Why can multimodal, multidisciplinary pain clinics not help all chronic pain patients?

BACKGROUND: Pain clinics tend to see more complex chronic pain patients than primary care settings, but the types of patients seen may differ among practices.OBJECTIVE: The aim of the present observational study was to describe the pain and demographic characteristics of patients attending a university-affiliated tertiary care pain clinic in Toronto, Ontario.METHODS: Data were collected on 1242 consecutive new patients seen over a three-year period at the Comprehensive Pain Program in central Toronto.RESULTS: Musculoskeletal problems affecting large joints and the spine were the predominant cause of pain (more prevalent in women), followed by neuropathic disorders (more prevalent in men) in patients with recognizable physical pathology. The most affected age group was in the 35- to 49-year age range, with a mean pain duration of 7.8 years before the consultation. While 77% of the Comprehensive Pain Program patients had relevant and detectable physical pathology for pain complaints, three-quarters of the overall study population also had significant associated psychological or psychiatric comorbidity. Women, in general, attended the pain clinic in greater numbers and had less apparent physical pathology than men. Finally, less than one in five patients was employed at the time of referral.CONCLUSIONS: The relevance of the data in relation to other pain clinics is discussed, as well as waiting lists and other barriers faced by chronic pain patients, pain practitioners and pain facilities in Ontario and Canada.

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Concomitant benzodiazepine and opioids decrease sleep apnoea risk in chronic pain patients

ERJ Open Research ◽

10.1183/23120541.00093-2020 ◽

2020 ◽

Vol 6 (3) ◽

pp. 00093-2020

Author(s):

Soodaba Mir ◽

Jean Wong ◽

Clodagh M. Ryan ◽

Geoff Bellingham ◽

Mandeep Singh ◽

...

Keyword(s):

Chronic Pain ◽

Sleep Apnoea ◽

Opioid Use ◽

Arousal Index ◽

Concurrent Use ◽

Pain Clinics ◽

Chronic Pain Patients ◽

Negative Impacts ◽

Opioid Users ◽

Pain Patients

BackgroundThe concurrent use of sedating centrally acting drugs and opioids by chronic pain patients occurs routinely despite concerns of negative impacts on respiration during sleep. The effects of centrally acting drugs and opioids on sleep apnoea have not been well characterised. The objective of this study was to assess the effect of concomitant centrally acting drugs and opioids on the prevalence and severity of sleep apnoea in chronic pain patients.MethodsWe conducted a prospective cohort study at five chronic pain clinics. Each participant underwent an in-laboratory polysomnography and daily morphine milligram equivalents were calculated. Participants were grouped into centrally acting drugs and opioid users versus sole opioid users.ResultsOf the 332 consented participants, 204 underwent polysomnography and 120 (58.8%) had sleep apnoea (72% obstructive, 20% central, and 8% indeterminate sleep apnoea). Overall, 35% (71 of 204) were taking opioids alone, and 65% (133 of 204) were taking centrally acting drugs and opioids. There was a 69% decrease in the odds of having sleep apnoea (apnoea–hypopnoea index ≥5 events·h−1) in participants taking benzodiazepine/opioids versus sole opioid users (OR 0.31, 95% CI:0.12–0.80, p=0.015). Additionally, concomitant benzodiazepine/opioids versus sole opioid use was associated with a decrease in respiratory arousal index scores (p=0.03). Mean overnight SpO2 was approximately 1% lower in the concomitant benzodiazepine/opioids group versus sole opioid users (93.1±2.5 versus 94.4±2.1%, p=0.01).ConclusionIn chronic pain patients on opioids, administration of certain benzodiazepine sedatives induced a mild respiratory depression but paradoxically reduced sleep apnoea risk and severity by increasing the respiratory arousal threshold.

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“What about me?”: A qualitative explorative study on perspectives of spouses living with complex chronic pain patients

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2017.04.027 ◽

2017 ◽

Vol 16 (1) ◽

pp. 173-173

Author(s):

L. Thrysøe Hansen ◽

L.I. Nielsen ◽

P. Gazerani ◽

L. Petrini

Keyword(s):

Chronic Pain ◽

Focus Group ◽

Chronic Pain Patient ◽

Close Relative ◽

Pain Patient ◽

Psychological Burden ◽

Pain Condition ◽

Pain Clinics ◽

Chronic Pain Patients ◽

Pain Patients

Abstract Aims Being a close relative of a chronic pain patient affects family life. No study has been carried out in Denmark to explore relatives’ life experiences and challenges while living with complex chronic pain patients. Hence, the aim of the study was to investigate the experiences of living with chronic pain patients from their spouses’ perspectives. In particular, this study focused on how spouses describe: (i) their everyday tasks and roles as a spouse; (ii) the types of changes and challenges that the pain condition brings into their partnership lives; (iii) a gender difference in these experiences; and (iv) the type of help they wish to receive from the healthcare system. Methods Two focus group interviews were conducted in Multidisciplinary Pain Center, Køge, including a total of 11 spouses (6 men). The spouses were contacted via their partners who were referred to public pain clinics. Focus group interview was chosen because is a suitable method for exploratory studies. The approach was phenomenological and transcriptions of interview records were used for analysis. Results Eight categories emerged from the data analysis: psychological burden, physical burden, the pain invisibility, roles, loss, worries concerning medicine, self-care, and needs concerning help and support. The differences between gender were vague. Spouses for whom the patient pain condition was a new situation (<1 year) appeared to worry more. Conclusions The study demonstrated that the spouses’ lives were dramatically affected. They had to support the family financially, do most of the household chores, be optimistic, a parent, and a pain care giver. The spouses experienced daily worries about several points including pain medicine by the patients. This study also highlighted an essential need for psychological support for coping with the changing life situation, the point that is currently neglected to a great extent.

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Pain clinics, a new role for psychiatrists

Psychiatric Bulletin ◽

10.1192/pb.25.12.473 ◽

2001 ◽

Vol 25 (12) ◽

pp. 473-474 ◽

Cited By ~ 3

Author(s):

John Wallace ◽

Gnanie Panch

Keyword(s):

Chronic Pain ◽

Psychiatric Comorbidity ◽

Psychiatric Treatment ◽

Treatment Options ◽

Psychiatric Morbidity ◽

Comprehensive Treatment ◽

Liaison Psychiatry ◽

Pain Clinics ◽

Chronic Pain Patients ◽

Pain Patients

Aims and MethodThe aim of this study was to find out the extent of psychiatric involvement in pain clinics and also clarify the treatment approaches taken for the significant psychiatric comorbidity reported in these clinics. A questionnaire survey was conducted, by a psychiatrist and an anaesthetist, of the 31 pain clinics in the Greater London area.ResultsPsychiatric involvement in the management of patients with chronic pain is extremely limited, despite the extensive psychiatric morbidity associated with these patients (response rate, 74%). The majority of surveyed pain clinics wish to provide a multi-disciplinary approach to these patients, utilising the skills of a psychiatrist for both assessment and management. Only a small minority of pain clinics, however, have sufficient access to a liaison psychiatry service that could provide the broad multi-disciplinary approach and the psychiatric treatment options that they believe chronic pain patients require.ImplicationsThe involvement of psychiatrists in pain clinics is very limited. Increased involvement is desired and would likely lead to an improved profile of pain clinics, a more realistic and comprehensive treatment approach and, in turn, enhanced patient care.

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Portuguese Version of the Intentional Non-Adherence Scale: Validation in a Population of Chronic Pain Patients

Frontiers in Pharmacology ◽

10.3389/fphar.2021.681378 ◽

2021 ◽

Vol 12 ◽

Author(s):

Rute Sampaio ◽

Mariana Cruz ◽

Simão Pinho ◽

Cláudia Camila Dias ◽

John Weinman ◽

...

Keyword(s):

Chronic Pain ◽

Scale Validation ◽

Pain Beliefs ◽

Portuguese Version ◽

Pain Clinics ◽

Chronic Pain Patients ◽

Adherence Scale ◽

Back Translation ◽

Tertiary Hospitals ◽

Pain Patients

Objective: Despite the effectiveness of pain medicines, nonadherence to prescribed medication remains a major problem faced by healthcare systems. The aim of present study was to perform the translation, cultural adaptation, and validation of the Intentional Non-Adherence Scale (INAS) for the European Portuguese language in a sample of chronic pain patients.Methods: A Portuguese version of the INAS scale was constructed through a process of translation, back translation, and expert’s panel evaluation. A total of 133 chronic pain patients were selected from two chronic pain clinics from tertiary hospitals in Porto, Portugal. The protocol interview included the assessment of pain beliefs (PBPI), beliefs about medicine (BMQ), medication adherence (MARS-P9), and two direct questions about adherence previously validated.Results: The internal consistency in all subscales was α = 0.902 for testing treatment; α = 0.930 for mistrust treatment; α = 0.917 for resisting treatment; and α = 0.889 for resisting illness. Exploratory and confirmatory factor analysis revealed a four-factor structure that explained 74% of the variance. The construct validity of the INAS was shown to be adequate, with the majority of the previously defined hypotheses regarding intercorrelations with other measures confirmed.Conclusion: The Portuguese version of INAS could be a valuable and available instrument for Portuguese researchers and clinicians to assess the intentional nonadherence determinants during the management of chronic pain.

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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

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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.

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