The journal of pain : official journal of the American Pain Society
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Randomized Controlled Trial
Does Pain Affect Preference? The Effect of Tonic Laboratory Pain on Discounting of Delayed Rewards.
Chronic pain patients show elevated risk behavior on decision-making tasks, as well as increased health risk behaviors (eg, smoking, prescription opioid abuse). Determining pain's effect on underlying cognitive processes that are associated with risk behavior is confounded by comorbidities linked with chronic pain, including depression, anxiety, and substance abuse. ⋯ Whereas the pain condition had no effect on delay discounting, participants' pain intensity, unpleasantness, and pain-induced negative valence were associated with less discounting of delayed rewards. However, the effects were very small.
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Review Meta Analysis Comparative Study
A Comparison of the Assay Sensitivity of Average and Worst Pain Intensity in Pharmacologic Trials: An ACTTION Systematic Review and Meta-Analysis.
Identifying methods to improve assay sensitivity in randomized clinical trials (RCTs) may facilitate the discovery of efficacious pain treatments. RCTs evaluating pain treatments typically use average pain intensity (API) or worst pain intensity (WPI) as the primary efficacy outcome. However, little evidence is available comparing the assay sensitivity of these 2 measures. ⋯ Twenty-seven active versus placebo comparisons were identified in 23 eligible articles. Using a random-effects meta-analysis, API SES and WPI SES did not differ significantly (difference = -.021, 95% confidence interval = -.047 to .004, P = .12). The findings indicate that, depending on the objectives of the study, either API or WPI could be used as a primary outcome measure in clinical trials for the chronic pain conditions included in this analysis.
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Randomized Controlled Trial
"I Was a Little Surprised": Qualitative Insights From Patients Enrolled in a 12-Month Trial Comparing Opioids With Nonopioid Medications for Chronic Musculoskeletal Pain.
Chronic musculoskeletal pain is a major public health problem. Although opioid prescribing for chronic pain has increased dramatically since the 1990s, this practice has come under scrutiny because of increases in opioid-related harms and lack of evidence for long-term effectiveness. The Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial was a pragmatic 12-month randomized trial comparing the benefits and harms of opioid versus nonopioid medications for chronic musculoskeletal pain. The current qualitative study was designed to better understand trial results by exploring patients' experiences, including perceptions of medications, experiences with the intervention, and whether expectations were met. Thirty-four participants who were purposefully sampled based on treatment group and intervention response participated in semistructured interviews. The constant comparison method guided analysis. Results revealed that participants often held strong beliefs about opioid medications, which sometimes changed during the trial as they gained experience with medications; participants described a wide variety of experiences with treatment effectiveness, regardless of study group or their response to the intervention; and participants highly valued the personalized pain care model used in SPACE. ⋯ SPACE trial results indicated no advantage for opioid over nonopioid medications. Qualitative findings suggest that, for both treatment groups, preexisting expectations and anticipated improvement in pain shaped experiences with and responses to medications. The personalized pain care model was described as contributing to positive outcomes in both groups.
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Diverse behavioral cues have been proposed to be useful cues in infant pain assessment, but there is a paucity of evidence on the basis of formal psychometric evaluation to establish their validity for this purpose. We aimed to examine 2 widely used coding systems, the Neonatal Facial Coding System (NFCS) and the Modified Behavior Pain Scale (MBPS), by examining their factor structures with confirmatory factor analysis using a large archival data set. The results indicated that an item-reduced NFCS scale with 3 items produced a 1-factor pain model that maintained the good psychometric properties of the 7-item scale. ⋯ Redefinition of the MBPS with cry as a sole indicator was suggested. This analysis provides 2 new iterations of the NFCS and MBPS that improve construct validity and internal consistency. These shorter versions also improve the feasibility of both measures and increase their potential for clinical use because less time is required for their administration.
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The population prevalence of pediatric chronic pain is not well characterized, in part because of a lack of nationally representative data. Previous research suggests that pediatric chronic pain prolongs inpatient stay and increases costs, but the population-level association between pediatric chronic pain and health care utilization is unclear. We use the 2016 National Survey of Children's Health to describe the prevalence of pediatric chronic pain, and compare health care utilization among children ages 0 to 17 years according to the presence of chronic pain. ⋯ In multivariable analysis, chronic pain was not associated with increased odds of primary care or mental health care use, but was associated with greater odds of using other specialty care (odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.62-2.47; P < .001), complementary and alternative medicine (OR = 2.32, 95% CI = 1.79-3.03; P < .001), and emergency care (OR = 1.62, 95% CI = 1.29-2.02; P < .001). In this population-based survey, children with chronic pain were more likely to use specialty care but not mental health care. The higher likelihood of emergency care use in this group raises the question of whether better management of pediatric chronic pain could reduce emergency department use.