Adjustment to Chronic Pain in Back Pain Patients Classified According to the Motivational Stages of Chronic Pain Management

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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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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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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Validating PRISM (Pictorial Representation of Illness and Self Measure) as a measure of suffering in chronic non-cancer pain patients during a mindfulness-based chronic pain management course

Journal of Pain ◽

10.1016/j.jpain.2009.01.013 ◽

2009 ◽

Vol 10 (4) ◽

pp. S2

Author(s):

J. Gardner-Nix ◽

C. Kassardjian

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Cancer Pain ◽

Pictorial Representation ◽

Chronic Pain Management ◽

Pain Patients

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The Impact of Pain Invisibility on Patient-Centered Care and Empathetic Attitude in Chronic Pain Management

Pain Research and Management ◽

10.1155/2018/6375713 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Emilie Paul-Savoie ◽

Patricia Bourgault ◽

Stéphane Potvin ◽

Emilie Gosselin ◽

Sylvie Lafrenaye

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Clinical Experience ◽

Patient Centered Care ◽

Chronic Pain Management ◽

Patient Centered ◽

Chronic Pain Patients ◽

Centered Care ◽

The Impact ◽

Pain Patients

Objectives. The use of interdisciplinary patient-centered care (PCC) and empathetic behaviour seems to be a promising avenue to address chronic pain management, but their use in this context seems to be suboptimal. Several patient factors can influence the use of PCC and empathy, but little is known about the impact of pain visibility on these behaviours. The objective of this study was to investigate the influence of visible physical signs on caregiver’s patient-centered and empathetic behaviours in chronic pain context. Methods. A convenience sample of 21 nurses and 21 physicians participated in a descriptive study. PCC and empathy were evaluated from self-assessment and observer’s assessment using a video of real patients with chronic pain. Results. The results show that caregivers have demonstrated an intraindividual variability: PCC and empathetic behaviours of the participants were significantly higher for patients who have visible signs of pain (rheumatoid arthritis and complex regional pain syndrome) than for those who have no visible signs (Ehler–Danlos syndrome and fibromyalgia) (p<0.001). Participants who show a greater difference in their patient-centered behaviour according to pain visibility have less clinical experience. Discussion. The pain visibility in chronic pain patients is an important factor contributing to an increased use of PCC and empathy by nurses and physicians, and clinical experience can influence their behaviours. Thus, pain invisibility can be a barrier to quality of care, and these findings reinforce the relevance to educating caregivers to these unconscious biases on their behaviour toward chronic pain patients.

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Functional Connectivity Alterations: Novel Therapy and Future Implications in Chronic Pain Management

January 2018 - Pain Physician ◽

10.36076/ppj.2018.3.e207 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. E207-E214 ◽

Cited By ~ 7

Author(s):

Dr. Stephen Thorp

Keyword(s):

Chronic Pain ◽

Back Pain ◽

Pain Management ◽

Functional Connectivity ◽

Diabetic Neuropathy ◽

Chronic Back Pain ◽

Brain Activity ◽

Pain Syndrome ◽

Pain Patients ◽

The Brain

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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