Economic long‐term effects of intensive interdisciplinary pain treatment in pediatric patients with severe chronic pain: Analysis of claims data

Chronic pain has high prevalence rates and is one of the top causes of years lived with disability. The aim of the present study was to evaluate the long-term effects of a multimodal day-clinic treatment for chronic pain. The sample included 183 chronic pain patients (114 females and 69 males; 53.3 ± 9.8 years) who participated in a four-week multimodal day-clinic treatment for chronic pain. The patients’ average current pain intensity (NRS), sensory and affective pain (Pain Perception Scale), and depression and anxiety (HADS) were assessed at pre- and posttreatment, as well as at three follow-ups (one month, six months, and twelve months after completion of the treatment). Multilevel models for discontinuous change were performed to evaluate the change of the outcome variables. Improvements from pretreatment to posttreatment and from pretreatment to all follow-ups emerged for pain intensity (NRS; 0.54 ≤ d ≤ 0.74), affective pain (Pain Perception Scale; 0.24 ≤ d ≤ 0.47), depression (HADS; 0.38 ≤ d ≤ 0.53), and anxiety (HADS; 0.26 ≤ d ≤ 0.43) (all p<0.05). Sensory pain as assessed with the Pain Perception Scale did not show any significant change. Patients suffering from chronic pain benefited from the multimodal pain treatment up to twelve months after completion of the treatment.

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Long‐term evaluation of combined prolonged‐release oxycodone and naloxone in patients with moderate‐to‐severe chronic pain: pooled analysis of extension phases of two Phase III trials

Neurogastroenterology & Motility ◽

10.1111/nmo.12463 ◽

2014 ◽

Vol 26 (12) ◽

pp. 1792-1801 ◽

Cited By ~ 17

Author(s):

M. Blagden ◽

J. Hafer ◽

H. Duerr ◽

M. Hopp ◽

B. Bosse

Keyword(s):

Chronic Pain ◽

Pooled Analysis ◽

Phase Iii ◽

Prolonged Release ◽

Two Phase ◽

Phase Iii Trials ◽

Severe Chronic Pain ◽

Term Evaluation

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A two-week inpatient programme with a booster improved long-term management of severe chronic paediatric pain

Journal of Child Health Care ◽

10.1177/1367493517697479 ◽

2017 ◽

Vol 21 (2) ◽

pp. 171-180 ◽

Cited By ~ 4

Author(s):

János Major ◽

Zsófia K Varga ◽

Andrea Gyimesi-Szikszai ◽

Szilvia Ádám

Keyword(s):

Clinical Outcomes ◽

Resource Utilization ◽

Pain Treatment ◽

Longitudinal Design ◽

Cost Effective ◽

Family Intervention ◽

Medical Visits ◽

Interdisciplinary Pain Treatment ◽

Short And Long Term

In the context of limited healthcare resources and increasing demands for more cost-effective healthcare solutions, this study assessed the short- and long-term clinical outcomes and resource utilization of a two-week inpatient, interdisciplinary, pain treatment (IIPT) including individual and group cognitive behavioural, occupational, physical and recreational therapy, education and family intervention and a booster in the chronic paediatric pain setting. Using a longitudinal design with a two-year follow-up, two-week IIPT resulted in sustainable improvements in mean and maximum pain intensity, physical functioning and internalization and reductions in the mean number of medical visits, school absence and frequency of pain medication at year 2 following IIPT. While pain-related disability scores did not improve, problem-focused coping became more prevalent, and patient and parent-assessed satisfaction as well as pain experience continued to improve throughout the study. Our results demonstrate that a two-week IIPT with a booster confers meaningful short- and long-term improvements in clinical outcomes and resource utilization among paediatric patients with severe chronic pain.

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Optogenetics and photopharmacology in pain research and therapeutics

STEMedicine ◽

10.37175/stemedicine.v1i3.43 ◽

2020 ◽

Vol 1 (3) ◽

pp. e43 ◽

Cited By ~ 2

Author(s):

Federico Iseppon ◽

Manuel Arcangeletti

Keyword(s):

Chronic Pain ◽

Pain Treatment ◽

Molecular Switches ◽

Genetic Profiling ◽

Pain Research ◽

Recent Advances ◽

Cellular Components ◽

The Brain

Pain afflicts billions of people worldwide, who suffer especially from long-term chronic pain. This gruelling condition affects the nervous system at all levels: from the brain to the spinal cord, the Dorsal Root Ganglia (DRG) and the peripheral fibres innervating the skin. The nature of the different molecular and cellular components of the somatosensory modalities, as well as the complexity of the peripheral and central circuitry are yet poorly understood. Light-based techniques such as optogenetics, in concert with the recent advances in single-cell genetic profiling, can help to elucidate the role of diverse neuronal sub-populations in the encoding of different sensory and painful stimuli by switching these neurons on and off via optically active proteins, namely opsins. Recently, photopharmacology has emerged from the efforts made to advance optogenetics. The introduction of azo-benzene-based light-sensitive molecular switches has been applied to a wide variety of molecular targets, from ion channels and receptors to transporters, enzymes and many more, some of which are paramount for pain research and therapy. In this Review, we summarise the recent advances in the fields of optogenetics and photopharmacology and we discuss the use of light-based techniques for the study of acute and chronic pain physiology, as well as their potential for future therapeutic use to improve pain treatment.

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Future Directions in Reducing Gastrointestinal Disorders in Children With ASD Using Fecal Microbiota Transplantation

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.630052 ◽

2021 ◽

Vol 11 ◽

Author(s):

Paulina Żebrowska ◽

Izabela Łaczmańska ◽

Łukasz Łaczmański

Keyword(s):

Pediatric Patients ◽

Fecal Microbiota Transplantation ◽

Neurodevelopmental Disorder ◽

Fecal Microbiota ◽

Autism Spectrum ◽

Long Term Effects ◽

Gi Symptoms ◽

Inflammatory Bowel ◽

Age Range

Research on the use of fecal microbiota transplantation (FMT) in the treatment of disorders related to digestive system ailments in children with autism spectrum disorders (ASDs) is a new attempt in a therapeutic approach. There are very little scientific evidences available on this emerging alternative method. However, it appears to be interesting not only because of its primary outcome, relieving the gastrointestinal (GI) symptoms, but also secondary therapeutic effect of alleviating autistic behavioral symptoms. FMT seems to be also promising method in the treatment of another group of pediatric patients, children with inflammatory bowel disease (IBD). The aim of this study is to discuss the potential use of FMT and modified protocols (MTT, microbiota transfer therapy) in the treatment of GI disorders in ASD children supported by reports on another disease, IBD concerning pediatric patients. Due to the few reports of the use of FMT in the treatment of children, these two patients groups were selected, although suffering from distant health conditions: neurodevelopmental disorder and gastrointestinal tract diseases, because of the the fact that they seem related in aspects of the presence of GI symptoms, disturbed intestinal microbiota, unexplained etiology of the condition and age range of patients. Although the outcomes for all are promising, this type of therapy is still an under-researched topic, studies in the group of pediatric patients are sparse, also there is a high risk of transmission of infectious and noninfectious elements during the procedure and no long-term effects on global health are known. For those reasons all obtained results should be taken with a great caution. However, in the context of future therapeutic directions for GI observed in neurodevelopmental disorders and neurodegenerative diseases, the topic seems worthy of attention.

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Long-term effects of pain in infants

Oxford Textbook of Pediatric Pain ◽

10.1093/med/9780198818762.003.0004 ◽

2021 ◽

pp. 38-46

Author(s):

Ruth E. Grunau ◽

Jillian Vinall Miller ◽

Cecil M. Y. Chau

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Pain Treatment ◽

Inflammatory Responses ◽

Imaging Techniques ◽

Preterm Neonates ◽

Long Term Effects ◽

Very Preterm Infants ◽

Very Preterm

The long-term effects of infant pain are complex, and vary depending on how early in life the exposure occurs, due to differences in developmental maturity of specific systems underway. Changes to later pain sensitivity reflect multiple factors such as age at pain stimulation, extent of tissue damage, type of noxious insult, intensity, and duration. In both full-term and preterm infants exposed to hospitalization, sequelae of early pain are confounded by parental separation and quality of pain treatment. Neonates born very preterm are outside the protective uterine environment, with repeated exposure to pain occurring during fetal life. Especially for infants born in the late second trimester, the cascade of autonomic, hormonal, and inflammatory responses to procedures may induce excitotoxicity with widespread effects on the brain. Quantitative advanced imaging techniques have revealed that neonatal pain in very preterm infants is associated with altered brain development during the neonatal period and beyond. Recent studies now provide evidence of pathways reflecting mechanisms that may underlie the emerging association between cumulative procedural pain exposure and neurodevelopment and behavior in children born very preterm. Owing to immaturity of the central nervous system, repetitive pain in very preterm neonates contributes to alterations in multiple aspects of development. Importantly, there is strong evidence that parental caregiving to reduce pain and stress in preterm infants in the Neonatal Intensive Care Unit (NICU) may prevent adverse effects, and sensitive parenting after NICU discharge may help ameliorate potential long-term effects.

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