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Confidence of practitioners to support self-management of pain: A multidisciplinary survey 从业人员支持疼痛自我管理的信心:一项多学科调查
Q2 Medicine Pub Date : 2023-11-04 DOI: 10.1177/20494637231212748
Chris Penlington, Pattramon Pornsukjantra, Paul Chazot, Frances Cole, Diarmuid Denneny
Background Supported self-management is an important component of management for persistent pain according to current recommendations and guidelines. However, it is unclear whether staff from differing disciplines who may be in early contact with people with established or developing persistent pain are confident to introduce and support self-management for this patient group. Aim To determine the confidence of staff across professional disciplines to introduce and support self-management. Design and Setting Cross-sectional online survey. Methods Charts were constructed to represent information on professional grouping, prior training in self-management and confidence in supporting key components of self-management for persistent pain. Analysis of variance was used to test for differences between groups. Results Overall, 165 practitioners reported confidence to support self-management below the midpoint of a ten-point scale and 93 above. There were few differences between different professions apart from in explaining pain (f = 6.879 p < .001), managing activity levels (f = 6.340 p < .001) and supporting healthy habits (f = 4.700, p = .001) in which physiotherapists expressed higher confidence than other professional groups. There was no difference in confidence expressed between staff who had or had not received previous training in self-management (f = 1.357, p = .233). Conclusions Many front-line staff who might be expected to introduce and deliver self-management support for persistent pain lack the confidence and skills to do so. This is consistent with a known lack of education about pain across disciplinary boundaries in primary and community-based care. In order to meet treatment priorities for persistent pain there is an urgent need to upskill the workforce by providing access to good quality training and resources.
背景:根据目前的建议和指南,支持性自我管理是持续性疼痛管理的重要组成部分。然而,目前尚不清楚的是,来自不同学科的工作人员是否有信心为这一患者群体介绍和支持自我管理,这些工作人员可能在早期接触到已有或正在发展的持续性疼痛患者。目的确定各专业人员引入和支持自我管理的信心。设计与设置横断面在线调查。方法构建图表,反映专业分组、先前自我管理培训和对支持持续疼痛自我管理关键组成部分的信心。方差分析用于检验组间差异。结果总体而言,165名从业人员对支持自我管理的信心低于10分制的中点,93名从业人员高于10分制的中点。不同职业之间除了对疼痛的解释差异不大(f = 6.879 p <.001),管理活动水平(f = 6.340 p <.001)和支持健康习惯(f = 4.700, p = .001)在这方面,物理治疗师比其他专业群体表现出更高的信心。在之前接受过或没有接受过自我管理培训的员工之间,信心表达没有差异(f = 1.357, p = 0.233)。结论许多一线工作人员可能会对持续性疼痛进行自我管理支持,但他们缺乏这样做的信心和技能。这与在初级和社区护理中缺乏跨学科疼痛教育是一致的。为了满足对持续性疼痛的优先治疗,迫切需要通过提供高质量的培训和资源来提高工作人员的技能。
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引用次数: 0
VirtualPain. Preliminary findings from a group-based digital therapeutics intervention for fibromyalgia VirtualPain。基于群体的数字治疗干预纤维肌痛的初步发现
Q2 Medicine Pub Date : 2023-11-03 DOI: 10.1177/20494637231210391
Ferran Vilalta-Abella, Bruno Porras-Garcia, Alexandra Ghiţă, Montserrat Vacas-Moreira, Mónica Prat-Galbany, José Gutiérrez-Maldonado
Introduction Fibromyalgia (FM) is a disorder characterized by chronic pain, with significant medical, psychological, and socio-economic implications. Although there is limited evidence, cognitive-behavioral therapy (CBT) has shown to be effective in improving FM symptoms. An alternative to enhance CBT effectiveness is to incorporate digital therapeutics (DTx). Aim We conducted a pilot study to investigate whether the addition of a DTx intervention ( VirtualPain) to cognitive-behavioral group therapy (CBGT) can reduce pain perception and associated symptoms in patients with FM. Method Ten patients with FM were initially recruited from a public hospital in Barcelona. The treatment consisted of 6 weeks of VirtualPain group sessions and 16 weeks of CBGT. Measures of catastrophizing, self-efficacy, and coping were recorded before, during, and after the protocol. In the DTx sessions, pain intensity was recorded before and after each session. Results The program (DTx and CBGT) showed a significant improvement in pain-related self-efficacy and relaxation measures. Improvement in pain perception was observed only after the DTx intervention. Conclusions This study provides preliminary results regarding the added value of DTx ( VirtualPain) as part of a CBGT for FM. The use of the program has facilitated a significant reduction in pain perception in each of the VirtualPain sessions, which provides further evidence of how this technology can be beneficial for improving FM treatments.
纤维肌痛(FM)是一种以慢性疼痛为特征的疾病,具有重要的医学、心理和社会经济影响。尽管证据有限,认知行为疗法(CBT)已被证明对改善FM症状有效。提高CBT有效性的另一种选择是结合数字治疗(DTx)。目的:我们进行了一项初步研究,以调查在认知行为群体治疗(CBGT)中添加DTx干预(VirtualPain)是否可以减轻FM患者的疼痛感知和相关症状。方法从巴塞罗那一家公立医院招募10例FM患者。治疗包括6周的VirtualPain组和16周的CBGT。在治疗方案之前、期间和之后分别记录灾难化、自我效能和应对措施。在DTx治疗过程中,记录每次治疗前后的疼痛强度。结果该方案(DTx和CBGT)在疼痛相关自我效能和放松措施方面有显著改善。仅在DTx干预后才观察到疼痛感知的改善。本研究提供了关于DTx (VirtualPain)作为FM CBGT一部分的附加价值的初步结果。该程序的使用促进了每次VirtualPain会话中疼痛感知的显著减少,这进一步证明了该技术如何有助于改善FM治疗。
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引用次数: 0
Healthcare resource utilisation and economic burden attributable to back pain in primary care: A matched case-control study in the United Kingdom 初级保健中背痛的医疗资源利用和经济负担:英国的一项匹配病例对照研究
Q2 Medicine Pub Date : 2023-10-20 DOI: 10.1177/20494637231208364
Dawit T Zemedikun, Jesse Kigozi, Gwenllian Wynne-Jones, Alessandra Guariglia, Krishnarajah Nirantharakumar, Tom Marshall, Tracy Roberts
Objective Incremental healthcare costs attributed to back pain, and characterisation by patient and clinical factors have rarely been documented. This study aimed to assess annual healthcare resource utilisation and costs associated with back pain in primary care. Methods Using the IQVIA Medical Research Data (IMRD), patients with back pain were identified (study period: 01 January 2006 to 31 December 2015) using diagnostic records and analgesics prescriptions ( n = 133,341), and propensity score matched 1:1 to patients without back pain. The annual incremental costs of back pain associated with consultations and prescriptions were estimated and extrapolated to a national level. Sensitivity analysis was conducted by restricting the study population to the most recent diagnosis of back pain. Variations in cost were assessed stratified by gender, age-groups, deprivation, and comorbidity categories. Results The mean age was 57 years, and 62% were females in both the case and control groups. The total incremental healthcare costs associated with back pain was £32.5 million in 2015 (£35.9 million in 2020), with per-patient cost of £244 (£265 in 2020) per year. On a national level, this translated to an estimated £3.2 billion (£3.5 billion in 2020). Eighty percent of the costs were attributed to consultations; and female gender, older age, higher deprivation, and higher comorbidity were all associated with increased mean healthcare costs of patients with back pain. Conclusion Our findings confirm the substantial healthcare costs attributed to back pain, even with primacy care costs only. The data also revealed significant cost variations across socio-demographic and clinical factors.
目的:由于背部疼痛而增加的医疗费用,以及患者和临床因素的特征,很少有文献记载。本研究旨在评估初级保健中与背痛相关的年度卫生保健资源利用和成本。方法使用IQVIA医学研究数据(IMRD),根据诊断记录和镇痛药处方(n = 133,341)确定腰痛患者(研究期间:2006年1月1日至2015年12月31日),倾向评分与非腰痛患者1:1匹配。与咨询和处方相关的背部疼痛的年度增量成本被估计和外推到全国水平。通过将研究人群限制为最近诊断的背痛进行敏感性分析。费用的变化按性别、年龄组、贫困和合并症类别分层评估。结果病例组和对照组患者平均年龄为57岁,女性占62%。2015年,与背痛相关的总增量医疗成本为3250万英镑(2020年为3590万英镑),每位患者每年的成本为244英镑(2020年为265英镑)。在全国范围内,这转化为估计32亿英镑(2020年为35亿英镑)。80%的费用用于咨询;女性、年龄较大、更严重的剥夺和更高的合并症都与背部疼痛患者的平均医疗费用增加有关。结论:我们的研究结果证实了大量的医疗保健费用归因于背部疼痛,即使只有初级保健费用。数据还揭示了不同社会人口和临床因素的显著成本差异。
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引用次数: 0
Does a diagnosis of depression influence observer ratings of pain severity? The mediating role of causal attributions of pain and pain genuineness 抑郁症的诊断会影响观察者对疼痛严重程度的评价吗?疼痛的因果归因和疼痛真实性的中介作用
Q2 Medicine Pub Date : 2023-10-18 DOI: 10.1177/20494637231206541
Kara Turcotte, Susan Holtzman
Researchers have been increasingly investigating observer and patient characteristics that may influence the assessment of pain in others. While rates of psychiatric conditions are high in chronic pain populations, surprisingly little attention has been given to if (and why) a comorbid psychiatric diagnosis may influence the estimation of pain in others. Using an experimental vignette paradigm, the current study examined whether a diagnostic label of major depressive disorder (MDD) would impact observer pain estimates of a woman with chronic pain, and whether causal attributions of pain and pain genuineness might help explain these effects. Participants ( n = 188) were given a vignette describing a female patient with chronic pain (who either had MDD or no mental health concerns), viewed a brief video clip of the patient, and then were asked to provide a variety of ratings about the woman’s pain. Results of a serial multiple mediation analysis revealed that participants in the MDD condition made greater psychological attributions for the woman’s pain, which was associated with lower perceptions of pain genuineness, which was then associated with lower estimates of pain intensity. These findings suggest that a diagnosis of depression may indirectly influence observer estimates of another person’s pain by heightening psychological attributions of pain, and making their pain seem less genuine. Further research is needed to elucidate the complex processes underlying pain estimation, including patient and observer characteristics, biases, and heuristics, in order to improve quality of care for those living with persistent pain.’
研究人员越来越多地研究可能影响他人疼痛评估的观察者和患者特征。虽然慢性疼痛人群中精神疾病的发病率很高,但令人惊讶的是,很少有人关注是否(以及为什么)共病精神诊断可能会影响其他人对疼痛的估计。本研究采用实验小插图范例,研究重度抑郁症(MDD)的诊断标签是否会影响观察者对慢性疼痛女性的疼痛估计,以及疼痛和疼痛真实性的因果归因是否有助于解释这些影响。研究人员给参与者(n = 188)看了一个描述慢性疼痛女性患者(患有重度抑郁症或没有精神健康问题)的小短文,观看了该患者的简短视频片段,然后被要求对该女性的疼痛进行各种评分。一系列多重中介分析的结果显示,重度抑郁症的参与者对女性的疼痛有更大的心理归因,这与较低的疼痛真实性感知有关,然后与较低的疼痛强度估计有关。这些发现表明,抑郁症的诊断可能会间接影响观察者对另一个人的痛苦的估计,因为它会加强对痛苦的心理归因,并使他们的痛苦看起来不那么真实。需要进一步的研究来阐明疼痛评估的复杂过程,包括患者和观察者的特征、偏见和启发式,以提高对那些患有持续性疼痛的人的护理质量。”
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引用次数: 0
‘I felt part of the solution’. A qualitative study about the interface between lived experience advocates, professionals and organisations in the field of persistent pain “我觉得自己是解决方案的一部分。”一项关于持续疼痛领域的生活体验倡导者,专业人士和组织之间界面的定性研究
Q2 Medicine Pub Date : 2023-10-18 DOI: 10.1177/20494637231208095
Cameron Hartley, Chris Penlington
Objectives To elicit perspectives of people with persistent pain about their experiences working with pain management professionals and services as patient advocates and to consider implications for current models of involving patients in service development and research. Design reflexive thematic analysis from a critical realist perspective. Methods Online interviews were conducted individually with 10 participants who had acted as patient advocates in the field of persistent pain. Participants were recruited through purposive and snowball sampling. Data were analysed and organised into themes and are presented descriptively. Results The relationship between patient advocates and the organisations they help is conceptualised as ‘an unequal partnership’. Participants described positive and affirming experiences with individual health professionals and research teams (Respect). This often occurred within a context of inflexible organisational policies that presented barriers to participation including a lack of financial compensation and expectation to work to inflexible deadlines. As a result, patient advocates could experience a lack of value attributed to their experiences and voices (unmet needs from institutions). Conclusion People with personal experience of engaging with services for persistent pain are in a strong position to contribute to service improvement. Although this contribution is recognised as valuable, it appears to be devalued by organisational barriers. Organisational policies around payment may lead to a lack of representation of those experiencing higher levels of disadvantage. As a result, services and policy makers may be missing out on insights that could be important for service development.
目的引出持续性疼痛患者作为患者倡导者与疼痛管理专业人员和服务机构合作的经历,并考虑将患者纳入服务开发和研究的当前模式的影响。批判现实主义视角下的设计反身性主题分析。方法对10名在持续性疼痛领域担任患者倡导者的参与者进行在线访谈。参与者是通过有目的的滚雪球抽样来招募的。数据被分析和组织成主题,并描述性地呈现。结果患者倡导者和他们帮助的组织之间的关系被概念化为“不平等的伙伴关系”。参与者描述了与个别卫生专业人员和研究团队的积极和肯定的经历(尊重)。这种情况经常发生在缺乏灵活的组织政策的背景下,这些政策对参与构成了障碍,包括缺乏经济补偿和期望在不灵活的最后期限前工作。因此,患者维权者的经验和声音可能会让他们感到缺乏价值(机构未满足的需求)。结论有持续性疼痛服务经验的患者在改善服务方面具有重要的作用。尽管这种贡献被认为是有价值的,但它似乎被组织障碍贬低了。有关薪酬的组织政策可能会导致那些处于较高不利地位的人缺乏代表性。因此,服务和政策制定者可能会错过可能对服务开发很重要的见解。
{"title":"‘I felt part of the solution’. A qualitative study about the interface between lived experience advocates, professionals and organisations in the field of persistent pain","authors":"Cameron Hartley, Chris Penlington","doi":"10.1177/20494637231208095","DOIUrl":"https://doi.org/10.1177/20494637231208095","url":null,"abstract":"Objectives To elicit perspectives of people with persistent pain about their experiences working with pain management professionals and services as patient advocates and to consider implications for current models of involving patients in service development and research. Design reflexive thematic analysis from a critical realist perspective. Methods Online interviews were conducted individually with 10 participants who had acted as patient advocates in the field of persistent pain. Participants were recruited through purposive and snowball sampling. Data were analysed and organised into themes and are presented descriptively. Results The relationship between patient advocates and the organisations they help is conceptualised as ‘an unequal partnership’. Participants described positive and affirming experiences with individual health professionals and research teams (Respect). This often occurred within a context of inflexible organisational policies that presented barriers to participation including a lack of financial compensation and expectation to work to inflexible deadlines. As a result, patient advocates could experience a lack of value attributed to their experiences and voices (unmet needs from institutions). Conclusion People with personal experience of engaging with services for persistent pain are in a strong position to contribute to service improvement. Although this contribution is recognised as valuable, it appears to be devalued by organisational barriers. Organisational policies around payment may lead to a lack of representation of those experiencing higher levels of disadvantage. As a result, services and policy makers may be missing out on insights that could be important for service development.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135825365","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}
引用次数: 0
Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews 手术后慢性疼痛和持续阿片类药物使用的患病率和决定因素:系统综述
Q2 Medicine Pub Date : 2023-10-17 DOI: 10.1177/20494637231204549
Neetu Bansal, Sheanne Ang, Li-Chia Chen
Background Chronic post-surgical pain (CPSP) and persistent post-operative opioid use (PPOU) are inconsistently defined in published literature. This review comprehensively summarised their definitions, prevalence and determinants from existing systematic reviews or meta-analyses. Methods Systematic reviews or meta-analyses evaluating the prevalence of CPSP and PPOU in adults after surgeries were retrieved from an electronic database search applying structured search strategies in PubMed, MEDLINE, Embase, CINAHL Plus and Cochrane Database of Systematic Reviews from inception to 31 December 2022. Two reviewers selected systematic reviews, extracted data regarding the definition, prevalence and risk factors of CPSP and PPOU and assessed the quality using the AMSTAR 2 tool. Results The study identified 6936 records related to chronic pain and persistent opioid use in patients after surgery, of which 24 articles were identified for full-text review. Eighteen systematic reviews were included in this umbrella review, of which five systematic reviews assessed chronic pain in patients who had undergone a surgical procedure, and 13 reviews assessed persistent opioid use after surgery. Despite considerable variations in patient characteristics (from age ≥18 years), types of surgeries, follow-up duration and the definitions of measures, most reviews were of medium to good quality (fulfilled 9-11/16 AMSTAR 2 criteria). The prevalence of CPSP and PPOU, commonly synthesised at 3, 6 or 12 months after surgeries, varied from 5%–58% and 2%–65%, respectively, despite various terminologies, definitions and timing of measures and associated determinants. The prevalence of neuropathic pain in CPSP was obtainable for four surgeries, with 9%–74%. Conclusion To inform future practice and policy to optimise pain management and opioid safety, consensus on standardising measurements and further studies assessing risk factors associated with CPSP, PPOU and adverse outcomes are needed.
背景:在已发表的文献中,慢性术后疼痛(CPSP)和持续性术后阿片类药物使用(PPOU)的定义不一致。本综述从现有的系统综述或荟萃分析中全面总结了它们的定义、患病率和决定因素。方法应用PubMed、MEDLINE、Embase、CINAHL Plus和Cochrane系统评价数据库从成立至2022年12月31日的结构化搜索策略,从电子数据库检索评估成人术后CPSP和PPOU患病率的系统评价或荟萃分析。两名审查员选择了系统评价,提取了关于CPSP和PPOU的定义、患病率和危险因素的数据,并使用AMSTAR 2工具评估了质量。结果本研究共发现6936例与术后患者慢性疼痛和持续性阿片类药物使用相关的记录,其中24篇被纳入全文综述。这项总括性综述包括18项系统综述,其中5项系统综述评估了接受手术的患者的慢性疼痛,13项综述评估了手术后持续使用阿片类药物。尽管患者特征(年龄≥18岁)、手术类型、随访时间和测量方法的定义存在相当大的差异,但大多数评价的质量为中等至良好(符合9-11/16 AMSTAR 2标准)。尽管有不同的术语、定义、测量时间和相关决定因素,CPSP和PPOU的患病率分别为5%-58%和2%-65%,通常在手术后3、6或12个月合成。CPSP患者神经性疼痛的发生率在4次手术中为9%-74%。结论为优化疼痛管理和阿片类药物安全性的未来实践和政策提供信息,需要就标准化测量达成共识,并进一步研究评估与CPSP、PPOU和不良后果相关的风险因素。
{"title":"Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews","authors":"Neetu Bansal, Sheanne Ang, Li-Chia Chen","doi":"10.1177/20494637231204549","DOIUrl":"https://doi.org/10.1177/20494637231204549","url":null,"abstract":"Background Chronic post-surgical pain (CPSP) and persistent post-operative opioid use (PPOU) are inconsistently defined in published literature. This review comprehensively summarised their definitions, prevalence and determinants from existing systematic reviews or meta-analyses. Methods Systematic reviews or meta-analyses evaluating the prevalence of CPSP and PPOU in adults after surgeries were retrieved from an electronic database search applying structured search strategies in PubMed, MEDLINE, Embase, CINAHL Plus and Cochrane Database of Systematic Reviews from inception to 31 December 2022. Two reviewers selected systematic reviews, extracted data regarding the definition, prevalence and risk factors of CPSP and PPOU and assessed the quality using the AMSTAR 2 tool. Results The study identified 6936 records related to chronic pain and persistent opioid use in patients after surgery, of which 24 articles were identified for full-text review. Eighteen systematic reviews were included in this umbrella review, of which five systematic reviews assessed chronic pain in patients who had undergone a surgical procedure, and 13 reviews assessed persistent opioid use after surgery. Despite considerable variations in patient characteristics (from age ≥18 years), types of surgeries, follow-up duration and the definitions of measures, most reviews were of medium to good quality (fulfilled 9-11/16 AMSTAR 2 criteria). The prevalence of CPSP and PPOU, commonly synthesised at 3, 6 or 12 months after surgeries, varied from 5%–58% and 2%–65%, respectively, despite various terminologies, definitions and timing of measures and associated determinants. The prevalence of neuropathic pain in CPSP was obtainable for four surgeries, with 9%–74%. Conclusion To inform future practice and policy to optimise pain management and opioid safety, consensus on standardising measurements and further studies assessing risk factors associated with CPSP, PPOU and adverse outcomes are needed.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135993272","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}
引用次数: 0
Implanted intrathecal drug delivery systems may be associated with improved survival in patients with cancer 植入式鞘内给药系统可能与癌症患者生存率的提高有关
Q2 Medicine Pub Date : 2023-10-16 DOI: 10.1177/20494637231202089
Alison Mitchell, Lesley Somerville, Nicola Williams, Jonathan McGhie, Alex McConnachie, Gordon McGinn, Jiyoung Lee
Background Intrathecal Drug Delivery Systems (IDDS) are underused in the management of cancer-related pain despite evidence of both efficacy and survival benefit. There is currently limited evidence to indicate which patients might benefit most from IDDS. Aim The aim of the study was to describe the baseline characteristics and survival outcomes of patients who accepted IDDS, patients who declined IDDS and patients who wished to go ahead with IDDS but whose condition deteriorated before they could do so. Design/participants The survival data for 75 consecutive patients who had been offered intrathecal drug delivery were examined as part of a retrospective cohort study. Survival data was compared between three groups: those who accepted intrathecal drug delivery and went on to receive it ( n = 41), those who accepted it but whose condition deteriorated before it commenced ( n = 17) and those who declined this treatment modality ( n = 17). Results Patients who received IDDS survived significantly longer after assessment compared to those who declined IDDS (hazard ratio (HR) for the IDDS group relative to the declined group 0.29 (95% CI 0.16 to 0.53), and 0.23 (95% CI 0.12 to 0.44) after adjustment for gender and baseline functional status. In patients who accepted IDDS but who were unable to commence treatment, survival after assessment was not significantly different from those who declined the IDDS (HR for the deteriorated group relative to the declined group 1.28 (95% CI 0.65 to 2.53), and 0.80 (95% CI 0.65 to 2.53) after adjustment for gender and baseline functional status). Conclusion In this retrospective analysis, an improvement in survival may be associated with patients who accept ongoing pain management with an implanted intrathecal drug delivery system compared to those patients who either declined intrathecal drug delivery or deteriorated before it could be commenced.
背景鞘内给药系统(IDDS)在癌症相关疼痛的治疗中应用不足,尽管有证据表明其疗效和生存获益。目前有有限的证据表明哪些患者可能从IDDS中获益最多。本研究的目的是描述接受IDDS的患者、拒绝IDDS的患者和希望继续进行IDDS但病情恶化的患者的基线特征和生存结果。设计/参与者:作为回顾性队列研究的一部分,研究了75例连续接受鞘内给药的患者的生存数据。对三组的生存数据进行比较:接受鞘内给药并继续接受的组(n = 41),接受鞘内给药但在开始前病情恶化的组(n = 17)和拒绝这种治疗方式的组(n = 17)。结果经性别和基线功能状态调整后,接受IDDS治疗的患者在评估后的存活时间明显长于IDDS治疗下降的患者(IDDS组相对于IDDS治疗下降组的风险比(HR)为0.29 (95% CI 0.16 ~ 0.53)和0.23 (95% CI 0.12 ~ 0.44)。在接受IDDS但无法开始治疗的患者中,评估后的生存率与拒绝IDDS的患者无显著差异(恶化组相对于下降组的HR为1.28 (95% CI 0.65至2.53),在调整性别和基线功能状态后为0.80 (95% CI 0.65至2.53))。结论:在这项回顾性分析中,与那些拒绝鞘内给药或在开始前病情恶化的患者相比,接受植入鞘内给药系统进行持续疼痛治疗的患者的生存率可能有所提高。
{"title":"Implanted intrathecal drug delivery systems may be associated with improved survival in patients with cancer","authors":"Alison Mitchell, Lesley Somerville, Nicola Williams, Jonathan McGhie, Alex McConnachie, Gordon McGinn, Jiyoung Lee","doi":"10.1177/20494637231202089","DOIUrl":"https://doi.org/10.1177/20494637231202089","url":null,"abstract":"Background Intrathecal Drug Delivery Systems (IDDS) are underused in the management of cancer-related pain despite evidence of both efficacy and survival benefit. There is currently limited evidence to indicate which patients might benefit most from IDDS. Aim The aim of the study was to describe the baseline characteristics and survival outcomes of patients who accepted IDDS, patients who declined IDDS and patients who wished to go ahead with IDDS but whose condition deteriorated before they could do so. Design/participants The survival data for 75 consecutive patients who had been offered intrathecal drug delivery were examined as part of a retrospective cohort study. Survival data was compared between three groups: those who accepted intrathecal drug delivery and went on to receive it ( n = 41), those who accepted it but whose condition deteriorated before it commenced ( n = 17) and those who declined this treatment modality ( n = 17). Results Patients who received IDDS survived significantly longer after assessment compared to those who declined IDDS (hazard ratio (HR) for the IDDS group relative to the declined group 0.29 (95% CI 0.16 to 0.53), and 0.23 (95% CI 0.12 to 0.44) after adjustment for gender and baseline functional status. In patients who accepted IDDS but who were unable to commence treatment, survival after assessment was not significantly different from those who declined the IDDS (HR for the deteriorated group relative to the declined group 1.28 (95% CI 0.65 to 2.53), and 0.80 (95% CI 0.65 to 2.53) after adjustment for gender and baseline functional status). Conclusion In this retrospective analysis, an improvement in survival may be associated with patients who accept ongoing pain management with an implanted intrathecal drug delivery system compared to those patients who either declined intrathecal drug delivery or deteriorated before it could be commenced.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136142514","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}
引用次数: 0
Baseline measures for women with mesh complications accessing a pain service (as part of the London Complex Mesh Centre) 有补片并发症的妇女获得疼痛服务的基线措施(作为伦敦复杂补片中心的一部分)
Q2 Medicine Pub Date : 2023-10-03 DOI: 10.1177/20494637231206014
Anish Thillainathan, Julia Cambitizi, Victoria Tidman, Katrine Petersen, Moein Tavakkoli, Andrew Paul Baranowski
Introduction Pelvic mesh was first used for stress urinary incontinence in 1998 following which its usage rapidly expanded to include treatment of pelvic organ prolapse. Numerous complications relating to mesh insertion soon became apparent, culminating in the Independent Medicines and Medical Devices Safety: First Do No Harm Report published by Baroness Cumberlege in 2020. Following this report, the UCLH London Complex Mesh Centre funded by NHS England, was one of a small number of specialist centres set up for mesh-injured women. The Pelvic Pain service of the Pain Management Centre at UCLH provides a service for patients attending the London Complex Mesh Centre. The aim of our study was to distinguish the differing needs of mesh-injured women from those with chronic pelvic pain by comparing patient-reported outcome measures between these two cohorts. Methods Distribution of data was calculated using the D’Agostino–Pearson normality test. Mann–Whitney tests were used to ascertain statistical difference between the two cohorts. Ethnicity was compared between groups using Fisher’s exact test. Quantile regression models were used to assess whether differences in medians between groups remained after adjustment for age and ethnicity. Statistical significance was set at p < .05. Results Patients with mesh were significantly older than those with chronic pelvic pain and were more likely to be of white ethnicity. After adjustment for age and ethnicity, analysis revealed that bladder interference, sex interference and DAPOS A were significantly higher amongst mesh-injured women, whereas GP and hospital admissions were significantly lower. Discussion Our data shows the importance of mesh-injured women having access to pain management services with pathways of care integrated within women’s and mental health services. It is essential that these programmes include support to discuss ways of returning to sexual relationships and have models to address anxiety such as graded exposure and psychological input.
盆腔网首次用于压力性尿失禁在1998年,随后其使用迅速扩大到包括盆腔器官脱垂的治疗。与补片插入有关的许多并发症很快就变得明显起来,最终在2020年由Baroness Cumberlege发表的《独立药品和医疗器械安全:第一份无害报告》中达到顶峰。在这份报告之后,由英国国民健康保险制度资助的UCLH伦敦复杂网状中心是为数不多的为网状受伤妇女设立的专业中心之一。UCLH疼痛管理中心的骨盆疼痛服务为参加伦敦复杂网状中心的患者提供服务。我们研究的目的是通过比较两组患者报告的结果来区分网伤妇女和慢性盆腔疼痛妇女的不同需求。方法采用D’agostino - pearson正态检验计算数据分布。使用Mann-Whitney检验来确定两个队列之间的统计学差异。使用Fisher精确检验比较各组之间的种族。分位数回归模型用于评估各组间中位数在调整年龄和种族后是否仍然存在差异。p <. 05。结果使用补片的患者年龄明显大于慢性盆腔疼痛患者,且多为白种人。在对年龄和种族进行调整后,分析显示,在网伤妇女中,膀胱干扰、性干扰和DAPOS A明显较高,而全科医生和住院率明显较低。我们的数据表明,受网伤妇女获得疼痛管理服务的重要性,并将护理途径纳入妇女和精神卫生服务。至关重要的是,这些规划包括支持讨论回归性关系的方式,并有解决焦虑的模式,如分级暴露和心理输入。
{"title":"Baseline measures for women with mesh complications accessing a pain service (as part of the London Complex Mesh Centre)","authors":"Anish Thillainathan, Julia Cambitizi, Victoria Tidman, Katrine Petersen, Moein Tavakkoli, Andrew Paul Baranowski","doi":"10.1177/20494637231206014","DOIUrl":"https://doi.org/10.1177/20494637231206014","url":null,"abstract":"Introduction Pelvic mesh was first used for stress urinary incontinence in 1998 following which its usage rapidly expanded to include treatment of pelvic organ prolapse. Numerous complications relating to mesh insertion soon became apparent, culminating in the Independent Medicines and Medical Devices Safety: First Do No Harm Report published by Baroness Cumberlege in 2020. Following this report, the UCLH London Complex Mesh Centre funded by NHS England, was one of a small number of specialist centres set up for mesh-injured women. The Pelvic Pain service of the Pain Management Centre at UCLH provides a service for patients attending the London Complex Mesh Centre. The aim of our study was to distinguish the differing needs of mesh-injured women from those with chronic pelvic pain by comparing patient-reported outcome measures between these two cohorts. Methods Distribution of data was calculated using the D’Agostino–Pearson normality test. Mann–Whitney tests were used to ascertain statistical difference between the two cohorts. Ethnicity was compared between groups using Fisher’s exact test. Quantile regression models were used to assess whether differences in medians between groups remained after adjustment for age and ethnicity. Statistical significance was set at p < .05. Results Patients with mesh were significantly older than those with chronic pelvic pain and were more likely to be of white ethnicity. After adjustment for age and ethnicity, analysis revealed that bladder interference, sex interference and DAPOS A were significantly higher amongst mesh-injured women, whereas GP and hospital admissions were significantly lower. Discussion Our data shows the importance of mesh-injured women having access to pain management services with pathways of care integrated within women’s and mental health services. It is essential that these programmes include support to discuss ways of returning to sexual relationships and have models to address anxiety such as graded exposure and psychological input.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135740403","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}
引用次数: 0
Restorative neurostimulation for chronic mechanical low back pain - Three year results from the United Kingdom post market clinical follow-up registry. 修复性神经刺激治疗慢性机械性腰痛——英国上市后临床随访登记的三年结果
IF 1.8 Q2 Medicine Pub Date : 2023-10-01 Epub Date: 2023-06-06 DOI: 10.1177/20494637231181498
Simon Thomson, Adam Williams, Girish Vajramani, Manohar Sharma, Sarah Love-Jones, Rajiv Chawla, Sam Eldabe

Introduction: Mechanical chronic low back pain is often associated with impaired neuromuscular control of the lumbar multifidus muscles, the most important stabilizers of the lumbar spine. Restorative neurostimulation is a modality for the treatment for this specific subset of patients aimed to facilitate restoration of neuromuscular control by bilateral stimulation of the L2 medial branches. Evidence from both prospective and randomised clinical trials to date has demonstrated substantial improvements in clinical outcomes such as pain, disability and health-related quality of life.

Methods: This study is an open label prospective follow-up for the treatment of chronic mechanical low back pain of nociceptive origin with restorative neurostimulation. Patients completed assessments for pain, disability and health-related quality of life. Outcomes were collected at 45, 90 and 180 days, and 1, 2 and 3 years after the activation visit.

Results: Forty-two patients were implanted with the device and 33 (79%) were available at the 3-year appointment. Patients in this cohort presented with severe chronic low back pain (NRS = 7.0 ± 0.2) and severe disability (ODI 46.6 ± 12.0). The health-related quality of life was also severely impacted at baseline (EQ-5D 0.426 ± 0.061). Changes in pain, disability and quality of life at three-year follow-up demonstrated a statistically significant improvement between baseline and 1, 2 and 3 years. After 3 years of therapy, average NRS scores had reduced to 2.7± 0.3 and mean ODI score to 26.0 ± 3.1 while EQ-5D-5L index improved to 0.707 ± 0.036.

Conclusions: The ongoing follow-up of this post market cohort continues to demonstrate that restorative neurostimulation provides a statistically significant, clinically meaningful and durable response across pain, disability and quality-of life scores for patients suffering chronic mechanical low back pain that has been refractory to conventional management.

Trial registration: ClinicalTrials.gov Identifier: NCT01985230.

引言机械性慢性腰痛通常与腰椎最重要的稳定器腰椎多裂肌的神经肌肉控制受损有关。恢复性神经刺激是治疗这一特定亚群患者的一种方式,旨在通过双侧刺激L2内侧支来促进神经肌肉控制的恢复。迄今为止,前瞻性和随机临床试验的证据表明,疼痛、残疾和健康相关的生活质量等临床结果有了显著改善。方法本研究是一项开放性前瞻性随访研究,旨在通过恢复性神经刺激治疗伤害性慢性机械性腰痛。患者完成了疼痛、残疾和健康相关生活质量的评估。在激活访视后45、90和180天以及1、2和3年收集结果。结果42例患者植入了该装置,33例(79%)在3年的预约中可用。该队列中的患者表现为严重慢性腰痛(NRS=7.0±0.2)和严重残疾(ODI 46.6±12.0)。与健康相关的生活质量在基线时也受到严重影响(EQ-5D 0.426±0.061)。三年随访中疼痛、残疾和生活质量的变化表明,在基线和1、2和3年之间,疼痛、残疾的改善具有统计学意义。治疗3年后,平均NRS评分降至2.7±0.3,平均ODI评分降至26.0±3.1,EQ-5D-5L指数提高至0.707±0.036。结论对该上市后队列的持续随访继续表明,恢复性神经刺激在疼痛、残疾和生活质量评分方面为患有传统治疗难治的慢性机械性腰痛的患者提供了具有统计学意义、临床意义和持久的反应。试验注册ClinicalTrials.gov标识符:NCT01985230。
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引用次数: 0
Low-dose ketamine infusions for chronic pain management: Does this qualify as evidence-based practice? 低剂量氯胺酮输注治疗慢性疼痛:这是否符合循证实践?
IF 1.8 Q2 Medicine Pub Date : 2023-10-01 Epub Date: 2023-06-21 DOI: 10.1177/20494637231182804
Harry M Griffiths

Chronic pain is becoming increasingly prevalent and burdensome both worldwide and in the United Kingdom. Due to the complexity of chronic pain and the therapeutic challenge associated, management is often difficult and requires multidisciplinary care encompassing a combination of pharmacological and non-pharmacological strategies. Conventional analgesic treatments, such as opioids and anticonvulsants, are effective in less than half of chronic pain sufferers and are typically limited to short-term use to prevent complications associated with long-term use such as tolerance and dependence. Consequently, research and clinical interest in alternative management options for chronic pain have increased in recent years, with ketamine being one example under investigation. However, since ketamine has been licensed as an anaesthetic for decades, it has bypassed the traditional scrutinous drug development sequence that is typically seen for therapeutics marketed for pain. As such, data supporting the unlicensed administration of ketamine for chronic pain management is lacking and is being outpaced by the rates of off-label use in pain clinics. Recent limited evidence suggests that ketamine, when given as an intravenous infusion in subanaesthetic doses for refractory pain patients, may provide modest analgesic effects in nearly all aetiologies of chronic pain, with side effects common but typically mild. However, there are concerns over the safety of this practice due to the paucity of robust supportive evidence and the accompanying lack of clinical guidelines or standardised protocols. This review shall summarise the literature examining the use of subanaesthetic-dose ketamine infusions for chronic pain to comment on the current level of evidence, with limitations of existing research and future recommendations discussed.

慢性疼痛在全世界和英国都变得越来越普遍和沉重。由于慢性疼痛的复杂性和相关的治疗挑战,管理往往是困难的,需要多学科的护理,包括药物和非药物策略的结合。阿片类药物和抗惊厥药等传统镇痛治疗方法对不到一半的慢性疼痛患者有效,而且通常仅限于短期使用,以防止长期使用引起的并发症,如耐受性和依赖性。因此,近年来对慢性疼痛的替代治疗方案的研究和临床兴趣有所增加,氯胺酮是研究中的一个例子。然而,由于氯胺酮作为一种麻醉剂已经被批准了几十年,它绕过了传统的药物开发程序,而这种程序通常是用于治疗疼痛的药物。因此,支持未经许可使用氯胺酮治疗慢性疼痛的数据是缺乏的,而且在疼痛诊所中,未经许可使用氯胺酮的比率超过了氯胺酮。最近有限的证据表明,当以亚麻醉剂量静脉输注氯胺酮用于难治性疼痛患者时,可能对几乎所有病因的慢性疼痛提供适度的镇痛作用,副作用常见但通常轻微。然而,由于缺乏强有力的支持性证据以及伴随的临床指南或标准化方案的缺乏,人们对这种做法的安全性表示担忧。本综述将总结研究亚麻醉剂量氯胺酮输注治疗慢性疼痛的文献,对目前的证据水平进行评价,并对现有研究的局限性和未来的建议进行讨论。
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引用次数: 0
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British Journal of Pain
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