British journal of pain
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British journal of pain · Aug 2018
Opioid prescribing in general practice: use of a two-stage review tool to identify and assess high-dose prescribing.
Long-term opioid analgesic prescribing in chronic non-cancer pain (CNCP) is a growing worldwide concern. This has implications for optimal healthcare management in general and chronic pain management specifically. This work documents the development of a review tool and its use in the South West of England in a locality that showed opioid prescribing levels higher than surrounding localities. ⋯ No published work to date has documented such an in-depth analysis of primary-care opioid analgesic prescribing utilising prescriber data. Assessing total-dose morphine-equivalent prescribing using this method provides valuable insights into the potential need for urgent medication review. The tool developed may be of value to other GP practices following validation.
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British journal of pain · Feb 2018
Better safe than sorry? Frequent attendance in a hospital emergency department: an exploratory study.
Pain accounts for the majority of attendances to the Emergency Department (ED), with insufficient alleviation of symptoms resulting in repeated attendance. People who frequently attend the ED are typically considered to be psychologically and socially vulnerable in addition to experiencing health difficulties. This service development study was commissioned to identify the defining characteristics and unmet needs of frequent attenders (FAs) in a UK acute district general hospital ED, with a view to developing strategies to meet the needs of this group. ⋯ It is recommended that a systemic approach is taken to improve the quality and accessibility of individualised care plans, provision of patient education, psychological care and implementation of policies and procedures. Change on an organisational level is likely to improve working culture, staff satisfaction and staff relationships with this vulnerable group of patients. A structured care pathway and supportive changes are likely to lead to economic benefits. Further research should build on findings to implement and test the efficacy of these interventions.
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British journal of pain · Nov 2017
Does perioperative ketamine have a role in the prevention of chronic postsurgical pain: the ROCKet trial.
Identifying operations and individuals with an increased risk of chronic postsurgical pain (CPSP) has led to significant interest in interventions with the potential to achieve primary prevention of this condition. Pharmacological prevention remains controversial with a Cochrane review identifying perioperative ketamine administration as the only intervention with possible benefit although, with only small, heterogeneous studies, the authors called for a large randomised controlled trial (RCT) to confirm the validity of this result. In response to these data, a group of researchers from Australia and Hong Kong designed the ROCKet trial - Reduction Of Chronic Post-surgical Pain with Ketamine, endorsed by the Australian and New Zealand College of Anaesthetists (ANZCA) Clinical Trials Network (CTN).
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British journal of pain · Nov 2017
The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management.
In an era of considerable advances in anaesthesiology and pain medicine, chronic pain after major surgery continues to be problematic. This article briefly reviews the known psychological risk and protective factors associated with the development of chronic postsurgical pain (CPSP). We begin with a definition of CPSP and then explain what we mean by a risk/protective factor. ⋯ Psychological interventions that target known psychological risk factors while enhancing protective psychological factors may reduce new incidence of CPSP. The primary goal of our ACT intervention is to teach patients a mindful way of responding to their postsurgical pain that empowers them to interrupt the negative cycle of pain, distress, behavioural avoidance and escalating opioid use that can limit functioning and quality of life while paradoxically amplifying pain over time. Early clinical outcome data suggest that patients who receive care from TPS physicians reduce their pain and opioid use, yet patients who also receive our ACT intervention have a larger decrease in daily opioid dose while reporting less pain interference and lower depression scores.
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British journal of pain · Aug 2017
Preliminary investigation of self-as-context in people with fibromyalgia.
Acceptance and commitment therapy (ACT), based on the Psychological Flexibility (PF) model, has been recently applied to fibromyalgia (FM), and appeared effective in improving functioning. However, evidence for some of the processes within the PF model, self-as-context (SAC) in particular, is lacking within this population. The current study validates a measure of SAC, the Self Experiences Questionnaire (SEQ), and preliminarily investigates the role of SAC in relation to functioning in FM. ⋯ Component factors showed good reliability, Cronbach's α = .90, and construct validity, supported by significant Pearson's correlations between SEQ scores, acceptance and outcomes (r = -.14 to -.33). In multiple regression analyses, SEQ scores significantly predicted pain-related interference (β = -.17, p < .05), work and social adjustment (β = -.14, p < .05) and depression (β = -.21, p < .01), but not depression-related interference, after controlling for pain, but only significantly predicted depression after controlling pain acceptance. These preliminary results show potentially important associations between SAC and functioning in people with FM.