Treatment Of Chronic Pain Patients Research Articles

Effects of Combining Music Therapy, Light Therapy, and Chromotherapy in the Treatment of Chronic Pain Patients: A Pilot Study.

It is currently considered that around 30% of chronic pain patients are totally refractory to medical treatment. Among patients who remain responsive to medical treatment, it is estimated that between 20% and 50% are likely to discontinue treatment due to severe side effects. Given these therapeutic difficulties, a significant number of patients turn to complementary therapies. The LineQuartz® is a medical device that combines 3 complementary therapies, namely, music therapy, light therapy, and chromotherapy. We propose to evaluate its effectiveness in chronic pain patients. Between October 2021 and October 2022, 44 patients aged between 23 and 85 years (mean: 55.4 years) were included in a prospective study. All patients had background pain intensity greater than 4/10 on the Numerical Pain Scale (NS). Treatment consisted of 4 half-hour sessions, divided into one session per week for 3 weeks (21 days). Patients were assessed by the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression scale (HAD) the day before starting treatment (Day 0) and the day after the end of treatment (Day 22). Apart from the BPI item, "relationship with others," all items improved significantly (p < 0.050). Background pain intensity (NS) and frequency of painful attacks improved very significantly (p < 0.001). The HAD anxiety subscore was also significantly improved (p < 0.001). Discussion. This open pilot study supports the idea that LineQuartz® has a place among complementary therapies dedicated to the treatment of chronic pain. However, these results need to be confirmed by a controlled study.

Ketamine in Chronic Pain: A Review.

Ketamine has been used in the treatment of several pain syndromes, particularly those with a relevant neuropathic component. Sub-anesthetic doses of ketamine produce a potent analgesic effect, due to its inhibition of N-methyl-D-aspartate receptors and enhancement of descending inhibitory pathways. Its short-term analgesic effect is well-documented perioperatively, with an associated reduction in postoperative chronic pain and opioid consumption. Despite some evidence regarding its long-term benefits, the number of clinical studies is still limited. In addition to its analgesic effects, ketamine also possesses an anti-depressive action, which might be useful in the treatment of chronic pain patients. Several side effects have been described, the psychomimetic ones being the most relevant due to their impact on treatment adhesion. At present, co-administration of ketamine and benzodiazepines or α2-agonists facilitates its clinical application. Despite current evidence and increasing use, further investigation is still needed regarding its long-term safety profile and clearer risk-benefit analysis.

Effect and safety of listening to music or audiobooks as a coadjuvant treatment for chronic pain patients under opioid treatment: a study protocol for an open-label, parallel-group, randomised, controlled, proof-of-concept clinical trial in a tertiary hospital in the Barcelona South Metropolitan area

BackgroundChronic non-cancer pain (CNCP) treatment’s primary goal is to maintain physical and mental functioning while improving quality of life. Opioid use in CNCP patients has increased in recent years, and...

Hirudoteraphy in pain management

This study was conducted in order to evaluate the results of leech application in the treatment of chronic pain patients. The patients were subjected to leech therapy on the day of their visit on the most painful area. In the study, observations were conducted both before and after leech therapy, and Visual Analogue Scale (VAS) scores were recorded to assess pain levels. The VAS scores ranged from 0 to 10, with 0 indicating no pain and 10 representing the highest level of pain possible. Duration of effect and recovery times were also recorded. The results showed that leech application is effective in the treatment of pain complaints. There was a significant decrease in pain complaints with leech therapy in patients and the average pain intensity in a 10 mm VAS before treatment decreased from 5.75 to 1.45 after treatment. A positive effect was observed in the applied treatments in a short period of 2 hours on average, and improvement was observed in 1-2 days.

A self-guided Internet-based intervention for individuals with chronic pain and depressive symptoms: study protocol of a randomized controlled trial

BackgroundDespite the existence of evidence-based therapy options for the treatment of chronic pain and comorbid depressive symptoms (e.g., CBT), many individuals remain untreated. Treatment gaps result from a lack of specialists, patient fear of stigmatization, or patient immobility. Internet-based self-help interventions could serve as an anonymous and flexible alternative treatment option. In a pilot study, chronic pain patients with comorbid depressive symptoms who used a generic Internet-based depression program showed a significant reduction in depressive symptoms (but not pain symptoms) compared to a waitlist control group. Based on these findings, we developed the low-threshold, anonymous, and cost-free Internet-based self-help intervention Lenio that is tailored to the specific needs of chronic pain patients with comorbid depressive symptoms. Lenio is accompanied by the smartphone application (app) COGITO designed to increase therapeutic success. With Lenio and COGITO addressing both chronic pain and depressive symptoms, the trial aims to increase treatment effects of online interventions for chronic pain patients by reducing both depressive symptoms and pain.MethodsThe effectiveness of the Internet-based self-help intervention and accompanying smartphone app will be evaluated in a randomized controlled trial (RCT). A total of 300 participants will be randomized into an intervention group (Lenio/COGITO), an active control group (depression-focused smartphone app), or a waitlist control group. Assessments will be done at baseline, after an 8-week intervention period (post), and after 16 weeks (follow-up). The primary outcome is the post-assessment reduction in “pain impairment” (mean value of impairment in daily life, free time, and work) as assessed by the DSF (German pain questionnaire). Secondary outcomes will include the reduction in depressive symptoms as well as in the severity of pain. DiscussionLenio is one of the first Internet-based interventions to reduce chronic pain and depression that will be empirically evaluated. Internet-based interventions could offer a promising alternative to conventional face-to-face psychotherapy in the treatment of chronic pain patients. The primary objective of the current study is to add essential insight into the feasibility, effectiveness, and acceptance of Internet-based interventions for people with chronic pain and depressive symptoms. Trial registrationDRKS-ID DRKS00026722, Registered on October 6th, 2021.

Tapering of opioid-based pain treatment for chronic pain patients in an outpatient setting

Caring for chronic pain patients under opioid therapy is challenging. Opioid treatments above 50 milligrams morphine equivalents (MME) per day are associated with an increased risk of morbidity and mortality. A tapering or a discontinuation should be discussed. Shared decision-making with individualized goals and motivational interviewing principles should be used. Tapering should be slow, with initial rate based on the duration of opioid use and with regular monitoring of patients. Inability to taper may require further reassessment of opioid dependence. Temporary increases in pain may occur at the start of tapering, but pain may improve or remain unchanged upon completion of tapering.

PO172 / #1038 PRELIMINARY RESULTS OF A NEW SUBTHRESHOLD STIMULATION METHOD WITH FAST PAIN RELIEF: IS IT POSSIBLE TO REDUCE THE TRIAL PHASE?: E-POSTER VIEWING

Spinal cord stimulation is an effective treatment for chronic pain patients with postlaminectomy syndrome and generally requires a 2-4 week trial phase to evaluate the efficacy of the therapy. Regarding these new programming modalities, we aim to assess whether it is possible to decrease this trial phase time.

Interpretable Machine Learning May Help Personalize Topical Analgesics for Pain Patients

Purpose: Topical analgesics have gained acceptance in guidelines for the treatment of pain. The Kailo Pain Patch® is a topically applied analgesic adhesive patch, with a recent study showing reduced pain severity and interference scales in comparison to a control group. However, as with any analgesic modality, treatment response is variable. Advances in technology, such as pharmacogenomic evaluation and machine learning (artificial intelligence) have emerged as tools to assist clinicians with selecting the most suitable treatments for a variety of disease states. There is limited data on the use of these technologies for pain management; only limited studies have applied machine learning to personalize the treatment of chronic pain patients. This report analyzed the PREVENT Study using an existing modified interpretable machine learning method to personalize the selection of the most suitable protocol for use of the Kailo Pain Patch® and other topical analgesics. Patients and methods: Data from the IRB-approved observational PREVENT study were used in the present analysis of 128 (89 females,39 males) chronic pain patients and 20 controls answering the Brief Pain (BPI) questionnaire along with additional questions in the baseline and after 30 days of treatment with the Kailo Pain Patch®. An interpretable machine-learning model was used to build pain outcome prediction models. This method is a multi-objective ensemble classification/regression technique, which combines multi-objective evolutionary algorithms with Support Vector Machines, Random Forests, and feature filtering techniques to optimize the classification model and minimize the utilized feature subset. Three basic endpoints were examined as outputs to the prediction models including Total BPI Severity, Total BPI Interference, and Total medication changes in the follow- up period. Both classification and regression models were constructed for these endpoints and a “leave-one-out” cross-validation strategy was used to evaluate the generalization ability, classification, and regression performance of the deployed models. Results: Experimental results showed that the trained models with the proposed machine learning method were able to predict endpoints with extremely high accuracy, with the AUC exceeding 90% and Spearman correlation metric exceeding 0.4 for all endpoints, overcoming the classification and regression performances of other benchmark models, including the recently introduced XGBoost. The interpretable machine learning method was able to reduce the number of significant features to 15 and was able to identify some of the most important characteristics of responders and non-responders allowing for a personalized approach to creating an individualized pain treatment approach. Applying the trained model in a previous IRB-approved Observational Study (OPERA) dataset (631 chronic pain patients) demonstrated that most of the participants (&gt;70%) who did not benefit from other topical analgesics therapies, as well as more than 50% of responders to OPERA study medications, would have noted improvement from the pain patch studied in PREVENT. Conclusions: Artificial intelligence and machine learning technologies are advancing multiple areas in fields of medicine, including pain management. A model has been developed which continues to be refined; here we show use of that model for predicting response to topical analgesic therapies. We will continue to refine these tools and make them available to front-line clinicians through a user-friendly web interface (https://kailo.insybio.com/) that can be used to support analgesic clinical decision making [15 questions].

Pharmaceuticalization to Opioid Pharmacovigilance: A Qualitative Investigation of the Impact of Opioid-related Policy Changes and the Perspectives of Residents and Chronic Non-cancer Pain Patients

As a result of the pharmaceuticalization of chronic pain over the past three decades, opioid therapy became a common form of treatment for chronic pain patients. However, the overprescribing of opioids led to the opioid overdose epidemic in the United States. In response, the Centers for Disease Control and Prevention implemented guidelines reducing the number of opioid prescriptions—better known as opioid pharmacovigilance. Little is known about the sociocultural challenges during the transition to opioid pharmacovigilance for the resident/patient relationship. Using a thematic analysis, we analyzed 20 semi-structured interviews of residents and chronic non-cancer pain (CNCP) patients in a family medicine residency practice. Findings suggest that due to the pharmaceuticalization of CNCP and the transition to opioid pharmacovigilance, residents develop a wariness to prescribe opioids, which leads to prejudice against patients. Patients report constrained care and a lack of alternative treatments for chronic pain, which inevitably leads to duplicitous behavior.

Acceptance and Commitment Therapy to Increase Resilience in Chronic Pain Patients: A Clinical Guideline.

Chronic pain remains a very difficult condition to manage for healthcare workers and patients. Different options are being considered and a biopsychosocial approach seems to have the most benefit, since chronic pain influences biological, psychological and social factors. A conservative approach with medication is the most common type of treatment in chronic pain patients; however, a lot of side effects are often induced. Therefore, a premium is set on novel nonpharmacological therapy options for chronic pain, such as psychological interventions. Previous research has demonstrated that resilience is a very important aspect in coping with chronic pain. A more recent type of cognitive-behavioural therapy is Acceptance and Commitment Therapy, in which psychological flexibility is intended to be the end result. In this manuscript, current evidence is used to explain why and how a comprehensive and multimodal treatment for patients with chronic pain can be applied in clinical practice. This multimodal treatment consists of a combination of pain neuroscience education and cognitive-behavioural therapy, more specifically Acceptance and Commitment Therapy. The aim is to provide a clinical guideline on how to contribute to greater flexibility and resilience in patients with chronic pain.

Clonidine is better than zopiclone for insomnia treatment in chronic pain patients.

Chronic pain is associated with insomnia. The objective of this clinical study was to compare the efficacy and safety of different prescribed doses of zopiclone and clonidine for the management of insomnia in patients with chronic pain. This prospective observational crossover study included 160 consenting adult patients receiving pain management treatment. For insomnia treatment, each patient ingested different prescribed doses of zopiclone or clonidine on alternate nights. Each patient used a special validated sleep diary to collect data including pain score, sleep scores, sleep duration, sleep medication dose, and adverse effects. Each patient completed the diary for 3 continuous weeks. Pain was measured using a numeric pain rating scale. Sleep score was measured using the Likert Sleep Scale. A change in the pain or sleep scores by 2 points was considered significant. Of the 160 study participants, 150 (93.8%) completed the study successfully, and their data were analyzed with IBM SPSS Statistics 25 (IBM Corporation, Armonk, NY) using Student's t test, analysis of variance, Pearson chi-square test, and regression analysis. A P value < .05 was considered significant. Pain score was lower with clonidine than zopiclone (P = .025). Time to fall asleep was shorter with clonidine than zopiclone (P = .001). Feeling rested on waking in the morning was better with clonidine than zopiclone (P = .015). Overall sleep quality was better with clonidine than zopiclone (P = .015). Total Likert sleep score was better with clonidine than zopiclone (P = .005). Total sleep duration was better with clonidine than zopiclone (P = .013). Adverse effects were commoner with zopiclone, including collapse, fall, confusion, amnesia, mood disorder, hallucination, nightmare, nocturnal restlessness, locomotor dysfunction, nausea and headache. A minor adverse effect of dry mouth was commoner with clonidine. Clonidine is significantly better than zopiclone with respect to sleep quality, analgesia, tolerability profile, and patient safety. Further studies comparing clonidine with other insomnia medications will be beneficial. Bamgbade OA, Tai-Osagbemi J, Bamgbade DO, etal. Clonidine is better than zopiclone for insomnia treatment in chronic pain patients. J Clin Sleep Med. 2022;18(6):1565-1571.

Presentation of an innovative interdisciplinary and cross-sector therapeutic concept for pain patients as part of aregional selective contract

HintergrundEine gestufte Versorgung in der Behandlung chronisch schmerzkranker Patient*innen ist in Deutschland nur in Ansätzen vorhanden. Vor dem Hintergrund der aktuellen Pandemiebedingungen hat sich eine Unter- und Fehlversorgung weiter verschärft.ZielEntwicklung und Aufbau eines sektorenübergreifenden Behandlungskonzepts für schmerzkranke Patient*innen im Rahmen eines Selektivvertrags.MethodenEingebettet in bereits vorhandene Versorgungsstrukturen wurden nach vorbezeichneten Kriterien sieben Versorgungspfade (Clinical Pathways, CP) definiert, in die eingeschriebene Patient*innen nach einem interdisziplinären Assessment geleitet werden.AufbauIm CP I verbleiben die Patient*innen in der Regelversorgung. Im CP II wird zusätzlich eine einmalige interprofessionelle Edukation von 3 h zur Prophylaxe weiterer Chronifizierung angeboten. Im CP III gehen die Patient*innen für sechs Monate in eine fachärztlich spezialisierte ambulante Schmerzbehandlung. Das CP IV ist eine teilstationäre multimodale Therapie, bei der viele Präsenztage durch telemedizinische Inhalte mit Unterstützung einer Reha-App ersetzt werden. CP V und VI sind vollstationäre multimodale Behandlungen über acht und 15 Tage. In CP VII kann bei ambulantem psychotherapeutischen Behandlungsbedarf für Patient*innen nach vollstationärer Behandlung zur Überbrückung des Wartezeitraums über sechs Monate eine niederfrequente Psychotherapie erfolgen.Qualitätssicherung und EvaluationDie wissenschaftliche Begleitung erfolgt mittels ausgewählter Fragebögen und psychometrischer Testverfahren jeweils drei, sechs und zwölf Monate nach erfolgtem Assessment, um die Inhalte des Vertrags zu evaluieren.

Telemedicine for chronic pain treatment during the COVID-19 pandemic: Do pain intensity and anxiousness correlate with patient acceptance?

IntroductionRecent recommendations for the treatment of chronic pain patients during the coronavirus disease 2019 (COVID‐19) pandemic suggest using telemedicine instead of in‐person consultations. Knowing whether patients with chronic pain are receptive to the use of telemedicine during a pandemic might improve tailored care.ObjectiveThe aims of the present study were to assess patients’ acceptance of telemedicine during the COVID‐19 pandemic in Switzerland and to examine the correlation of acceptance with pain intensity and anxiousness.MethodsAn anonymous survey was conducted from March 31, 2020, to July 30, 2020, with 61 patients referred to the Pain Center at the Bern University Hospital Inselspital in Bern, Switzerland. Collected data were analyzed descriptively, and correlations were calculated between acceptance of telemedicine and mean levels of current pain, psychological distress, and fear of COVID‐19.ResultsOur main finding was an average level of acceptance of telemedicine, with a mean of 6.25 on a scale from 0 (not at all) to 10 (completely), with substantial variability and range (SD = 3.56). The acceptance of telemedicine correlated negatively with current mean pain level (r = −0.44), worries (r = −0.42), and fear of COVID‐19 (r = −0.4), as well as positively with the general condition (r = 0.46).ConclusionsUsing telemedicine for chronic pain treatment during the COVID‐19 crisis was accepted to a sufficient degree by a considerable proportion of patients. However, the higher the mean levels of pain and anxiousness, the lower the acceptance, indicating that these severely burdened patients may suffer most from treatment restrictions. For this subgroup, telemedicine might not suffice and in‐person visits should be considered.

Attitude changes toward chronic pain management of pain physicians in Turkey during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to a decrease or interruption of outpatient and elective interventional procedures of patients with chronic pain worldwide. This study aims to investigate the attitude changes of pain physicians in Turkey in the treatment of chronic pain patients and the compliance of these changes with the published guidelines. A total of 113 pain physicians were sent an online questionnaire forms to be completed voluntarily. The questionnaire was completed by 61% (n=69) of the total physicians to whom it was sent to. The rate of physicians who did not request the COVID-19 polymerase chain reaction test from their patients before any interventional procedure was 48% (n=33). The rate of physicians who ignored the immunosuppressive effect and while prescribing opioids and did not reduce the opioid dose was 42% (n=29). The rate of physicians who did not reduce the corticosteroid dose they used in their interventional procedures was 61% (n=42). It was determined that 49.1% (n=28) of physicians who applied facet joint medial branch radiofrequency denervation (RFD) during the pandemic period decreased the number of diagnostic blocks they ap-plied compared to the pre-pandemic period. It was found that 51% (n=24) of the physicians who applied genicular nerve RFD during this period did not perform any diagnostic blocks. It was found that the majority of physicians did not change their preferences in the dose and/or type of opioid and corticosteroid drugs, but they tended to reduce the number of diagnostic blocks they applied before facet joint medial branch/genicular RFD procedures.

Pain Management During the COVID-19 Pandemic.

Chronic pain management during the coronavirus disease 2019 (COVID-19) pandemic is a challenging process, especially with growing evidence that COVID-19 infection is associated with myalgias, referred pain, and widespread hyperalgesia. In light of the limited data available for COVID-19-related impact on chronic pain patients, this review explores the changes in the healthcare delivery system due to social distancing and safety precautions to provide the appropriate management of chronic pain patients during the COVID-19 pandemic. Understanding both the general problems facing chronic pain patients as well as specific problems in the COVID-19 era including deconditioning, increased mental health concerns, financial burdens, and potential for medication-induced immune-suppression is vital in the appropriate management of patients. Telemedicine, the practice of caring for patients remotely when the provider and patient are not physically present with each other, is becoming increasingly used and recognized as a valuable tool to both health care providers and patients. This paper concentrates on the proper utilization of the available resources to help patients with the most severe conditions as well as the most vulnerable group. COVID-19 may be associated with a profound effect on both the health care system and patients with chronic pain. As a result, delaying, or stopping, treatment for chronic pain patients will have negative consequences, and strong pain evaluations must be administered to triage patients appropriately. Recent recommendations for the safe use of non-opioid analgesics, opioid analgesics, and interventional pain management procedures are vital to know and understand specifically during the pandemic era. Further researches are needed to identify the advance planning and rapid responses to reduce the impact of the pandemic.

Is Buprenorphine Effective for Chronic Pain? A Systematic Review and Meta-analysis.

The objective was to perform a systematic review and meta-analysis of the literature on the effects of buprenorphine on chronic pain outcomes (i.e., patient-reported pain intensity) in patients with and without opioid use disorder (OUD). Ovid/Medline, PubMed, Embase, and the Cochrane Library were searched for studies that explored the effectiveness (in reducing pain) of buprenorphine treatment for chronic pain patients with and without a history of OUD. Randomized controlled trials and observational studies were included in the review. Two separate searches were conducted to identify buprenorphine trials that included chronic pain patients either with or without OUD. Five studies used validated pain report measures and included a chronic pain population with OUD. Nine studies used validated report measures and included chronic pain patients without OUD. Meta-analysis was performed using the R, version 3.2.2, Metafor package, version 1.9-7. The meta-analysis revealed that buprenorphine has a beneficial effect on pain intensity overall, with a small mean effect size in patients with comorbid chronic pain and OUD and a moderate- to large-sized effect in chronic pain patients without OUD. Our results indicate that buprenorphine is modestly beneficial in reducing pain intensity in patients without OUD. Although informative, these findings should be carefully interpreted due to the small amount of data available and the variation in study designs.

Psychotherapy in pain management: New viewpoints and treatment targets based on a brain theory.

The current paper provides an explanation of neurophysiological pain processing based the Dimensional Systems Model (DSM), a theory of higher cortical functions in which the cortical column is considered the binary digit for all cortical functions. Within the discussion, novel views on the roles of the basal ganglia, cerebellum, and cingulate cortex are presented. Additionally, an applied Clinical Biopsychological Model (CBM) based on the DSM will be discussed as related to psychological treatment with chronic pain patients. Three specific areas that have not been adequately addressed in the psychological treatment of chronic pain patients will be discussed based on the CBM. The treatment approaches have been effectively used in a clinical setting. Conclusions focus on a call for researchers and clinicians to fully evaluate the value of both the DSM and CBM.

A physical therapist’s role in pain management: A biopsychosocial perspective

AbstractAimPeople suffering with chronic pain have a decreased quality of life in both the physical and psychosocial dimensions. Popular treatment methods for a chronic pain patient are opioid prescriptions and surgery, which may not be beneficial to long‐term outcomes in chronic pain patients, and may actually result in reducing a patient's overall health.PurposeThis review will examine the role of the physical therapist in treating chronic pain patients in regard to the biopsychosocial model. Reviewing chronic pain through a biopsychosocial perspective, screening, evaluation, intervention selection, and problems with programs adherence in regard to chronic pain patients in physical therapy will be discussed. Psychosocial components of chronic pain including fear of movement and depression are also examined in how they can hinder or interfere with physical therapy treatment and evaluation.ConclusionWhen treating chronic pain patients, applying the biopsychosocial perspective to physical therapy with a focus on restoring physical function could provide the least invasive treatment for chronic pain patients with optimal outcomes.

Prevalence of opioid misuse, abuse and dependence among chronic pain patients on opioids followed in chronic pain clinic in a tertiary care hospital Riyadh, Saudi Arabia

Background: Opioids have proven very useful for treatment of acute pain and cancer pain, and in the developed countries, opioids are increasingly used for the treatment of chronic non-malignant pain patients as well. Treatment of chronic pain patients with opioids may have several long-term consequences; especially, addiction that has been a feared complication. Objective: The objective of the study was to estimate the prevalence of opioid misuse, abuse and dependence amongst chronic pain patients on opioids followed in chronic pain clinic. Study Design and Settings: This is a cross-sectional study that carried out in chronic pain clinic in a tertiary care hospital Riyadh, Saudi Arabia (King Faisal Specialist Hospital and Research Centre [KFSH and RC]). All chronic pain patients on opioids, apart from acute pain patients and children, were eligible for the study. The Alcohol, Smoking and Substance Involvement Screening Test (Opioid ASSIST) screening questionnaire in Arabic was used as a screening tool for opioid misuse, abuse and dependence. Results: A total of 219 chronic pain patients participated in the study. There were 80 males (36.5%) and 139 females (63.5%). Prevalence of opioids misuse, abuse and dependence in chronic pain patients attending chronic pain clinic in KFSH and RC is 12.8%, 9.1% and 3.2%, respectively, based on opioids ASSIST questionnaire cut points. Conclusion: Opioid use disorders are common in pain clinics. They should be considered as serious complications of using opioids in managing chronic pain patients. Considering the high risk of opioid misuse, abuse and dependence amongst chronic pain patients, more screening and rehabilitation services are necessary.

Factors Affecting the Population’s Opinions Regarding Cannabis Treatment for Chronic Pain Patients

Factors Affecting the Population’s Opinions Regarding Cannabis Treatment for Chronic Pain Patients