Lack of Correlation Between Opioid Dose Adjustment and Pain Score Change in a Group of Chronic Pain Patients

Patients with chronic pain managed with opioid medications are at high risk for opioid overuse or misuse. West Virginia University (WVU) established a High-Risk Pain Clinic to use sublingual buprenorphine/naloxone (bup/nal) plus a multimodal approach to help chronic pain patients with history of Substance Use Disorder (SUD) or aberrant drug-related behavior. The objective of this study was to report overall retention rates and indicators of efficacy in pain control from approximately six years of High-Risk Pain Clinic data. A retrospective chart review was conducted for a total of 78 patients who enrolled in the High-Risk Pain Clinic between 2014 and 2020. Data gathered include psychiatric diagnoses, prescribed medications, pain score, buprenorphine/naloxone dosing, time in clinic, and reason for dismissal. A linear mixed effects model was used to assess the pain score from the Defense and Veterans Pain Rating Scale (DVPRS) and daily bup/nal dose across time. The overall retention of the High-Risk Pain Clinic was 41%. The mean pain score demonstrated a significant downward trend across treatment time (p < 0.001), while the opposite trend was seen with buprenorphine dose (p < 0.001). With the benefit of six years of observation, this study supports buprenorphine/naloxone as a safe and efficacious component of comprehensive chronic pain treatment in patients with SUD or high-risk of opioid overuse or misuse.

Download Full-text

Pain, Stress and Anxiety of Chronic Pain Patients Prior to, During and After Political Turmoil in Thailand

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.201827 ◽

2018 ◽

Vol 36 (4) ◽

pp. 291

Author(s):

Sasikaan Nimmaanrat

Keyword(s):

Chronic Pain ◽

Pain Score ◽

Pain Clinic ◽

P Value ◽

Military Dictatorship ◽

Chronic Pain Patients ◽

The Mean ◽

Stress Score ◽

Political Turmoil ◽

Pain Patients

Objective: Thailand was plagued with serious political turmoil for many years. We would like to know whether this turmoil has had an impact on our chronic pain patients in terms of intensity of pain, stress and anxiety, as well as daily living and sleep.Material and Methods: Patients with at least 3 months of pain prior to 31 October 2013 (the date that the demonstrations started) were enrolled in this study. The data were collected from the patients who attended our pain clinic from December 2014 to May 2015. The patients were asked to complete a questionnaire on their severity of pain, stress and anxiety for the 3 different stages: prior to the demonstrations (period 1), during the demonstrations (period 2) and under military dictatorship or after the demonstrations (period 3).Results: There were 120 patients, 49 males (40.8%) and 71 females (59.2%). The mean age was 56.3±15.8 years old (range 18-88). The majority were Buddhist (108 patients, 90.0%) while 11 patients (9.2%) were Muslim and 1 patient (0.8%) was Christian. The mean duration of pain prior to the beginning of the demonstrations was 62.8 months (range 3-324 months). Regarding the pain score, the mean maximum pain score was significantly different between periods 1 (8), 2 (7.7) and 3 (6.8) (p-value<0.001). Regarding the anxiety score, the mean maximum anxiety score was significantly different between periods 1 (3.8), 2 (4.8) and 3 (2.9) (p-value=0.03). Regarding the stress score, the mean maximum stress score was significantly different between periods 1 (3.8), 2 (4.4) and 3 (2.8) (p-value=0.02). Using multiple logistic regression analysis, no factors (gender, age, religious, duration of pain and levels of anxiety and stress) were found to have contributed to the reduction of pain intensity.Conclusion: The demonstrations during the political turmoil did not increase the severity of pain but led to higher levels of stress and anxiety. On the other hand, under the military dictatorship, lower pain scores as well as stress and anxiety levels in chronic pain patients attending our pain clinic have been found.

Download Full-text

Concurrent and lagged associations of prescription opioid use with pain and negative affect in the daily lives of chronic pain patients.

10.31234/osf.io/nypb4 ◽

2019 ◽

Author(s):

Ryan Carpenter ◽

Sean Patrick Lane ◽

Stephen Bruehl ◽

Timothy J Trull

Keyword(s):

Chronic Pain ◽

Negative Affect ◽

Multilevel Models ◽

Negative Reinforcement ◽

Prescription Opioid ◽

Opioid Misuse ◽

Opioid Use ◽

Opioid Dose ◽

Chronic Pain Patients ◽

Pain Patients

Objective: Prescribed opioids for chronic pain management contribute significantly to the opioid crisis. There is a need to understand the real-world benefits that, despite risks, lead chronic pain patients to persist in opioid use. Negative reinforcement models of addiction posit that individuals use substances to reduce aversive states but have seldom been applied to prescribed opioids. Using ecological momentary assessment, we examined reciprocal associations between opioid use and physical pain, for which opioids are prescribed, and negative affect (NA), for which they are not. Method: Chronic low back pain patients on long-term opioid therapy (n = 34) without significant past-year opioid misuse reported multiple times daily via smartphone over 2 weeks (nobservations = 2,285). We hypothesized that pain and NA would be positively associated with subsequent opioid use, and that use would be negatively associated with subsequent pain and NA. Results: Time-lagged multilevel models indicated that participants were more likely to use opioids and in larger doses following elevated pain and NA. There was also an interaction of concurrent pain and NA on opioid dose. In turn, participants reported reduced pain and NA following larger doses. Additionally, individuals at high risk for opioid misuse, compared with low risk, took larger doses following pain, but also experienced smaller subsequent pain and NA reductions. Conclusions: Opioid use was bidirectionally associated with pain and NA. Findings fit negative reinforcement models associated with risk of developing opioid use disorder. Educating patients and providers about negative reinforcement may help reduce opioid use and opioid-associated risks. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Download Full-text

Age-Dependent Opioid Escalation in Chronic Pain Patients

Yearbook of Anesthesiology and Pain Management ◽

10.1016/s1073-5437(08)70477-7 ◽

2006 ◽

Vol 2006 ◽

pp. 233

Author(s):

S.E. Abram

Keyword(s):

Chronic Pain ◽

Chronic Pain Patients ◽

Age Dependent ◽

Pain Patients

Download Full-text

Pain Influences Several Levels of Attention

Zeitschrift für Neuropsychologie ◽

10.1024/1016-264x.16.4.235 ◽

2005 ◽

Vol 16 (4) ◽

pp. 235-242 ◽

Cited By ~ 4

Author(s):

Astrid von Bueren Jarchow ◽

Bogdan P. Radanov ◽

Lutz Jäncke

Keyword(s):

Chronic Pain ◽

Divided Attention ◽

Covert Attention ◽

Attention Task ◽

Attentional Deficits ◽

Control Subjects ◽

Chronic Pain Patients ◽

Divided Attention Task ◽

Pain Stimuli ◽

Pain Patients

Abstract: The aim of the present study was to examine to what extent chronic pain has an impact on various attentional processes. To measure these attention processes a set of experimental standard tests of the “Testbatterie zur Aufmerksamkeitsprüfung” (TAP), a neuropsychological battery testing different levels of attention, were used: alertness, divided attention, covert attention, vigilance, visual search, and Go-NoGo tasks. 24 chronic outpatients and 24 well-matched healthy control subjects were tested. The control subjects were matched for age, gender, and education. The group of chronic pain patients exhibited marked deficiencies in all attentional functions except for the divided attention task. Thus, the data supports the notion that chronic pain negatively influences attention because pain patients` attention is strongly captivated by the internal pain stimuli. Only the more demanding divided attention task has the capability to distract the focus of attention to the pain stimuli. Therefore, the pain patients are capable of performing within normal limits. Based on these findings chronic pain patients' attentional deficits should be appropriately evaluated and considered for insurance and work related matters. The effect of a successful distraction away from the pain in the divided attention task can also open new therapeutic aspects.

Download Full-text