Chronic Nonmalignant Pain Research Articles

Katastrofizacija, anksioznost i depresivnost kod pacijenata s kroničnom nemalignom boli

The aim of this study was to determine the level of anxiety and depression and the intensity of pain in patients with chronic non-malignant pain, the correlation of catastrophizing with these factors, and the interaction of a multidisciplinary program for the treatment of chronic pain and the level of catastrophizing, anxiety, depression and pain intensity. The study was conducted on a sample of 44 participants aged 32 to 80 years who participated in the multidisciplinary program for chronic pain management at the Institute for Pain Management of the Clinical Medical Center Osijek. Pain intensity was measured using the Visual Analog Scale (VAS); the Depression, Anxiety and Stress Scale (DASS-21) was used to measure anxiety and depression; while catastrophizing was measured using the Pain Catastrophizing Scale (PCS). There was a moderate positive correlation between anxiety, depression, and pain intensity in patients with chronic non-malignant pain; a positive correlation between anxiety, depression, pain intensity, and catastrophic factors; and a reduction of anxiety, depression, pain intensity and catastrophization at the end of a multidisciplinary chronic pain treatment program. The findings contribute to a better understanding of the relation between emotional distress, cognitions and pain intensity in patients with chronic non-malignant pain.

Roles, barriers and behavioral determinants related to community pharmacists' involvement in optimizing opioid therapy for chronic pain: a qualitative study

Background Opioid are currently widely used to manage chronic non-malignant pain (CNMP), but there is a growing concern about harm resulting from opioid misuse and the need for medicine optimization, in which pharmacists could potentially play a key role. Objective This study explored pharmacists' roles, barriers and determinants related to their involvement in optimizing prescribed opioids for patients with chronic pain. Setting Community pharmacies in the United Kingdom. Method Semi-structured interviews based on the Theoretical Domains Framework were conducted between January and May 2020 with 20 community pharmacists recruited through professional networks. Data were analysed thematically. Main outcome measure: Pharmacists’ perceived roles, barriers and behavioural determinants in relation to opioid therapy optimization. Result Pharmacists demonstrated desire to contribute to opioid therapy optimization. However, they described that they were often challenged by the lack of relevant knowledge, skills and training, inadequate time and resources, systemic constraints (such as lack of access to medical records and information about diagnosis), and other barriers including relationships with doctors and patients. Conclusion The contribution of community pharmacists to optimize opioid therapy in CNMP is unclear and impeded by lack of appropriate training and systemic constraints. There is a need to develop innovative practice models by addressing the barriers identified in this study to enhance the contribution of community pharmacists in optimization of opioid therapy for chronic pain.

Targeted Drug Delivery for Chronic Nonmalignant Pain: Longitudinal Data From the Product Surveillance Registry

ObjectivesTo assist in assessment of therapy risks and benefits of targeted drug delivery (TDD) for chronic nonmalignant pain using registry data on product performance, adverse events, and elective device replacement.Materials and MethodsThe Product Surveillance Registry (PSR) (NCT01524276) is an ongoing prospective, long‐term, multicenter registry enrolling consented patients implanted with an intrathecal drug delivery system. Patients are followed prospectively with participating investigators providing pump and catheter performance data for events related to the device, procedure, and therapy. Event descriptions include patient symptoms and outcomes.ResultsRegistry data from the 4646 patients (59.7% female) treated with TDD for chronic, nonmalignant pain at 59 registry sites between August 2003 and October 2019, with over 17,000 patient‐years (4646 patients with 44 months average follow‐up), were analyzed. Registry discontinuation was largely (46.2% of discontinued patients) due to study site closure and patient death; exit due to an adverse or device event was limited to 10.2%.ConclusionsTreating chronic pain with escalating doses of strong systemic opioids often leads to inconsistent pain control, impaired function, untenable side effects, and reduced quality of life and this practice has contributed to the current opioid crisis in the United States. TDD has been an available therapy for these patients for greater than 30 years, and data from this real‐world registry offer supporting evidence to the long‐term safety of this therapy as an alternative to systemic opioids, as well as insights into patient acceptance and satisfaction.

Pain Rehabilitation's Effect on People in Chronic Pain: A Prospective Cohort Study.

Multidisciplinary long-term pain rehabilitation programs with a team of healthcare professionals are an integrated approach to treat patients with chronic non-malignant pain. In this longitudinal prospective cohort study, we investigated the long-term effects of multidisciplinary pain rehabilitation on the self-reported causes of pain, pain self-management strategies, sleep, pain severity, and pain’s interference with life, pre- and post-treatment. Eighty-one patients, aged 20–69 years, with chronic pain responded. The two most frequently reported perceived causes of pain were fibromyalgia and accidents. The difference in average self-reported pain severity decreased significantly at one-year follow-up (p < 0.001), as did pain’s interference with general activities, mood, walking ability, sleep, and enjoyment of life. At one-year follow-up, participants (21%) rated their health as good/very good and were more likely to state that it was better than a year before (20%). No change was found in the use of pain self-management strategies such as physical training at one-year follow-up. The intervention was effective for the participants, as reflected in the decreased pain severity and pain interference with life.

Association of dyslipidemia with chronic non-malignant pain in elderly patients with femoral neck fractures treated by primary total hip arthroplasty: a retrospective study.

ObjectiveThe association of chronic non-malignant pain (CNP) with dyslipidemia is unclear. This retrospective study was performed to evaluate the association between CNP and dyslipidemia in elderly patients with femoral neck fractures (FNFs) treated by primary unilateral total hip arthroplasty (THA).MethodsWe retrospectively identified 521 consecutive patients with FNFs (AO/OTA type 31B) who underwent primary unilateral THA from 2009 to 2021. The study population was divided into patients with and without CNP. Serum lipids were measured for each patient. The association between CNP and dyslipidemia was assessed using a multivariate binary logistic regression model.ResultsIn total, 436 patients (220 with CNP, 216 without CNP) were eligible for analysis. In the quantile regression, the adverse effect of CNP was significantly attenuated by resilience in patients with a high high-density lipoprotein (HDL) concentration and low low-density lipoprotein (LDL) concentration. The multivariate binary logistic regression model showed that the HDL and LDL concentrations were the only variables significantly associated with the development of CNP.ConclusionBoth a low HDL and high LDL concentration may result in the occurrence of CNP in elderly patients with FNFs treated by primary unilateral THA.

Pediatric Opioid Prescribing: A Call for Calm.

Pediatric Opioid Prescribing: A Call for Calm.

Multimodal Interventions to Improve the Management of Chronic Non-Malignant Pain in Primary Care Using Participatory Research.

Background: The use of diverse therapies combined with a multidisciplinary approach and prevention initiatives for patients with chronic non-malignant pain (CNMP) can improve health and have a positive impact on psychotropic drug use and the self-management of pain. Purpose: This purpose of this study has been two-fold: to conduct a literature review with a view to selecting best evidence recommendations for CNMP and to prioritize self-care recommendations using a participatory methodology for the analysis and selection of interventions. Methods: A qualitative, descriptive, and documentary method based on participatory action research was used. Findings: Based on the study results, a multimodal psychosocial intervention program has been designed for CNMP that includes psychoeducational therapy, pharmacological therapy, physical exercise, and health assets. Discussion: The findings are consistent with previous studies underlining the need to invest in resources for the management of CNMP, including strategies for good differential diagnoses and pharmacological treatments combined with non-pharmacological treatments to confer greater well-being for people living with pain who want to participate in their own recovery.

Correlation between Depression and Anxiety in Patients with Chronic Non-Malignant Pain

Introduction. Two-thirds of primary care patients with depression also have somatic symptoms present, making detection of depression more difficult. Primary health care is the first level of screening for depression, and early detection is key to treatment success. Anxiety also has a high comorbidity rate with chronic pain conditions. Generalized anxiety disorder (GAD) is common among patients with “medically unexplained” chronic pain and chronic physical illness and is also a predictor of chronic musculoskeletal pain after trauma. Belonging to different ethnic groups and ignorance of these differences by primary care physicians can be an obstacle to good health care, especially early recognition of depressive symptoms. Aim. The aim of this proposed, systematic work was to draw conclusions from empirical research dealing with the processes involved in the examination of depression, anxiety, and chronic non malignant pain. The research question for this review paper was to examine the correlation of depression and anxiety with chronic non-malignant pain. The aim was to examine the role of primary health care in recognizing, preventing, and treating depression and anxiety in patients with chronic non-malignant pain, and whether there is a difference in the correlation between depression, anxiety, and chronic non-malignant pain according to ethnicity. Methods. Methods for identifying the study were derived from the Medline database (via PubMed). The analysis included all scientific papers in English, regardless of methodology, published since 2011. The papers dealt with the correlation between depression, anxiety, and chronic non-malignant pain, and included the population of primary care patients over 18 years of age who suffer from chronic nonmalignant pain and at the same time have symptoms of depression and anxiety present or are members of ethnic groups. 403 articles were found, original and review papers, of which, after a detailed reading, 10 were selected that meet the inclusion criteria for the purposes of this review. Results. Depression and anxiety are significantly more present in people with chronic pain (23%), compared to those who do not have chronic pain (12%). The most common is chronic musculoskeletal pain, with one-third of patients having depression. Depression and anxiety are significantly associated with the intensity and duration of pain. Chronic pain and depression also differ according to ethnic groups, with cultural differences and language barriers being a barrier to early detection of depression. Conclusion. Depression is the most common mental health disorder associated with chronic pain. It is extremely important to treat both depression and pain, in order to prevent the development of severe depression and chronic pain at an early stage. The integrated program at the level of primary health care is expected to have positive effects on both the physical and mental condition of patients. Cultural differences and ethnicity, which can significantly reduce the detection of depressive symptoms at the primary health care level, should certainly be taken into account.

Gender differences in perceived pain and health-related quality of life in people with chronic non-malignant pain: a cross-sectional study

Background Chronic pain has a disproportionate impact on members of vulnerable population groups, and women are at substantially greater risk than men of suffering multiple chronic pain disorders. Moreover, one of the aspects most affected by the presence of chronic pain is that of health-related quality of life (HRQoL), worsening over time, as the disease persists. Objectives To describe the profile of patients who suffer non-malignant chronic pain, from a gender perspective, and to identify factors related to their HRQoL and mental health. Design A cross-sectional study was carried out in patients with chronic non-cancer pain. Methods Sociodemographic variables, pain intensity at rest and in motion, SF-36 health questionnaire, anxiety, and depression were evaluated. Results The study population consisted of 531 subjects, of whom 64.2% were women. The mean age was 52.9 (SD: 10.4) years. The pain intensity recorded on the visual analogue scale was 6 (SD: 2.7) at rest and 8 (SD: 2) in motion. Physical component score and mental component score of quality of life were worse in women vs men: 33.73 (6.77) vs 32.33 (6.20), for the physical component; 36.89 (12.77) vs 32.91 (11.51), for mental component. Anxiety, depression and pain intensity, showed poorer results in women. Conclusion Gender is a factor that should be considered in assessing and managing chronic pain, due to its influence on the perception of pain, and HRQoL. Impact statement Gender is an important modifier of the perception of pain, and HRQoL. To achieve a patient-centred approach, nurses should incorporate gender as a differential factor to adapt and individualize pain management and patient education.

Opioid treatment agreements in chronic non-malignant pain: The solution or the problem?

Opioid treatment agreements (OTAs) are routinely used in the primary care setting for patients initiating chronic opioid therapy for non-malignant pain despite limited empirical evidence supporting their use. In this commentary, we review the current practice guidelines in Ontario with regard to OTAs and evidence supporting their utilization in practice. We highlight the lack of high-quality evidence that OTAs lead to beneficial outcomes for patients or prescribing physicians and review the ethical quagmire they create in clinical practice. Physicians utilizing OTAs need to be aware of the limitations of OTAs and sensitive to their potential impact on the physician-patient relationship. Instead, we advocate for a return to a collaborative, patient-centered approach with physicians encouraged to involve patients in a shared decision-making process to set mutually agreeable goals for treatment with opioids, to obtain informed consent from patients, and to better tailor these agreements to reflect the interests of all parties involved. Further research and debate are required to improve the effectiveness and ethical justification for using OTAs in clinical practice.

PDG27 A Systematic Review of Concomitant Opioid and Sedative or Skeletal Muscle Relaxant Use on Patient Outcomes in Chronic Non-Malignant Pain

Multiple studies show risks with concomitant opioid and benzodiazepine use in the general population, but few discusses effect of opioids with other sedatives, and health policies are not in consensus with concomitant use. This review is a comprehensive outlook of current evidence analyzing the impact of concomitant opioid and sedative use in chronic non-malignant pain. Literature search strategy using phrase “opioid AND CNS depressants OR benzodiazepine OR sedatives OR gabapentinoids NOT cancer” was conducted in PubMed, Embase, Web of Science, and Scopus (N=43,924). Excluded case reports, reviews, non-English, pediatric, non-human, duplicates, and non-opioid-related outcome studies (N=43,914) for total 14 articles. 12 studies were retrospective (2 cross-sectional, 1 case-control, 10 cohort) and 2 were prospective in nature (N=450-3,078,163 participants). Gabapentin (N=1), psychotropics (N=1), skeletal muscle relaxants (N=2), and sedatives or hypnotics (N=2) were studied. Overall, concomitant use of sedatives or muscle relaxants with opioids was associated with hospitalizations (N=5), mortality (N=4), motor vehicle accidents (N=1), inappropriate drug utilization (N=4), or anxiety and depression (N=2). Higher dosages of opioids (N=4) corresponded to negative outcomes regardless of concomitant medications. Increasing age had higher prevalence of concomitant use but was not always associated with negative outcomes. South had generally higher concomitant prescriptions (N=2). Considering increasing incidence of co-prescriptions and adverse outcomes, we evaluated whether policy changes recommending avoidance of concomitant opioid and skeletal muscle relaxant/sedative use are needed and reasonable. All 14 studies are diverse but showed higher age, higher opioid dose, and South with more coprescription-associated negative outcomes. The overall consistency of negative outcomes needs further investigation of interactions despite limitations. Policy makers, third party payers, clinicians, and patients should know the risks of concomitant prescribing to solidify current policy recommendations, ensure adequate drug monitoring and co-prescribing controls through prior authorization, reduce number of co-prescriptions, and improve clinical outcomes.

“I'm empowered to look after myself” — Mindfulness as a way to manage chronic pain: An interpretative phenomenological analysis of participant experiences in Scotland

Background and Primary AimChronic pain is a common problem that can impact on psychological and social wellbeing and activity levels. Despite pharmacological treatments, there is often a lack of improvement in physical and emotional functioning and health-related quality of life. Mindfulness meditation has become an increasingly popular self-management technique. The aim of the study was to explore the experiences of patients with chronic pain who took part in a mindfulness programme. MethodsA mixed-methods feasibility study was carried out. Participants were aged 18 years or over with non-malignant chronic pain recruited from general medical practices in Fort William, Scotland. In 2013 participants undertook an eight-week mindfulness programme based on Mindfulness-Based Stress Reduction (MBSR) and were interviewed immediately post-programme and at eight-months’ post-programme. Analysis of qualitative data involved Interpretative Phenomenological Analysis (IPA). FindingsThirty-four patients consented to take part in the study; twenty-four took part in the programme (14 attended four or more sessions, 10 attended one to three). Twenty-three were interviewed. Participant experiences of the programme were themed under: factors affecting experience (influence of earlier life events; the process of taking part in, and of relating to, the programme); and effects of the programme (impact on emotions, mental health, adverse events and a process of change). The process of change, resulting after better understanding the relationship between mindfulness and pain, involved learning to ‘listen to the body’, gaining a sense of community, learning to accept pain, and approaching life with more self-care, awareness, appreciation and empowerment. ConclusionParticipants reported a variety of experiences. For some, these included undergoing a process of change which may have supported them in living with their painful condition. This contributes to our understanding of how mindfulness could benefit people with chronic pain.

Good Sleep Quality Improves the Relationship Between Pain and Depression Among Individuals With Chronic Pain.

Individuals with chronic pain often experience co-existing sleep problems and depression-related states. Chronic pain, sleep problems, and depression interrelate, and have been shown to exacerbate one another, which negatively impacts quality of life. This study explored the relationships between pain severity, pain interference, sleep quality, and depression among individuals with chronic pain. Secondly, we tested whether sleep quality may moderate the relationship between pain and depression. A cross-sectional survey was completed by 1,059 adults with non-malignant chronic pain conditions (Mage 43 years, 88% identified as women) and collected measures related to pain severity, pain interference, sleep quality, and depression. Multiple regression analyses found that pain severity, pain interference, and sleep quality are all significantly associated with depression. Secondly, moderated regression analyses revealed that sleep quality moderates the relationship between pain interference and depression among individuals with chronic pain such that good sleep quality attenuates the effect of pain interference on depression, and poor sleep quality amplifies the effect of pain interference on depression. These findings suggest that sleep quality may be a relevant therapeutic target for individuals with chronic pain and co-existing depression.

Non-drug treatments for chronic non-malignant pain: patients' perceptions

The prevalence of chronic pain in Spain is 17%. There is a need for more scientific data on non-drug treat-ments that can be effectively used to treat chronic pain. The aim of this study is to analyze how patients with chronic non-malignant pain perceive non-drug approaches. Mixed, descriptive and phenomenological study. Nineteen patients enrolled in a workshop on pain management and non-drug treatments that consisted of four sessions (one session a week). Each session lasted four hours. The patients then participated in a reflective writing activity about their personal experiences. Data from this activity was then ana-lyzed. Atlas.ti 8 software was used for the qualitative data analysis. Sixteen participants tried an alternative therapy and fourteen assessed its benefits. The participants' expecta-tions were divided into three groups of similar size: relief from physical pain, emotional pain management and tools for use in daily life. All the participants were satisfied with the workshop. Perceived personal benefits were better pain and sleep management, reduced fatigue, reduced drug consumption; a more positive approach to life, better mood, more positive energy, more motivation and improved capacity to cope. The participants commented that the workshop had helped them to reduce pain levels and consume to fewer analgesics, and had reduced other symptoms associated with chronic disease, thus improving their perceived health. They also expressed great satisfaction with the organization and teachers.

Survey of physician comfort and attitudes on perioperative opioid prescription in patients with chronic pain

Objective: This study examines current practices, experiences, beliefs, concerns regarding negative outcomes and confidence of non-pain specialty anaesthetists regarding prescribing opioids to chronic pain patients. Design: An electronic cross-sectional survey was conducted by physicians from the Division of Anaesthesiology, excluding pain specialists, at the Singapore General Hospital. Methods: An online survey was conducted, investigating: (a) sociodemographic and practice characteristics; (b) current opioid prescribing practices; (c) experiences and beliefs towards prescribing opioid analgesics for chronic non-malignant pain; (d) confidence and comfort when prescribing opioids; and (e) educational and training needs in chronic pain management. Results: A total of 123 anaesthetists (80.9%) responded to the survey. It was noted that only 38.2% of respondents were comfortable managing patients with chronic pain. The majority (86.2%) felt that anaesthetists should be the primary doctors in the management of postoperative pain in chronic pain patients, and 61% believed that chronic pain trained specialist anaesthetists should be responsible; 92.7% of respondents agreed that patients who are educated about their pain tend to do better. Most importantly, 96.7% of respondents feel that they will benefit from more education regarding pain management in chronic pain patients. Conclusions: The majority of non-pain specialist anaesthetists recognise the importance of education regarding pain management for non-malignant chronic pain patients. Many feel that they are not confident in managing these patients and will benefit from continuing medical education and self-assessment courses to improve their confidence. These results could be used to enrich current pain management courses.

The Influence of Age on Central Effects of Methylnaltrexone in Patients with Opioid-Induced Constipation.

BackgroundMethylnaltrexone, a peripherally acting µ-opioid receptor antagonist approved for the treatment of opioid-induced constipation (OIC), has restricted diffusion across the blood–brain barrier (BBB) and has not been demonstrated to impact opioid-induced central analgesia. Age-related changes in BBB permeability may compromise methylnaltrexone’s restricted diffusion and alter opioid-induced central analgesic effects.ObjectiveThis analysis evaluated whether opioid analgesia is compromised in older adults receiving methylnaltrexone for OIC.MethodsThe analysis included adults diagnosed with OIC who received opioids for pain management and who had a terminal illness or chronic nonmalignant pain. Data were pooled from four randomized, double-blind trials and stratified by age (< 65 years and ≥ 65 years). Endpoints included pain intensity scores, symptoms of opioid withdrawal, treatment-related adverse events (TRAEs), and rescue-free laxation (RFL) within 4 h of treatment.ResultsOverall, 1323 patients were < 65 years of age (n = 908, methylnaltrexone; n = 415, placebo) and 304 patients were ≥ 65 years of age (n = 171, methylnaltrexone; n = 133, placebo). Nonsignificant pain intensity score reductions were observed in all groups. In the older cohort, measures of opioid withdrawal did not show statistical differences from baseline in either the methylnaltrexone or placebo groups. The most frequently reported TRAEs were abdominal pain, flatulence, and nausea. Relative to the first dose, gastrointestinal TRAEs potentially related to opioid withdrawal declined with the second dose and were comparable with placebo, regardless of age. RFL response within 4 h of methylnaltrexone treatment increased significantly in both age cohorts relative to placebo.ConclusionsMethylnaltrexone use did not adversely affect pain control, opioid withdrawal effects, or AEs while providing effective RFL, regardless of age. These results suggest that age does not appear to influence the safety and efficacy of methylnaltrexone for OIC. Further research is needed to assess the impact of other factors that alter BBB permeability, such as dementia, stroke, or drug interactions, on the safety and efficacy of methylnaltrexone.Clinical Trial Registration NumbersStudy 302, NCT00402038; study 3200K1-4000, NCT00672477; study 3200K1-3356, NCT00529087; study 3201, NCT01186770.

Factors promoting self-medication and irrational use of opioids in chronic non-malignant pain management in Pakistan: A qualitative in-depth investigation

Abstract Introduction In many Lower and Middle-Income Countries (LMICs) people self-medicate, with non-prescription and prescription drugs both of which are easily available over the counter (1). One of the most common causes for self-medication is chronic pain (2). The role of community pharmacists becomes critical especially in LMICs where medicines are freely available and pharmacists are directly involved in supply of opioid medicines. Unresolved, prolonged chronic non-malignant pain (CNMP) may lead to self-medication with opioid analgesics and can cause irrational use of opioids. The complications of self-medication with opioids are vast in terms of both scarce resources and adverse clinical consequences such as adverse drug reactions, drug interactions and mortality associated with the diversion from intended use of opioid medicines. Self- medication with opioid analgesics in LMICs have not been explored before. Aim This study was designed to explore the factors that might contribute in promoting self-medication and irrational opioid medicine use in CNMP management and exploring potential roles of community pharmacists in stopping/avoiding self-medication with opioids in one LMIC, Pakistan. Method Qualitative interviews involving various stakeholders such as pharmacy policy makers (n=10) and people suffering from CNMP (n=12) were conducted. Additionally, focus groups were conducted with community pharmacists (n=38) and doctors (n=30). A semi-structured interview guide was drafted after an extensive literature review and was used for individual interviews and focus groups for each stakeholder respectively. The study duration was from December 2019 to July 2020. Critical case sampling, a type of purposive sampling, was done in order to promote applicability to other cases. Data was analysed using a CAQDAS software N-vivo 12, using thematic analysis. Ethical approval was obtained. Results Non-availability of community pharmacists in all pharmacies and lack of medication review services are amongst the major factors that are contributing towards self-medication of opioid medicines. Additionally, lack of awareness of people about opioid medicines and absence of strict laws regarding sale of opioid medicines under a valid prescription allows easy availability and promotes aberrant drug seeking behaviour. These factors contribute towards people not seeking professional health care services for the management of CNMP and continue self-medicating with opioid medicines. As a result, they do not get effective analgesic relief and waste limited financial resources. The major themes and sub-themes are presented in Table 1. Conclusion Self-medication with opioid medicines can cause irrational, inappropriate, and ineffective use of medicines and can additionally burden the limited financial resources available for health care needs. This in-depth exploratory study identifies many barriers that can promote self-medication with opioids and recognises a need for a multi-faceted intervention involving community pharmacists to promote rational opioid medicine use. However, major limitations of the proposed intervention identified from this study are the absence of integrated health systems and under-utilisation of community pharmacy workforce. The government needs to invest in infrastructure development, develop new health policies regarding medicine sale and build the role and capacity of pharmacy workforce to perform specialised roles in public safety especially in opioid medicines.

Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors

The opioid crisis creates challenges for cancer pain management. Acupuncture confers clinical benefits for chronic nonmalignant pain, but its effectiveness in cancer survivors remains uncertain. To determine the effectiveness of electroacupuncture or auricular acupuncture for chronic musculoskeletal pain in cancer survivors. The Personalized Electroacupuncture vs Auricular Acupuncture Comparative Effectiveness (PEACE) trial is a randomized clinical trial that was conducted from March 2017 to October 2019 (follow-up completed April 2020) across an urban academic cancer center and 5 suburban sites in New York and New Jersey. Study statisticians were blinded to treatment assignments. The 360 adults included in the study had a prior cancer diagnosis but no current evidence of disease, reported musculoskeletal pain for at least 3 months, and self-reported pain intensity on the Brief Pain Inventory (BPI) ranging from 0 (no pain) to 10 (worst pain imaginable). Patients were randomized 2:2:1 to electroacupuncture (n = 145), auricular acupuncture (n = 143), or usual care (n = 72). Intervention groups received 10 weekly sessions of electroacupuncture or auricular acupuncture. Ten acupuncture sessions were offered to the usual care group from weeks 12 through 24. The primary outcome was change in average pain severity score on the BPI from baseline to week 12. Using a gatekeeping multiple-comparison procedure, electroacupuncture and auricular acupuncture were compared with usual care using a linear mixed model. Noninferiority of auricular acupuncture to electroacupuncture was tested if both interventions were superior to usual care. Among 360 cancer survivors (mean [SD] age, 62.1 [12.7] years; mean [SD] baseline BPI score, 5.2 [1.7] points; 251 [69.7%] women; and 88 [24.4%] non-White), 340 (94.4%) completed the primary end point. Compared with usual care, electroacupuncture reduced pain severity by 1.9 points (97.5% CI, 1.4-2.4 points; P < .001) and auricular acupuncture reduced by 1.6 points (97.5% CI, 1.0-2.1 points; P < .001) from baseline to week 12. Noninferiority of auricular acupuncture to electroacupuncture was not demonstrated. Adverse events were mild; 15 of 143 (10.5%) patients receiving auricular acupuncture and 1 of 145 (0.7%) patients receiving electroacupuncture discontinued treatments due to adverse events (P < .001). In this randomized clinical trial among cancer survivors with chronic musculoskeletal pain, electroacupuncture and auricular acupuncture produced greater pain reduction than usual care. However, auricular acupuncture did not demonstrate noninferiority to electroacupuncture, and patients receiving it had more adverse events. ClinicalTrials.gov Identifier: NCT02979574.

Acute impact of a national lockdown during the COVID-19 pandemic on wellbeing outcomes among individuals with chronic pain.

Changes to wellbeing in a community-based sample of 638 adults with non-malignant chronic pain were assessed during a period of mandated lockdown measures in the UK to control the COVID-19 outbreak. Participants completed an online survey pre-lockdown and were followed up during lockdown. Multivariate analysis demonstrated that decreased ability to self-manage pain, restricted access to healthcare and increased dependence on others were associated with negative wellbeing outcomes related to sleep, anxiety and depression. Essential but non-urgent services are required during periods of lockdown to maintain independence and self-management in order to preserve wellbeing in this population.

Memory complaints and cognitive performance in fibromyalgia and chronic pain: The key role of depression.

To explore the relationship between perceived cognitive problems and cognitive performance in three different samples, taking into account the possible influence of depression, catastrophizing, pain intensity, or medication. Seventy individuals with fibromyalgia, 74 with non-malignant chronic pain and 40 pain-free controls, completed measures of verbal episodic memory, sustained attention, response inhibition, depression, catastrophizing, and pain intensity. Fibromyalgia and chronic pain patients performed worse than controls in verbal memory and sustained attention, but these differences disappeared when depressed participants were excluded from the analyses. Memory complaints were related with depression in all pain patients. However, in the case of fibromyalgia, memory complaints were also related by pain intensity and inversely related by short-term episodic memory. This case-control study shows the importance of jointly assessing cognitive performance and memory complaints and of controlling for variables such as depression, catastrophizing, pain intensity and medication in the studied samples. Accordingly, this study highlights the differences in memory complaints, between the patients with fibromyalgia and the patients with other chronic pain conditions. Finally, it has highlighted the important role played by depression in cognitive performance and memory complaints considering the Neurocognitive Model of Attention to pain.