Evidence-based Pain Treatment Research Articles

Factors Associated With Chronic Pain Intensity in U.S. Army Soldiers.

Chronic pain is prevalent among U.S. military personnel and veterans. The effectiveness of evidence-based pain treatments can be boosted with knowledge of factors associated with chronic pain perception. This study examined the factors that influence soldiers' self-rating of their chronic pain intensity. The study design was a retrospective review of the intake questionnaire from 203 soldiers seen at an Interdisciplinary Pain Management Center. The intake covered various aspects of soldiers' chronic pain experience, including pain intensity, interference in functioning, emotional sequelae, and pain-related catastrophic thinking. Pain intensity and impact were measured using the Defense and Veterans Pain Rating Scale. The mood was measured using the depression (Patient Health Questionnaire [PHQ]-9) and the anxiety (Generalized Anxiety Disorder-7) scales from the PHQ. Pain-related catastrophic thinking was measured using the Pain Catastrophizing Scale (PCS). Pain interference was assessed using a five-item scale that inquired about concentration, life and recreation enjoyment, task performance, and socializing. Data were analyzed using descriptive statistics and linear regression analyses. The mean duration of pain was 34.73 ± 38.66 months. Regression analysis using scores from the PHQ-9, Generalized Anxiety Disorder-7, three PCS subscales (rumination, magnification, and helplessness), and pain interference scale as predictors showed that pain interference and PCS helplessness factors were significant predictors of average pain rating (R2 = 24%, P < .001). Pain interference in functioning and pain-related thoughts of helplessness accounted for a significant degree of the variance in soldiers' self-rating of their chronic pain. The findings suggest that added attention should be directed at helping patients boost their self-efficacy in using pain-coping methods to improve their functioning and address the perception of helplessness about their pain.

Barriers to accessing pain management services among veterans with bipolar disorder.

To identify barriers veterans with bipolar disorder face to accessing chronic pain management services within a Veterans Affairs (VA) health care system. Veterans (n = 15) with chronic pain and bipolar disorder and providers (n = 15) working within a mid-Atlantic VA health care system. Data were collected from August 2017-June 2018. Veteran interviews focused on their chronic pain experiences and treatment, including barriers that arose when trying to access pain management services. Provider interviews focused on whether they address chronic pain with veteran patients and, if so, what considerations arise when addressing pain in veterans with bipolar disorder and other serious mental illnesses. Veterans were at least 18 years old, had a confirmed bipolar disorder and chronic pain diagnosis, and engaged in outpatient care within the VA health care system. Clinicians provided direct care services to veterans within the same VA. Interviews lasted approximately 60 min and were transcribed and analyzed using a rapid analysis protocol. Four major themes emerged from veteran and provider interviews: siloed care (unintegrated and uncoordinated mental and physical health care), mental health primacy (prioritization of mental health symptoms at expense of physical health symptoms), lagging expectations (unfamiliarity with comprehensive evidence-based pain management options), and provider-patient communication concerns (inefficient communication about pain concerns and treatment options). Veterans with co-occurring pain and bipolar disorder face unique barriers that compromise equitable access to evidence-based pain treatment. Our findings suggest that educating providers about bipolar disorder and other serious mental illnesses and the benefit of effective non-pharmacological pain interventions for this group may improve care coordination and care quality and reduce access disparities.

Nurse-led Tele-Collaborative Pain Care for Rural Patients with Substance Use Disorder

PurposeRates of chronic non-cancer pain in patients with substance use disorders (SUD) are higher than in patients without SUD. Yet access to evidence-based pain treatment for patients with SUD is limited, particularly in rural areas where care access is often poor. The purpose of this study was to examine feasibility and preliminary efficacy of a nurse-led collaborative pain intervention for patients with comorbid chronic pain and SUD, delivered exclusively via telehealth. MethodsSubjects were 62 patients with chronic musculoskeletal pain enrolled in specialty SUD treatment at a single VA medical center and residing in rural geographic regions. Subjects received an initial pain assessment and treatment recommendations, 6 follow-up appointments over four months, and a 10-session weekly pain education class. All clinical encounters were delivered via video conference or telephone, based on patient preference and internet availability. Subjects completed an interviewer administered survey at baseline, 1- and 4-month follow-up that assessed pain severity and interference as measured by the Brief Pain Inventory, depression symptoms as measured by the Beck Depression Inventory-II, and daily substance use outcomes as measured by the Timeline Followback. ResultsPatients on average were 48 years old, and the majority were male (86%) and White Non-Hispanic (91%). By 4-month follow-up, pain severity (B = -0.67 [-1.05, -0.29]), pain interference (B = -0.94 [-1.50, -0.39]), and depression symptoms (B = -4.30 [-7.96, -0.63]) had significantly declined from baseline. A significant reduction in days of alcohol (OR = 0.64 [0.46, 0.90]) and cannabis use (OR = 0.47 [0.34, 0.66]) was also observed at 4-month follow-up. ConclusionPreliminary analyses show promise for synchronous telehealth collaborative pain interventions delivered to rural patients receiving SUD treatment, with particular benefit in reducing pain, depression symptoms, and alcohol and cannabis use.

Nurses' perspectives on pain management practices during newborn blood sampling in China

IntroductionNurses' use of evidence-based pain treatments for newborns during needle-related procedures in China was unknown. This study aimed to ascertain knowledge and use of pain management strategies and usefulness of a publicly accessible 'BSweet2Babies' video, produced in Mandarin, demonstrating the use of breastfeeding, skin-to-skin care (SSC), and sweet solutions during painful procedures. MethodsAn online survey was conducted during six nursing conferences in China ascertaining nurses' previous viewing of the video and knowledge and use of the demonstrated strategies. Results221 nurses participated. Only 25 (11.3%) had previously seen the video. Over half knew that breastfeeding (n = 138, 62.4%) and SSC (n = 173, 78.3%) reduced pain, and 89 (40.3%) knew that sucrose reduced pain, but these strategies were infrequently used. Most intended to use the strategies in the future. DiscussionA knowledge-to-action gap for newborn pain management was identified. Future research is needed to improve the implementation of effective pain treatment for newborns.

Barriers and Facilitators to Effective Procedural Pain Treatments for Pediatric Patients in the Chinese Context: A Qualitative Descriptive Study

PurposeTo explore nurse and physician leaders' perceptions of barriers and facilitators to using evidence-based procedural pain treatments (i.e., sweet solutions, breastfeeding, and topical anesthetics) for hospitalized infants and children in the Chinese context. Design and methodsA descriptive qualitative study was conducted at three pediatric inpatient surgical units in one hospital in China. Purposive sampling was used to recruit nurse/physician leaders who were engaged in the clinical management of the 3 units. Data collection included a focus group and individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the analysis of the data. ResultsTen participants attended the focus group and 13 took part in individual interviews. The findings highlight 41 implementation determinants, including two neutral influencing factors, 22 barriers, and 17 facilitators. These influencing factors aligned with the four CFIR domains and 25 of the 29 CFIR constructs. Common barriers to using evidence-based pain treatments across different contexts were identified, such as health care professionals' limited knowledge and misconceptions on pediatric pain management, no specific policies, low priority, heavy workload, staff shortage, and limited time. Unique determinants in the Chinese context were also identified, including parents' concerns of these new interventions, parent wrath, hierarchical managerial system, and lower authority of nurses. ConclusionsMultiple barriers as well as facilitators to using evidence-based pain management strategies were identified. Practice implicationsThe findings inform further development of implementation strategies and could be used as baseline data for comparing the barriers and facilitators evaluated during and after implementation.

Pharmacologic Management for Cancer Pain

Chronic pain is a major factor that impairs functionality and compromises quality of life. Unfortunately, this type of pain is often under-treated due to lack of education about the use and range of effective non-pharmacologic modalities, about how to use and monitor pharmacologic modalities, and the fear about real and imagined adverse effects that are associated with its management. Cancer is diagnosed in approximately 40% of the population with up to 89% experiencing some form of pain in the later stages of the disease. Unfortunately, a significant portion of this population receives inadequate treatment for their pain. Here we provide a review of the evidence-base for determining the best approach for managing the pain of malignancy in the hope of providing a basic framework for the physician to better utilize the pharmacological options that comprise an important component of comprehensive pain care for the cancer patient. This review contains 2 figures, 7 tables, and 106 references. Keywords: Cancer pain, malignant pain, opioids, chronic pain, analgesic options, adjuvant options, cancer pharmacology, evidence-based pain treatment

Pharmacologic Management for Cancer Pain

Chronic pain is a major factor that impairs functionality and compromises quality of life. Unfortunately, this type of pain is often under-treated due to lack of education about the use and range of effective non-pharmacologic modalities, about how to use and monitor pharmacologic modalities, and the fear about real and imagined adverse effects that are associated with its management. Cancer is diagnosed in approximately 40% of the population with up to 89% experiencing some form of pain in the later stages of the disease. Unfortunately, a significant portion of this population receives inadequate treatment for their pain. Here we provide a review of the evidence-base for determining the best approach for managing the pain of malignancy in the hope of providing a basic framework for the physician to better utilize the pharmacological options that comprise an important component of comprehensive pain care for the cancer patient. This review contains 2 figures, 7 tables, and 106 references. Keywords: Cancer pain, malignant pain, opioids, chronic pain, analgesic options, adjuvant options, cancer pharmacology, evidence-based pain treatment

Pharmacologic Management for Cancer Pain

Chronic pain is a major factor that impairs functionality and compromises quality of life. Unfortunately, this type of pain is often under-treated due to lack of education about the use and range of effective non-pharmacologic modalities, about how to use and monitor pharmacologic modalities, and the fear about real and imagined adverse effects that are associated with its management. Cancer is diagnosed in approximately 40% of the population with up to 89% experiencing some form of pain in the later stages of the disease. Unfortunately, a significant portion of this population receives inadequate treatment for their pain. Here we provide a review of the evidence-base for determining the best approach for managing the pain of malignancy in the hope of providing a basic framework for the physician to better utilize the pharmacological options that comprise an important component of comprehensive pain care for the cancer patient. This review contains 2 figures, 7 tables, and 106 references. Keywords: Cancer pain, malignant pain, opioids, chronic pain, analgesic options, adjuvant options, cancer pharmacology, evidence-based pain treatment

Barriers and facilitators to using pain treatment during newborn screening blood tests at a mother-baby unit

BackgroundNewborns undergo blood tests for newborn screening (NBS). Breastfeeding, skin-to-skin care (SSC) and sweet solutions effectively reduce pain; however, these strategies are inconsistently used. AimsTo assess the utilization of, and barriers and facilitators to using pain treatment during NBS. MethodsOnline survey of nurses in a mother-baby unit ascertaining pain management during NBS, and barriers/facilitators to using the three strategies. Participants viewed a video portraying the use of each strategy during NBS. ResultsThirty-six of 45 nurses participated (response rate = 80%). Thirty-five (97%) reported completing NBS outside the patient's room. Breastfeeding was sometimes supported (44%) and 40% never suggested SSC, while 53% often used sucrose. After viewing the video, nurses preferred sucrose (mean = 82) over breastfeeding (mean = 44) or SSC (mean = 44). Main barriers to using breastfeeding and SSC were ergonomics, contextual factors and time. ConclusionsFurther work is warranted to address barriers to using evidence-based pain treatment for newborns during NBS.

Associations Between Early Care Decisions and the Risk for Long-term Opioid Use for Patients With Low Back Pain With a New Physician Consultation and Initiation of Opioid Therapy.

The aim of this study was to identify associations between early care decisions and long-term opioid (LTO) use in opioid-naïve patients with a new physician consultation for low back pain (LBP) at which an opioid was prescribed. A retrospective study of claims data was used to identify opioid-naïve LBP patients who were prescribed opioids at the index physician visit. Early care variables captured included additional nonopioid medications prescribed within 14 days and provider visits or diagnostic imaging within 30 days of the index visit. A multivariate logistic model was used to identify early care variables associated with the outcome of (LTO) use in the year following the index visit controlling for patient factors. A total of 707 patients were included in this study. The mean age was 38.1 (±11.6), and 67.8% were female individuals and 76.9% were Medicaid beneficiaries. Early care medications were muscle relaxants (32.2%), nonsteroidal anti-inflammatories (29.3%), oral steroids (11.7%), and benzodiazepines (8.3%). The most common early care provider visits were with primary care (31.0%) and physical therapy (13.0%). A total of 172 patients (24.3%) progressed to LTO use. Controlling for patient factors, early care variables increasing risk for LTO use were an early benzodiazepine prescription and primary care visit. An early physical therapy visit was associated with reduced risk for LTO use. Early care decisions were predictive of LTO use following a new LBP consultation at which opioids were prescribed. Our results support recommendations to avoid concurrent benzodiazepine prescribing and to consider other evidence-based pain treatments such as physical therapy early, particularly for patients at high risk for LTO use or misuse.

Drug Counselors' Attitudes Toward Nonpharmacologic Treatments for Chronic Pain.

To examine methadone counselors' attitudes toward individual and group-based nonpharmacologic treatments for chronic pain. Thirty methadone drug counselors were interviewed about their attitudes toward pain interventions and completed a survey on the perceived efficacy of and willingness to refer patients to nonpharmacologic pain treatments. Counselors reported favorable attitudes toward interventions commonly found in interdisciplinary pain management, particularly, conventional psychological approaches. On average, counselors rated cognitive-behavioral therapy (individual or group) as the treatment with the highest perceived efficacy and the one to which they were most willing to refer patients with pain. In contrast, on average, counselors rated the use of herbal medicine, aromatherapy, and magnets among the lowest in perceived efficacy and in willingness to refer patients with pain. Generally, higher perceived efficacy was associated with higher referral willingness, and scores on both dimensions were comparable across individual and group interventions. Findings indicate that methadone drug counselors perceive several nonpharmacologic evidence-based pain treatments as efficacious for methadone-maintained patients with chronic pain and counselors would be willing to refer their patients to these therapies if they were available. If some of these nonpharmacologic interventions were shown to be effective in methadone maintenance treatment, they have the potential to address, at least in part, the routine undertreatment of pain in this vulnerable patient population.

Setting the Stage for Improved Practices During Vaccine Injections: A Knowledge Synthesis of Interventions for the Management of Pain and Fear.

Setting the Stage for Improved Practices During Vaccine Injections: A Knowledge Synthesis of Interventions for the Management of Pain and Fear.

A closer look: Alternative pain management practices by heart failure patients with chronic pain

ObjectiveTo describe alternative non-pharmaceutical non-nutraceutical pain self-management strategies used by people with heart failure (HF) in order to reduce chronic non-cardiac pain. BackgroundLittle is known about alternative pain self-treatments used by HF patients with chronic pain. MethodsA cross-sectional descriptive design was used with 25 hospitalized HF patients who had chronic pain and used at least one alternative pain treatment. Pain intensity, pain interference with function, and current pain treatments were measured with the Brief Pain Inventory. ResultsAlternative treatments included walking, stretching, use of heat and cold. Five patients used evidence-based pain treatments for their chronic pain conditions. Patients reported moderate pain intensity and pain interference with activity. ConclusionsPatients with HF and chronic pain use few alternative pain treatments. Screening for chronic pain and referral to Integrative Medicine and/or Palliative care for a pain management consult might reduce the added burden of pain in people with HF.

Improving the Pharmacologic Management of Pain in Older Adults: Identifying the Research Gaps and Methods to Address Them

There has been a growing recognition of the need for better pharmacologic management of chronic pain among older adults. To address this need, the National Institutes of Health Pain Consortium sponsored an "Expert Panel Discussion on the Pharmacological Management of Chronic Pain in Older Adults" conference in September 2010 to identify research gaps and strategies to address them. Specific emphasis was placed on ascertaining gaps regarding use of opioid and nonsteroidal anti-inflammatory medications because of continued uncertainties regarding their risks and benefits. Eighteen panel members provided oral presentations; each was followed by a multidisciplinary panel discussion. Meeting transcripts and panelists' slide presentations were reviewed to identify the gaps and the types of studies and research methods panelists suggested could best address them. Fifteen gaps were identified in the areas of treatment (e.g., uncertainty regarding the long-term safety and efficacy of commonly prescribed analgesics), epidemiology (e.g., lack of knowledge regarding the course of common pain syndromes), and implementation (e.g., limited understanding of optimal strategies to translate evidence-based pain treatments into practice). Analyses of data from electronic health care databases, observational cohort studies, and ongoing cohort studies (augmented with pain and other relevant outcomes measures) were felt to be practical methods for building an age-appropriate evidence base to improve the pharmacologic management of pain in later life. Addressing the gaps presented in the current report was judged by the panel to have substantial potential to improve the health and well-being of older adults with chronic pain.