Role In Pain Management Research Articles

The effects of cannabinoids on the kidney.

Cannabinoids are a class of drugs derived from the Cannabis plant that are widely used for the treatment of various medical conditions and recreational use. Common examples include Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD), spice, and 2-arachidonoylglycerol (2-AG). With more than 100 cannabinoids identified, their influence on the nervous system, role in pain management, and effects due to illicit use have been extensively studied. However, their effects on peripheral organs, such as the kidneys, require further examination. With dramatic rises in use, production, and legalization, it is essential to understand the impact and mechanistic properties of these drugs as they pertain to renal and cardiovascular physiology. The goal of this review is to summarize prior literature on the expression of cannabinoid receptors and how cannabinoids influence renal function. This review first discusses the interaction of the endocannabinoid system (ECS) and renal physiology and pathophysiology. Following, we briefly discuss the role of the ECS in various kidney diseases and the potential therapeutic applications of drugs targeting the cannabinoid system. Lastly, recent studies have identified several detrimental effects of cannabinoids, not only on the kidney but also in contributing to adverse cardiovascular outcomes. Thus, the negative impact of cannabinoids on renal function and the development of various cardiovascular diseases is also discussed.

Prevalence and Effect of Cannabinoids in Pain Management for Hand Pathologies.

Cannabinoids are a diverse group of compounds under investigation for various medical purposes, including analgesia. Given the evolving landscape of cannabinoid use, we aimed to analyze their prevalence and effect in pain management among urban orthopedic hand patients. An electronic survey was administered to 122 new patients presenting to the orthopedic hand clinic of a major urban academic hospital. Demographic data, numerical rating scale pain scores, cannabinoid usage, and other concomitant pain regimens were recorded. Approximately half of the new patients were dissatisfied with current pain management for their hand pathology. Prescription (Rx) and over-the-counter (OTC) pain medications were used by 58% (71/122) of patients, while cannabinoids were used by 15% (18/122) of patients. Compared with pre-usage pain scores, both cannabinoids and Rx/OTC medications induced significant reductions in pain associated with patients' hand pathologies (Cannabinoid: Δ4.4, P = .002; Rx/OTC: Δ3.0, P < .001). Cannabinoids induced a larger analgesic effect, but this difference was not statistically or clinically significant (P = .06). Subjectively, cannabinoid users either preferred their cannabinoid over Rx/OTC medications or liked both equally. Opioid use was higher among cannabinoid users (22.2% vs 12.5%), although this was not statistically significant (P = .28). Approximately 15% of new urban hand patients use cannabinoids for pain control, and these compounds have similar analgesic efficacy in hand pathologies as Rx/OTC medications. Cannabinoids are equally liked or preferred relative to traditional medications in this cohort, and they may play an important role in pain management for hand patients.

From Spice Rack to Medicine Cabinet: Zingiber Officinale's Role in Pain Management and Inflammation

From Spice Rack to Medicine Cabinet: Zingiber Officinale's Role in Pain Management and Inflammation

Advancements in Soft Robotic Implants for Long-Term Drug Delivery and Tissue Monitoring

Soft robotic implants are a major upgrade in medical devices providing novel means for long-term drug administration and tissue tracking. The eco-friendly biodegradable body-prosthetic will not only be compatible with the human body, but can also mingle completely without inducing foreign-body responses and discomfort. Since these implants provide programmed and localized drug delivery; hence the significance of these sutures could be found in administering the drugs at a specific site and specific interval so as to diminish the side effects and improved therapeutic outcomes. Modern developments of soft robotics implants have improved their design, performance, interaction with biological and other natural materials. Material developments are becoming smarter, where responsive materials in the form of: smart materials, which can react to environmental stimuli and adjust drug delivery rates immediately (and); etc. Moreover, the evolution of microfabrication and nanotechnology also created high precision and less invasive devices, rendering more efficient and well-accepted to patients. These implants are especially valuable for long-term afflictions like diabetes and cancer as they streamline the ongoing, precise delivery of medications. They also have a crucial role in pain management and postoperative care, effectively providing prolonged release of analgesics, and ultimately enhance patient comfort thus contributing to smoother recovery. For tissue monitoring, implantable flexible soft robotic devices with integrated sensors and actuators are able to provide real-time data collection and analysis for the continuous monitoring of vital physiological information, such as cardiovascular health, neural activity, skin conditions (wound healing) etc. This is important, particularly for early detection of complications and receiving timely interventions to optimize patient outcomes. In the future there are a number of intriguing applications that could be developed with these soft robotic implants like personalized medicine and integration with other state-of-the-art medical technologies. Further research and development should/hopefully will address outstanding challenges e.g. technical, regulatory etc to allow more wide-ranging clinical application with consequent transformative impacts on healthcare. Finally, soft robotic implants show great potential to improve drug delivery and tissue monitoring, with continuous development bringing the field closer to better performing medical solutions.

The Role of the Cardiac Surgery Patient in Pain Management: The Patient Perspective.

One and a half million cardiac surgeries are completed worldwide each year where undertreated postoperative pain increases the risk of patient morbidity and mortality. Patient-centered pain management is recommended to improve patient outcomes but there is insufficient information regarding how the patient views their role. The objective of this study is to explore cardiac surgery patients' perspectives on their role in postoperative pain management. This study used an interpretive phenomenological design and convenience sampling. Six participants who had undergone cardiac surgery were recruited from a cardiac rehabilitation program in Western Canada. The first author conducted semi-structured digitally recorded interviews. Sociodemographic characteristics and measures of anxiety and depression were also collected. Emergent thematic analysis of the qualitative data generated three themes: attitude, coping and care, and communication. The findings of this study address a gap in the literature with regard to patients' perceived roles in pain management. There is a complex relationship between patient attitude, coping and care, and communication which, in turn, influences how patients view their role within the pain management continuum. These themes contribute to the development of the patient role within the pain management continuum and form an integrated feedback loop. The patient's attitude contributes to their ability to cope with pain and participate in pain assessment and management. Furthermore, their ability to cope and desire to participate influences the development of their attitude. These findings may enhance providers' understanding of the patient's perspective and improve pain management outcomes.

The effects of morphine administration on the central nervous system (CNS): advantages and disadvantages

Morphine, a potent opioid analgesic, plays a critical role in pain management but elicits complex effects on the central nervous system (CNS), demonstrating both beneficial and detrimental outcomes. This paper reviews preclinical studies to examine morphine's interactions with the CNS, notably via binding to opioid receptors, leading to analgesia as well as a series of adverse effects, including addiction, tolerance, and neurological impairments. Acute exposure to morphine alters neurotransmitter activity, gene expression, and neuronal firing rates. In contrast, chronic use results in significant neuronal damage, altered memory functions, increased pain sensitivity, and neuroinflammation, highlighting the drug's impact on neurogenesis and neural cell viability. Additionally, morphine's protective properties against neurotoxic insults are discussed, alongside its potential to disrupt cellular and molecular pathways, culminating in neurotoxicity and cognitive deficits. Given the dual nature of morphine's impact on the CNS - protective vs. harmful, depending on specific conditions such as dosage, disease type, and administration frequency - this paper underscores the necessity for further research to untangle this complex interplay to leverage morphine's pain management benefits while minimizing its risks. A thorough evaluation of morphine administration practices can help reconcile these conflicting results.

Effectiveness of methylene blue as a local anesthetic and analgesic in perianal operations: A prospective double-blind randomized control trial

BackgroundPerianal operations often result in significant postoperative pain, which negatively affects patient comfort and recovery. The search for effective pain relief options has led to the investigation of methylene blue, a biological stain with potential analgesic properties. AimsThis study aimed to evaluate the analgesic and anaesthetic effects of a mixture of methylene blue and lidocaine compared to plain lidocaine in the management of postoperative pain after perianal operations. MethodsA prospective, double-blinded, randomized controlled trial was conducted at a single center between 2015 and 2023. A total of 727 adult patients undergoing perianal surgical operations were randomly assigned to two groups: the experimental group received a solution of methylene blue and lidocaine, while the control group received plain lidocaine. Pain levels were assessed using the Visual Analog Scale (VAS), and follow-up visits and phone calls were conducted. The analysis included 727 participants who underwent operations for perianal abscess, fistula, fissure, and haemorrhoid. The participants were divided into the experimental group (N=329) and the control group (N=398). The data were analyzed using SPSS version 28, applying descriptive and inferential statistical methods. ResultsThe study included a total of 727 patients, with a mean age of 47 years (ranging from 18 to 90 years). Among the patients, 56.5% were males and 43.5% were females. The two groups showed significant differences in terms of postoperative analgesic use and pain-free days (p<0.001). Specifically, the methylene blue group had lower Visual Analog Scale (VAS) scores compared to the control group (p<0.05, p<0.001), respectively. No significant differences in immediate complications were observed between the two groups. ConclusionMethylene blue is an effective intervention for reducing postoperative pain after perianal operations, potentially decreasing the need for additional pain medication. The findings of this study suggest that methylene blue has a promising role in pain management without an increase in complications.

Loco-Regional Anesthesia for Pain Management in Robotic Thoracic Surgery.

Robotic thoracic surgery is a prominent minimally invasive approach for the treatment of various thoracic diseases. While this technique offers numerous benefits including reduced blood loss, shorter hospital stays, and less postoperative pain, effective pain management remains crucial to enhance recovery and minimize complications. This review focuses on the application of various loco-regional anesthesia techniques in robotic thoracic surgery, particularly emphasizing their role in pain management. Techniques such as local infiltration anesthesia (LIA), thoracic epidural anesthesia (TEA), paravertebral block (PVB), intercostal nerve block (INB), and erector spinae plane block (ESPB) are explored in detail regarding their methodologies, benefits, and potential limitations. The review also discusses the imperative of integrating these anesthesia methods with robotic surgery to optimize patient outcomes. The findings suggest that while each technique has unique advantages, the choice of anesthesia should be tailored to the patient's clinical status, the complexity of the surgery, and the specific requirements of robotic thoracic procedures. The review concludes that a multimodal analgesia strategy, potentially incorporating several of these techniques, may offer the most effective approach for managing perioperative pain in robotic thoracic surgery. Future directions include refining these techniques through technological advancements like ultrasound guidance and exploring the long-term impacts of loco-regional anesthesia on patient recovery and surgical outcomes in the context of robotic thoracic surgery.

The deep and the deeper: Spinal cord and deep brain stimulation for neuropathic pain

Neuropathic pain occurs in people experiencing lesion or disease affecting the somatosensorial system. It is present in 7 % of the general population and may not fully respond to first- and second-line treatments in up to 40 % of cases. Neuromodulation approaches are often proposed for those not tolerating or not responding to usual pharmacological management. These approaches can be delivered surgically (invasively) or non-invasively. Invasive neuromodulation techniques were the first to be employed in neuropathic pain. Among them is spinal cord stimulation (SCS), which consists of the implantation of epidural electrodes over the spinal cord. It is recommended in some guidelines for peripheral neuropathic pain. While recent studies have called into question its efficacy, others have provided promising data, driven by advances in techniques, battery capabilities, programming algorithms and software developments. Deep brain stimulation (DBS) is another well-stablished neuromodulation therapy routinely used for movement disorders; however, its role in pain management remains limited to specific research centers. This is not only due to variable results in the literature contesting its efficacy, but also because several different brain targets have been explored in small trials, compromising comparisons between these studies. Structures such as the periaqueductal grey, posterior thalamus, anterior cingulate cortex, ventral striatum/anterior limb of the internal capsule and the insula are the main targets described to date in literature. SCS and DBS present diverse rationales for use, mechanistic backgrounds, and varying levels of support from experimental studies. The present review aims to present their methodological details, main mechanisms of action for analgesia and their place in the current body of evidence in the management of patients with neuropathic pain, as well their particularities, effectiveness, safety and limitations.

Chronic pain healthcare workers’ challenges in pain management and receptiveness towards VR as an adjunct management tool: a qualitative study

Abstract Background Chronic pain is often a debilitating condition that affects individuals physically and mentally. Reliance on pharmacotherapy for pain management comes with risks of analgesic misuse and dependence. Hence, non-pharmacologic treatment plays a crucial role in pain management. Virtual reality is a novel method in chronic pain management. However, there is little understanding about healthcare providers’ perspectives on the use of virtual reality technology in managing chronic pain. This study aims to explore the current management challenges faced by chronic pain healthcare providers and their perspectives on using virtual reality as adjunctive therapy in managing chronic pain. Method Individual semi-structured interviews were conducted among all chronic pain healthcare providers in a tertiary hospital. The interviews were analysed using qualitative thematic analysis. Results Eight chronic pain healthcare providers participated in this study. Financial issues were cited as one of the biggest barriers to utilisation of non-pharmacological treatment. Participants highlighted the importance of psychosocial support from family and healthcare providers. Challenges identified included absence of patient engagement and lack of awareness about pain management among healthcare providers as well as the lack of an integrated multidisciplinary approach in our healthcare system. Participants were receptive towards the use of virtual reality in chronic pain management and offered ample opinions and suggestions for its application in chronic pain management. Conclusions A multilevel, multifaceted approach is needed to improve chronic pain management. Virtual reality technology could be considered as an adjunct therapy to address some of the challenges and limitations identified in this study.

Cingulotomy for Intractable Pain: A Systematic Review of an Underutilized Procedure.

Pain management is a critical aspect of cancer treatment and palliative care, where pain can significantly impact quality of life. Chronic pain, which affects a significant number of people worldwide, remains a prevalent and challenging symptom for patients. While medications and psychosocial support systems play a role in pain management, surgical and radiological interventions, including cingulotomy, may be necessary for refractory cases. Cingulotomy, a neurosurgical procedure targeting the cingulate gyrus, aims to disrupt neural pathways associated with emotional processing and pain sensation, thereby reducing the affective component of pain. Although cingulotomy has shown promise in providing pain relief, particularly in patients refractory to traditional medical treatment, its use has declined in recent years due to advancements in non-destructive therapies and concerns about long-term efficacy and patient suitability. Modern stereotactic methods have enhanced the precision and safety of cingulotomy, reducing associated complications and mortality rates. Despite these advancements, questions remain regarding its long-term efficacy and suitability for patients with limited life expectancy, particularly those with cancer. A comprehensive systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, aimed at providing insights into the efficacy, potential benefits, and limitations of this neurosurgical procedure in managing intractable pain. An electronic search of PubMed, Embase, Scopus, and Web of Science was conducted with open database coverage dates. The review focused on outcomes such as pain intensity and quality of life. The inclusion criteria encompassed human studies of any age experiencing intractable cancer or non-cancer pain, with cingulotomy as the primary intervention. Various study designs were considered, including observational studies, clinical trials, and reviews focusing on pain and cingulotomy. Exclusion criteria included non-human studies, non-peer-reviewed articles, and studies unrelated to pain or cingulotomy. This review highlights the efficacy of stereotactic anterior cingulotomy in managing intractable pain, particularly when conventional treatments fail. Advanced MRI-guided techniques enhance precision, but challenges like cost and expertise persist. Studies included in this review showed significant pain relief with minimal adverse effects, although the optimal target remains debated. Neurocognitive risks exist, but outcomes are generally favorable. Expected adverse events include transient effects like urinary incontinence and confusion. Reoperation may be necessary for inadequate pain control, with a median pain relief duration of three months to a year. A double stereotactic cingulotomy appears to be safe and effective for refractory pain.

Minimally Invasive Treatment of Facet Osteoarthritis Pain in Spine: A Clinical Approach Evaluating Cryotherapy

Chronic pain management remains a challenging aspect of neurosurgical care, with facet arthrosis being a significant contributor to the global burden of low back pain. This study evaluates the effectiveness of cryotherapy as a minimally invasive treatment for patients with facet arthrosis. By focusing on reducing drug dependency and pain intensity, the research aims to contribute to the evolving field of pain management techniques, offering an alternative to traditional pain management strategies. Through a retrospective longitudinal analysis of patients with facet osteoarthritis treated via cryotherapy between 2013 and 2023, we evaluated the impact on medication usage and pain levels, utilizing the Visual Analog Scale for pre- and posttreatment comparisons. The study encompassed 118 subjects, revealing significant pain alleviation, with Visual Analog Scale scores plummeting from 9.0 initially to 2.0 after treatment. Additionally, 67 patients (56.78%) reported decreased medication consumption. These outcomes underscore cryotherapy's potential as a pivotal tool in chronic pain management. The findings illuminate cryotherapy's efficacy in diminishing pain and curtailing medication dependency among patients with facet arthrosis. This study reaffirms cryotherapy's role in pain management and propels the discourse on nontraditional therapeutic avenues, highlighting the urgent need for personalized and innovative treatment frameworks.

Paracetamol versus Non-Steroidal Anti-Inflammatory Drugs in Acute Pain in Trauma Management: Systemic Review

Background: Effective pain management is essential for patient recovery and quality of life. Paracetamol (Acetaminophen) and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are commonly used analgesics, but their comparative efficacy remains debated. Objective: To systematically review and compare the efficacy of paracetamol and NSAIDs in various pain scenarios. Methods: A comprehensive search was conducted across major databases, primarily using PubMed. The search yielded studies that compared paracetamol to any NSAID in human trials. Following strict inclusion and exclusion criteria, 11 studies with 3,038 participants were finally included in the review. Results: Paracetamol demonstrated comparable efficacy to NSAIDs in multiple scenarios such as post-trauma, post-partial Mastectomy Pain, and migraine in children. While, in certain situations like postoperative pain after Day-Case Operative Hysteroscopy, Pain Post-Total Hip Arthroplasty, and Pain during Rapid Maxillary Expansion, NSAIDs showcased superior efficacy. In some cases, however, such as renal colic, conflicting study evidence was presented. Moreover, in acute settings when administered I.V., paracetamol was slightly more effective. Finally, the combination of NSAIDs with paracetamol did not always offer enhanced analgesic effects. Conclusion: The choice between paracetamol and NSAIDs should be based on the specific clinical scenario and patient needs. While paracetamol is often seen as a safer option, NSAIDs play a vital role in pain management in certain conditions. Generally, due to its safety profile and less GIT and CVS complications, paracetamol should be preferred in pain management as first-line agent, especially in mild cases before moving to NSAIDS in more moderate to severe cases. The route of administration can also affect the analgesic\&amp;apos;s efficacy with the IV route showing higher efficacy. The findings highlight the potential for reducing opioid use by optimizing the use of non-opioids.

Pharmacological Prescribing and Satisfaction with Pain Treatment Among Non-Hispanic Black Men with Chronic Pain.

Pharmacological strategies are often central to chronic pain management; however, pain treatment among non-Hispanic Black men may differ because of their disease profiles and healthcare interactions. However, less is known about pain medication prescribing and patients' satisfaction with pain treatment and management among non-Hispanic Black men with self-reported chronic pain. This study assessed factors associated with non-Hispanic Black men being prescribed/recommended narcotics/opioids for chronic pain and their satisfaction with pain treatment/management. Data were analyzed from 286 non-Hispanic Black men with chronic pain who completed an internet-delivered questionnaire. Participants were recruited nationwide using a Qualtrics web-based panel. Logistic regression was used to identify factors associated with being prescribed/recommended narcotics/opioids for pain management treatment. Then, ordinary least squares regression was used to identify factors associated with their satisfaction level with the pain treatment/management received. On average, participants were 56.2 years old and 48.3% were prescribed/recommended narcotics/opioids for chronic pain. Men with more chronic conditions (Odds Ratio [OR] = 0.57, P = 0.043) and depression/anxiety disorders (OR = 0.53, P = 0.029) were less likely to be prescribed/recommended narcotics/opioids. Men who were more educated (OR = 2.09, P = 0.044), reported more frequent chronic pain (OR = 1.28, P = 0.007), and were allowed to participate more in decisions about their pain treatment/management (OR = 1.11, P = 0.029) were more likely to be prescribed/recommended narcotics/opioids. On average, men with more frequent chronic pain (B = -0.25, P = 0.015) and pain problems (B = -0.16, P = 0.009) were less satisfied with their pain treatment/management. Men who were allowed to participate more in decisions about their pain treatment/management reported higher satisfaction with their pain treatment/management (B = 0.55, P < 0.001). Playing an active role in pain management can improve non-Hispanic Black men's satisfaction with pain treatment/management. This study illustrates the importance of patient-centered approaches and inclusive patient-provider interactions to improve chronic pain management.

Cannabidiol and pain.

Chronic pain presents significant personal, psychological, and socioeconomic hurdles, impacting over 30% of adults worldwide and substantially contributing to disability. Unfortunately, current pharmacotherapy often proves inadequate, leaving fewer than 70% of patients with relief. This shortfall has sparked a drive to seek alternative treatments offering superior safety and efficacy profiles. Cannabinoid-based pharmaceuticals, notably cannabidiol (CBD), hold promise in pain management, driven by their natural origins, versatility, and reduced risk of addiction. As we navigate the opioid crisis, ongoing research plunges into CBD's therapeutic potential, buoyed by animal studies revealing its pain-relieving prowess through various system tweaks. However, the efficacy of cannabis in chronic pain management remains a contentious and stigmatized issue. The International Association for the Study of Pain (IASP) presently refrains from endorsing cannabinoid use for pain relief. Nevertheless, evidence indicates their potential in alleviating cancer-related, neuropathic, arthritis, and musculoskeletal pain, necessitating further investigation. Crucially, our comprehension of CBD's role in pain management is a journey still unfolding, with animal studies illustrating its analgesic effects through interactions with the endocannabinoid, inflammatory, and nociceptive systems. As the plot thickens, it's clear: the saga of chronic pain and CBD's potential offers a compelling narrative ripe for further exploration and understanding.

INTEGRATING ACUPRESSUE TECHNIQUE WITH NURSING CARE

Based on traditional Chinese medicine principles, the practice of utilizing acupressure to relieve symptomslike pain, during first stage of labor, diverse pain, nausea vomiting, discomfort, sleep quality, fatigue, dysmenorrheaetc., aid in healing process, induce relaxation, and enhance overall well-being1.Acupressure serves as a complementary therapy employing fingers and hands to stimulate acupoints and maintain the balance of energy. A review study explored that Acupressure demonstrates efficacy in alleviating diverse types of pain across various demographics. This review initiates the establishment of a robust evidence foundation supporting acupressures role in pain management. Healthcare providers could consider integrating acupressure into their practice as a viable alternative therapy to assist patients experiencing pain2.This noninvasive technique has been demonstrated to be successful, has no risk, and is simple to incorporate into nursing practice/ nursing care1.According to some preliminary research acupressure may be beneficial for headache, post operative pain, and low back discomfort. Pain from further illness might also help. The LI 4 pressure point is occasionally used to treat headaches3. As part of their emphasis on providing holistic patient care, nurses are increasingly using acupressure to help comfort, pain management and symptom control. According to many research reports, acupressure may be regarded as a viable nursing intervention4. The author explores potential clinical applications of acupressure, delineates the technique, discusses methods for evaluating patient outcomes and proposes strategies to enhance future research on this integrative intervention.

Hospital Chaplains, Spirituality, and Pain Management: A Qualitative Study

BackgroundNurses include spirituality in holistic nursing care of persons in pain. However, there is a lack of awareness of spiritual suffering and the role of chaplains and spiritual care in pain management. AimThe purpose of this pilot is to report hospital chaplains’ qualitative report of spirituality and pain management in an acute care setting. MethodThis qualitative inquiry pilot involved guided interviews of hospital chaplains on their role in pain management. A thematic analysis was performed. ResultsSpiritual suffering in people in pain was the dominant theme. This included spiritual fear, and nurses suffering as a witness to pain. Chaplain interventions was a theme that involved spiritual support to persons in pain. ConclusionsSpiritual suffering can occur in people in pain. An early consultation with hospital chaplains can augment pain management. A person in pain may experience spiritual suffering and a chaplain can provide the appropriate assessment and intervention.

Mobilizing nurses to address the opioid misuse epidemic

BackgroundThe opioid epidemic is a major health challenge in the United States. PurposeMembers from the American Academy of Nursing joined to write a consensus paper about nurses' role in the opioid epidemic. MethodsThe panel reviewed the history of the opioid epidemic and policies to care for patients with opioid use disorder (OUD) and how registered nurses (RNs) and advanced practice nurses (APRNs) could increase care for people with OUD. DiscussionRecommendations are presented to advance policies that empower RNs and APRNs to abate the opioid epidemic. ConclusionRecommendations include (a) advance legislation that supports RNs and APRNs full scope of practice and expands professional role in pain management and addiction prevention; (b) evaluate effective policies that promote RN and APRN care; support federal elimination of X-waiver with state law alignment; (c) sustain the use of nurses in telemedicine; (d) support nursing research on nurse involvement in all aspects of OUD.

A synthesis of meta-analyses of mindfulness-based interventions in pain.

Mindfulness interventions have become popular in recent decades, with many trials, systematic reviews, and meta-analyses of the impact of mindfulness-based interventions (MBIs) on pain. Although many meta-analyses provide support for MBIs, the results are more mixed than they at first appear. The aim of this umbrella review was to determine the strength of evidence for MBIs by synthesizing available meta-analyses in pain. We conducted a systematic search in 5 databases and extracted data from published meta-analyses as the unit of analysis. For each outcome, we reported the range of effect sizes observed across studies and identified the largest meta-analysis as the "representative" study. We separately analysed effect sizes for different pain conditions, different types of MBIs, different control groups, and different outcomes. We identified 21 meta-analyses that included 127 unique studies. According to Assessment of Multiple Systematic Review ratings, the meta-analyses ranged from very strong to weak. Overall, there was an impact of MBIs on pain severity, anxiety, and depression but not pain interference or disability. When conditions were considered in isolation, only fibromyalgia and headache benefited significantly from MBIs. Mindfulness-based interventions were more efficacious for pain severity than passive control conditions but not active control conditions. Only pain severity and anxiety were affected by MBIs at follow-up. Overall, our results suggest that individual meta-analyses of MBIs may have overestimated the efficacy of MBIs in a range of conditions. Mindfulness-based interventions likely have a role in pain management but should not be considered a panacea.

The intersection of drug use discrimination and racial discrimination in the management of chronic non-cancer pain in United States primary care safety-net clinics: Implications for healthcare system and clinic-level changes

BackgroundClinicians’ bias related to patients’ race and substance use history play a role in pain management. However, patients’ or clinicians’ understandings about discriminatory practices and the structural factors that contribute to and exacerbate these practices are underexamined. We report on perceptions of discrimination from the perspectives of patients with chronic non-cancer pain (CNCP) and a history of substance use and their clinicians within the structural landscape of reductions in opioid prescribing in the United States. MethodsWe interviewed 46 clinicians and 94 patients, using semi-structured interview guides, from eight safety-net primary care clinics across the San Francisco Bay Area from 2013 to 2020. We used a modified grounded theory approach to code and analyze transcripts. ResultsClinicians discussed using opioid prescribing guidelines with the goals of increased opioid safety and reduced bias in patient monitoring. While patients acknowledged the validity of clinicians’ concerns about opioid safety, they indicated that clinicians made assumptions about opioid misuse towards Black patients and patients suspected of substance use. Clinicians discussed evidence of discrimination in opioid prescribing at the clinic-wide level; racialized stereotypes about patients likely to misuse opioids; and their own struggles to overcome discriminatory practices regarding CNCP management. ConclusionWhile clinicians and patients acknowledged opioid safety concerns, the practical application of opioid prescribing guidelines impacted how patients perceived and engaged with CNCP care particularly for patients who are Black and/or report a history of substance use. We recommend healthcare system and clinic-level interventions that may remediate discriminatory practices and associated disparities.