Patients Attending Pain Clinics Research Articles

Factors Associated with an Increased Risk of Opioid Misuse Among Patients with Non-Cancer Pain in Malaysian Pain Clinic Settings

ABSTRACT This study examined the factors associated with a high risk of opioid misuse among patients receiving opioid treatment for their non-cancer pain in Malaysian pain clinics. The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), a validated instrument for predicting the risk of aberrant drug-related behaviors, were used as a proxy to indicate risk of opioid misuse. Data analysis was stratified into high-risk and low-risk patient groups. Patient factors assessed included pain intensity, pain interference with daily activities, and health-related quality of life. Prescription opioid exposure was examined via patient medical and prescription records review. Among the 61 patients recruited, 62.3% scored ≥18 on the SOAPP-R, which indicates a high risk for opioid misuse. Factors associated with a high risk of opioid misuse were found to be high level of pain interference with daily activities, poorer mental health, and younger age. High-risk patients were found to be prescribed a lower mean daily opioid dose of <20 mg/day compared to low-risk patients (20–49 mg/day). This highlights the need for further research to distinguish aberrant drug-related behaviors due to inadequate pain management from that of actual prescription opioid misuse among non-cancer pain patients attending pain clinics.

P095 Fibromyalgia correlates with neurodivergent traits in a self-selected community population

Abstract Background/Aims Chronic musculoskeletal pain is now a common feature among younger women. Many such women exhibit a range of additional physical and psychological features and fulfil criteria for fibromyalgia. Hypermobility, irritable bowel syndrome and migraine are frequent comorbid conditions. These are all in part mediated by dysfunction of the autonomic nervous system and commonly include fatigue, poor sleep and brain fog. Anxiety, social withdrawal and a range of autistic traits are frequently described by those with chronic musculoskeletal pain, and autistic people are over-represented among patients attending pain clinics. This study was designed to explore the correlation between the degree of pain and autistic traits described within a self-selected community-based population. Methods The study used a nonexperimental, correlational design with data collected from a volunteer sample of 448 adults (aged 18-60) who completed online self-report questionnaires assessing each of autistic traits (RAADS score), fibromyalgia symptoms (ACR criteria) and hypermobility (Beighton’s test). Correlation analysis and linear regressions were used to test the relationships between each disorder. Data was analysed using parametric and non-parametric techniques to assess prevalence, strength and significance of relationships, causes of variance within populations and mediations. Results Our self-selected community population had a mean age of 24 years and was 77% female. The prevalence of significant autistic traits, fibromyalgia and hypermobility were all much greater than expected at 65%, 40% and 44% respectively. Those identifying as non-binary or trans had the highest rates. Fibromyalgia was strongly associated with autistic traits, with dysautonomia a better predictor than chronic pain. Regression analyses revealed hypermobility partially mediated the relationship between autistic traits and fibromyalgia. Conclusion This is the first community study to provide evidence for a direct association between fibromyalgia and neurodivergent traits. Although self-selected, the findings in our predominantly young population confirm that these conditions are common and that those with autistic traits are at significantly increased risk of developing fibromyalgia, especially if they are hypermobile. Those who self-identify as non-binary or trans appear at particular risk of developing features of fibromyalgia. Disclosure L. Ryan: None. H. Beer: None. E. Thomson: None. E. Philcox: None. C. Kelly: None.

Autistic Traits Correlate with Chronic Musculoskeletal Pain: A Self-Selected Population Based Survey

Chronic musculoskeletal pain is an increasingly frequent feature in young people. Many exhibit a range of additional physical and psychological features and fulfil criteria for fibromyalgia. Hypermobility, irritable bowel syndrome and migraine are frequent comorbid conditions. These are all in part mediated by dysfunction of the autonomic nervous system and commonly include fatigue, poor sleep and brain fog. Anxiety, social withdrawal and a range of autistic traits are frequently described by those with chronic musculoskeletal pain, and autistic people are over-represented among patients attending pain clinics. This study was designed to explore the correlation between the degree of pain and autistic traits described within a self-selected community-based population. The study used a nonexperimental, correlational design with data collected from a volunteer sample of 448 adults (aged 18-60) who completed online self-report questionnaires assessing each of autistic traits (RAADS-R score), fibromyalgia symptoms (ACR criteria) and hypermobility (Beighton’s test). Correlation analysis and linear regressions were used to test the relationships between each disorder. Data was analysed using parametric and non-parametric techniques to assess prevalence, strength and significance of relationships, causes of variance within populations and mediations. Our self-selected community population had a mean age of 24 years and was 77% female. The prevalence of significant autistic traits, fibromyalgia and hypermobility were all much greater than expected at 63.4%, 40.6% and 43.7% respectively. Those identifying as non-binary or trans had the highest rates. Fibromyalgia was significantly associated with autistic traits, with dysautonomia a stronger predictor than chronic pain. Regression analyses revealed hypermobility partially mediated the relationship between autistic traits and fibromyalgia. This is the first community study to provide evidence for a direct association between fibromyalgia and autistic traits. Although self-selected, the findings in our predominantly young female population confirm that these conditions are common and that those with autistic traits are at significantly increased risk of developing fibromyalgia, especially if they are hypermobile.

Quality of life and disability of chronic non-cancer pain in adults patients attending pain clinics: A prospective, multicenter, observational study

Quality of life and disability of chronic non-cancer pain in adults patients attending pain clinics: A prospective, multicenter, observational study

Epidemiology of Chronic Pain in the Latium Region, Italy: A Cross-Sectional Study on the Clinical Characteristics of Patients Attending Pain Clinics

In Italy, chronic pain affects more than a quarter of the population, whereas the average European prevalence is 21%. This high prevalence might be due to the high percentage of Italian people who do not receive treatment, even after the passing of law 38/2010 (the right to access pain management in Italy), which created a regional network for the diagnosis and treatment of noncancer chronic pain. Italian epidemiologic studies on chronic pain are scanty, and this observational, multicenter, cross-sectional study is the first to investigate the clinical characteristics of patients who attended the pain management clinics in the Latium Region, Italy, for the management of their noncancer chronic pain. A total of 1,606 patients (mean age 56.8 years, standard deviation ± 11.4), 67% women, were analyzed. Severe pain was present in 54% of the sample. Women experienced pain and had it in two or more sites more often than men (57% vs. 50%, p = .02; and 55.2% vs. 45.9%, p < .001, respectively). Chronic pain was musculoskeletal (45%), mixed (34%), and neuropathic (21%). In more than 60% of the cases, chronic pain was continuous, and in 20% it had lasted for more than 48 months; long-lasting pain was often neuropathic. Low back (33.4%) and lower limbs (28.2%) were the main locations. Severe intensity of pain was statistically significantly associated with female gender (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.06-1.84); with International Classification of Diseases, Ninth Revision, codes for chronic pain syndrome (OR 2.14; 95% CI 1.55-2.95); and with continuous pain (OR 2.02; 95% CI 1.54-2.66). Neuropathic pain and mixed pain were significantly associated with number of sites, and a trend seemed to be present (OR 2.11 and 3.02 for 2 and 3 + sites; 95% CI 1.59-2.79 and 2.00-4.55, respectively).

Analysis of Anxiety, Depression and Aggression in Patients Attending Pain Clinics.

The aim of the study was to measure the frequency of such emotional disturbances as anxiety, depression and aggression among patients treated in a pain clinic, as well as assess the factors contributing to such disorders. Research was conducted from January 2014 to April 2018 and involved patients treated in two pain clinics in the city of Warsaw, Poland. The study used the Hospital Anxiety and Depression Scale—Modified Version (HADS-M) and the Numerical Rating Scale (NSR). 1025 patients were recruited. The main reasons for their attending the pain clinic were osteoarticular pain (43.61%) and neuropathic pain (41.56%). Emotional disturbances in the form of anxiety were diagnosed in 32.39% of all the patients, depression in 17.85%, and aggression in 46.15%. The factors determining the level of anxiety in the study group were: sex, age, pain intensity and the lack of pharmacological treatment. Depression was determined by sex, pain intensity and the time of treatment in the clinic, while aggression by age and pain intensity.

Prevalence of central and peripheral neuropathic pain in patients attending pain clinics in Spain: factors related to intensity of pain and quality of life.

BackgroundThe objective of the study was to estimate the prevalence of pure central neuropathic pain (CNP) and peripheral neuropathic pain (PNP) among patients attending pain clinics in Spain. The study also aimed to analyze factors associated with pain intensity and quality of life (QoL).MethodsA cross-sectional study was performed including 53 patients with pure CNP and 281 with pure PNP attending in 104 pain clinics in Spain. The revised grading system proposed in 2008 to determine a definite, probable or possible diagnosis of NP was used. Pain features, psychological variables and QoL were assessed. Descriptive, bivariate and multivariate analyses were performed.ResultsThe prevalence of pure CNP and PNP amongst neuropathic pain patients was 2.4% (95% CI: 1.7;3.1) and 12.9% (95% CI: 1.5;14.3), respectively. Comorbid anxiety, depression or sleep disorders were high in both groups, but higher in CNP patients (51.1%, 71.4%, respectively). Pain intensity in PNP patients was associated with the presence of depression and sleep disturbances. However, in CNP patients, it was related with pain in the lower limbs. The impairment of QoL was greater in CNP patients than in PNP patients; pain location, presence of depression and sleep disturbance were the factors that most negatively affected QoL. Among PNP patients, women and those with higher pain intensity had worse QoL.ConclusionPain intensity and QoL are affected by different factors in patients suffering from CNP or PNP. Identifying these factors could serve to guide therapeutic strategies and improve the QoL of patients.

Complementary Therapies for Chronic Pain: The Case for Acupuncture

Many patients with chronic pain turn to complementary therapies as part of their search for relief. In the USA, for example, use of complementary therapies was reported by 52% of 463 chronic patients in primary care (current use) [1], 82% of veterans with chronic noncancer pain (ever used) [2] and 35–39% of patients attending pain clinics [3]. Among US users of complementary therapies, pain conditions, including back and neck pain, joint problems and arthritis, are among the ten most common reasons for use [4]. In a survey of Europeans with chronic pain, 69% of respondents used nondrug treatments [5]. Acupuncture was one of the most popular nondrug treatments (used by 13%). Acupuncture is a complementary medical therapy that has received considerable attention in western countries over the last few decades and is growing in popularity [4]. Like other complementary therapies, it is used frequently for chronic pain [6]. However, acupuncture remains contro­ versial among many researchers and some physicians. Why is this? An ideal treatment for pain would outperform placebo in efficacy trials, provide clear clinical benefit under real life conditions, have a clearly understood biological mechanism, have a good safety record, be cost effective, be acceptable and accessible to patients and physicians, and facilitate or promote self­management. In addition, if used as part of an integrative treatment approach, it should lead to reductions in the use of harmful treatments. How does acupuncture perform when assessed using these criteria? Over 70 systematic reviews of acupuncture for a variety of pain conditions have been published [7]. Many of the primary studies have been small, poor quality trials. At least some of the systematic reviews for the same pain condition have come to opposite conclusions (e.g., temporomandibular disorder) [8,9]. Overall, acupuncture does not consistently outperform ‘placebo’ or ‘sham’ acupuncture [10,11]. In a meta­ana­ lysis using the gold standard of individual patient data from nearly 18,000 patients and 29 randomized trials, Vickers et al. found that the specific effects of acupuncture compared with sham were small and of questionable clinical significance [12]. Thus, acupuncture’s performance relative to placebo or sham is unclear.

High prevalence of confirmed, but also of potential and believed, neuropathic pain in pain clinics

Epidemiological data about neuropathic pain are still scarce. A national survey, based on neurologic clinical diagnosis, was performed to determine its prevalence among patients attending pain clinics. An epidemiological cross-sectional study involving pain clinics across all regions in Spain was carried out. Pain specialists evaluated the medical files and the clinical condition of patients attending their practices systematically during 1 day. They used the revised definition and grading system proposed in 2008 to decide whether a given patient had definite (i.e., confirmed), probable (potential) or possible (believed) neuropathic pain. Also, they provided a diagnostic label for neuropathic pain conditions and appraised treatment adequacy. In a single day, 178 pain specialists provided data from 2173 patients. Definite, probable and possible neuropathic pain was cited in 639 (29.4%), 304 (14.0%) and 97 (4.5%) patients, respectively. Almost two-thirds of these were women. A diagnostic label of primary pure central and/or peripheral neuropathic pain was cited in 344 (15.8%) patients. The most common diagnostic label (568 patients) was low back pain or sciatica causing mixed neuropathic pain. Definite neuropathic pain diagnosis was less likely in patients with mixed pain conditions and in women derived from primary care. Co-morbid depressive or anxiety symptoms were usual. Definite (confirmed) neuropathic pain alone was as prevalent as neuropathic pain ascertained with screening questionnaires in prior recent European studies. The clinical relevance of the surplus of patients with potential and believed neuropathic pain ascertained by clinicians is uncertain.

The stigmatisation of people with chronic back pain

Purpose. This study responded to the need for better theoretical understanding of experiences that shape the beliefs, attitudes and needs of chronic back patients attending pain clinics. The aim was explore and conceptualise the experiences of people of working age who seek help from pain clinics for chronic back pain.Methods. This was a qualitative study, based on an interpretative phenomenological approach (IPA). During in-depth interviews in their homes, participants were invited to ‘tell their story’ from the time their pain began. Participants were twelve male and six female patients, aged between 28 and 62 years, diagnosed as having chronic benign back pain. All had recently attended one of two pain clinics as new referrals. The interview transcripts were analysed thematically.Findings. Stigmatisation emerged as a key theme from the narrative accounts of participants. The findings expose subtle as well as overt stigmatising responses by family, friends, health professionals and the general public which appeared to have a profound effect on the perceptions, self esteem and behaviours of those interviewed.Conclusions. The findings suggest that patients with chronic back pain feel stigmatised by the time they attend pain clinics and this may affect their attitudes and behaviours towards those offering professional help. Theories of chronic pain need to accommodate these responses, while pain management programmes need to address the realities and practicalities of dealing with stigma in everyday life.

What Do Patients Expect From Their First Visit to a Pain Clinic?

To examine patients' expectations of their first outpatient visit to a pain clinic. We asked patients what would be the most satisfying and the most disappointing outcomes of their visit and whether they expected changes in medication and further investigations to result from their consultation. Patients completed questionnaires and a structured interview to assess expectations before their clinic appointment. Seventy-seven patients with chronic pain who were first time referrals to a regional pain clinic participated in the study. Patient expectations and questionnaires measuring depression and pain-related disability were completed prior to the pain clinic appointment. Most patients expected an explanation or an improved understanding of their pain problem. The most common satisfying outcome was relief or control of pain, and the most common disappointing outcome was being told nothing could be done. The majority of patients expected further medical investigations and changes to the prescribed medication. Depression and pain-related disability strongly influenced patient expectations. For patients attending pain clinics, the explanation of their pain problem is rated as important as the cure or relief of their pain. Improved understanding of patient expectations by pain clinic clinicians may lead to greater patient satisfaction and reduced treatment dropout.

Predictors of psychological distress in chronic pain patients.

The purpose of this study was to identify sources of psychological distress in patients attending pain clinics. Patients attending two pain clinics in the UK completed a self-report assessment questionnaire which included a 12-item, 5-point semantic differential measure of psychological well-being/distress, together with a range of single-item measures of pain and psychosocial factors measured using 5-point verbal report scales. Multiple regression analysis identified that 60% of the variance associated with psychological distress was explained by a combination of fears about the future, regrets about the past, age (younger people were more distressed), practical help (more help was associated with more distress), feeling unoccupied and personal relationship problems. These results support previous findings which have suggested that a significant proportion of the emotional disturbance in chronic pain patients is associated with psychosocial factors which are either secondary to, or concurrent with, the pain. The method described provides a simple and quick method of assessment which may be used by nurses in clinical settings to identify sources of psychological distress in patients with chronic pain and opportunities for therapeutic intervention.