Dumfries House Chronic Pain Group

Abstract Introduction In individuals with chronic pain, sleep disturbances have been suggested to increase suffering, perception of pain, and to negatively affect long-term prognosis. This systematic review and meta-analysis aims to determine the pooled prevalence of sleep disturbances in chronic non-cancer pain patients with no other sleep disorders, using the patient-rated questionnaires Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Methods Multiple databases were searched for studies reporting the prevalence of sleep disturbances in chronic pain patients. Chronic pain was defined as pain >3 months. Comorbid sleep disorders such as sleep disordered breathing and restless leg syndrome were excluded. Sleep disturbances were defined using the PSQI cutoff of > 5 (poor sleep quality) and ISI ≥ 8 (subthreshold to clinical insomnia). The meta-analysis was conducted to examine the pooled prevalence of PSQI and ISI data using the inverse-variance random-effects model and to examine mean differences in PSQI scores. Results The systematic search resulted in 25,486 articles and 20 were included for analysis. In 12 studies using PSQI, the pooled prevalence of sleep disturbance was 75.3% among 3,597 chronic pain patients (mean age 53 ± 12 years; 74% female). In eight studies using ISI, the pooled prevalence was 72.9% among 2,578 chronic pain patients (mean age 63 ± 12 years; 57% female). The meta-analysis showed a significant mean difference of 2.75 (p < 0.001) in the global PSQI score between the chronic pain group versus the non-chronic pain group. The meta-analysis also showed a significant mean difference in the scores of four of seven PSQI components: sleep latency, sleep efficiency, sleep duration, and sleep disturbances (p < 0.05). Conclusion In chronic pain patients, the pooled prevalence of sleep disturbances as measured by PSQI (75.3%) and ISI (72.9%) studies was much higher than those reported for the general population. The relatively high prevalence of sleep disturbances in chronic pain patients emphasizes the importance of further characterizing the relationship between sleep and chronic pain. Support (if any):

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An observational study of pain self-management strategies and outcomes: does type of pain, age, or gender, matter?

Scandinavian Journal of Pain ◽

10.1515/sjpain-2018-0070 ◽

2018 ◽

Vol 18 (4) ◽

pp. 645-656 ◽

Cited By ~ 3

Author(s):

Marion K. Slack ◽

Ramon Chavez ◽

Daniel Trinh ◽

Daniel Vergel de Dios ◽

Jeannie Lee

Keyword(s):

Chronic Pain ◽

Acute Pain ◽

Management Strategies ◽

Demographic Characteristics ◽

Self Management ◽

Treatment Level ◽

Pain Group ◽

Age And Gender ◽

Pain Characteristics ◽

And Gender

AbstractBackground and aimsAcute pain is differentiated from chronic pain by its sudden onset and short duration; in contrast, chronic pain is characterized by a duration of at least several months, typically considered longer than normal healing time. Despite differences in definition, there is little information on how types of self-management strategies or outcomes differ when pain is chronic rather than acute. Additionally, age and gender are thought to be related to types of strategies used and outcomes. However, strategies used and outcomes can be influenced by level of education, socioeconomic status, occupation, and access to the health care system, which can confound associations to type of pain, age or gender. The purpose of this study was to examine the association of strategies used for pain self-management and outcomes with type of pain, acute or chronic, age, or gender in a socioeconomically homogenous population, pharmacists.MethodsPharmacists with acute or chronic pain and a valid email completed an on-line questionnaire on demographic characteristics, pain characteristics, pharmacological and non-pharmacological strategies for managing pain, and outcomes (e.g. pain intensity). Univariate analysis was conducted by stratifying on type of pain (acute or chronic), then stratifying on gender (men vs. women) and age (younger vs. older). Thea priorialpha level was 0.05.ResultsA total of 366 pharmacists completed the questionnaire, 212 with acute pain (average age=44±12.1; 36% men) and 154 with chronic pain (average age=53±14.0; 48% men). The chronic pain group reported substantially higher levels of pain before treatment, level of post-treatment pain, level of pain at which sleep was possible, and goal pain levels (effect sizes [ES’s]=0.37–0.61). The chronic pain group were substantially more likely to use prescription non-steroidal anti-inflammatory medications (NSAIDS), opioids, and non-prescription pain relievers (ES’s=0.29–0.80), and non-medical strategies (ES’s=0.56–0.77). Participants with chronic pain also were less confident (ES=0.54) and less satisfied (ES=0.52). In contrast, there were no differences within either the acute or chronic pain groups related to gender and outcomes. In the acute pain group, there also were no gender differences related to management strategies. However, younger age in the acute pain group was associated with use of herbal remedies and use of rest. Within the chronic pain group, men were more likely to use NSAIDS and women more likely to use hot/cold packs or massage while older participants were more likely to use massage. Variability in post-treatment level of pain and percent relief was high in all groups (coefficient of variation=25%–100%).ConclusionsThe differences between acute and chronic pain were substantial and included differences in demographic characteristics, pain characteristics, management strategies used, and outcomes. In contrast, few associations between age and gender with either management strategies or outcomes were identified, although the variability was high.ImplicationsWhen managing or researching pain management, acute pain should be differentiated from chronic pain. Because of the substantial variability within the gender and age groups, an individual approach to pain management irrespective of age and gender may be most useful.

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Chronic Pain Has Little Effect on Physical Condition During the COVID-19 Pandemic in Japan: A Web-based Cross-Sectional Survey

10.21203/rs.3.rs-138931/v1 ◽

2021 ◽

Author(s):

Tomoko Tetsunaga ◽

Tomonori Tetsunaga ◽

Haruo Misawa ◽

Hironori Tsuji ◽

Toshifumi Ozaki ◽

...

Keyword(s):

Chronic Pain ◽

Interpersonal Relationships ◽

Physical Condition ◽

Multiple Logistic Regression Analysis ◽

Control Group ◽

Work Study ◽

Cross Sectional Survey ◽

Pain Group ◽

Cross Sectional ◽

Anxiety Depression

Abstract Background Chronic pain affects people negatively, both mentally and physically. It is unclear how chronic pain affects people during social isolation and remote work due to the COVID-19 pandemic. The aim of this study was to analyze the effect of chronic pain on life during the COVID-19 pandemic.Methods This retrospective study included 4,972 matched-participants with or without chronic pain (2,311 males, 2,661 females; mean age, 53.8 years). The participants were divided into a chronic pain group (n=2,486) and a control group (n=2,486). Participants with chronic pain for three months or more were classified into the chronic pain group. All participants completed self-reported questionnaires. Factors related to physical condition during the COVID-19 pandemic were identified by univariate and multivariate analyses.Results Significant differences were found between participants with and without chronic pain for the pain that developed during the COVID-19 pandemic, lifestyle, interpersonal relationships, psychological factors related to COVID-19, and deterioration of physical condition. Multiple logistic regression analysis identified insomnia, poor work/study/housework performance, and anxiety/depression as factors related to deterioration of physical condition. Chronic pain was not identified as factor related to deterioration of physical condition.Conclusions The effect of chronic pain on lifestyle and physical condition during the COVID-19 pandemic was limited. The factors related to deterioration of the physical condition were insomnia, poor work/study/housework performance, and anxiety/depression.

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Endoscopic Stenting and Sphincterotomy of the Minor Papilla in Symptomatic Pancreas Divisum: Results and Complications

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.1.131 ◽

1995 ◽

Vol 1 (3) ◽

pp. 131-139 ◽

Cited By ~ 6

Author(s):

Seth A. Cohen ◽

Frederick D. Rutkovsky ◽

Jerome H. Siegel ◽

Franklin E. Kasmin

Keyword(s):

Chronic Pain ◽

Clinical Response ◽

Pancreas Divisum ◽

Controlled Study ◽

Endoscopic Stenting ◽

Pain Group ◽

Minor Papilla ◽

Pancreatic Duct Stent ◽

Pancréas Divisum

Pancreas divisum has been postulated as a cause of acute pancreatitis and a chronic pain syndrome in a small subgroup of patients and can be treated with endoscopic dorsal pancreatic duct stent placement and minor papilla sphincterotomy. Twenty patients (9 with at least one attack of idiopathic pancreatitis, and 11 with severe pancreatic-type pain) were treated endoscopically. Dorsal duct stents were placed in 19 patients with subsequent needle knife sphincterotomy of the minor papilla over the stent. Clinical response was judged by comparison of symptoms (using a 0-to-l0 scale and the patient's overall assessment). The symptom score improved from 9.3 to 5.1 in the pancreatitis group and from 9.3 to 5.7 in the pain group. A good clinical response was observed in 3 of 7 patients in the pancreatitis group and in 6 of 11 in the pain group at a mean follow-up of 22 months. Complications of sphincterotomy were limited to pancreatitis in 6 patients (29%), 5 mild and 1 moderate according to published criteria. No patient required more than 4 days hospitalization. Two of 39 stents migrated into the pancreas, and another stent fractured and remained lodged in the pancreas. Eight of 9 patients evaluated demonstrated new morphologic duct changes on follow-up pancreatograms. Endoscopic stenting and sphincterotomy of the minor papilla are feasible and may be effective in some patients with pancreas divisum but carries a significant complication rate. The subjective improvement in patients with chronic pain warrants further controlled study.

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Characteristics of Evoked Potential Multiple EEG Recordings in Patients with Chronic Pain by Means of Parallel Factor Analysis

Computational and Mathematical Methods in Medicine ◽

10.1155/2012/279560 ◽

2012 ◽

Vol 2012 ◽

pp. 1-10 ◽

Cited By ~ 6

Author(s):

Juan Wang ◽

Xiaoli Li ◽

Chengbiao Lu ◽

Logan J. Voss ◽

John P. M. Barnard ◽

...

Keyword(s):

Chronic Pain ◽

Factor Analysis ◽

Parallel Factor Analysis ◽

Cortical Activation ◽

Pain Group ◽

Chronic Pain Patients ◽

Parallel Factor ◽

Somatosensory Stimuli ◽

Eeg Recordings ◽

Pain Patients

This paper presents an alternative method, called as parallel factor analysis (PARAFAC) with a continuous wavelet transform, to analyze of brain activity in patients with chronic pain in the time-frequency-channel domain and quantifies differences between chronic pain patients and controls in these domains. The event related multiple EEG recordings of the chronic pain patients and non-pain controls with somatosensory stimuli (pain, random pain, touch, random touch) are analyzed. Multiple linear regression (MLR) is applied to describe the effects of aging on the frequency response differences between patients and controls. The results show that the somatosensory cortical responses occurred around 250 ms in both groups. In the frequency domain, the neural response frequency in the pain group (around 4 Hz) was less than that in the control group (around 5.5 Hz) under the somatosensory stimuli. In the channel domain, cortical activation was predominant in the frontal region for the chronic pain group and in the central region for controls. The indices of active ratios were statistical significant between the two groups in the frontal and central regions. These findings demonstrate that the PARAFAC is an interesting method to understanding the pathophysiological characteristics of chronic pain.

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Levels of physical activity in people with chronic pain

South African Journal of Physiotherapy ◽

10.4102/sajp.v73i1.323 ◽

2017 ◽

Vol 73 (1) ◽

Cited By ~ 6

Author(s):

Romy Parker ◽

Emma Bergman ◽

Anelisiwe Mntambo ◽

Shannon Stubbs ◽

Matthew Wills

Keyword(s):

Physical Activity ◽

Chronic Pain ◽

Pain Management ◽

Brief Pain Inventory ◽

Cross Sectional Study ◽

Control Group ◽

Chronic Pain Management ◽

Pain Group ◽

Cross Sectional ◽

Management Intervention

Background: People who suffer from chronic pain are thought to have lower levels of physical activity compared to healthy individuals. However, there is a lack of evidence concerning levels of physical activity in South Africans with chronic pain. Objectives: To compare levels of physical activity in a South African sample of people with chronic pain compared to matched controls. Methods: A cross-sectional study was conducted with 24 participants (12 with chronic pain and 12 in the control group matched for age, gender and residential area). Convenience sampling was used. The participants with chronic pain (12) were identified from the Groote Schuur Hospital, Chronic Pain Management Clinic (CPMC) waiting list and had not yet received any chronic pain management intervention. Healthy matched controls were selected from volunteers in the community. With the desired alpha level set at 0.05 and the power at 0.9, 45 participants were required to detect a minimum of a 50 per cent difference between groups in levels of physical activity as measured in steps per day using pedometers. The international physical activity questionnaire (IPAQ) and the brief pain inventory (BPI) were used as measures of physical activity and pain. Objective indicators of physical activity that were used included the 6-minute walk test (6MWT), repeated sit-to-stand test (RSST), 7 days of pedometry and body mass index (BMI). Results: The chronic pain group performed significantly worse on the 6MWT (335 m [30–430] vs 680 m [430–795]; U = 0.5; p < 0.01) and on the RSST (17.9 s [11.83–105] vs 7.85 s [5.5–11.5]; U = 0; p < 0.01). The chronic pain group also had significantly lower scores on pedometry (mean daily: 2985.1 [32.8–13785.4] vs 6409.4 [4207.1–15313.6]; U = 35; p < 0.03). The BMI for the chronic pain group was significantly higher than matched controls (29.36 kg/m2 [18.94–34.63] vs 22.16 kg/m2 [17.1–30.86]; U = 34; p < 0.03). Conclusion: Participants with chronic pain had a reduced capacity for physical activity. The pedometry results illustrate a range of maladaptive strategies adopted by those with chronic pain. The majority of people with chronic pain appear to avoid physical activity leading to greater disability as a result of immobility and muscle atrophy. However, a small subgroup appears to ignore their pain and push themselves physically despite their pain. This perseverance behaviour leads to further pain as a consequence of muscle and joint overuse. Both maladaptive behavioural responses result in further sensitisation of the central nervous system. The method used to target physical activity in these patients should be considered in treatment planning, specifically for physiotherapy.

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Replication of a cognitive behavioral therapy for chronic pain group protocol by therapists in training

Postgraduate Medicine ◽

10.1080/00325481.2015.1000230 ◽

2015 ◽

Vol 127 (2) ◽

pp. 242-250 ◽

Cited By ~ 1

Author(s):

David Cosio

Keyword(s):

Chronic Pain ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Pain Group

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Idiographic measurement of depressive thinking: development and preliminary validation of the Sentence Completion Test for Chronic Pain (SCP)

Scandinavian Journal of Pain ◽

10.1515/sjpain-2018-0059 ◽

2018 ◽

Vol 18 (3) ◽

pp. 491-503

Author(s):

Adina C. Rusu ◽

Dirk Hallner

Keyword(s):

Chronic Pain ◽

Construct Validity ◽

Internal Consistency ◽

Content Validity ◽

Sentence Completion ◽

Pain Group ◽

Completion Test ◽

Healthy Control ◽

Coding Manual ◽

Pain Patients

Abstract Background and aims Depression is a common feature of chronic pain, but there is only limited research into the content and frequency of depressed cognitions in pain patients. This study describes the development of the Sentence Completion Test for Chronic Pain (SCP), an idiographic measure for assessing depressive thinking in chronic pain patients. The sentence completion task requires participants to finish incomplete sentences using their own words to a set of predefined stems that include negative, positive and neutral valenced self-referenced words. In addition, the stems include past, future and world stems, which reflect the theoretical negative triad typical to depression. Complete responses are coded by valence (negative, positive and neutral), pain and health-related content. Methods A total of 89 participants were included in this study. Forty seven adult out-patients formed the depressed pain group and were compared to a non-clinical control sample of 42 healthy control participants. This study comprised several phases: (1) theory-driven generation of coding rules; (2) the development of a coding manual by a panel of experts (3) comparing reliability of coding by expert raters without the use of the coding manual and with the use of the coding manual; (4) preliminary analyses of the construct validity of the SCP. The internal consistency of the SCP was tested using the Kuder-Richardson coefficient (KR-20). Inter-rater agreement was assessed by intra-class correlations (ICC). The content and construct validity of the SCP was investigated by correlation coefficients between SCP negative completions, the Hospital Anxiety and Depression Scale (HADS) depression scores and the number of symptoms on the Structured Clinical Interview for DSM-IV-TR (SCID). Results As predicted for content validity, the number of SCP negative statements was significantly greater in the depressed pain group and this group also produced significantly fewer positive statements, compared to the healthy control group. The number of negative pain completions and negative health completions was significantly greater in the depressed pain group. As expected, in the depressed pain group, the correlation between SCP negatives and the HADS Depression score was r=0.60 and the correlation between SCP negatives and the number of symptoms on the SCID was r=0.56. Conclusions The SCP demonstrated good content validity, internal consistency and inter-rater reliability. Implications Uses for this measure, such as complementing questionnaire measures by an idiographic assessment of depressive thinking and generating hypotheses about key problems within a cognitive-behavioural case-formulation, are suggested.

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Preoperative Acute Pain Is Associated with Postoperative Delirium

Pain Medicine ◽

10.1093/pm/pnaa314 ◽

2020 ◽

Author(s):

Xian Ding ◽

Xiang Gao ◽

Qizhong Chen ◽

Xuliang Jiang ◽

Yi Li ◽

...

Keyword(s):

Chronic Pain ◽

Acute Pain ◽

Plasma Levels ◽

Postoperative Delirium ◽

Enzyme Linked Immunosorbent Assay ◽

Preoperative Pain ◽

Pain Group ◽

Group 13 ◽

Reactive Protein ◽

Group 5

Abstract Background Studies have provided some evidence that pain is a risk factor for postoperative delirium (POD). Therefore, we investigated the relationship between preoperative pain and POD after noncardiac surgery. Methods POD was assessed with the Montreal Cognitive Assessment, and preoperative cognition was assessed with the Mini-Mental State Examination. Plasma C-reactive protein (CRP) was detected by enzyme-linked immunosorbent assay before surgery. Preoperative pain was classified by its duration before surgery as chronic pain (lasting more than 1 month), acute pain (lasting less than 1 month), or no pain (no obvious pain). Multiple linear regression was used to adjust for confounding. Results From October 15, 2018, through August 12, 2019, a total of 67 patients were randomized; 7 were excluded because they were discharged before the seventh postoperative day. The prevalence of POD was significantly higher in the acute pain group (13 of 20; 65%) than in the chronic pain group (5 of 20; 25%) or the no pain group (6 of 20; 30%) (P = 0.019), indicating that delirium is associated with preoperative acute pain. The plasma level of preoperative CRP was also higher in the acute pain group than in the other two groups (mean [interquartile range]: 10.7 [3.3, 29.3] vs 1 [0.5, 3.8]mg/l; P < 0.001), suggesting that elevated preoperative plasma levels of CRP were associated with delirium. Conclusions Preoperative acute pain was associated with POD, and increased plasma levels of CRP provide a marker. In addition, we found that illiteracy and advanced age were risk factors for POD.

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Altered relationship between anandamide and glutamate in circulation after 30 min of arm cycling: A comparison of chronic pain subject with healthy controls

Molecular Pain ◽

10.1177/1744806919898360 ◽

2019 ◽

Vol 15 ◽

pp. 174480691989836 ◽

Cited By ~ 1

Author(s):

Niclas Stensson ◽

Anna Grimby-Ekman

Keyword(s):

Physical Activity ◽

Chronic Pain ◽

Dynamic Load ◽

Endocannabinoid System ◽

Control Group ◽

Healthy Controls ◽

Pain Group ◽

Post Exercise ◽

Arm Cycling ◽

Group Post

The insufficient knowledge of biochemical mechanisms behind the emergence and maintenance of chronic musculoskeletal pain conditions constrains the development of diagnostic and therapeutic tools for clinical use. However, physical activity and exercise may improve pain severity and physical function during chronic pain conditions. Nevertheless, the biochemical consequences of physical activity and exercise in chronic pain need to be elucidated to increase the precision of this therapeutic tool in chronic pain treatment. The endocannabinoid system has been suggested to play an important role in exercise-induced reward and pain inhibition. Moreover, glutamatergic signalling has been suggested as an important factor for sensation and transmission of pain. In addition, a link has been established between the endocannabinoid system and glutamatergic pathways. This study examines the effect of dynamic load arm cycling (30 min) on levels of lipid mediators related to the endocannabinoid system and glutamate in plasma of chronic pain subjects and pain-free controls. Pain assessments and plasma levels of arachidonoylethanolamide (anandamide), 2-aracidonoylglycerol, oleoylethanolamide, palmitoylethanolamide, stearoylethanolamide and glutamate from 21 subjects with chronic neck pain (chronic pain group) and 11 healthy controls were analysed pre and post intervention of dynamic load arm cycling. Pain intensity was significantly different between groups pre and post exercise. Post exercise, anandamide levels were significantly decreased in health controls but not in the chronic pain group. A strong positive correlation existed between anandamide and glutamate in the control group post exercise but not in the chronic pain group. Moreover, the glutamate/anandamide ratio increased significantly in the control group and differed significantly with the chronic pain group post exercise. The altered relationship between anandamide and glutamate after the intervention in the chronic pain group might reflect alterations in the endocannabinoid-glutamate mechanistic links in the chronic pain group compared to the pain-free control group.

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