scholarly journals Exploring factors which influence the prescription of medicines to manage neuropathic pain from the perspective of prescribers: a qualitative study

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i26-i27
Author(s):  
C Mshelia ◽  
M C Kennedy ◽  
G McHugh
Keyword(s):  
Primary Care ◽  
Neuropathic Pain ◽  
Pain Management ◽  
Nurse Practitioners ◽  
Good Practice ◽  
Research Progress ◽  
Spontaneous Pain ◽  
Treatment Choices ◽  
Primary Care Settings ◽  
Timely Access

Abstract Introduction Neuropathic pain (NP) is estimated to affect about 8% of the population in the UK. NP is defined as ‘pain caused by a lesion or disease of the somatosensory nervous system’ (1). NP often results in alterations in the pain pathway caused by tissue and nerve damage leading to hypersensitivity, characterised by spontaneous pain (no stimuli exist but the organism feels pain), allodynia (painless tactile stimulus or warmth are perceived as pain) and hyperalgesia (painful stimuli make the organism feel pain of greater intensity) (2). Most people present with neuropathic pain for the first time in primary care settings. It is important therefore, to understand the experiences of the prescribers who prescribe to this group of patients in order to highlight areas of good practice and to identify areas where support is required, and improvements need to be made. Aim To explore prescribers’ experiences of managing patients with neuropathic pain and the influence of these experiences on prescribing and treatment choices. Methods This study adopted a qualitative approach and obtained ethical approval. Purposive and snowball sampling methods were used to recruit General Practitioners (GPs), Advanced Nurse Practitioners (ANPs) and Pharmacist Independent Prescribers working in general practices in West Yorkshire. Semi-structured interviews were conducted face-to-face or by the telephone. The interviews took place between December 2019 and September 2020. The interviews were transcribed verbatim. Thematic analysis was used to identify key themes from the data. NVivo (version 12.6) was used to aid the analysis. Results 21 healthcare professionals responsible for prescribing medication to people with neuropathic pain were interviewed (GPs = 10, ANPs = 6 Pharmacists = 5). Prescribers identified several factors which influence their prescribing and treatment choices. These factors were grouped into micro, meso and macro factors. Micro factors were prescriber related factors such as experience or training in pain management, support from colleagues and prescriber-patient relationship. Meso factors were related to the patient and included factors such as side effects, comorbid conditions and addictive tendency. Macro level factors were those related to the health system such as timely access to specialists, length of consultations and cost-effective prescribing. Table 1 provides some illustrative quotes from the prescribers. All prescribers reported to derive satisfaction from being able to successfully help their patients manage the NP symptoms but acknowledged that this was sometimes not possible. Conclusion This study found that the experiences of prescribers with regards to managing NP is more negative than positive. Prescribers highlighted the challenges of managing neuropathic pain in primary care settings. This is largely due to the complexities of the condition and of prescribing decisions as well poor treatment outcomes for patients. A study limitation is the generalisability of the sample with participants not representing more geographical areas. Prescribers require appropriate support and training in managing NP to build their confidence in making prescribing decisions. It is also important to ensure patients get timely access to pain specialists and pain management clinics for specialist treatment. References 1. International Association for the Study of Pain (IASP). Taxonomy 2017 [Available from: https://www.iasp-pain.org/Taxonomy#Peripheralneuropathicpain. 2. Yan Y-y, Li C-y, Zhou L, Ao L-y, Fang W-r, Li Y-m. Research progress of mechanisms and drug therapy for neuropathic pain. Life Sciences. 2017;190(Supplement C):68–77.

Management of Painful Physical Symptoms Associated With Depression and Mood Disorders

CNS Spectrums ◽  
2005 ◽  
Vol 10 (S19) ◽  
pp. 1-16 ◽  
Author(s):  
Thomas N. Wise ◽  
Lesley M. Arnold ◽  
Vladimir Maletic ◽  
David L. Ginsberg
Keyword(s):  
Primary Care ◽  
Neuropathic Pain ◽  
Mood Disorders ◽  
Primary Care Physicians ◽  
Depressive Disorders ◽  
Pain Perception ◽  
Antidepressant Treatment ◽  
Physical Symptoms ◽  
Emotional Symptoms ◽  
Primary Care Settings

AbstractDepression is a common, recurring illness that continues to be underdiagnosed and undertreated in both psychiatric and primary care settings. It is increasingly being recognized that painful physical symptoms, which commonly exist comorbid with depressive disorders, play a role in complicating diagnosis of depression. Patients tend to discuss physical pain with primary care physicians and emotional pain with psychiatrists, often oblivious to the fact that both may be aspects of one disorder. Those who present with somatic complaints are three times less likely to be accurately diagnosed than patients with psychosocial complaints. However, thorough evaluation of mood and anxiety disorders in primary care is sparse due to the limited time primary care physicians can spend with each patient. Better recognition and treatment of both physical and emotional symptoms associated with mood disorders may increase a patient's chance of achieving remission, which is the optimum therapeutic goal.Abnormalities of serotonin and noradrenaline are strongly associated with depression and are thought to play a role in pain perception. Brain-derived neurotrophic factor, which is increased with antidepressant treatment, appears to influence regulation of mood and perception of pain. Clinical evidence indicates that dual-acting agents may have an advantage in modulating pain over those agents that increase either serotonin or noradrenaline alone. The novel dual-acting agents, such as venlafaxine and duloxetine, are better tolerated than tricyclic antidepressants and monoamine oxidase inhibitors. These agents have demonstrated efficacy in depression and in diabetic neuropathic pain independently. Therefore, unless otherwise stated, all inferences to studies of pain in this monograph refer to neuropathic pain in nondepressed patients.

scholarly journals Stem Cells in the Treatment of Neuropathic Pain: Research Progress of Mechanism

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Meichen Liu ◽  
Kai Li ◽  
Yunyun Wang ◽  
Guoqing Zhao ◽  
Jinlan Jiang
Keyword(s):  
Stem Cells ◽  
Neuropathic Pain ◽  
Current Treatment ◽  
Research Progress ◽  
Spontaneous Pain ◽  
Preclinical Research ◽  
Peripheral Mechanism ◽  
Current Treatment Strategy ◽  
Spinal Cord Level ◽  
Clinical Drugs

Neuropathic pain (NP) is pain caused by somatosensory nervous system injury or disease. Its prominent symptoms are spontaneous pain, hyperalgesia, and allodynia, and the sense of pain is extremely strong. Owing to the complex mechanism, conventional painkillers lack effectiveness. Recently, research on the treatment of NP by stem cells is increasing and promising results have been achieved in preclinical research. In this review, we briefly introduce the neuropathic pain, the current treatment strategy, and the development of stem cell therapy, and we collected the experimental and clinical trial articles of many kinds of stem cells in the treatment of neuropathic pain from the past ten years. We analyzed and summarized the general efficacy and mechanism of stem cells in the treatment of neuropathic pain. We found that the multiple-mechanism approach was different from the single mechanism of routine clinical drugs; stem cells play a role in peripheral mechanism, central mechanism, and disinhibition of spinal cord level that lead to neuropathic pain, so they are more effective in analgesia and treatment of neuropathic pain.

scholarly journals Design Process and Utilization of a Novel Clinical Decision Support System for Neuropathic Pain in Primary Care: Mixed Methods Observational Study

10.2196/14141 ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. e14141 ◽  
Author(s):  
Dale Guenter ◽  
Mohamed Abouzahra ◽  
Inge Schabort ◽  
Arun Radhakrishnan ◽  
Kalpana Nair ◽  
...  
Keyword(s):  
Primary Care ◽  
Neuropathic Pain ◽  
Decision Support ◽  
Family Medicine ◽  
Clinical Decision Support ◽  
Nurse Practitioners ◽  
Clinical Decision Support Systems ◽  
Usability Testing ◽  
Clinical Decision ◽  
Training Tool

Background Computerized clinical decision support systems (CDSSs) have emerged as an approach to improve compliance of clinicians with clinical practice guidelines (CPGs). Research utilizing CDSS has primarily been conducted in clinical contexts with clear diagnostic criteria such as diabetes and cardiovascular diseases. In contrast, research on CDSS for pain management and more specifically neuropathic pain has been limited. A CDSS for neuropathic pain has the potential to enhance patient care as the challenge of diagnosing and treating neuropathic pain often leads to tension in clinician-patient relationships. Objective The aim of this study was to design and evaluate a CDSS aimed at improving the adherence of interprofessional primary care clinicians to CPG for managing neuropathic pain. Methods Recommendations from the Canadian CPGs informed the decision pathways. The development of the CDSS format and function involved participation of multiple stakeholders and end users in needs assessment and usability testing. Clinicians, including family medicine physicians, residents, and nurse practitioners, in three academic teaching clinics were trained in the use of the CDSS. Evaluation over one year included the measurement of utilization of the CDSS; change in reported awareness, agreement, and adoption of CPG recommendations; and change in the observed adherence to CPG recommendations. Results The usability testing of the CDSS was highly successful in the prototype environment. Deployment in the clinical setting was partially complete by the time of the study, with some limitations in the planned functionality. The study population had a high level of awareness, agreement, and adoption of guideline recommendations before implementation of CDSS. Nevertheless, there was a small and statistically significant improvement in the mean awareness and adoption scores over the year of observation (P=.01 for mean awareness scores at 6 and 12 months compared with baseline, for mean adoption scores at 6 months compared with baseline, and for mean adoption scores at 12 months). Documenting significant findings related to diagnosis of neuropathic pain increased significantly. Clinicians accessed CPG information more frequently than they utilized data entry functions. Nurse practitioners and first year family medicine trainees had higher utilization than physicians. Conclusions We observed a small increase in the adherence to CPG recommendations for managing neuropathic pain. Clinicians utilized the CDSS more as a source of knowledge and as a training tool than as an ongoing dynamic decision support.

scholarly journals Evaluation of an innovative tele-education intervention in chronic pain management for primary care clinicians practicing in underserved areas

2018 ◽  
Vol 25 (8) ◽  
pp. 484-492 ◽  
Author(s):  
Andrea D Furlan ◽  
Jane Zhao ◽  
Jennifer Voth ◽  
Samah Hassan ◽  
Ruth Dubin ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Nurse Practitioners ◽  
Self Efficacy ◽  
Healthcare Providers ◽  
Physician Assistants ◽  
Chronic Pain Management ◽  
Healthcare Outcomes ◽  
The Impact

Introduction Inadequate knowledge and training of healthcare providers are obstacles to effective chronic pain management. ECHO (extension for community healthcare outcomes) uses case-based learning and videoconferencing to connect specialists with providers in underserved areas. ECHO aims to increase capacity in managing complex cases in areas with poor access to specialists. Methods A pre-post study was conducted to evaluate the impact of ECHO on healthcare providers’ self-efficacy, knowledge and satisfaction. Type of profession, presenting a case, and number of sessions attended were examined as potential factors that may influence the outcomes Results From June 2014 to March 2017, 296 primary care healthcare providers attended ECHO, 264 were eligible for the study, 170 (64%) completed the pre-ECHO questionnaire and 119 completed post-ECHO questionnaires. Participants were physicians (34%), nurse practitioners (21%), pharmacists (13%) and allied health professionals (32%). Participants attended a mean of 15 ± 9.19 sessions. There was a significant increase in self-efficacy ( p < 0.0001) and knowledge ( p < 0.0001). Self-efficacy improvement was significantly higher among physicians, physician assistants and nurse practitioners than the non-prescribers group ( p = 0.03). On average, 96% of participants were satisfied with ECHO. Satisfaction was higher among those who presented cases and attended more sessions. Discussion This study shows that ECHO improved providers’ self-efficacy and knowledge. We evaluated outcomes from a multidisciplinary group of providers practicing in Ontario. This diversity supports the generalisability of our findings. Therefore, we suggest that this project may be used as a template for creating other educational programs on other medical topics.

scholarly journals Changes to telehealth practices in primary care in New Brunswick (Canada): A comparative study pre and during the COVID-19 pandemic

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0258839
Author(s):  
Claire Johnson ◽  
Jérémie B. Dupuis ◽  
Pierre Goguen ◽  
Gabrielle Grenier
Keyword(s):  
Primary Care ◽  
Comparative Study ◽  
New Brunswick ◽  
Nurse Practitioners ◽  
Online Survey ◽  
Primary Care Providers ◽  
Care Providers ◽  
Timely Access ◽  
Access To Primary Care

Background During the COVID-19 pandemic, telehealth technologies were used in the primary health care setting in New Brunswick as a means to continue providing care to patients while following public health guidelines. This study aimed to measure these changes and examine if they improved timely access to primary care. A secondary goal was to identify which telehealth technologies were deemed sustainable by primary care providers. Methods This was a comparative study on the use of telehealth technology before and during the COVID-19 pandemic. Between April 2020 and November 2020, 114 active primary care providers (family physicians or nurse practitioners) responded to the online survey. Results The findings illustrated an increase in the use of telehealth technologies. The use of phone consultations increased by 122%, from 43.9% pre-pandemic to 97.6% during the pandemic (p < 0.001). The use of virtual consultation (19.3% pre-pandemic vs. 41.2% during the pandemic, p < 0.001), emails and texts also increased during the pandemic. Whereas the more structural organizational tools (electronic medical charts and reservation systems) remained stable. However, those changes did not coincide with a significant improvement to timely access to care during the pandemic. Many participants (40.1%) wanted to keep phone consultations, and 21.9% of participants wanted to keep virtual consultations as part of their long-term practice. Interpretation The observed increase in the use of telehealth technologies may be sustainable, but it has not significantly improved timely access to primary care in New Brunswick.

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