Pain Treatment Centers Research Articles

Effective Interventions for Idiopathic Chronic Pelvic Pain: A Systematic Review.

Chronic pelvic pain (CPP) in women is a debilitating condition with symptoms that affect both medical and psychological systems, yet for those with idiopathic CPP (i.e., those without a known physiologic cause), no consensus for intervention exists. A systematic review was conducted to identify the effectiveness of current biomedical, psychosocial, and integrative interventions for idiopathic CPP (ICPP). Five databases (PubMed, CINAHL, Cochrane, PsycInfo, Web of Science) were systematically searched with multiple keywords for publications from 2008-2022. Articles were coded for sample characteristics, research design, type of intervention, and intervention outcomes. Nineteen studies met criteria. The majority of the interventions (14 studies) were biomedical, either invasive (e.g., injections), or non-invasive (e.g., medications). Five studies evaluated integrative interventions that combined biomedical and psychosocial components (e.g., a multimodal pain treatment center). Invasive biomedical interventions were better at relieving short-term pain and non-invasive biomedical interventions were superior for long-term pain; integrated interventions reduced both short-term and long-term pain. Integrative interventions also improved mental health, sexual health, and QOL. Although most interventions for ICPP have been biomedical, integrative interventions showed greater outcome effectiveness, suggesting a focus on integrative interventions in the future.

Principles of Organization of Multidisciplinary Clinics and Pain Treatment Centers (Literature Review and Own Experience)

Pain is one of the most important problems of modern medicine. The high prevalence of pain causes significant material and social losses. As an effective measure to solve this problem, the idea of organizing a network of pain treatment centers and clinics was put forward. The purpose of the work is to describe the structure of the organization of multidisciplinary clinics and pain treatment centers. The article discusses the basic principles of the organization of pain treatment centers and the system of analgesic care. An example of the work of the pain center on the basis of a multidisciplinary hospital (Volga District Medical Center of the FMBA of Russia) is given. The authors shared the structure and organization of the work of this pain treatment center. They also presented the results of his work. Currently, there are no specialized pain centers in Russia. Now in many cities of Russia there is a process of formation of analgesic care. However, this process faces a number of difficulties.

Pelvic mapping to explore patterns of chronic pelvic pain.

Chronic pelvic pain syndromes (CPPS) are commonly encountered by urologists and urogynecologists and pose diagnostic and therapeutic challenges. Body maps have been helpful adjuncts to verbal descriptions of pain and may serve a role in phenotyping what is known to be a heterogeneous patient population. The aim of this study was to assess whether patterns of pain as marked on a body mapofthepelvis exist among common CPPS diagnoses. The secondary aim was to investigate the association between the total number of pain locations markedonthemap and clinical indices in patients with 1 to 3 CPPS diagnoses. Data was collected on patients who visited the Northwell Health Pelvic Pain Treatment Center(PPTC) from January to May 2022 and were diagnosed with at least one of four major CPPS diagnoses: interstitial cystitis/bladder pain syndrome (IC/BPS), pelvic floor myalgia (PFM), chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and vulvodynia. Demographic data as well as survey data from pelvic pain maps, Genitourinary Pain Index (GUPI) forms, and the short form-6 of the Pain Catastrophizing Scale (PCS-6) were recorded. Descriptive statistics among CPPS groups and Pearson correlations among the number of CPPS diagnoses were computed. One hundred seventy females and 125males with CPPS were included in the study. Significant cross-over in mapping patterns was notable between IC/BPS and PFM groups, both most commonly marking "abdomen" and "genital" regions. The most distinct pattern of pain was seen in patients with CP/CPPS and in patients with vulvodynia. Among the total sample, as the mean number of pain locations marked within the pelvis increased, GUPI and PCS scores increased (p < 0.05). As the number of CPPS diagnoses increased, the strength of the relationship independently increased. Pelvic body mapping demonstrated that different forms of CPPS displayed different distributions of pain, but mapping was not predictive of any diagnostic group. Nevertheless, the pelvic body map proved useful in identifying precise locations of pain and may help uncover regions of pain that cannot be easily communicated. The total number of pain sites marked appeared to correlate with worse clinical features.

Pain is one of the crucial issues of modern medicine. The high pain prevalence causes significant material and social losses. The main scientific and practical efforts are aimed at studying the issues of pain etiology, pathogenesis and therapy. As an effective measure to solve this problem, the idea of organizing a network of centers and clinics for the pain treatment

Pain is one of the crucial issues of modern medicine. The high pain prevalence causes significant material and social losses. The main scientific and practical efforts are aimed at studying the issues of pain etiology, pathogenesis and therapy. As an effective measure to solve this problem, the idea of organizing a network of centers and clinics for the pain treatment was put forward. Purpose of the work: description of the structure of the organization of multidisciplinary clinics and pain treatment centers. There are currently few publications on the organization of pain relief. The article discusses the basic principles of organizing pain treatment centers and pain relief systems abroad. In this organization, attention is drawn to the principles of interdisciplinary interaction, the development of treatment tactics and the organization of work with a patient suffering from pain. Further, the paper presents the experience of organizing specialized pain relief care abroad. An example of the work of a pain center on the basis of a multidisciplinary hospital (Privolzhsky District Medical Center of the Federal Medical and Biological Agency of Russia) is given. The authors shared the structure and organization of this pain treatment center. They also presented the results of its work. Conclusion. Currently, there are no specialized pain centers in Russia. Now in many cities of Russia, there is a process of formation of pain relief care. However, this process faces a number of difficulties.

Pharmacological treatments of neuropathic pain: real-life comparisons using propensity score matching.

Studies comparing different drug treatments for chronic neuropathic pain (NP) are very limited. We, therefore, examined 4 recommended treatments, namely, antidepressants (duloxetine, venlafaxine, and tricyclic antidepressants), antiepileptics (gabapentine and pregabalin), weak opioids, and strong opioids, among patients with NP evaluated before first visit in a tertiary pain treatment centre and 6 months later. Patients with both a clinical diagnosis of NP and a DN4 score ≥3/7 were selected from patients enrolled in the Quebec Pain Registry. Each participant was assigned an inverse weighting of the probability of receiving any NP treatment, taking into account their age, sex, baseline pain intensity, pain duration, pain catastrophizing tendency, education level, employment, and comedications at 6-month follow-up (M6). Patients were considered as improved if they presented at least a 30% reduction on average pain intensity at M6 compared with baseline. A total of 944 patients completed both baseline and M6 evaluations. Overall, 23.0% of patients were significantly improved for pain intensity at M6. There was no significant difference in proportions patients taking or not antidepressants, gabapentinoids, or weak opioids. Among patients taking strong opioids (N = 288), 13.9% (N = 40/288) were improved vs 27.0% (177/656) of those who were not on opioids (P < 0.004). Inverse probability of treatment weighting confirmed that the proportion of patients who improved was significantly lower among those taking strong opioids compared with those who did not (P < 0.001). In conclusion, long-term use of strong opioids is a treatment suited for a limited proportion of patients with chronic NP.

Pain and Opioid Use in Cancer Survivors: A Practical Guide to Account for Perceived Injustice

The presence of pain decreases survival rates in cancer. Pain management in clinical settings is often suboptimal and secondary to other cancer-related treatments, leaving many people undertreated. Opioid use is associated with side effects and decreased survival rate in cancer patients. Hence, there is an urgent need for considering factors such as perceived injustice that sustain post-cancer pain and trigger a behavioral pattern associated with opioid use. Injustice beliefs represent a maladaptive pattern of cognitive appraisal that may be a salient target for improving pain-related coping in these patients. Perceived injustice is associated with increased opioid prescription and prospectively predicted opioid use at 1-year follow-up, urging the need for targeted interventions to diminish perceived injustice. Explain the importance of screening for perceived injustice in patients with pain following cancer treatment, its potential relevance for opioid abuse, and its potential impact on the management of pain following cancer. Also, prove clinicians with a clinical guide for an approach comprising of modified pain neuroscience education, motivational interviewing, and acceptance-based interventions to account for perceived injustice in patients having pain following cancer. A narrative review, perspective and treatment manual. Several universities, a university of applied science department, a university hospital, and a private clinic (i.e., transdisciplinary pain treatment center). Patients were cancer survivors with pain. Intervention included modified pain neuroscience education, motivational interviewing, and acceptance-based interventions. Measurements were taken through the Injustice Experience Questionnaire (IEQ). The IEQ can be used to assess perceived injustice in a valid way. Education about pain, including discussing perceived injustice, should be the first part of the management of pain in cancer survivors. In order to obtain the often-required behavioral change towards a more adaptive lifestyle, motivational interviewing can be used. To thoroughly tackle perceived injustice in patients having pain following cancer, special emphasis should be given to the individual reasons patients identify for experiencing (continued) pain and related symptoms. Pain acceptance should also be thoroughly addressed. Clinical trials exploring the benefits, including cost-effectiveness, of such a multimodal approach in patients with pain following cancer treatment are needed. In light of its potential relevance for opioid abuse and potential impact on conservative management strategies, clinicians are advised to screen for perceived injustice in patients with pain following cancer treatment. Therapeutic targeting of perceived injustice can be done through an approach comprising of modified pain neuroscience education, motivational interviewing, and acceptance-based interventions.

Medical pain care for children and adolescents with chronic pain in Germany : An inventory

Chronic pain in children and adolescents is increasing in prevalence, affects the quality of life, predisposes to pain in adulthood and causes numerous contacts to the healthcare system. In contrast, the number of therapeutic offers tailored to the special needs of this age group is insufficient and confusing. The working group on pain in children and adolescents of the German Pain Society therefore documented appropriate facilities in aquestionnaire survey carried out using asnowball system. The response rate of 27/109 questionnaires was low. Thus, the results may not be entirely representative. Nevertheless, the heterogeneity of the offers and in total an undersupply became very clear. In order to improve the care situation, joint efforts by the various pediatric subdisciplines dealing with pain, an increase in the number of child pain treatment centers and a better networking are necessary.

Biopsychosocial Characteristics of Patients With Chronic Pain Expecting Different Levels of Pain Relief in the Context of Multidisciplinary Treatments.

Evidence suggests that patients' expectations predict chronic pain treatment outcomes. Although patients vary in terms of expected pain relief, little is known about individual factors related to such variations. This study aims to investigate how patients with various levels of pain relief expectations differ on the basis of biopsychosocial baseline characteristics in the context of multidisciplinary chronic pain treatment. Data from 3110 individuals with chronic pain attending one of 3 multidisciplinary pain treatment centers were considered. Participants completed a self-reported measure of pain relief expectations and provided information pertaining to biological, psychological, and social variables. A backward stepwise regression helped identify biopsychosocial variables that significantly predicted expected pain relief. Subsequent analyses suggest that patients reporting low, moderate, high, and very high expectations of pain relief differed significantly in terms of pain duration and depressive symptoms. Significant between-group differences were also found with regard to overall physical health, age, sex, and ethnicity. Identifying characteristics related to different levels of pain relief expectations is a fundamental step in generating a more comprehensive understanding of how expectations can be of use in the successful management of chronic pain conditions.

The Adaptation of Pain Assessment Tools from High-Income to Low- and Middle-Income Countries: Psychometric Properties of a Set of Chronic Pain Questionnaires in Mongolian and New Zealand Patient Samples.

Chronic pain is a leading cause of disability in low- and middle-income countries; however, pain assessment tools have generally been developed and validated in high-income countries. This study examines the psychometric properties of a set of translated pain (and distress) questionnaires in Mongolia and documents the characteristics of people seeking treatment for chronic pain in Mongolia, compared with those in New Zealand, which is representative of high-income countries. Cross-sectional, observational. Hospital-based pain treatment centers in New Zealand and Mongolia. People seeking treatment for chronic pain in Mongolia (N = 142) and New Zealand (N = 159). The Brief Pain Inventory, the Depression Anxiety Stress Scale-21, the Pain Catastrophizing Scale, and the Pain Self-Efficacy Questionnaire were translated into Mongolian and administered to patients attending a hospital-based pain service. Questionnaires that were completed by patients in New Zealand were used for comparisons. Internal reliability, convergent validity, and factor structure were assessed in both groups. Patients in Mongolia were older and reported lower pain intensity, interference, and distress and higher pain self-efficacy than those in New Zealand. The translated questionnaires had good internal consistencies, and the relationships between pain variables were similar across both groups. The factor structure for the Pain Catastrophizing Scale was consistent across both groups, but this was not the case for the Brief Pain Inventory or the Depression Anxiety Stress Scale-21. Findings indicate that some pain outcome measures may be appropriate for use in Mongolia and should be investigated in other low- and middle-income countries.

PC-FACS

PC-FACS

Characterization of the Iatrogenic Drug Risk in Elderly Patients With Chronic Pain Who Consult the Pain Assessment and Treatment Centre at the Nimes University Hospital

Characterization of the Iatrogenic Drug Risk in Elderly Patients With Chronic Pain Who Consult the Pain Assessment and Treatment Centre at the Nimes University Hospital

Development and validation of the Treatment Expectations in Chronic Pain Scale.

To develop and examine the psychometric properties of the Treatment Expectations in Chronic Pain (TEC) scale, a brief measure of treatment expectations of chronic non-cancer pain treatment. A cross-sectional study design was used. After conducting a literature review and expert discussions, a preliminary version of the TEC scale was developed. Cognitive interviews with 10 clinicians and 14 patients were conducted to examine the scale's face validity and item wording. Last, two hundred and five patients on the waitlist for a multidisciplinary pain treatment centre completed a battery of self-report questionnaires to examine the TEC scale's reliability and construct validity. Mokken scale analysis was conducted to select the final items. Reliability (Cronbach's alpha and Guttman's lambda2 ) and construct validity (Pearson correlations) were assessed. The final scale was composed of nine items that each measured ideal and predicted expectations about process and outcome of treatment. Mokken scale analysis showed the presence of two subscales: ideal and predicted expectations. The TEC scale had good internal consistency (α=0.876-0.869) and adequate discriminant validity as assessed by its low correlation with measures of depression, anxiety, and quality of life (r=-.038 to .114). The scale had however low correlation with a theoretically related measure of optimism (r=.240). The TEC scale is a reliable scale measuring pain treatment expectation. Further evaluation of its psychometric properties is needed. The scale has the potential to deepen our understanding of the role treatment expectations play in chronic non-cancer pain treatment response. Statement of contribution What is already known on this subject? Expectations play a role in pain perception and the response to pain treatment Patients' expectations about pain and its management are associated with treatment satisfaction The absence of a validated tool to measure treatment expectations in chronic non-cancer pain prevents further exploration and understanding of the role of expectations in the context of multidisciplinary pain treatment . What does this study add? A new, reliable 9-item scale measuring treatment expectations among chronic non-cancer pain patients attending specialized multidisciplinary pain clinics .

(308) The Divergent Effects of Subjective Social Status on Depressive Symptoms in a Sample of Black and White Adults with Chronic Low Back Pain

While conventional socioeconomic status measures such as education, income, and occupation are often important predictors of health, subjective social status is also a critical determinant of physical and mental health among adults. Subjective social status takes into account perceived standing on multiple dimensions of socioeconomic status and social position. What remains unclear is whether subjective social status is similarly associated with health for individuals from different racial backgrounds. The aim of this ongoing study was to examine the association between subjective social status and depressive symptoms, and whether the nature of this association differed between Black and White adults with chronic low back pain (cLBP). Participants included 44 adults with cLBP (24 Black and 20 White) recruited from an academic pain treatment center in Birmingham Alabama. Subjective social status was measured using a symbolic ladder with 10 rungs that asked participants to place themselves in comparison with others in the U.S., with consideration for what it means to be at the top and bottom of society (e.g., the top have the most money and education and the best jobs). Participants also provided sociodemographic data (e.g., ethnicity/race) and completed the Center for Epidemiological Studies – Depression Scale. Results revealed that the association between subjective social status and depressive symptoms was significantly moderated by racial background (t = -5.56, p

Chronic Pediatric Pain Management: a Review of Multidisciplinary Care and Emerging Topics

Chronic pain is a prevalent, disabling, and expensive pediatric condition. Specific treatment options have limited evidence and are often extrapolated from adult care. This review evaluates pain outcome measures, psychological treatment, pharmacologic management, multidisciplinary treatment models, and emerging topics in pediatric pain medicine. Multimodal cognitive behavioral therapy and intensive interdisciplinary pain treatment have the strongest evidence for improving pain and function while decreasing healthcare utilization. There is emerging evidence that parental involvement in care is an important factor in pediatric outcomes. While there is increased interest in emerging topics such as use of marijuana-derived products, acupuncture, and virtual reality, the evidence behind such interventions remains limited. Pediatric chronic pain treatment centers on the biopsychosocial model of pain and multidisciplinary treatment. Recent research shows that intensive interdisciplinary pain treatment can improve pain, function, and healthcare utilization. Long-term benefits and risks of emerging treatments in pediatric chronic pain remain poorly understood.

Examination of the Course of Low Back Pain Intensity Based on Baseline Predictors and Health Care Utilization Among Patients Treated in Multidisciplinary Pain Clinics: A Quebec Pain Registry Study.

The study objectives were to identify baseline predictors of low back pain severity changes over a one-year period among patients attending multidisciplinary tertiary clinics and determine whether health care utilization impacts this outcome. This is a retrospective cohort study using the Quebec Pain Registry (QPR). A total of 686 low back pain (LBP) patients (55.8% females, mean age = 56.51 ± 14.5 years) from the QPR were selected for this study. Patients completed self-report questionnaires and nurse-administered questionnaires before their first appointment at a multidisciplinary pain treatment center. Analysis was conducted using a linear growth model. There was a modest (10%) improvement in pain severity scores over a 12-month period. Pain catastrophizing and depressive symptoms predicted higher baseline levels of pain severity (P < 0.001). Having used self-management approaches over the past six months was associated with higher levels of pain severity at 12 months (P < 0.001). Results from this study showed no clear pattern of association between the use of different treatment disciplines and pain severiy over the first year after multidisciplinary treatment intervention. These results raise an important question as to the best way of utilizing scarce multidisciplinary resources to optimize cost-effectiveness and improve outcomes among complex, chronic LBP patients.

The Impact of Perceived Injustice on Pain-related Outcomes: A Combined Model Examining the Mediating Roles of Pain Acceptance and Anger in a Chronic Pain Sample.

Perceived injustice (PI) has been identified as an important risk factor for pain-related outcomes. To date, research has shown that pain acceptance and anger are mediators of the association between PI and pain-related outcomes. However, a combined conceptual model that addresses the interrelationships between these variables is currently lacking. Therefore, the current study aimed to examine the potential mediating roles of pain acceptance and anger on the association between PI and adverse pain-related outcomes (physical function, pain intensity, opioid use status). This cross-sectional study used a sample of 354 patients with chronic pain being treated at a tertiary pain treatment center. Participants completed measures of PI, pain acceptance, anger, physical function, pain intensity, and opioid use status. Mediation analyses were used to examine the impact of pain acceptance and anger on the association between PI and pain-related outcomes. Examination of the specific indirect effects revealed that pain acceptance fully mediated the relationship between PI and physical function, as well as the relationship between PI and opioid use status. Pain acceptance emerged as a partial mediator of the relationship between PI and pain intensity. This is the first study to provide a combined conceptual model investigating the mediating roles of pain acceptance and anger on the relationship between PI and pain outcomes. On the basis of our findings, low levels of pain acceptance associated with PI may help explain the association between PI and adverse pain outcomes. Clinical and theoretical implications are discussed.

Intrathecal pain management: a team-based approach.

ObjectivePhysician assistants (PAs), nurse practitioners (NPs), and registered nurses (RNs) provide professional services on pain management teams. This review provides an overview of the practical management of chronic pain with intrathecal (IT) therapy using an interprofessional approach (eg, physicians and other health care professionals), with a focus on the contributions of PAs, NPs, and RNs.MethodsNarrative review based on literature searches of the Medline database and treatment guidelines on the use of IT therapy in the management of patients with chronic pain.ResultsThe specific roles and responsibilities of PAs, NPs, and RNs in the management of patients receiving IT therapy vary by practice. In many pain treatment centers, PAs, NPs, and RNs are responsible for patient education, postimplant maintenance, and ongoing supportive care of patients receiving IT therapy. Topics that we address include patient selection, patient expectations and goal setting, medication selection, outcome assessment, and treatment adjustment. Currently, morphine and ziconotide (a nonopioid, selective N-type calcium channel blocker) are the only agents approved by the US Food and Drug Administration for IT analgesia. We provide relevant information on the dosing, titration, and adverse effect management of these medications for PAs, NPs, and RNs responsible for administering IT therapy.ConclusionPAs, NPs, and RNs are valuable members of IT pain management teams. Treatment success requires ongoing monitoring of efficacy and adverse effects, with corresponding adjustments to medication selection and dosing, in addition to good communication among the health care professionals involved in patient care.

Sleep quality in subjects suffering from chronic pain.

SummaryBackgroundSleeping problems are very common in patients with chronic pain. The aim of the study was to investigate the association between different dimensions of chronic pain and sleep quality in chronic pain patients.MethodsIn this cross-sectional interview-based questionnaire study, patients from 3 different pain treatment centers in Vienna aged 18–65 years, with pain lasting 3 months or longer were asked to participate. The association between the short-form McGill pain questionnaire (SF-MPQ) and sleep quality (sleep onset latency, interrupted sleep due to pain, sleep duration and recovering effect of sleep) was assessed.ResultsIn this study 121 patients (male 32, female 89, mean age 49 ± 9 years) could be analyzed. Of the patients 38.8% needed more than 30 min for falling asleep, 63.6% reported sleep fragmentation, 30.6% slept less than 5 h and 60.3% reported no recovering effect of sleep. The strongest associations between pain characteristics and sleep quality were found for pain intensity and affective pain aspects. Logistic regression analyses revealed that one point more in the total score of SF-MPQ increased the odds of needing more than 30 min for falling asleep, waking up more than 3 times due to pain, sleeping less than 5 h, and perceiving the sleep as non-recovering, by 6%. Adjusting for physical and psychological quality of life lowered the odds ratios and the association was no longer significant.ConclusionThe results underline the importance of paying attention to sleep quality in patients with chronic pain. The results also indicate that psychological factors might mediate the association between pain and sleep quality.

Poster 104: Development and Design of a Predictive Nomogram for Missed Appointments at an Academic Pain Treatment Center: A Prospective Year-Long Longitudinal Study

Poster 104: Development and Design of a Predictive Nomogram for Missed Appointments at an Academic Pain Treatment Center: A Prospective Year-Long Longitudinal Study

Factors Associated With Missed Appointments at an Academic Pain Treatment Center: A Prospective Year-Long Longitudinal Study.

Interventional pain treatment centers represent an integral part of interdisciplinary care. Barriers to effective treatment include access to care and financial issues related to pain clinic operations. To address these challenges, specialty clinics have taken steps to identify and remedy missed clinic appointments. However, no prospective study has sought to identify factors associated with pain clinic "no-shows." We performed a prospective, longitudinal year-long study in an inner-city, academic pain clinic in which patients scheduled for office visits and procedures were categorized as to whether they showed up or did not show up for their scheduled appointment without cancelling the day before. Twenty demographic (age, employment status), clinical (eg, diagnosis, duration of pain), and environmental (season, time and day of appointment) variables were assessed for their association with missing an appointment. The logistic regression model predicting no-shows was internally validated with crossvalidation and bootstrapping methods. A predictive nomogram was developed to display effect size of predictors for no-shows. No-show data were collected on 5134 patients out of 5209 total appointments for a capture rate of 98.6%. The overall no-show rate was 24.6% and was higher in individuals who were young (<65 years), single, of ethnic minority background, received Medicare/Medicaid, had a primary diagnosis of low back pain or headaches, were seen on a day with rain or snow or for an initial consult, and had at least 1 previous pain provider. Model discrimination (area under curve) was 0.738 (99% confidence interval, 0.70-0.85). A minimum threshold of 350 points on the nomogram predicted greater than 55% risk of no-shows. We found a high no-show rate, which was associated with predictable and unpredictable (eg, snow) factors. Steps to reduce the no-show rate are discussed. To maximize access to care, operation managers should consider a regression model that accounts for patient-level risk of predictable no-shows. Knowing the patient level, no-show rate can potentially help to optimize the schedule programming by staggering low- versus high-probability no-shows.