Health-literacy-adapted CBT and pain education for low-SES individuals with chronic pain: One-year follow-up

BACKGROUND: Despite calls for the development and evaluation of pain education programs during early medical student training, little research has been dedicated to this initiative.OBJECTIVES: To develop a pain management and palliative care seminar for medical students during their surgical clerkship and evaluate its impact on knowledge over time.METHODS: A multidisciplinary team of palliative care and pain experts worked collaboratively and developed the seminar over one year. Teaching methods included didactic and case-based instruction, as well as small and large group discussions. A total of 292 medical students attended a seminar during their third- or fourth-year surgical rotation. A 10-item test on knowledge regarding pain and palliative care topics was administered before the seminar, immediately following the seminar and up to one year following the seminar. Ninety-five percent (n=277) of students completed the post-test and 31% (n=90) completed the follow-up test.RESULTS: The mean pretest, post-test and one-year follow-up test scores were 51%, 75% and 73%, respectively. Mean test scores at post-test and follow-up were significantly higher than pretest scores (all P<0.001). No significant difference was observed in mean test scores between follow-up and post-test (P=0.559), indicating that students retained knowledge gained from the seminar.CONCLUSIONS: A high-quality educational seminar using interactive and case-based instruction can enhance students’ knowledge of pain management and palliative care. These findings highlight the feasibility of developing and implementing pain education material for medical students during their training.

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A Triage Approach to Managing a Two Year Wait-List in a Chronic Pain Program

Pain Research and Management ◽

10.1155/2005/516313 ◽

2005 ◽

Vol 10 (3) ◽

pp. 155-157 ◽

Cited By ~ 6

Author(s):

Alexander J Clark ◽

Ian Beauprie ◽

Lynne B Clark ◽

Mary E Lynch

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Fast Track ◽

Treatment Plan ◽

Treatment Recommendations ◽

Management Unit ◽

Waiting List ◽

One Year ◽

Referring Physicians

OBJECTIVE: Individuals with chronic pain referred to specialist chronic pain management programs frequently wait months to years for assessment and care. In the authors' pain management program, approximately 600 patients are on the waiting list. An innovative recommendation program to encourage and educate referring physicians to continue active care of pain during this waiting period was developed.METHODS: All referrals to the Queen Elizabeth II Health Sciences Centre's Pain Management Unit for a one-year period were reviewed and triaged as either 'regular waiting list' or 'fast track'. Patients in the fast track group were seen within four months and required limited interventions or were urgent in nature. The regular waiting list group waited up to 27 months for assessment and development of a treatment plan. Treatment recommendations were faxed to the referring physician. A follow-up questionnaire was sent to each physician to assess whether these treatment recommendations were useful.RESULTS: Recommendations were faxed for 297 patients. One hundred forty-nine physicians returned the follow-up questionnaire. Ninety-five physicians used the recommendations and 68 patients followed the recommendations. Seventy-nine physicians felt that the recommendations were helpful to them in their care of the patient. For 39 patients, the recommendations were helpful. The most frequently used recommendations were those on medications (eg, tricylic antidepressants, anticonvulsants, nonsteroidal anti-inflammatory drugs and controlled-release opioids). Other modalities included participation in an interdisciplinary group program and physiotherapy.CONCLUSIONS: A triage review process with recommendations faxed to referring physicians was developed and put into action for one year. The recommendations were used by 32% of the physicians (64% of responding physicians). Fifty-three per cent of responding physicians felt that the recommendations were helpful in the care of their patient. This process led to a benefit in care, as perceived by the physician, in 26% of patients (of physicians who returned the questionnaire [13% of all patients]) on the waiting list for a tertiary care pain management unit.

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An observational study of two rehabilitation strategies for patients with chronic pain, focusing on sick leave at one-year follow-up

Journal of Rehabilitation Medicine ◽

10.2340/16501977-1218 ◽

2013 ◽

Vol 45 (10) ◽

pp. 1049-1057 ◽

Cited By ~ 7

Author(s):

D Merrick ◽

G Sundelin ◽

B Stålnacke

Keyword(s):

Chronic Pain ◽

Observational Study ◽

Sick Leave ◽

One Year ◽

Rehabilitation Strategies

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Pain, Sleep, and Health-Related Quality of Life after Multidisciplinary Intervention for Chronic Pain

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910233 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10233

Author(s):

Hafdís Skúladóttir ◽

Herdis Sveinsdottir ◽

Janean E. Holden ◽

Thóra Jenný Gunnarsdóttir ◽

Sigridur Halldorsdottir ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Sleep Problems ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Pre Treatment ◽

One Year

Multidisciplinary pain-management programs have the potential to decrease pain intensity, improve health-related quality of life (HRQOL), and increase sleep quality. In this longitudinal prospective cohort study, the aim was to investigate the long-term effects of multidisciplinary pain rehabilitation interventions in Iceland. More precisely, we (a) explored and described how individuals with chronic pain evaluated their pain severity, sleep, and HRQOL at pre-treatment and at one-year follow-up and (b) examined what predicted the participants’ one-year follow-up HRQOL. Seventy-nine patients aged 20–68 years, most of whom were women (85%), responded. The participants scored their pain lower at one-year follow-up (p < 0.001). According to their response, most of them had disrupted sleep, mainly because of pain. One year after the treatment, more participants slept through the night (p = 0.004), and their HRQOL increased. Higher pre-treatment mental component summary (MCS) scores and having pursued higher education predicted higher MCS scores at one-year follow-up, and higher pre-treatment physical component summary (PCS) scores predicted higher PCS scores at one-year follow-up. Sleep problems, being a woman, and having children younger than 18 years of age predicted lower MCS scores at one-year follow-up. These findings are suggestive that patients should be examined with respect to their mental status, and it could be beneficial if they received some professional support after completing the intervention.

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High rate of stroke and low rate of atrial fibrillation in low socioeconomic strata and blacks: the atrial fibrillation paradox

European Heart Journal ◽

10.1093/ehjci/ehaa946.0351 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.B Kostis ◽

S Zinonos ◽

J Cabrera ◽

W.J Kostis

Keyword(s):

Atrial Fibrillation ◽

Low Socioeconomic Status ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

High Rate ◽

Low Ses ◽

Low Socioeconomic ◽

Socioeconomic Strata ◽

One Year

Abstract Background and introduction Persons living in areas of low socioeconomic status (SES) usually have higher rates of adverse cardiovascular events (CVE) including stroke. Also, atrial fibrillation (AF) is associated with higher rate of CVEs. One would expect that both the rate of stroke and the occurrence of AF would be higher in areas of low SES. Purpose and methods Using MIDAS, a validated statewide data base of all hospitalizations for cardiovascular disease in NJ with follow up of more than 25 years, we examined the rate of hospitalization for AF by SES in patients with history of myocardial infarction for the years 1995 to 2015 (n=258,339). Zip codes in New Jersey were aggregated into 4 categories representing quarters of the distribution of SES areas. Results At one-year follow-up, patients in the lowest SES (lowest 25th percentile) and Blacks were more likely to suffer a stroke (p<0.0001). During one-year follow-up, patients in the lowest 25th percentile (Figure) were significantly less likely (p<0.0001) to be readmitted with a diagnosis of AF. Blacks had lower rate of admission with a diagnosis AF compared to Whites (p<0.0001) (Figure). Cox proportional hazards regression adjusting for demographics and co-morbidities confirmed the validity of these differences. In this analysis patients in the lowest SES quartile and Blacks were less likely to be admitted with AF than those in the highest quartile (HR 0.95, 95% CI 0.92–0.99). Also, Blacks were less likely to be admitted with AF than Whites (HR 0.76, 95% CI 0.71–0.82). This phenomenon (AF paradox) of lower incidence of AF in low SES and in Blacks has been attributed to under-ascertainment of AF in these groups, that may lead to underuse of anticoagulation and result in the occurrence of stroke. Conclusion Atrial fibrillation is underdiagnosed in patients at low socioeconomic strata and in Blacks and may lead to underuse of anticoagulation and the occurrence of stroke. Special efforts are warranted in detecting AF in these groups. Funding Acknowledgement Type of funding source: None

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Assessment and treatment at a pain clinic: A one-year follow-up of patients with chronic pain

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2016.08.004 ◽

2017 ◽

Vol 17 (1) ◽

pp. 233-242 ◽

Cited By ~ 5

Author(s):

Andrea Hållstam ◽

Monika Löfgren ◽

Lina Benson ◽

Christer Svensén ◽

Britt-Marie Stålnacke

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Pain Clinic ◽

Health Related Quality ◽

Pain Clinics ◽

Related Quality ◽

Health Related ◽

One Year

AbstractBackground and aimsPain is one of the most common reasons for patients to seek primary health care. Pain relief is likely to be achieved for patients suffering from acute pain, but for individuals with chronic pain it is more likely that the condition will persist. These patients have the option of being referred to specialised pain clinics. However, the complexity surrounding chronic pain patients is not well studied in these settings. This study aimed to describe patients with chronic pain referred to a pain clinic by using the information submitted during their first visit and one year later and also to identify associations between baseline characteristics and improvements in health-related quality of life in the follow-up.MethodsThis was a longitudinal observational study of a sample consisting of 318 patients referred to a pain clinic. One group of patients containing 271 individuals (median age 48, 64% females) was assessed and received conventional pain treatment (CPT group) and a second group of 47 patients (median age 53, 64% females) was assessed by a pain specialist and referred back to their physician with a treatment recommendation (assessment only, AO group). Patient-reported outcome measures in health-related quality of life (EQ-5D), pain intensity (VAS), mental health (HADS), insomnia (ISI), pain-related disability (PDI), kinesiophobia (TSK) and sense of coherence (SOC) were collected at the first visit and one year later.ResultsAt baseline, the CPT group reported a low EQ-5D Index (median (md) 0.157) and EQVAS (md 40) as well as considerable high, current pain intensity VAS (md 58), HADS anxiety (md 8), ISI (md 17), PDI (md 36) and TSK (md 39). The AO group showed similar problems (no significant differences compared to the CPT group), except for ISI, where the AO group reported less severe problems. At the one-year follow-up, the CPT group had a statistically significant improvement in EQ-5D, VAS, ISI, PDI and TSK. In the AO group no significant changes were observed. In the CPT group there was an association between a high ISI level at baseline and an improved EQ-5D Index in the follow-up.ConclusionsThe study describes rarely explored groups of patients with chronic pain at a pain clinic. Severe pain problems were present in both groups at their first visit. A statistically significant improvement could be seen in the group that was conventionally treated while this was not the case among those subjects who were assessed and referred. The results imply, that relatively limited treatment strategies were helpful for the patients’ health-related quality of life. Despite these improvements, the patients were not fully recovered, pointing to the chronicity of pain conditions and the need of support for many patients.ImplicationsIncreased knowledge about assessment, selection and treatment at pain clinics is important to improve the quality of the work performed at these clinics. Despite limited resources, further efforts should be made to collect comparable, valid data on a regular base from pain clinics in order to develop recommendation models.

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