British Journal of Pain最新文献

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.

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: Experimental evidence supports the hypothesis of reciprocal influence between neural systems involved in cognition and central pain processing circuits. Furthermore, studies have demonstrated bidirectional communication between central pain processing areas and the immune system, leading to changes in behaviour, sensory perception, mood, and cognition. However, the academic community has not yet reached a consensus on whether effective analgesic interventions can mitigate or reverse cognitive deterioration.

Methods: This systematic review evaluated the effectiveness of various therapeutic interventions in improving cognitive functions (primary outcome) and altering the profile of immunological markers (secondary outcome) in chronic pain patients. The review was limited to randomised controlled trials addressing chronic pain of any aetiology, with searches conducted in PubMed, EMBASE, and Scopus databases.

Results: The qualitative synthesis of twelve studies conducted between 2003 and 2021, involving 1432 participants in experimental (n = 950) and control (n = 482) groups, revealed some interesting patterns. Only half of the studies (6/12) reported cognitive improvement, with attention being the most analysed cognitive domain, followed by memory and executive function. Fibromyalgia was the most studied aetiology of chronic pain. The strategies of intervention/treatment and durations varied widely; however, milnacipran versus placebo emerged as the most frequently employed intervention. Only one study reported immunological markers, limiting the evaluation of this outcome.

Conclusion: Based on this analysis, it is not possible to affirm that interventions targeting chronic pain improve cognition. This review suggests new research directions and calls for more robust methodological approaches.

Background: Digital pain drawings are an emerging method for pain assessment, but it is still unclear how these could best support pain treatment and management decisions. Therefore, this study explored the potential clinical utility of digital pain drawings.

Methods: We conducted a narrative study, involving qualitative interviews with healthcare professionals providing pain management services to people living with musculoskeletal pain conditions working across different disciplines and care levels in the healthcare system of the United Kingdom. We transcribed interviews, conducted thematic content analysis to identify themes and presented results using a framework approach.

Results: We interviewed three general practitioners, five rheumatology healthcare professionals, four physiotherapists, two pain consultants and one rheumatology nurse. We identified four themes describing current pain assessment practices, potential advantages of digital pain drawings either alone or in combination with other pain information (e.g. perceived pain triggers and relieving factors) and outcome measures (e.g. quality of sleep, function and anxiety). Digital pain drawings provide an opportunity of enriching patient-provider communication, particularly for people with language barriers. Digital pain drawings may also support healthcare professionals across different disciplines and care levels (e.g. primary and secondary care) in decisions related to referrals, differential diagnosis, treatment planning, evaluating response to treatment and scheduling follow-up visits when combining pain drawings with other pain information, such as pain consequences and perceived causes.

Conclusion: Digital pain drawings are clinically useful because of their potential to guide diagnosis, treatment and management choices in managing musculoskeletal chronic pain. Future research should investigate how these potential benefits are achieved by integrating digital pain drawings in clinical practice across different disciplines and care levels in the UK's healthcare system and beyond.

Background: While physical therapists have provided group physical therapy interventions for patients admitted to inpatient psychiatric pain service lines, to date, it has not been assessed whether the patients' outcomes of pain and function have improved during their stay. Thus, our aim is to evaluate how group physical therapy, as part of an inpatient psychiatric rehabilitation team, impacts outcomes for patients receiving chronic pain treatment services.

Methods: Data was retrospectively retrieved from patients who received group physical therapy during their inpatient psychiatric pain admission. At evaluation and discharge, PROMIS Pain Interference Scale tracked pain, while AM-PAC Basic Mobility Outpatient Short Form measured functional mobility. Paired samples statistics were used to evaluate outcomes.

Results: Over a 6-month period, 25 patients (average age 40.28 +/- 15.93 years) received group physical therapy. All patients had the treatment diagnosis of chronic pain. The null hypothesis, that there was no difference between evaluation and discharge scores, was rejected for both the PROMIS Pain Interference Scale t (25) = 3.82, two-tailed p < .001 and the AM-PAC Mobility Score t (25) = -2.24, two-tailed p = .03.

Conclusions: Group physical therapy, as part of an inpatient psychiatric pain management team, assists with improving patient outcomes of pain and mobility.

Objective: Persons with chronic pain suffer from additional symptoms and deficits that are directly or indirectly related to their condition. Attentional deficits are a common problem in these individuals. The same is true for sleep disturbances. It is well-known that night sleep affects attention the next day. Therefore, sleep disturbances might be responsible for the association between chronic pain and deficits in attention.

Methods: We studied the gaze behaviour (absolute and relative fixation times, i.e., attentional biases) in patients with chronic musculoskeletal pain (N = 20) and pain-free individuals (N = 28). For that purpose, we used an eye-tracker to monitor gaze behaviour during the presentation of affective stimuli, that is, pictures of faces displaying joy, anger, pain, and neutral expressions. In addition, we assessed subjective/wellbeing parameters, as well as objective sleep parameters with a portable polysomnography (PSG) device during two nights at home, with the aim of testing the mediating role of sleep for the relationship between chronic pain and alterations of attention.

Results: Patients with chronic pain exhibited overall shorter fixation times (on average ∼160 ms shorter fixation times). With respect to the attentional biases, all participants looked longer at the affective faces compared to the neutral ones, independent of group or type of affective stimulus. Several subjective sleep/wellbeing parameters, together with two PSG parameters (sleep efficiency and duration of awakenings), were significantly worse in patients with chronic pain. Despite this, only subjective sleep quality and sleep efficiency mediated the association of chronic pain and attentional processes.

Conclusions: Our findings confirm previous studies showing attentional deficits and sleep disturbances in patients with chronic pain. However, our results only partially support the hypothesis that the relationship between chronic pain and altered attentional processes is due to disturbed sleep. Other mechanisms might be involved, highlighting the need for further studies.

Background: Amputation leads to significant physical, psychological, and emotional challenges, with chronic pain being among the most debilitating outcomes. Conditioned Pain Modulation (CPM) is a key mechanism for understanding pain modulation reflecting the central nervous system's capacity to regulate pain.

Objective: This study aimed to evaluate CPM in amputees, comparing CPM between the amputated and non-amputated sides, and to identify factors influencing CPM in this population.

Method: Eighty-six amputees participated in the study. Sociodemographic and pain-related variables, including age, occupation, smoking status, pre-amputation pain duration, phantom limb pain, and pressure pain threshold, were assessed. Multiple linear regression models were performed to explore factors associated with CPM on both sides, with additional t-tests to compare CPM values between sides.

Results: The multivariate model for the amputated side explained 26.3% of CPM variability, with significant associations found for pre-amputation pain duration and retirement status, as well as PPT mean of the amputated side, smoking, and phantom limb pain and age. In contrast, the non-amputated side model explained 26.5% (Adjusted R-squared) of the variability, with the following significant variables: duration of pre-amputation pain (negative correlation), smoking history, phantom limb pain (negative correlation), and frequency of telescoping sensation (negative correlation). There were no significant differences in CPM between amputated and non-amputated sides (p > 0.05).

Conclusion: The findings suggest that CPM on the amputated side is more influenced by pain experience and sociodemographic variables, while the non-amputated side shows less variability and is more resilient to these influences.

Background: Surgery is one of the most common indications for a patient's first opioid prescription, with some patients progressing to unintended long-term use. There is no current data from the United Kingdom on how much patients use of the opioid medication dispensed at discharge from hospital. This study investigates discharge opioid prescribing and usage following common surgical procedures.

Methods: This cohort study was conducted at the Oxford University Hospitals NHS Foundation Trust and involved 20 of the most commonly performed adult surgical procedures. At least 20 patients per procedure were surveyed using a standardised telephone questionnaire 6-8 days after discharge to establish the amount of used and unused opioids. Opioid doses were converted to oral morphine equivalent (OME) for analysis.

Results: The amount of opioid given to patients after all types of surgery far exceeded requirement, with often large variations in prescribing practices for the same procedures, most notably in trauma and orthopaedics.For the cohort of 426 patients, a total of 55 080 mg OME was dispensed on discharge, with only 34.4% actually used by patients, leaving a total of 36 108.5 mg OME unused in the community, risking inappropriate opioid use, overdose, or diversion.

Conclusions: Opioid overprescribing is common after surgery and represents waste, expense, and risk to patients. There is a clear need to develop a procedure-specific evidence-base for discharge opioid prescribing, adopting an "enough but not too much" approach to ensure that patients have adequate analgesia to facilitate functional surgical recovery, but not more than is needed.

Background: Complex Regional Pain Syndrome (CRPS) is a rare, chronic pain disorder that can have a devastating impact. Its cause remains unclear and debate over treatment strategies continues. The aim of the study was to utilise patient-reported outcomes to aid in the further evaluation of treatment options.

Method: An online survey was distributed with ethical approval to members of a CRPS charity. The Checklist for Reporting Results of Internet E-Surveys was implemented. Adults who met the patient-reported aspect of the Budapest Criteria were included (non-validated). Functional scores were reported using the shortened Disabilities of the Arm, Shoulder and Hand outcome measurement tool (QuickDASH) and Lower Extremity Functional Scale (LEFS). Participants completed a pre-injury score, a score related to injury and a score related specifically to CRPS symptoms. Respondents were also asked to rate a number of pharmacological and non-pharmacological treatments for CRPS.

Results: Respondents were mostly female (87%, 447/514) with a mean age of 49 years (SD 13). 69% (354/514) reported trauma as the inciting event. Anxiety (55%, 283/514) was the most commonly reported co-morbidity. Opioids (72%, 258/358) and Physical Therapy/Rehabilitation (63%, 281/444) were reported as the most beneficial (used by >10% of respondents) pharmacological and non-pharmacological therapies respectively. Median CRPS functional scores were significantly worse than scores relating to the injury alone, for both QuickDASH (56 (IQR 36-77) versus 77 (IQR 61-91), p < .001) and LEFS (20 (IQR 8-40) versus 7 (IQR 3-17), p < .001).

Conclusion: We present the first study using validated patient-reported outcome measures of limb-specific function in a solely CRPS population. These data quantify the devastating impact of CRPS and help make its prevention and treatment a priority amongst those who encounter it. The treatment data should inform future research, especially in successful therapies that were less commonly utilised.