Predicting the outcome of pain management among chronic back pain patients by using motivational stages of chronic pain management

Background: Chronic pain is a major public health problem resulting in physical and emotional pain for individuals and families, loss of productivity, and an annual cost of billions of dollars. The lack of objective measures available to aid in diagnosis and evaluation of therapies for chronic pain continues to be a challenge for the clinician. Objectives: Functional magnetic resonance imaging (fMRI) is an imaging technique that can establish regional areas of interest and examine synchronous neuronal activity in functionally related but anatomically distinct regions of the brain, known as functional connectivity. Study Design: The present investigation examines changes in functional connectivity in 4 common pain syndromes: chronic back pain (CBP), fibromyalgia, diabetic neuropathy, and complex regional pain syndrome (CRPS). Setting: This is a review of the current understanding of functional connectivity. Methods: Utilizing functional imaging, patients with these conditions have been shown to have significant structural and functional differences when compared to healthy controls. Results: Functional connectivity, therefore, has the potential to assist in diagnostic classification of different pain conditions, predict individual responses to specific therapeutic interventions, and serve as a gateway for personalized medicine. Indirect activation of brain activity can be seen by the blood flow to the brain at specific sites, with chronic pain patients having increased brain activity. Limitations: The present investigation is limited in that few studies have examined this relatively new modality. Conclusions: Knowing and observing the brain’s activity as related to pain gives pain patients an opportunity to decrease pain-related brain activity and decrease severe chronic pain. This modality can be used along with interventional pain management techniques in order to provide optimum pain relief. Key words: Functional connectivity, fMRI, chronic pain, chronic back pain, fibromyalgia, diabetic neuropathy, chronic regional pain syndrome

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Educating Physicians in Family Medicine Residencies About Nonpharmacologic Approaches to Pain:

Family Medicine ◽

10.22454/fammed.2020.865003 ◽

2020 ◽

Vol 52 (3) ◽

pp. 189-197

Author(s):

Ann Marie Chiasson ◽

Audrey J. Brooks ◽

Mari Ricker ◽

Patricia Lebensohn ◽

Mei-Kuang Chen ◽

...

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Family Medicine ◽

Self Efficacy ◽

Medical Knowledge ◽

Primary Care Providers ◽

Control Group ◽

Chronic Pain Management ◽

Care Providers ◽

Pain Patients

Background and Objectives: Opioid misuse is at an all-time crisis level, and nationally enhanced resident and clinician education on chronic pain management is in demand. To date, broad-reaching, scalable, integrative pain management educational interventions have not been evaluated for effectiveness on learner knowledge or attitudes toward chronic pain management. Methods: An 11-hour integrative pain management (IPM) online course was evaluated for effect on resident and faculty attitudes toward and knowledge about chronic pain. Participants were recruited from family medicine residencies participating in the integrative medicine in residency program. Twenty-two residencies participated, with 11 receiving the course and 11 serving as a control group. Evaluation included pre/post medical knowledge and validated measures of attitude toward pain patients, self-efficacy for nondrug therapies, burnout, and compassion. Results: Forty-three participants (34.4%) completed the course. The intervention group (n=50), who received the course, improved significantly (P<.05) in medical knowledge, attitude toward pain patients, and self-efficacy to prescribe nondrug therapies while the control group (n=54) showed no improvement. There was no effect on burnout or compassion for either group. The course was positively evaluated, with 83%-94% rating the course content and delivery very high. All participants responded that they would incorporate course information into practice, and almost all thought what they learned in the course would improve patient care (98%). Conclusions: Our findings demonstrate the feasibility of an online IPM course as an effective and scalable intervention for residents and primary care providers in response to the current opioid crisis and need for better management of chronic pain. Future directions include testing scalability in formats that lead to improved completion rates, implementation in nonacademic settings, and evaluation of clinical outcomes such as decreased opioid prescribing.

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The periaqueductal gray and descending pain modulation: why should we study them and what role do they play in chronic pain?

Journal of Neurophysiology ◽

10.1152/jn.00998.2014 ◽

2015 ◽

Vol 114 (4) ◽

pp. 2080-2083 ◽

Cited By ~ 17

Author(s):

Kasey S. Hemington ◽

Marie-Andrée Coulombe

Keyword(s):

Chronic Pain ◽

Back Pain ◽

Functional Connectivity ◽

Recent Literature ◽

Chronic Back Pain ◽

Periaqueductal Gray ◽

Pain Modulation ◽

Pain Research ◽

Descending Pain Modulation ◽

Pain Patients

In this Neuro Forum we discuss the significance of a recent study by Yu et al. ( Neuroimage Clin 6: 100–108, 2014). The authors examined functional connectivity of a key node of the descending pain modulation pathway, the periaqueductal gray (PAG), in chronic back pain patients. Altered PAG connectivity to pain-related regions was found; we place results within the context of recent literature and emphasize the importance of understanding the descending component of pain in pain research.

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The Psychological Inflexibility in Pain Scale (PIPS) – validation, factor structure and comparison to the Chronic Pain Acceptance Questionnaire (CPAQ) and other validated measures in German chronic back pain patients

BMC Musculoskeletal Disorders ◽

10.1186/s12891-015-0641-z ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 10

Author(s):

Antonia Barke ◽

Jenny Riecke ◽

Winfried Rief ◽

Julia A. Glombiewski

Keyword(s):

Chronic Pain ◽

Back Pain ◽

Factor Structure ◽

Chronic Back Pain ◽

Pain Scale ◽

Psychological Inflexibility ◽

Pain Acceptance ◽

Pain Patients

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Loss of nucleus accumbens low-frequency fluctuations is a signature of chronic pain

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1918682117 ◽

2020 ◽

Vol 117 (18) ◽

pp. 10015-10023 ◽

Cited By ~ 3

Author(s):

Meena M. Makary ◽

Pablo Polosecki ◽

Guillermo A. Cecchi ◽

Ivan E. DeAraujo ◽

Daniel S. Barron ◽

...

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Nucleus Accumbens ◽

Chronic Low Back Pain ◽

Chronic Back Pain ◽

Chronic Phase ◽

Anterior Cingulate ◽

Low Back ◽

Pain Patients

Chronic pain is a highly prevalent disease with poorly understood pathophysiology. In particular, the brain mechanisms mediating the transition from acute to chronic pain remain largely unknown. Here, we identify a subcortical signature of back pain. Specifically, subacute back pain patients who are at risk for developing chronic pain exhibit a smaller nucleus accumbens volume, which persists in the chronic phase, compared to healthy controls. The smaller accumbens volume was also observed in a separate cohort of chronic low-back pain patients and was associated with dynamic changes in functional connectivity. At baseline, subacute back pain patients showed altered local nucleus accumbens connectivity between putative shell and core, irrespective of the risk of transition to chronic pain. At follow-up, connectivity changes were observed between nucleus accumbens and rostral anterior cingulate cortex in the patients with persistent pain. Analysis of the power spectral density of nucleus accumbens resting-state activity in the subacute and chronic back pain patients revealed loss of power in the slow-5 frequency band (0.01 to 0.027 Hz) which developed only in the chronic phase of pain. This loss of power was reproducible across two cohorts of chronic low-back pain patients obtained from different sites and accurately classified chronic low-back pain patients in two additional independent datasets. Our results provide evidence that lower nucleus accumbens volume confers risk for developing chronic pain and altered nucleus accumbens activity is a signature of the state of chronic pain.

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Impact of the COVID-19 pandemic on chronic pain management

Srpski medicinski casopis Lekarske komore ◽

10.5937/smclk2-32971 ◽

2021 ◽

Vol 2 (3) ◽

pp. 197-212

Author(s):

Andrew Auyeung ◽

Hank Wang ◽

Iulia Pirvulescu ◽

Nebojša Knežević

Keyword(s):

United States ◽

Chronic Pain ◽

Pain Management ◽

The United States ◽

Chronic Pain Management ◽

Steroid Use ◽

Chronic Pain Patients ◽

Interventional Pain Management ◽

Tools And Techniques ◽

Pain Patients

Introduction: The COVID-19 pandemic has generated considerable turmoil in the interventional pain management (IPM) community. Due to IPM being classified as 'elective', numerous pain practices across the United States were forced to close during the pandemic, leaving chronic pain patients untreated for indefinite periods, and IPM physicians with increased stress and burnout. Results: In response to these detrimental effects, various re-opening tools and techniques have been created to facilitate a cautious resumption of in-person interventional pain practice. Due to their ability to minimize person-to-person contact, telehealth and pharmacotherapy played a more significant role in IPM during the pandemic, but their increased utilization has also led to the exacerbation of substance abuse and the opioid epidemic. The interplay between steroid use and its immunosuppressive effects, in relation to the COVID-19 infection and the COVID-19 vaccine, has also arisen as an issue of concern. Conclusion: As practices begin to safely re-open throughout the United States, the effects felt by chronic pain patients during the pandemic must be emphasized and not ignored. This review emphasizes the struggles pain patients have had to face during the pandemic and the need to update and redefine regulations regarding interventional and chronic pain management.

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Chronic Pain Patients Exhibit Individually Unique Cortical Signatures of Pain

10.1101/2020.09.05.284117 ◽

2020 ◽

Author(s):

Astrid Mayr ◽

Pauline Jahn ◽

Anne Stankewitz ◽

Bettina Deak ◽

Anderson Winkler ◽

...

Keyword(s):

Chronic Pain ◽

Back Pain ◽

Pain Intensity ◽

Chronic Back Pain ◽

Anterior Insula ◽

Individual Level ◽

Intensity Changes ◽

Complex Picture ◽

The Individual ◽

Pain Patients

AbstractWe investigated how the trajectory of pain patients’ ongoing and fluctuating pain is encoded in the brain. In repeated fMRI sessions, 20 chronic back pain patients and 20 chronic migraineurs were asked to continuously rate the intensity of their endogenous pain. Linear mixed effects models were used to disentangle cortical processes related to pain intensity and to pain intensity changes. We found that the intensity of pain in chronic back pain patients is encoded in the anterior insula, the frontal operculum, and the pons; the change of pain of chronic back pain and chronic migraine patients is mainly encoded in the anterior insula. At the individual level, we identified a more complex picture where each patient exhibited their own signature of endogenous pain encoding. The diversity of the individual cortical signatures of chronic pain encoding results adds to the understanding of chronic pain as a complex and multifaceted disease.

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Differences in Swedish and Australian medical student attitudes and beliefs about chronic pain, its management, and the way it is taught

Scandinavian Journal of Pain ◽

10.1515/sjpain-2018-0039 ◽

2018 ◽

Vol 18 (3) ◽

pp. 533-544 ◽

Cited By ~ 1

Author(s):

Linda Rankin ◽

Britt-Marie Stålnacke ◽

Christopher J. Fowler ◽

Gisselle Gallego

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Medical Students ◽

Clinical Guidelines ◽

Management Education ◽

Attitudes And Beliefs ◽

Chronic Pain Management ◽

Chronic Pain Patients ◽

Swedish Medical ◽

Pain Patients

Abstract Background and aims Medical students receive training in the management of chronic pain, but the training is often suboptimal. Considering that the basis for physician’s knowledge is their medical education, it is important to explore the attitudes and beliefs of medical students with respect both to chronic pain management and to their views on current pain education. Therefore, the aim of this study was to compare Swedish and Australian medical student’s attitudes and beliefs about patients with chronic pain, and their perceptions regarding their chronic pain management education. Methods An online survey was conducted with final year Australian and Swedish medical students from two different universities between December 2016 and February 2017. Attitudes and beliefs towards chronic pain patients were measured using the Health Care Providers’ Pain and Impairment Scale (HC-PAIRS). A thematic analysis was conducted on open end questions regarding their views on their education and important skills for chronic pain management. Results A total of 57 Swedish and 26 Australian medical students completed the HC-PAIRS scale. The Swedish medical students showed statistically significantly lower total mean HC-PAIRS scores compared to Australian medical students (46 and 51, respectively). Australian students had statistically significantly higher scores than the Swedish students for two of four factors: functional expectations and need for cure, whereas no significant differences were seen for the factors social expectations or for projected cognition. From the open end questions it was evident that final year medical students are knowledgeable about key chronic pain items described in clinical guidelines. However, both cohorts described their chronic pain training as poor and in need of improvement in several areas such as more focus on the biopsychosocial model, working in multidisciplinary teams, seeing chronic pain patients and pharmacological training. Conclusions Attitudes and beliefs are formed during medical education, and our study exploring attitudes of medical students towards chronic pain and how it is taught have provided valuable information. Our survey provided detailed and cohesive suggestions for education improvement that also are in line with current clinical guidelines. This study indicates that the Swedish final year students have a more positive attitude towards chronic pain patients compared to their Australian counterparts. The majority of students in both cohorts perceived chronic pain management education in need of improvement. Implications This study highlights several areas of interest that warrant further investigation, for example, the impact of a changed medical curriculum in alignment with these clinical guidelines requested by students in this survey, and correspondingly if their attitudes towards chronic pain patients can be improved through education. Further, we conclude that it would be valuable to align the implementation of the HC-PAIRS instrument in order to achieve comparable results between future studies.

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