidelines. A protocol is published on PROSPERO (CRD42019155583). CINAHL, MEDLINE, PsycINFO, and the Web of Science were searched for breakthrough pain terms from the inception dates of each database to 26th August 2022. We identified 65 studies that included data on breakthrough pain definitions, descriptions, or classifications from patients ( n = 30), clinicians ( n = 6), and experts ( n = 29), but none with data from caregivers. Most experts proposed that breakthrough pain was a sudden, severe, brief pain occurring in patients with adequately controlled mild-moderate background pain. However, definitions varied and there was no consensus. Pain characteristics were broadly similar across studies though temporal factors varied widely. Experts classified breakthrough pain into nociceptive, neuropathic, visceral, somatic, or mixed types. Patients with breakthrough pain commonly experienced depression, anxiety, and interference with daily life. Despite ongoing efforts, there is still no consensus on the definition of breakthrough pain. A compromise is needed on breakthrough pain nomenclature to collect reliable incidence and prevalence data and to inform further refinement of the construct.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139157581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-19DOI: 10.1177/20494637231221647
Joanne O’Brien-Kelly, David Moore, Ian O’Leary, T. O’Connor, Zena Moore, D. Patton, L. Nugent
To develop an eHealth resource to support fibromyalgia patients and explore it for usability and impact on their self-management and self-efficacy. Fibromyalgia is a complex, non-progressive chronic condition characterised by a bewildering array of symptoms for patients to self-manage. International guidelines recommend patients receive illness-specific information once diagnosed to promote self-management and improve health-related quality of life. A 3-phase mixed methods exploratory sequential design. Qualitative interviews explored the information and self-management needs of fibromyalgia patients attending a large tertiary hospital in Dublin. Identified themes together with an extensive review of the literature of interventions proven to be impactful by patients with fibromyalgia were utilised in the design and development of the eHealth resource. The resource was tested for usability and impact using pre and post-intervention outcomes measures. Patient interviews highlighted a lack of easy accessible evidenced information to support self-management implicating the urgent need for a practical solution through development of a tailored eHealth resource. Six themes emerged for inclusion; illness knowledge, primary symptoms, treatment options, self-management strategies, practical support and reliable resources. Forty-five patients who tested the site for usability and impact demonstrated a statistically significant improvement in self-efficacy after 4 weeks access with a medium positive effect size. Patients with the most severe fibromyalgia impact scores pre-intervention demonstrated the most improvement after 4 weeks. Patients gave the resource a System Usability Score A rating, highly recommending it for fellow patients diagnosed with fibromyalgia. The study demonstrated how the development of a novel eHealth resource positively impacted fibromyalgia patients’ self-efficacy to cope with this debilitating condition. This study suggests that access to eHealth can positively impact patients self-efficacy, has the potential to be a template for eHealth development in other chronic conditions, supporting advanced nurse practitioners working in chronic disease management.
开发一种支持纤维肌痛患者的电子保健资源，并探索其可用性及其对患者自我管理和自我效能的影响。纤维肌痛是一种复杂的非进行性慢性疾病，其特点是患者需要自我管理的症状令人困惑。国际指南建议患者在确诊后接受针对具体疾病的信息，以促进自我管理并改善与健康相关的生活质量。采用三阶段混合方法探索性顺序设计。定性访谈探讨了在都柏林一家大型三甲医院就诊的纤维肌痛患者对信息和自我管理的需求。在设计和开发电子健康资源的过程中，利用了所确定的主题以及对纤维肌痛患者证明有效的干预措施文献的广泛回顾。利用干预前和干预后的结果测量，对该资源的可用性和影响进行了测试。对患者的访谈显示，他们缺乏易于获取的有据可查的信息来支持自我管理，这意味着迫切需要通过开发量身定制的电子健康资源来找到切实可行的解决方案。该网站包含六个主题：疾病知识、主要症状、治疗方案、自我管理策略、实际支持和可靠资源。45 名患者对网站的可用性和影响进行了测试，结果表明，在使用网站 4 周后，患者的自我效能感有了显著提高，且效果中等。干预前纤维肌痛影响评分最严重的患者在 4 周后的改善幅度最大。患者对该资源的系统可用性评分为 A 级，并强烈推荐给其他被诊断为纤维肌痛的患者。这项研究表明，开发新型电子健康资源如何对纤维肌痛患者应对这种衰弱病症的自我效能产生积极影响。这项研究表明，获取电子健康资源可对患者的自我效能产生积极影响，并有可能成为其他慢性病电子健康资源开发的模板，为从事慢性病管理的高级执业护士提供支持。
{"title":"Development and impact of a tailored eHealth resource on fibromyalgia patient’s self-management and self-efficacy: A mixed methods approach","authors":"Joanne O’Brien-Kelly, David Moore, Ian O’Leary, T. O’Connor, Zena Moore, D. Patton, L. Nugent","doi":"10.1177/20494637231221647","DOIUrl":"https://doi.org/10.1177/20494637231221647","url":null,"abstract":"To develop an eHealth resource to support fibromyalgia patients and explore it for usability and impact on their self-management and self-efficacy. Fibromyalgia is a complex, non-progressive chronic condition characterised by a bewildering array of symptoms for patients to self-manage. International guidelines recommend patients receive illness-specific information once diagnosed to promote self-management and improve health-related quality of life. A 3-phase mixed methods exploratory sequential design. Qualitative interviews explored the information and self-management needs of fibromyalgia patients attending a large tertiary hospital in Dublin. Identified themes together with an extensive review of the literature of interventions proven to be impactful by patients with fibromyalgia were utilised in the design and development of the eHealth resource. The resource was tested for usability and impact using pre and post-intervention outcomes measures. Patient interviews highlighted a lack of easy accessible evidenced information to support self-management implicating the urgent need for a practical solution through development of a tailored eHealth resource. Six themes emerged for inclusion; illness knowledge, primary symptoms, treatment options, self-management strategies, practical support and reliable resources. Forty-five patients who tested the site for usability and impact demonstrated a statistically significant improvement in self-efficacy after 4 weeks access with a medium positive effect size. Patients with the most severe fibromyalgia impact scores pre-intervention demonstrated the most improvement after 4 weeks. Patients gave the resource a System Usability Score A rating, highly recommending it for fellow patients diagnosed with fibromyalgia. The study demonstrated how the development of a novel eHealth resource positively impacted fibromyalgia patients’ self-efficacy to cope with this debilitating condition. This study suggests that access to eHealth can positively impact patients self-efficacy, has the potential to be a template for eHealth development in other chronic conditions, supporting advanced nurse practitioners working in chronic disease management.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138959063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-19DOI: 10.1177/20494637231221688
Nicola Cornwall, Charlotte Woodcock, Julie Ashworth, Sarah A Harrisson, L. Dikomitis, Simon White, T. Helliwell, Eleanor Hodgson, R. Knaggs, Tamar Pincus, M. Santer, Christian D Mallen, Clare Jinks
Regular review of patients prescribed opioids for persistent non-cancer pain (PCNP) is recommended but not routinely undertaken. The PROMPPT (Proactive clinical Review of patients taking Opioid Medicines long-term for persistent Pain led by clinical Pharmacists in primary care Teams) research programme aims to develop and test a pharmacist-led pain review (PROMPPT) to reduce inappropriate opioid use for persistent pain in primary care. This study explored the acceptability of the proposed PROMPPT review to inform early intervention development. Interviews ( n = 15) and an online discussion forum ( n = 31) with patients prescribed opioids for PCNP and interviews with pharmacists ( n = 13), explored acceptability of a proposed PROMPPT review. A prototype PROMPPT review was then tested and refined through 3 iterative cycles of in-practice testing (IPT) ( n = 3 practices, n = 3 practice pharmacists, n = 13 patients). Drawing on the Theoretical Framework of Acceptability (TFA), a framework was generated (including a priori TFA constructs) allowing for deductive and inductive thematic analysis to identify aspects of prospective and experienced acceptability. Patients felt uncertain about practice pharmacists delivering the proposed PROMPPT review leading to development of content for the invitation letter for IPT (introducing the pharmacist and outlining the aim of the review). After IPT, patients felt that pharmacists were suited to the role as they were knowledgeable and qualified. Pharmacists felt that the proposed reviews would be challenging. Although challenges were experienced during delivery of PROMPPT reviews, pharmacists found that they became easier to deliver with time, practise and experience. Recommendations for optimisations after IPT included development of the training to include examples of challenging consultations. Uptake of new healthcare interventions is influenced by perceptions of acceptability. Exploring prospective and experienced acceptability at multiple time points during early intervention development, led to mini-optimisations of the prototype PROMPPT review ahead of a non-randomised feasibility study.
{"title":"Acceptability of a proposed practice pharmacist-led review for opioid-treated patients with persistent pain: A qualitative study to inform intervention development","authors":"Nicola Cornwall, Charlotte Woodcock, Julie Ashworth, Sarah A Harrisson, L. Dikomitis, Simon White, T. Helliwell, Eleanor Hodgson, R. Knaggs, Tamar Pincus, M. Santer, Christian D Mallen, Clare Jinks","doi":"10.1177/20494637231221688","DOIUrl":"https://doi.org/10.1177/20494637231221688","url":null,"abstract":"Regular review of patients prescribed opioids for persistent non-cancer pain (PCNP) is recommended but not routinely undertaken. The PROMPPT (Proactive clinical Review of patients taking Opioid Medicines long-term for persistent Pain led by clinical Pharmacists in primary care Teams) research programme aims to develop and test a pharmacist-led pain review (PROMPPT) to reduce inappropriate opioid use for persistent pain in primary care. This study explored the acceptability of the proposed PROMPPT review to inform early intervention development. Interviews ( n = 15) and an online discussion forum ( n = 31) with patients prescribed opioids for PCNP and interviews with pharmacists ( n = 13), explored acceptability of a proposed PROMPPT review. A prototype PROMPPT review was then tested and refined through 3 iterative cycles of in-practice testing (IPT) ( n = 3 practices, n = 3 practice pharmacists, n = 13 patients). Drawing on the Theoretical Framework of Acceptability (TFA), a framework was generated (including a priori TFA constructs) allowing for deductive and inductive thematic analysis to identify aspects of prospective and experienced acceptability. Patients felt uncertain about practice pharmacists delivering the proposed PROMPPT review leading to development of content for the invitation letter for IPT (introducing the pharmacist and outlining the aim of the review). After IPT, patients felt that pharmacists were suited to the role as they were knowledgeable and qualified. Pharmacists felt that the proposed reviews would be challenging. Although challenges were experienced during delivery of PROMPPT reviews, pharmacists found that they became easier to deliver with time, practise and experience. Recommendations for optimisations after IPT included development of the training to include examples of challenging consultations. Uptake of new healthcare interventions is influenced by perceptions of acceptability. Exploring prospective and experienced acceptability at multiple time points during early intervention development, led to mini-optimisations of the prototype PROMPPT review ahead of a non-randomised feasibility study.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138961413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-15DOI: 10.1177/20494637231222327
Lars B Eriksson, Torsten Gordh, Rolf Karlsten, Riccardo LoMartire, Andreas Thor, Åke Tegelberg
In most cases, a combination of paracetamol and ibuprofen are the optimal treatment for postoperative pain in third molar surgery. If stronger analgesia is required, opioids are traditionally administered. In day-case, surgery; however, opioids should be avoided. Thus, the anaesthetic agent S-ketamine in analgesic doses might be preferred. The study was designed as a randomized placebo-controlled double-blind clinical trial. The study enrolled healthy subjects according to the American Society of Anaesthesiologists classification; I or II (ASA), aged 18 to 44 years, with a body weight between 50 and 100 kg. The patients were randomized into three groups where two doses of S-ketamine were compared (high: 0.25 mg/kg or low: 0.125 mg/kg) with placebo (saline). A primary outcome of the study was that VAS at 4 h postoperatively, showed no significant difference between the placebo and high-dose S-ketamine group or in the low-dose group. We found a significant difference between the groups for the first 24 h, with a lower VAS-score in the high-dose S-ketamine group. The time to when 50% had taken their first rescue medication was 12 min later in the high-dose ketamine group. Pre-emptive S-ketamine 0.25 mg/kg gave a global significant reduction of pain by VAS during the first 24 h postoperatively. The time from end of surgery to first rescue medication were longer in the high-dose ketamine group compared to both low-dose ketamine and placebo groups.
在大多数情况下，扑热息痛和布洛芬是治疗第三磨牙手术术后疼痛的最佳药物。如果需要更强的镇痛效果，传统上会使用阿片类药物。但在日间手术中，应避免使用阿片类药物。因此，镇痛剂量的麻醉剂 S-Ketamine 可能是首选。该研究设计为随机安慰剂对照双盲临床试验。根据美国麻醉医师协会的分类，该研究招募了年龄在 18 至 44 岁之间、体重在 50 至 100 公斤之间的 I 类或 II 类（ASA）健康受试者。患者被随机分为三组，将两种剂量的S-氯胺酮（高剂量：0.25毫克/千克或低剂量：0.125毫克/千克）与安慰剂（生理盐水）进行比较。研究的主要结果是，术后 4 小时的 VAS 显示，安慰剂组和高剂量 S-Ketamine 组以及低剂量组之间没有显著差异。我们发现，在最初的 24 小时内，各组之间存在明显差异，高剂量 S-Ketamine 组的 VAS 评分较低。在大剂量氯胺酮组中，50%的患者服用第一种抢救药物的时间要晚12分钟。术前使用0.25毫克/千克的S-氯胺酮可在术后24小时内显著降低VAS评分。与低剂量氯胺酮组和安慰剂组相比，高剂量氯胺酮组从手术结束到首次使用抢救药物的时间更长。
{"title":"Intravenous S-ketamine’s analgesic efficacy in third molar surgery. A randomized placebo-controlled double-blind clinical trial","authors":"Lars B Eriksson, Torsten Gordh, Rolf Karlsten, Riccardo LoMartire, Andreas Thor, Åke Tegelberg","doi":"10.1177/20494637231222327","DOIUrl":"https://doi.org/10.1177/20494637231222327","url":null,"abstract":"In most cases, a combination of paracetamol and ibuprofen are the optimal treatment for postoperative pain in third molar surgery. If stronger analgesia is required, opioids are traditionally administered. In day-case, surgery; however, opioids should be avoided. Thus, the anaesthetic agent S-ketamine in analgesic doses might be preferred. The study was designed as a randomized placebo-controlled double-blind clinical trial. The study enrolled healthy subjects according to the American Society of Anaesthesiologists classification; I or II (ASA), aged 18 to 44 years, with a body weight between 50 and 100 kg. The patients were randomized into three groups where two doses of S-ketamine were compared (high: 0.25 mg/kg or low: 0.125 mg/kg) with placebo (saline). A primary outcome of the study was that VAS at 4 h postoperatively, showed no significant difference between the placebo and high-dose S-ketamine group or in the low-dose group. We found a significant difference between the groups for the first 24 h, with a lower VAS-score in the high-dose S-ketamine group. The time to when 50% had taken their first rescue medication was 12 min later in the high-dose ketamine group. Pre-emptive S-ketamine 0.25 mg/kg gave a global significant reduction of pain by VAS during the first 24 h postoperatively. The time from end of surgery to first rescue medication were longer in the high-dose ketamine group compared to both low-dose ketamine and placebo groups.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139000887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-12DOI: 10.1177/20494637231221451
Florence Eastwood, Emma Godfrey
Fibromyalgia (FM) is a chronic pain disorder characterised by widespread pain, fatigue and cognitive symptoms. Acceptance and commitment therapy (ACT) aims to improve psychological flexibility and has been found to be beneficial in treating chronic pain; however, there are few studies evaluating its efficacy in treating FM. This systematic review and meta-analysis evaluated the efficacy of acceptance and commitment therapy in patients with fibromyalgia. PubMed, Embase and PsychInfo databases were searched. Randomised Controlled Trials (RCTs) were eligible for inclusion if participants had FM, and the intervention was based on the ACT framework/model, and not combined with any other active therapy; any non-ACT control was accepted. A meta-analysis was performed, with the primary outcomes pain acceptance (chronic pain acceptance questionnaire, CPAQ), health-related quality of life (fibromyalgia impact questionnaire, FIQ), attrition rate and frequency of adverse events, and the secondary outcomes pain intensity, disability, depression, anxiety, and fatigue. Six RCTs, with a total of 384, mostly-female, participants were included, with ACT being delivered online, in a group setting, or one-to-one. ACT was superior to controls in improving FIQ score at post-intervention (SMD −1.05, 95% CI −2.02, −0.09) and follow-up (SMD −1.43, 95% CI −2.17, −0.69) and CPAQ post-intervention (SMD 1.05, 95% CI 0.61, 1.49) and at follow-up (SMD 0.95, 95% CI 0.40, 1.49). Attrition was below 20% in 4/6 studies and no adverse events were reported as attributable to ACT. All secondary outcomes showed large-to-moderate pooled effect estimates post-intervention, indicating improvement in anxiety, depression, pain and disability. Fatigue also improved, with a large negative effect. The results suggest ACT improved outcomes in patients with FM: there was an overall improvement in all outcomes post-intervention, with most maintained at follow-up. This review was, however, limited by the small body of evidence and differing methodologies of included studies.
纤维肌痛（FM）是一种慢性疼痛疾病，以广泛性疼痛、疲劳和认知症状为特征。接纳与承诺疗法（ACT）旨在提高心理灵活性，已被发现对治疗慢性疼痛有益；然而，很少有研究评估其对治疗纤维肌痛的疗效。本系统综述和荟萃分析评估了接受和承诺疗法对纤维肌痛患者的疗效。检索了 PubMed、Embase 和 PsychInfo 数据库。只要参与者患有纤维肌痛，干预措施基于接纳与承诺疗法的框架/模式，且未与任何其他积极疗法相结合，任何非接纳与承诺疗法的对照研究均可纳入随机对照试验（RCT）。荟萃分析的主要结果为疼痛接受度（慢性疼痛接受度问卷，CPAQ）、健康相关生活质量（纤维肌痛影响问卷，FIQ）、减员率和不良事件频率，次要结果为疼痛强度、残疾、抑郁、焦虑和疲劳。六项研究共纳入了 384 名参与者，其中大部分为女性，ACT 采用在线、小组或一对一的方式进行。在改善干预后（SMD-1.05，95% CI -2.02，-0.09）和随访（SMD-1.43，95% CI -2.17，-0.69）的FIQ得分以及干预后（SMD 1.05，95% CI 0.61，1.49）和随访（SMD 0.95，95% CI 0.40，1.49）的CPAQ得分方面，ACT优于对照组。4/6项研究的自然减员率低于20%，无不良事件报告可归因于ACT。干预后，所有次要结果都显示出大到中等的集合效应估计值，表明焦虑、抑郁、疼痛和残疾状况有所改善。疲劳感也有所改善，并产生了较大的负效应。结果表明，ACT 可改善 FM 患者的预后：干预后所有预后均有整体改善，且大部分在随访时保持不变。然而，由于纳入研究的证据较少且研究方法各不相同，该综述受到了限制。
{"title":"The efficacy, acceptability and safety of acceptance and commitment therapy for fibromyalgia – a systematic review and meta-analysis","authors":"Florence Eastwood, Emma Godfrey","doi":"10.1177/20494637231221451","DOIUrl":"https://doi.org/10.1177/20494637231221451","url":null,"abstract":"Fibromyalgia (FM) is a chronic pain disorder characterised by widespread pain, fatigue and cognitive symptoms. Acceptance and commitment therapy (ACT) aims to improve psychological flexibility and has been found to be beneficial in treating chronic pain; however, there are few studies evaluating its efficacy in treating FM. This systematic review and meta-analysis evaluated the efficacy of acceptance and commitment therapy in patients with fibromyalgia. PubMed, Embase and PsychInfo databases were searched. Randomised Controlled Trials (RCTs) were eligible for inclusion if participants had FM, and the intervention was based on the ACT framework/model, and not combined with any other active therapy; any non-ACT control was accepted. A meta-analysis was performed, with the primary outcomes pain acceptance (chronic pain acceptance questionnaire, CPAQ), health-related quality of life (fibromyalgia impact questionnaire, FIQ), attrition rate and frequency of adverse events, and the secondary outcomes pain intensity, disability, depression, anxiety, and fatigue. Six RCTs, with a total of 384, mostly-female, participants were included, with ACT being delivered online, in a group setting, or one-to-one. ACT was superior to controls in improving FIQ score at post-intervention (SMD −1.05, 95% CI −2.02, −0.09) and follow-up (SMD −1.43, 95% CI −2.17, −0.69) and CPAQ post-intervention (SMD 1.05, 95% CI 0.61, 1.49) and at follow-up (SMD 0.95, 95% CI 0.40, 1.49). Attrition was below 20% in 4/6 studies and no adverse events were reported as attributable to ACT. All secondary outcomes showed large-to-moderate pooled effect estimates post-intervention, indicating improvement in anxiety, depression, pain and disability. Fatigue also improved, with a large negative effect. The results suggest ACT improved outcomes in patients with FM: there was an overall improvement in all outcomes post-intervention, with most maintained at follow-up. This review was, however, limited by the small body of evidence and differing methodologies of included studies.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139006867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-09-01DOI: 10.1177/20494637231199332
Zofia J Zakrzewska, Parinaz Hosseini-Ashrafi, Ishrat Hussain, Zachary James Moulder, Jithu Subhash, Melissa Tan, Martin Ewart Johnson, Joanna M Zakrzewska
Background and aims: Patients often first present with symptoms of trigeminal neuralgia (TN) to primary care. However, there has been little research to determine whether the diagnosis and management of this condition is carried out according to current guidelines. Furthermore, there is little up-to-date information regarding the prevalence of TN in the UK. The aim is to estimate the prevalence of TN and to audit the diagnosis and management process of TN in primary care.
Methods: Between 2019 and 2020 a search was made at five UK GP practices with a total patient population of 55,842 using EMIS and SystmOne patient record systems to review patient consultations to identify patients coded with TN or facial pain (FP). These records were reviewed to ascertain the basis for diagnosis, management in primary care and referral to secondary care.
Results: 157 patients were identified; 54 coded with FP and 103 with TN. These results indicate a prevalence of 22.3 in 10,000. There was no difference in documented symptoms between the two groups. Seven patients had all ICDH3 criteria recorded, with two meeting the requirements for TN diagnosis. 58.8% of patients with TN were started on carbamazepine, the current gold standard treatment, compared with 16.7% in the FP group. 38.2% of TN patients were referred to a range of different specialities.
Conclusion: The prevalence of TN may be higher than previously thought. Key diagnostic criteria are often omitted, leading to potential misdiagnosis or delays in diagnosis. Relatively few referrals are made, though all patients should be considered for imaging.
{"title":"Management of trigeminal neuralgia: A multi-centre case study in general practice.","authors":"Zofia J Zakrzewska, Parinaz Hosseini-Ashrafi, Ishrat Hussain, Zachary James Moulder, Jithu Subhash, Melissa Tan, Martin Ewart Johnson, Joanna M Zakrzewska","doi":"10.1177/20494637231199332","DOIUrl":"10.1177/20494637231199332","url":null,"abstract":"<p><strong>Background and aims: </strong>Patients often first present with symptoms of trigeminal neuralgia (TN) to primary care. However, there has been little research to determine whether the diagnosis and management of this condition is carried out according to current guidelines. Furthermore, there is little up-to-date information regarding the prevalence of TN in the UK. The aim is to estimate the prevalence of TN and to audit the diagnosis and management process of TN in primary care.</p><p><strong>Methods: </strong>Between 2019 and 2020 a search was made at five UK GP practices with a total patient population of 55,842 using EMIS and SystmOne patient record systems to review patient consultations to identify patients coded with TN or facial pain (FP). These records were reviewed to ascertain the basis for diagnosis, management in primary care and referral to secondary care.</p><p><strong>Results: </strong>157 patients were identified; 54 coded with FP and 103 with TN. These results indicate a prevalence of 22.3 in 10,000. There was no difference in documented symptoms between the two groups. Seven patients had all ICDH3 criteria recorded, with two meeting the requirements for TN diagnosis. 58.8% of patients with TN were started on carbamazepine, the current gold standard treatment, compared with 16.7% in the FP group. 38.2% of TN patients were referred to a range of different specialities.</p><p><strong>Conclusion: </strong>The prevalence of TN may be higher than previously thought. Key diagnostic criteria are often omitted, leading to potential misdiagnosis or delays in diagnosis. Relatively few referrals are made, though all patients should be considered for imaging.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10642494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42351598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-10-18DOI: 10.1177/20494637231208167
Catharine Montgomery, Helen M Poole, Emma Begley, Yasir Abbasi
{"title":"Taking the pain out of pain.","authors":"Catharine Montgomery, Helen M Poole, Emma Begley, Yasir Abbasi","doi":"10.1177/20494637231208167","DOIUrl":"https://doi.org/10.1177/20494637231208167","url":null,"abstract":"","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10642502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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