Pain medicine : the official journal of the American Academy of Pain Medicine
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Multicenter Study
Impact of an Electronic Pain and Opioid Risk Assessment Program: Are There Improvements in Patient Encounters and Clinic Notes?
A comprehensive electronic self-report assessment, called PainCAS(®) (Clinical Assessment System), was developed and implemented in three clinics. PainCAS captures demographic information, pain assessment, quality-of-life variables, and contains validated, electronic versions of screeners for risk of aberrant opioid-related behaviors (the SOAPP and COMM). This investigation sought to determine the impact of PainCAS on documentation of pain and opioid risk evaluations. Exploratory hypotheses examined changes in the content of the patient-provider interaction and any impact on outcome. ⋯ Results indicate that use of the PainCAS electronic pain assessment improves documentation of chart elements in clinic notes and is associated with increased discussion of key, pain-relevant topics during the clinical visit.
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A recent US federal review and clinical guideline on opioids for chronic pain asserted that the literature contributes no evidence on efficacy because all trials had "inadequate duration." To explore the evidence, we examined durations of studies on opioid, nonopioid drug, and behavioral therapies for chronic pain. ⋯ No common nonopioid treatment for chronic pain has been studied in aggregate over longer intervals of active treatment than opioids. To dismiss trials as "inadequate" if their observation period is a year or less is inconsistent with current regulatory standards. The literature on major drug and nondrug treatments for chronic pain reveals similarly shaped distributions across modalities. Considering only duration of active treatment in efficacy or effectiveness trials, published evidence is no stronger for any major drug category or behavioral therapy than for opioids.
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Randomized Controlled Trial
Combined Intrathecal Morphine and Dexmedetomidine for Postoperative Analgesia in Patients Undergoing Major Abdominal Cancer Surgery.
To compare the analgesic effect of combined intrathecal morphine and dexmedetomidine with either drug alone for postoperative analgesia in patients undergoing major abdominal cancer surgery. ⋯ Our results do not support improved analgesia with the combination of intrathecal morphine and dexmedetomidine, despite the absence of significant adverse effects.
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OBJECTIVE : Pain catastrophizing is an important predictor of functioning and disability among individuals with chronic pain, and modification of catastrophic interpretations of pain is a proposed treatment mechanism of pain rehabilitation. The purpose of the current study is to examine the relationship between changes in catastrophic thinking and treatment outcomes for a large sample of patients with chronic pain. METHODS : 648 adult patients with chronic pain completed a 3-week intensive outpatient comprehensive pain rehabilitation program. ⋯ RESULTS : Consistent with prior research, pain catastrophizing was associated with several negative pain-related outcomes. Results of a within-subjects mediational analysis indicated that pain catastrophizing not only improved during the treatment program, but also accounted for a significant portion of the variance in the reduction of pain severity, pain interference, and depression at the end of treatment. CONCLUSIONS : This study adds further support to the position that pain catastrophizing has a detrimental role in adaptation to chronic pain, and that this construct can be successfully modified in treatment to improve patient outcomes.
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Ultrasound-guided cervical nerve root block (US-CRB) is considered a safe and effective method for the treatment of radicular pain. However, previous studies on the spreading pattern of injected solution in US-CRB have reported conflicting results. The aim of this study was to investigate the spreading pattern in relation to injection volume. ⋯ The spreading pattern of injected solution in US-CRB could be partially affected by the injectant volume. However, further studies are needed to assess the importance of other factors, such as needle position and physiological effects.