Pain In Survivors Research Articles

Prevalence and Risk Factors for Opioid-Related Complications in Patients with Myeloproliferative Neoplasms: An International Survey of 502 Patients By the MPN Quality of Life Study Group

Introduction:Myeloproliferative Neoplasm (MPN) patients encounter debilitating pain syndromes as a result of their disorder. Opioids are frequently employed in cancer-related pain but have been increasingly recognized for their risk profiles including accidental overdose, addiction and death. With many MPN patients facing near-normal life expectancies, chronicity of opioid use may increase the risk of adverse events. In this survey, we evaluated the prevalence of MPN opioid use, risk factors for negative outcomes and compared the features of this population to MPN patients not receiving opioid therapy.Methods:This study was performed by the MPN Quality of Life Study Group. A survey was designed by a team of MPN investigators experienced with MPN symptomatology. Patients completed the MPN-10, a 10 item survey of MPN symptoms completed on a 0 (absent) to 10 (worst imaginable) scale (Blood. 2011 Jul 14;118(2):401-8). Other surveyed tools included the Opioid Risk Tool (ORT) as well as DSMV criteria for Opioid Use Disorder (OUD). The survey was posted on high-traffic MPN-related webpages focused on patient education and advocacy (MPN Forum, MPN Net, MPN Research Foundation, MPN Voice)for a total of 28 days. Patients currently receiving opioids were compared to patients not receiving opioids and statistical significance was defined as p<0.05.ResultsDemographicsA total of 416 patients completed the survey and were compared by active opioids use (n=69) vs. no active opioid use (n=347). Patients described a history of myelofibrosis (MF, 28.8%), polycythemia vera (PV, 44.2%) and essential thrombocythemia (ET, 26.9%). Most MPNs were diagnosed between 1-3 years ago (22.2%), 3-10 years ago (35.0%) or >10 years ago (30.4%). Patients were furthermore of expected mean age (60.7), primarily female (75.0%) and from the United States (66.6%). Few patients had a history of transformation to acute leukemia (0.5%), severe bleeding (12.3%) or blood clot (26.5%). Mean individual symptom scores and prevalences were 3.0 and 65.6% for abdominal discomfort and 3.3 and 59.4% for bone pain, respectively, indicating a low to moderate symptom burden.Patients Receiving Opioid TherapyPatients on opioid therapy (n=69) displayed a number of high risk features for adverse outcomes including a personal history of substance abuse (20.2%), respiratory disease (33%) and mental health disorders (60.1%). By DSMV criteria, 5.9% of opioid patients scored ‘mild’ and 2.9% scored ‘moderate’ for OUD (total 8.8%), consistent with prevalence in the general population. Approximately 24.6% of opioid-using patients scored moderate to high risk on the ORT but despite this, did not appear more likely to meet criteria for OUD (p=0.81). Palliative care and pain management were involved in only 34.3% of patients and side effects of opioids were discussed in only 70.1% of all cases.Opioid vs. Non-Opioid PatientsCompared to patients not receiving opioid therapy, patients currently on opioid treatment were more likely to describe more frequent and/or more severe abdominal discomfort (88.4% vs. 61.0%, p<0.001; mean 5.0 vs. 2.6, p<0.001), bone pain (87.0% vs. 53.9%, p<0.001; mean 5.6 vs. 2.4, p<0.001), unintentional weight loss (41.2% vs. 21.4%, p=0.001), inactivity (94.2% vs. 71.5%, p<0.001), early satiety (84.1% vs. 58.2%, p<0.001), and impaired quality of life (mean 4.9 vs. 6.6, p<0.001). They were also more likely to describe regularly taking pain medications (85.5% vs. 34.5%, p<0.001) as well as attempt non-pharmacological treatments to manage symptoms (Figure 1). Despite more aggressive pain treatment approaches, only 42% of opioid patients reported satisfaction with their current pain plan vs. 62.2% of patients not receiving opioid therapy.Conclusions:MPN patients face significant symptom burden despite often limited reduction in life expectancy. Patients furthermore demonstrate a high prevalence of risk factors for opioid-related complications including overdose and substance misuse. Despite aggressive pain regimens, opioid patients are less likely to voice adequate symptom control or satisfaction with their pain treatment plans. Providers should be cognizant of opioid-related complications and consider subspecialty pain management referrals or adaptation of the JCO Clinical Practice Guidelines for Management of Chronic Pain in Survivors of Adult Cancers (J Clin Oncol. 2016 Sep 20;34(27):3325-45). [Display omitted] DisclosuresScherber:Orphan Pharmaceuticals: Honoraria; Incyte: Consultancy. Palmer:Novartis: Research Funding. Dueck:Phytogine: Employment; Pfizer: Honoraria; Bayer: Employment. Mesa:Gilead: Research Funding; Novartis: Consultancy; CTI: Research Funding; Galena: Consultancy; Incyte: Research Funding; Promedior: Research Funding; Ariad: Consultancy; Celgene: Research Funding.

Pain in Head and Neck Cancer Survivors: Prevalence, Predictors, and Quality‐of‐Life Impact

Pain is common among patients with cancer, stemming from both malignancy and side effects of treatment. The extent to which pain persists after treatment has received little attention. We examined the prevalence, predictors, and impact on quality of life (QOL) caused by pain among survivors of head and neck cancer. Cohort study. Tertiary head and neck cancer survivorship clinic. We identified survivors of head and neck cancer ≥1 year after diagnosis and examined the prevalence and risk factors for development of pain. Pain and QOL were assessed with multiple QOL instruments. Ordinal regression modeling examined predictors of pain in survivors. We identified 175 patients at a median of 6.6 years after diagnosis. Among survivors, 45.1% reported pain, and 11.5% reported severe pain. Among patients with current pain, 46% reported low overall QOL versus only 12% of those without pain ( P < .001). On multivariable analysis after adjustment for age, sex, and stage of disease, pain was associated with trimodality treatment (odds ratio [OR], 3.55; 95% CI, 1.06-12.77). Multivariable analysis of QOL issues revealed that pain was associated with major depression (OR, 3.91; 95% CI, 1.68-9.11), anxiety (OR, 4.22; 95% CI, 2.28-7.81), poor recreation (OR, 3.31; 95% CI, 1.70-6.48), and low overall QOL (OR, 2.20; 95% CI, 1.12-4.34). Years after head and neck cancer treatment, pain remains a significant problem and is associated with worse QOL. Future efforts should focus on preventing pain from treatment and comprehensive management.

Chronic pain in survivors of childhood cancer: a developmental model of pain across the cancer trajectory.

Chronic pain in survivors of childhood cancer: a developmental model of pain across the cancer trajectory.

Biopsychosocial Assessment of Pain with Thermal Imaging of Emotional Facial Expression in Breast Cancer Survivors.

Background: Recent research has evaluated psychological and biological characteristics associated with pain in survivors of breast cancer (BC). Few studies consider their relationship with inflammatory activity. Voluntary facial expressions modify the autonomic activity and this may be useful in the hospital environment for clinical biopsychosocial assessment of pain. Methods: This research compared a BC survivors group under integral treatment (Oncology, Psychology, Nutrition) with a control group to assess the intensity of pain, behavioral interference, anxiety, depression, temperament-expression, anger control, social isolation, emotional regulation, and alexithymia and inflammatory activity, with salivary interleukin 6 (IL-6). Then, a psychophysiological evaluation through repeated measures of facial infrared thermal imaging (IRT) and hands in baseline—positive facial expression (joy)—negative facial expression (pain)—relaxation (diaphragmatic breathing). Results: The results showed changes in the IRT (p < 0.05) during the execution of facial expressions in the chin, perinasal, periorbital, frontal, nose, and fingers areas in both groups. No differences were found in the IL-6 level among the aforementioned groups, but an association with baseline nasal temperature (p < 0.001) was observable. The BC group had higher alexithymia score (p < 0.01) but lower social isolation (p < 0.05), in comparison to the control group. Conclusions: In the low- and medium-concentration groups of IL-6, the psychophysiological intervention proposed in this study has a greater effect than on the high concentration group of IL-6. This will be considered in the design of psychological and psychosocial interventions for the treatment of pain.

Association between sleep disturbance and new-onset subjective knee pain in Great East Japan Earthquake survivors: A prospective cohort study in the Miyagi prefecture.

The Great East Japan Earthquake (GEJE) and Tsunami devastated the northeastern coast of Japan on March 11, 2011. This study aimed to determine whether sociopsychological factors, such as sleep disturbance and psychological distress, influenced new-onset subjective knee pain in survivors during the post-disaster phase of the GEJE. From November 2012 to February 2013 (2 years after the GEJE) and from November 2013 to February 2014 (3 years after the GEJE), survivors (≥18 years) completed self-reported questionnaires. A total of 1470 survivors responded to the questionnaires and were included in this study. New-onset subjective knee pain was defined as knee pain by encircled response absent at 2 years but present at 3 years after the GEJE. Two years after the GEJE, ≥10/24 points on the Kessler Psychological Distress Scale, and ≥6/24 points on the Athens Insomnia Scale defined the presence of psychological distress and sleep disturbance, respectively. Multiple logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between new-onset subjective knee pain and psychological distress or sleep disturbance. Among the participants, 10.9% (160/1470) reported experiencing new-onset subjective knee pain. Sleep disturbance was significantly associated with new-onset subjective knee pain (OR, 1.57, 95% CI, 1.08-2.29, P=0.017); however, psychological distress was not (OR, 1.07, 95% CI, 0.65-1.78, P=0.80). This is the first study to indicate an association between sleep disturbance and new-onset subjective knee pain among survivors of the GEJE. 247/300.

Topical Review: Pain in Survivors of Pediatric Cancer: Applying a Prevention Framework

To apply a biopsychosocial framework to understand factors influencing pain in survivors of pediatric cancer to inform pain prevention efforts and highlight the need for interdisciplinary care. This topical review draws from both pediatric cancer survivorship research and chronic noncancer pain research to illustrate how components of a preventative model can be applied to pain in survivorship. Pain is a common experience among long-term survivors of pediatric cancer. The pain experience in survivorship can be conceptualized in terms of biological disease and treatment factors, cognitive and affective factors, and social and contextual factors. We review literature pertinent to each of these biopsychosocial factors and tailor an existing public health prevention framework for pain in survivors of pediatric cancer. Classifying survivors of pediatric cancer into pain risk categories based on their daily experiences of pain, pain-related functional impairment, and distress could help guide the implementation of pain-related prevention and intervention strategies in this population. Future research is needed to establish the efficacy of screening measures to identify patients in need of psychosocial pain and pain-related fear management services, and interdisciplinary pediatric chronic pain management programs in survivors of pediatric cancer.

Interventions for treating persistent pain in survivors of torture.

Persistent (chronic) pain is a frequent complaint in survivors of torture, particularly but not exclusively pain in the musculoskeletal system. Torture survivors may have no access to health care; where they do, they may not be recognised when they present, and the care available often falls short of their needs. There is a tendency in state and non-governmental organisations' services to focus on mental health, with poor understanding of persistent pain, while survivors may have many other legal, welfare, and social problems that take precedence over health care. To assess the efficacy of interventions for treating persistent pain and associated problems in survivors of torture. We searched for randomised controlled trials (RCTs) published in any language in CENTRAL, MEDLINE, Embase, Web of Science, CINAHL, LILACS, and PsycINFO, from database inception to 1 February 2017. We also searched trials registers and grey literature databases. RCTs of interventions of any type (medical, physical, psychological) compared with any alternative intervention or no intervention, and with a pain outcome. Studies needed to have at least 10 participants in each arm for inclusion. We identified 3578 titles in total after deduplication; we selected 24 full papers to assess for eligibility. We requested data from two completed trials without published results.We used standard methodological procedures expected by Cochrane. We assessed risk of bias and extracted data. We calculated standardised mean difference (SMD) and effect sizes with 95% confidence intervals (CI). We assessed the evidence using GRADE and created a 'Summary of findings' table. Three small published studies (88 participants) met the inclusion criteria, but one had been retracted from publication because of ethical problems concerned with confidentiality and financial irregularities. Since these did not affect the data, the study was retained in this review. Despite the search including any intervention, only two types were represented in the eligible studies: two trials used cognitive behavioural therapy (CBT) with biofeedback versus waiting list on unspecified persistent pain (58 participants completed treatment), and one examined the effect of complex manual therapy versus self-treatment on low back pain (30 participants completed treatment). Excluded studies were largely either not RCTs or did not report pain as an outcome.There was no difference for the outcome of pain relief at the end of treatment between CBT and waiting list (two trials, 58 participants; SMD -0.05, 95% CI -1.23 to 1.12) (very low quality evidence); one of these reported a three-month follow-up with no difference between intervention and comparison (28 participants; SMD -0.03, 95% CI -0.28 to 0.23) (very low quality evidence). The manual therapy trial also reported no difference between complex manual therapy and self-treatment (30 participants; SMD -0.48, 95% CI -9.95 to 0.35) (very low quality evidence). Two studies reported dropouts, one with partial information on reasons; none of the studies reported adverse effects.There was no information from any study on the outcomes of use of analgesics or quality of life.Reduction in disability showed no difference at the end of treatment between CBT and waiting list (two trials, 57 participants; SMD -0.39, 95% CI -1.17 to 0.39) (very low quality evidence); one of these reported a three-month follow-up with no difference between intervention and comparison (28 participants; SMD 0, 95% CI -0.74 to 0.74) (very low quality evidence). The manual therapy trial reported superiority of complex manual therapy over self-treatment for reducing disability (30 participants; SMD -1.10, 95% CI - 1.88 to -0.33) (very low quality evidence).Reduction in distress showed no difference at the end of treatment between CBT and waiting list (two trials, 58 participants; SMD 0.07, 95% CI -0.46 to 0.60) (very low quality evidence); one of these reported a three-month follow-up with no difference between intervention and comparison (28 participants; SMD -0.24, 95% CI -0.50 to 0.99) (very low quality evidence). The manual therapy trial reported superiority of complex manual therapy over self-treatment for reducing distress (30 participants; SMD -1.26, 95% CI - 2.06 to -0.47) (very low quality evidence).The risk of bias was considered high given the small number of trials, small size of trials, and the likelihood that each was underpowered for the comparisons it reported. We primarily downgraded the quality of the evidence due to small numbers in trials, lack of intention-to-treat analyses, high unaccounted dropout, lack of detail on study methods, and CIs around effect sizes that included no effect, benefit, and harm. There is insufficient evidence to support or refute the use of any intervention for persistent pain in survivors of torture.

Living status, economic hardship and sleep disturbance were associated with subjective shoulder pain in survivors of the Great East Japan Earthquake: A cross sectional study.

The Great East Japan Earthquake and devastating Tsunami hit hard everything on the northeastern coast of Japan. This study aimed to determine socio-psychological factors for "subjective shoulder pain" of the survivors at 2 years evaluated by a self-report questionnaire. Between November 2012 to February 2013, survivors replied to the self-report questionnaire, and 2275 people consented to join this study. Living status was divided into 5 categories (1. same house as before the earthquake (reference group), 2. temporary small house, 3. apartment, 4. house of relatives or acquaintance, 5. new house) and economic hardship was divided into 4 categories (1. normal (reference group), 2. a little bit hard, 3. hard, 4. very hard). Gender, age, body mass index, living areas, smoking and drinking habits, complications of diabetes mellitus and cerebral stroke, working status, and walking time were considered as the confounding factors. Kessler Psychological Distress Scale of ≥10/24 and Athens Insomnia Scale of ≥6/24 points were defined as a presence of psychological distress and sleep disturbance, respectively. We used multiple logistic regression analysis to examine the association of shoulder pain with living environment, economic hardship, psychological distress, and sleep disturbance at 2 years after the earthquake. There were significant differences in the risk of having shoulder pain in those with "apartment" (OR=1.74, 95% CI=1.03-2.96), "house of relatives or acquaintance" (OR=2.98, 95% CI=1.42-6.25), economic hardship of "hard" (OR=1.71, 95% CI=1.08-2.7) and "very hard" (OR=2.51, 95% CI=1.47-4.29), and sleep disturbance (OR=2.96, 95% CI=2.05-4.27). Living status of "apartment" and "house of relatives or acquaintance", economic hardship of "hard" and "very hard", and "sleep disturbance" were significantly associated with shoulder pain.

Association Between Sleep Disturbance and New-onset Subjective Shoulder Pain in Survivors of the Great East Japan Earthquake: A Prospective Cohort Study in Miyagi Prefecture.

The Great East Japan Earthquake (GEJE) and Tsunami devastated the northeastern coast of Japan on March 11, 2011. This study attempted to determine whether socio-psychological factors such as sleep disturbance and psychological distress influenced new-onset subjective shoulder pain in survivors, during the post disaster phase of the GEJE. From November 2012 to February 2013 (2 years after the GEJE) and November 2014 to January 2015 (4 years after the GEJE), survivors (18 years old or over) answered self-reported questionnaires. In total, 1,454 survivors responded to the questionnaires and were thus included in this study. New-onset subjective shoulder pain was defined as shoulder pain by encircled response absent at 2 years, and present at 4 years after the GEJE. Two years after the GEJE, ≥ 10/24 points on the Kessler Psychological Distress Scale-6, and ≥ 6/24 points on the Athens Insomnia Scale defined the presence of psychological distress and sleep disturbance, respectively. Multiple logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between new-onset subjective shoulder pain, and psychological distress or sleep disturbance. Amongst participants, 7.2% (105/1,454) reported new-onset subjective shoulder pain. Sleep disturbance was significantly associated with new-onset subjective shoulder pain (OR = 1.92, 95% CI = 1.24-2.98, P = 0.004); however, psychological distress was not (OR = 0.78, 95% CI = 0.42-1.42, P = 0.41). In conclusion, this is the first study indicating an association between sleep disturbance and new-onset subjective shoulder pain amongst the survivors of the GEJE.

Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline.

To provide evidence-based guidance on the optimum management of chronic pain in adult cancer survivors. An ASCO-convened expert panel conducted a systematic literature search of studies investigating chronic pain management in cancer survivors. Outcomes of interest included symptom relief, pain intensity, quality of life, functional outcomes, adverse events, misuse or diversion, and risk assessment or mitigation. A total of 63 studies met eligibility criteria and compose the evidentiary basis for the recommendations. Studies tended to be heterogeneous in terms of quality, size, and populations. Primary outcomes also varied across the studies, and in most cases, were not directly comparable because of different outcomes, measurements, and instruments used at different time points. Because of a paucity of high-quality evidence, many recommendations are based on expert consensus. Clinicians should screen for pain at each encounter. Recurrent disease, second malignancy, or late-onset treatment effects in any patient who reports new-onset pain should be evaluated, treated, and monitored. Clinicians should determine the need for other health professionals to provide comprehensive pain management care in patients with complex needs. Systemic nonopioid analgesics and adjuvant analgesics may be prescribed to relieve chronic pain and/or to improve function. Clinicians may prescribe a trial of opioids in carefully selected patients with cancer who do not respond to more conservative management and who continue to experience distress or functional impairment. Risks of adverse effects of opioids should be assessed. Clinicians should clearly understand terminology such as tolerance, dependence, abuse, and addiction as it relates to the use of opioids and should incorporate universal precautions to minimize abuse, addiction, and adverse consequences. Additional information is available at www.asco.org/chronic-pain-guideline and www.asco.org/guidelineswiki.

Management of Chronic Pain in Survivors of Adult Cancers: ASCO Clinical Practice Guideline Summary

As a result of extraordinary advancements in diagnosis and treatment, approximately 14million individuals are living in the United States with a history of cancer (excluding nonmelanomatous skin cancers). Two thirds of these individuals are surviving 5 or more years after diagnosis. Unfortunately, these impressive outcomes in survival often come with physical, psychosocial, and financial burdens as a result of the tumor, exposure to cancer treatment, or other medical comorbidities. Chronic pain can be a serious, negative consequence of surviving cancer. Although estimates vary, the prevalence of pain in cancer survivors has been reported to be as high as 40%. Predictors include the type and invasiveness of the tumor, the treatment regimen used, time since cancer treatment, and the efficacy of initial pain therapy. Significant pain is associated with impaired quality of life in this population. Many guidelines and recommendations have been advanced to support the management of cancer pain, yet the focus of these documents has been primarily on relieving acute pain or pain associatedwith advanced disease. Few evidence-based cancer pain guidelines address the more nuanced care required when pain persists formonths or years. This situation is in part a result of the relative absenceof studies exploring the experiences of chronic pain in cancer survivors or the long-term safety and effectiveness of analgesic interventions. Whereas opioid-based pharmacotherapy is widely accepted as the foundation of care for acute pain or pain associated with advanced cancer, the management of patients who are free of cancer after treatment or are living with cancer as a chronic illness is not grounded in broad consensus. The management of these populations with chronic cancer pain requires greater consideration of a multimodality plan of care that balances pharmacologic and nonpharmacologic techniques and may necessitate the involvement of an interdisciplinary team. The goals of treatment in these populations should focus on improving function and limiting longterm adverse effects of pain and its treatment as much as or more than they do on improving comfort. As the population of cancer survivors expands, all clinicians who interact with these individuals, including oncologists, advanced practice providers, and primary care physicians, will require the knowledge and skills to implement best practices in the management of chronic pain. When analgesic drugs are used, the imperative to prescribe safely must expand beyond immediate adverse effects, such as respiratory depression or constipation associated with opioids, to incorporate awareness and mitigation of long-term consequences of these and other analgesic agents. The purpose of this guideline summary is to provide guidance to

CT-guided satellite ganglion block for the treatment of Prostatectomy pain in survivors of breast cancer

To describe the feasibility and efficacy of CT-guided satellite ganglion block in the management of Prostatectomy pain in survivors of breast cancer. Twenty-six breast cancer survivors with the complex regional pain syndrome were included in this retrospective study between 2012-07 and 2014-07. All suffered from prostatectomy pain and received CT-guided satellite ganglion block. Three blocks were performed for each patient using the same approach each time. Postmastectomy pain intensity using a visual analog score (VAS) and Patient satisfaction score (PSS) during scheduled visits at baseline, 2, 6 and 9 weeks following the CT-guided satellite ganglion block. All patients had temporary Horner's syndrome indicating the effectiveness of the CT-guided satellite ganglion block and there were no adverse events resulting from the block. The mean visual analog scale score (VAS) was significantly decreased and and Patient satisfaction score (PSS) was significantly increased after each block. CT-guided satellite ganglion block is a safe and successful treatment of Prostatectomy pain with few or no side-effects.

Managing chronic pain in survivors of torture.

All generalist and specialist clinicians are likely to encounter torture survivors among refugees and asylum seekers. A minority of people survive torture and a smaller minority reach a developed country; those who do tend to be the more resilient and resourceful. They have many health, social and welfare problems; persistent pain in the musculoskeletal system is one of the most common. There is little specific evidence on pain in survivors of torture; the guidelines on interdisciplinary specialist management are applicable. Most of the literature on refugee survivors of torture has an exclusive focus on psychological disorders, with particularly poor understanding of pain problems. This article summarizes the current status of assessment and treatment of pain problems in the torture survivor.

Chronic pain following physical and emotional trauma: the station nightclub fire.

Objective: The purpose of this study was to evaluate factors associated with chronic pain in survivors of a large fire, including those with and without burn injury.Methods: This study employed a survey-based cross-sectional design to evaluate data from survivors of The Station nightclub fire. The primary outcome measure was the presence and severity of pain. Multiple linear regressions with a stepwise approach were used to examine relationships among variables. Variables considered included age, gender, marital status, burn injury, total body surface area, skin graft, pre-morbid employment, time off work, return to same employment, depression (Beck depression inventory, BDI), and post-traumatic stress (impact of event scale – revised).Results: Of 104 fire survivors, 27% reported pain at least 28 months after the event. Multiple factors associated with pain were assessed in the univariate analysis but only age (p = 0.012), graft (p = 0.009), and BDI score (p < 0.001) were significantly associated with pain in the multiple regression model.Discussion: A significant number of fire survivors with and without burn injuries experienced chronic pain. Depth of burn and depression were significantly associated with pain outcome. Pain management should address both physical and emotional risk factors in this population.

Survivorship: Pain Version 1.2014

Many posttreatment cancer survivors experience chronic pain, often leading to psychological distress; decreased activity, motivation, and personal interactions; and an overall poor quality of life. This section of the NCCN Guidelines for Survivorship provides screening and management recommendations for pain in survivors. A multidisciplinary approach is recommended, with a combination of pharmacologic treatments, psychosocial and behavioral interventions, physical therapy and exercise, and interventional procedures.

Education as Treatment for Chronic Pain in Survivors of Torture and Other Violent Events in Cambodia: Experiences With Implementation of a Group‐Based “Pain School” and Evaluation of Its Effect in a Pilot Study

The DIGNITY Institute Against Torture is a Danish nongovernmental organization with a Copenhagen‐based rehabilitation program for torture survivors, where the majority of patients suffer from chronic pain and are treated with a group‐based, ten‐session, psycho‐educational “pain school.” This material was presented to therapists at the Transcultural Psychosocial Organization Cambodia, so as to develop a culturally adapted “Khmer Pain School,” which was subsequently tested in a pilot study with 34 completers. The Brief Pain Inventory and the Disability Rating Index, contextualized and translated into Khmer, were the main outcome measures. Results revealed that therapists and clients found the Cambodian pain school to be relevant and helpful. The quantitative outcome indicators demonstrated clinical improvement, with significant effect sizes.

Chronic pain in survivors of critical illness: a retrospective analysis of incidence and risk factors.

IntroductionChronic pain has been reported in survivors of critical illness for many years after discharge from hospital. This study investigates the incidence and site of chronic pain in survivors of critical illness between 6 months and 1 year after hospitalization, including ICU admission. A retrospective analysis of the risk factors for chronic pain in this patient group was also completed.MethodsA questionnaire method was used to investigate the incidence of chronic pain and the specific body parts affected. A retrospective study and multivariable analysis were used to investigate the risk factors for chronic pain in this patient group. All survivors of a general intensive care unit (ICU) in South Wales in a 6-month period were included in this study.ResultsChronic pain was reported in 44% of all respondents. The shoulder was the most commonly reported joint affected by pain (22%). Risk factors for chronic pain between 6 months and 1 year after ICU discharge were increasing patient age and severe sepsis.ConclusionsChronic pain is a problem in survivors of critical illness, especially in the shoulder joint, and further studies are needed investigating therapeutic interventions that address this long-term problem.

Pain in long-term breast cancer survivors: the role of body mass index, physical activity, and sedentary behavior

Although pain is common among post-treatment breast cancer survivors, studies that are longitudinal, identify a case definition of clinically meaningful pain, or examine factors contributing to pain in survivors are limited. This study describes longitudinal patterns of pain in long-term breast cancer survivors, evaluating associations of body mass index (BMI), physical activity, sedentary behavior with mean pain severity and above-average pain. Women newly diagnosed with stages 0-IIIA breast cancer (N = 1183) were assessed, on average, 6 months (demographic/clinical characteristics), 30 months (demographics), 40 months (demographics, pain), 5 years (BMI, physical activity, and sedentary behavior), and 10 years (demographics, pain, BMI, physical activity, and sedentary behavior) post-diagnosis. This analysis includes survivors who completed pain assessments 40 months post-diagnosis (N = 801), 10 years post-diagnosis (N = 563), or both (N = 522). Above-average pain was defined by SF-36 bodily pain scores ≥1/2 standard deviation worse than age-specific population norms. We used multiple regression models to test unique associations of BMI, physical activity, and sedentary behavior with pain adjusting for demographic and clinical factors. The proportion of survivors reporting above-average pain was higher at 10 years than at 40 months (32.3 vs. 27.8 %, p < 0.05). Approximately one-quarter of survivors reported improved pain, while 9.0 % maintained above-average pain and 33.1 % reported worsened pain. Cross-sectionally at 10 years, overweight and obese survivors reported higher pain than normal-weight survivors and women meeting physical activity guidelines were less likely to report above-average pain than survivors not meeting these guidelines (p < 0.05). Longitudinally, weight gain (>5 %) was positively associated, while meeting physical activity guidelines was inversely associated, with above-average pain (OR, 95 % CI = 1.76, 1.03-3.01 and 0.40, 0.20-0.84, respectively) (p < 0.05). Weight gain and lack of physical activity place breast cancer survivors at risk for pain long after treatment ends. Weight control and exercise interventions should be tested for effects on long-term pain in these women.

Spinal Cord Stimulation in the Treatment of Cancer-Related Pain: “Back to the Origins”

Spinal cord stimulation (SCS) has been used in the treatment of chronic pain for more than 40 years. The most common indication for SCS in the USA is failed back surgery syndrome (FBSS). Interestingly, the first two spinal cord stimulators ever implanted were in patients suffering from bronchogenic carcinoma and pelvic cancer, respectively. While cancer accounts for millions of deaths each year in the USA, pain is often the first sign of malignancy. An increasing number of people suffer from cancer-related pain each year and many receive suboptimal relief. Given the demonstrated value of spinal cord stimulation in the treatment of neuropathic pain, spinal cord stimulation should be considered "earlier" as an adjunct to the treatment of cancer-related pain. In addition, with the improving survival rates associated with advances in cancer treatment, spinal cord stimulation may help reduce the risk of development of chronic neuropathic pain in survivors.

Prevalence and incidence of longer term pain in survivors of polytrauma

Little is known about the longer term status of pain or the factors associated with pain-related outcome in patients after polytrauma. The current study evaluated the prevalence and severity of pain at least 2 years after injury compared with preinjury status using several pain scores in a Swiss cohort of survivors of blunt polytrauma. Pearson correlation testing was used for the comparison of different measures of pain. Uni and multivariate analyses of patient, trauma, and treatment characteristics, as well as parameters of self-reported, health-related quality of life and functional outcome, were undertaken to determine associations with pain after polytrauma. Depending on the measure used, 46% to 85% of polytrauma survivors indicated the presence of pain at longer term follow-up. Both the prevalence and the severity of pain were increased compared with the preinjury status (P < .001) and varied importantly depending on scoring. The Trauma Outcome Profile was the most sensitive pain measure and showed the greatest correlation with objective, longer term outcomes (R = .5). Pain measured by the SF-36 was found to have the best internal criterion validity among the scores investigated (R = .6-.8). Patients' longer term pain status had greater associations with health-related quality-of-life scores (R = .6-.8) than with capacity to work or income (R = .4-.5). Our study shows a high rate of longer term pain in survivors of polytrauma and important differences in the type and sensitivity of the standard pain measures investigated. Given the potential impact of these findings, international guidelines for the assessment of pain in polytraumatized patients are needed.