High-impact Chronic Pain Research Articles

Cancer survivors experience extensive chronic pain.

Corresponding author Changchuan Jiang, MD, MPH, a medical resident at Mount Sinai St. Luke's and Mount Sinai West in New York City, notes that the study is the first to offer a comprehensive estimate of chronic pain among the growing population of cancer survivors, which totaled 15.5 million in 2016 and is expected to reach 26.1 million by 2040. The condition, which is one of the most common long-term effects of cancer treatment, can result in impaired quality of life as well as less adherence to treatment and higher health care costs, the authors note. They add that their findings point to unmet needs among this population. The study involved data from 4526 adult survivors of cancer who participated in the 2016 through 2017 National Health Interview Survey. Approximately 34.6% of survivors reported chronic pain whereas 16.1% reported high-impact chronic pain. Those findings led to prevalence estimates of 5.39 million, or 35%, of all cancer survivors who are dealing with chronic pain. The results also demonstrated that chronic pain was more common in patients with specific types of cancer, including that of the bone, kidney, throat, and uterus, as well as in survivors who were unemployed or had less than a high school education, a low household income, and inadequate health insurance. In addition to Mount Sinai, researchers from the American Cancer Society, Memorial Sloan Kettering Cancer Center, and the University of Virginia collaborated on the study.

Challenges in the clinical implementation of a biopsychosocial model for assessment and management of orofacial pain.

Distress, suffering and care-seeking behaviour are characteristics of pain-related disease and illness. Pain that transitions from an acute to a chronic phase carries with it the potential of further effects: these include a worsening of the disease or illness; high-impact chronic pain; and substantial personal, societal and economic burden. The biopsychosocial model directly addresses these multiple processes, yet clinical frameworks supporting this model are not universally implemented. This paper explores barriers to clinical implementation of a full biopsychosocial framework for temporomandibular disorders (TMD) and other oro-facial pain (OFP) conditions. In June 2016, INfORM invited OFP researchers to a workshop designed to optimise the DC/TMD Axis-II. Workshop groups identified five sources of implementation barriers: (1) cultures and societies, (2) levels-of-care settings, (3) health services, (4) cross-cultural validity of self-report instruments and (5) provider and patient health literacy. Three core problems emerged: (A) mental health aspects are seldom fully considered, thus impairing the recognition of illness, (B) training in use of validated multi-axial assessment protocols is under-rated and insufficiently used, and (C) clinical assessment often fails to recognise that sensory and emotional dimensions are fundamental aspects of pain. To improve patient care, these barriers and problems require action. Most importantly, TMD/OFP educators and researchers need to coordinate globally and (i) be educated in the biopsychosocial model, (ii) implement evidence-based biopsychosocial guidelines for assessment and management of OFP conditions at their institutions, (iii) incorporate this model in undergraduate and postgraduate dental curricula and (iv) be responsive to stakeholders, including regulatory authorities and practitioners.

Prevalence of Chronic Pain and High-Impact Chronic Pain in Cancer Survivors in the United States

This survey study uses data from the National Health Interview Survey to investigate the prevalence of, and socioeconomic risk factors for, chronic pain and high-impact chronic pain among cancer survivors in the United States.

Health Care Costs and Opioid Use Associated With High-impact Chronic Spinal Pain in the United States.

A descriptive analysis of secondary data. The aim of this study was to estimate health care costs and opioid use for those with high-impact chronic spinal (back and neck) pain. The US National Pain Strategy introduced a focus on high-impact chronic pain-that is, chronic pain associated with work, social, and self-care restrictions. Chronic neck and low-back pain are common, costly, and associated with long-term opioid use. Although chronic pain is not homogenous, most estimates of its costs are averages that ignore severity (impact). We used 2003 to 2015 Medical Expenditures Panel Survey (MEPS) data to identify individuals with chronic spinal pain, their health care expenditures, and use of opioids. We developed prediction models to identify those with high- versus moderate- and low-impact chronic spinal pain based on the variables available in MEPS. We found that overall and spine-related health care costs, and the use and dosage of opioids increased significantly with chronic pain impact levels. Overall and spine-related annual per person health care costs for those with high-impact chronic pain ($14,661 SE: $814; and $5979 SE: $471, respectively) were more than double that of those with low-impact, but still clinically significant, chronic pain ($6371 SE: $557; and $2300 SE: $328). Those with high-impact chronic spinal pain also use spine-related opioids at a rate almost four times that of those with low-impact pain (48.4% vs. 12.4%), and on average use over five times the morphine equivalent daily dose (MEDD) in mg (15.3 SE: 1.4 vs. 2.7 SE: 0.6). Opioid use and dosing increased significantly across years, but the increase in inflation-adjusted health care costs was not statistically significant. Although most studies of chronic spinal pain do not differentiate participants by the impact of their chronic pain, these estimates highlight the importance of identifying chronic pain levels and focusing on those with high-impact chronic pain. 3.

(375) An Analysis of Physician and Patient Reporting of Treatable Targets in an Interdisciplinary Pain Management Program

Interdisciplinary pain management programs (IPMP) provide low-risk, cost-effective treatment for patients with “high-impact chronic pain”. Patient participation is important for successful outcomes and may be influenced by patient and physician perceptions of treatment targets. The purpose of this study was to determine the presence of difficulty with 7 key clinical domains and the level of agreement between patients and physicians identifying these. It was hypothesized that more impaired patients would be recommended for more intense treatment and that higher levels of physician-patient agreement would predict higher levels of enrollment in treatment. A retrospective chart review was performed of 544 patients evaluated in an outpatient academic pain clinic. Patient characteristics; patient and physician reported presence of difficulty with 7 clinical domains (pain, sleep, mood, physical functioning, ability to cope with pain, ability to manage pain flare-ups and medication effectiveness); treatment recommendation (>80 h total treatment in an IPMP vs 80h of treatment had significantly more physician-identified problem domains. Levels of physician-patient agreement did not vary by treatment recommendation or treatment enrollment status (P's >.05). Despite agreement between patients and physicians, only 57.4% of patients began treatment. As hypothesized, more impaired patients were recommended for more treatment. However, patient-physician agreement did not appear to affect the treatment recommendation or enrollment status. Further studies are needed to identify other barriers to treatment.

Exploring the prevalence and construct validity of high-impact chronic pain across chronic low-back pain study samples

BACKGROUND CONTEXTThe US National Pain Strategy focused attention on high-impact chronic pain and its restrictions. Although many interventions have been studied for chronic low-back pain, results are typically reported for heterogeneous samples. To better understand chronic pain and target interventions to those who most need care, more granular classifications recognizing chronic pain's impact are needed. PURPOSETo test whether chronic pain impact levels can be identified in chronic low-back pain clinical trial samples, examine the baseline patient mix across studies, and evaluate the construct validity of high-impact chronic pain. STUDY DESIGN/SETTINGDescriptive analyses using 12 large study datasets. PATIENT SAMPLESChronic low-back pain patients in nonsurgical, nonpharmacologic trials in the US, Canada, and UK. OUTCOME MEASURESPreference-based health utilities from the SF-6D and EQ-5D, employment status and absenteeism. METHODSWe used two logistic regression models to predict whether patients had high-impact chronic pain and whether the remainder had low- or moderate-impact chronic pain. We developed these models using two datasets. Models with the best predictive power were used to impute impact levels for six other datasets. Stratified by these estimated chronic pain impact levels, we characterized the case mix of patients at baseline in each dataset, and summarized their health-utilities and work productivity. This study was funded by a National Center for Complementary and Integrative Medicine grant. The authors have no potential conflicts of interest. RESULTSThe logistic models had excellent predictive power to identify those with high-impact chronic pain. Although studies were all of chronic low-back pain patients, the baseline mix of patients varied widely. Across all datasets, utilities, and productivity were similar for those with high-impact chronic pain and worsened as chronic pain impact increased. CONCLUSIONSThere is a need to better categorize chronic pain patients to allow the targeting of optimal interventions for those with each level of chronic pain impact.

Exercise as a Treatment for Chronic Pain

Exercise as a Treatment for Chronic Pain

Researchers Home in on High-Impact Chronic Pain With Treatment, Research, and Policy Implications

Researchers Home in on High-Impact Chronic Pain With Treatment, Research, and Policy Implications

Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults - United States, 2016.

Chronic pain, one of the most common reasons adults seek medical care (1), has been linked to restrictions in mobility and daily activities (2,3), dependence on opioids (4), anxiety and depression (2), and poor perceived health or reduced quality of life (2,3). Population-based estimates of chronic pain among U.S. adults range from 11% to 40% (5), with considerable population subgroup variation. As a result, the 2016 National Pain Strategy called for more precise prevalence estimates of chronic pain and high-impact chronic pain (i.e., chronic pain that frequently limits life or work activities) to reliably establish the prevalence of chronic pain and aid in the development and implementation of population-wide pain interventions (5). National estimates of high-impact chronic pain can help differentiate persons with limitations in major life domains, including work, social, recreational, and self-care activities from those who maintain normal life activities despite chronic pain, providing a better understanding of the population in need of pain services. To estimate the prevalence of chronic pain and high-impact chronic pain in the United States, CDC analyzed 2016 National Health Interview Survey (NHIS) data. An estimated 20.4% (50.0 million) of U.S. adults had chronic pain and 8.0% of U.S. adults (19.6 million) had high-impact chronic pain, with higher prevalences of both chronic pain and high-impact chronic pain reported among women, older adults, previously but not currently employed adults, adults living in poverty, adults with public health insurance, and rural residents. These findings could be used to target pain management interventions.

Prevalence and Profile of High-Impact Chronic Pain in the United States

The multidimensional nature of chronic pain is not reflected by definitions based solely on pain duration, resulting in high prevalence estimates limiting effective policy development. The newly proposed concept of high-impact chronic pain (HICP) incorporates both disability and pain duration to identify a more severely impacted portion of the chronic pain population yet remains uncharacterized at the population level. As such, we used the 2011 National Health Interview Survey (N = 15,670) to 1) assess the likelihood of disability in the overall chronic pain population, 2) estimate the prevalence of HICP, and 3) characterize the disability, health status, and health care use profile of this population in the United States. Overall, chronic pain, defined as pain experienced on most days or every day in the previous 3 months, was strongly associated with an increased risk of disability after controlling for other chronic health conditions (odds ratio = 4.43; 95% confidence interval = 3.73–5.26), where disability was more likely in those with chronic pain than in those with stroke or kidney failure, among others. HICP affected 4.8% of the U.S. adult population, or approximately 10.6 million individuals, in 2011. The HICP population reported more severe pain and more mental health and cognitive impairments than persons with chronic pain without disability, and was also more likely to report worsening health, more difficulty with self-care, and greater health care use. HICP clearly represents a more severely impacted portion of the chronic pain population. Understanding this heterogeneity will contribute to developing more effective legislation promoting safe and cost-effective approaches to the prevention and treatment of chronic pain. PerspectiveHICP is a powerful new classification that differentiates those with debilitating chronic pain from those with less impactful chronic pain. By addressing the multidimensionality of chronic pain, this classification will improve clinical practice, research, and the development of effective health policy.

Opioid-Sparing Modalities for Nursing: Update on ASPMN Task Force

The National Pain Strategy states, “Every effort should be made to prevent illnesses and injuries that lead to pain, the progression of acute pain to a chronic condition, and the development of high-impact chronic pain.” Studies have indicated ketamine, lidocaine infusions, epidurals and peripheral nerve blocks improve pain management and potentially decrease the transition to chronic pain. As an organization devoted to art and science of pain management, there are substantial ethical implications to reviewing these modalities further. Numerous studies and systematic reviews are available on these medications. However, the nursing implications of dosing, length of therapy, and safety considerations are rarely acknowledged. A task force has been established with a goal to review pain modalities such as ketamine, lidocaine infusions, epidurals, and peripheral nerve blocks through the nursing lens. Dosing, safety components, side effects and nursing implications will be reviewed in an effort to standardize practice, improve utilization of these modalities by RNs and APRNs and overcome barriers to use. The plan is to develop an ASPMN Best Practice Guideline on opioid-sparing options with parameters for dosing, length of therapy and monitoring guidelines. This presentation will focus on literature review, findings to date and status of guideline development.

Neurogenic inflammation in fibromyalgia.

Fibromyalgia is a high impact chronic pain disorder with a well-defined and robust clinical phenotype. Key features include widespread pain and tenderness, high levels of sleep disturbance, fatigue, cognitive dysfunction and emotional distress. Abnormal processing of pain and other sensory input occurs in the brain, spinal cord and periphery and is related to the processes of central and peripheral sensitization. As such, fibromyalgia is deemed to be one of the central sensitivity syndromes. There is increasing evidence of neurogenically derived inflammatory mechanisms occurring in the peripheral tissues, spinal cord and brain in fibromyalgia. These involve a variety of neuropeptides, chemokines and cytokines with activation of both the innate and adaptive immune systems. This process results in several of the peripheral clinical features of fibromyalgia, such as swelling and dysesthesia, and may influence central symptoms, such as fatigue and changes in cognition. In turn, emotional and stress-related physiological mechanisms are seen as upstream drivers of neurogenic inflammation in fibromyalgia.

Racial and Socioeconomic Disparities in Disabling Chronic Pain: Findings From the Health and Retirement Study

High-impact chronic pain is unequally distributed among midlife and older U.S. adults. Efforts to reduce the burden of disabling chronic pain should prioritize socioeconomically vulnerable groups, who may have the least access to multimodal pain treatment to improve function.

United States National Pain Strategy for Population Research: Concepts, Definitions, and Pilot Data

National Pain Strategy population research objectives include: estimating chronic pain prevalence, studying pain treatment with electronic health care data, and developing metrics to assess progress in reducing chronic pain impact. In this article, the National Pain Strategy Population Research Workgroup reviews concepts relevant to achieving these aims. High-impact chronic pain was defined as persistent pain with substantial restriction of life activities lasting 6months or more. In pilot work, we tested a brief assessment of high-impact chronic pain, and used electronic health records data to describe pain-related health care. A mail survey of adult health plan enrollees (N=770) reported that 14% had high-impact chronic pain. Relative to persons with lower-impact chronic pain, those with high-impact chronic pain were more often frequent users of health care for pain, reported lower quality of life, greater pain-related interference with activities, and more often reported pain at multiple anatomic locations. Analyses of health care data (N=289,464) reported that pain patients had higher health care costs compared with others and that pain services were typically delivered in primary care. These results support the feasibility of developing data on chronic pain through national health interview surveys and large electronic health care databases. Pilot analyses supported the feasibility of brief chronic pain assessments suitable for national health surveys and use of electronic health care databases to develop data regarding trends in the delivery of pain treatments, costs, and effectiveness. These methods are relevant to achieving the aims of the US National Pain Strategy.

Terminology, criteria, and definitions in complex regional pain syndrome: challenges and solutions.

Complex regional pain syndrome has long been recognized as a severe and high impact chronic pain disorder. However, the condition has historically been difficult to define and classify and little attention has been given to where complex regional pain syndrome sits within other apparently similar chronic pain disorders, such as fibromyalgia and regional pain syndrome. In this review challenges in regard to nomenclature, definitions, and classification of complex regional pain syndrome are reviewed and suggestions are provided about future directions.