Pattern of Cumulative Treatment Hours on Pain Impact and PROMIS Outcomes

2021 ◽  
Author(s):  
Hongjin Li ◽  
Diane M Flynn ◽  
Krista B Highland ◽  
Larisa A Burke ◽  
Honor M Mcquinn ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Pain Management ◽  
Pain Treatment ◽  
Additive Models ◽  
Self Report ◽  
Interdisciplinary Treatment ◽  
Additional Patient ◽  
Impact Fatigue ◽  
Interdisciplinary Pain Treatment ◽  
Interdisciplinary Pain Management

ABSTRACT Introduction Participation in interdisciplinary treatments is associated with improvement in pain intensity, physical function, and additional pain-related outcome domains. However, the effect of cumulative treatment hours on outcomes remains unknown among military patients. The present analysis examined the relationship between cumulative interdisciplinary treatment hours and pain management outcomes at a single interdisciplinary pain management center (IPMC). Materials and Methods This is a retrospective observational study of data previously collected as standard of care at the Madigan Army Medical Center, approved by the Institutional Review Board. We included patients who received treatment at the IPMC and completed at least two self-report assessment batteries: one at baseline and at least one between 90 and 180 days after baseline (n = 882). The primary outcome was pain impact. Secondary outcomes included fatigue, depression, anxiety, and sleep-related impairment. Results Generalized additive models indicated that cumulative treatment hours were significantly associated with improvement in pain impact, fatigue, and depression. Patients who had higher baseline pain impact, who had mild or no depressive symptoms, and who were >40 years of age had greater improvements in pain impact following treatment, relative to those with lower pain impact, moderate-to-severe depressive symptoms, and were 40 years of age or younger, respectively. Additional research is needed to elucidate the effect of different therapies and additional patient factors in understanding the “therapeutic dose” of interdisciplinary pain management. Conclusions A higher number of cumulative treatment hours was associated with improvement of pain impact, fatigue, and depression among military personnel receiving interdisciplinary pain treatment. At least 30 hours of sustained interdisciplinary treatment appears to be the threshold for improvement in pain impact and related outcomes.

scholarly journals Dialectical Pain Management: Feasibility of a Hybrid Third-Wave Cognitive Behavioral Therapy Approach for Adults Receiving Opioids for Chronic Pain

Pain Medicine ◽  
2020 ◽  
Author(s):  
Deborah Barrett ◽  
Carrie E Brintz ◽  
Amanda M Zaski ◽  
Mark J Edlund
Keyword(s):  
Chronic Pain ◽  
Depressive Symptoms ◽  
Pain Management ◽  
Dialectical Behavior Therapy ◽  
Emotion Dysregulation ◽  
Qualitative Interviews ◽  
Self Report ◽  
Control Group ◽  
Global Rating ◽  
Pain Acceptance

Abstract Objectives This study evaluated the feasibility, acceptability, and potential effectiveness of a hybrid skills-based group intervention, dialectical pain management (DPM), for adults with chronic pain who are receiving long-term opioid therapy. DPM adapts dialectical behavior therapy, a rigorous psychotherapeutic approach to emotion dysregulation, to treat disorders of physiological dysregulation. Methods Individuals with chronic pain (N = 17) participated in one of two 8-week DPM intervention cohorts. At pre-test and post-test, participants completed quantitative self-report assessments measuring pain intensity and interference, depressive symptoms, pain acceptance, beliefs about pain medications, and global rating of change. Within 2 weeks after the intervention, participants completed qualitative interviews to assess participant satisfaction and obtain feedback about specific intervention components. Results Of the 17 enrolled, 15 participants completed the group with 12 (70%) attending six or more sessions. Participants reported high satisfaction with the intervention. Preliminary findings suggested a significant increase in pain acceptance and a significant reduction in depressive symptoms. Participants also reported an improved relationship with their pain conditions and increased flexibility in responding to pain and applying coping skills. Several participants showed a reduction in opioid dosage over the course of the intervention. Discussion Findings support that DPM is a feasible and well-received intervention for individuals with chronic pain. Additional research with a control group is needed to further determine the intervention’s efficacy and impact.

scholarly journals Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study (Preprint)

2020 ◽  
Author(s):  
Anya Griffin ◽  
Luke Wilson ◽  
Amanda B Feinstein ◽  
Adeline Bortz ◽  
Marissa S Heirich ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Virtual Reality ◽  
Pain Management ◽  
Development Process ◽  
Pain Treatment ◽  
Functional Limitations ◽  
Great Promise ◽  
Movement Data ◽  
Iterative Development ◽  
Interdisciplinary Pain Treatment

BACKGROUND In the field of pain, virtual reality (VR) technology has been increasingly common in the context of procedural pain management. As an interactive technology tool, VR has the potential to be extended beyond acute pain management to chronic pain rehabilitation with a focus on increasing engagement with painful or avoided movements. OBJECTIVE We outline the development and initial implementation of a VR program in pain rehabilitation intervention to enhance function in youth with chronic pain. METHODS We present the development, acceptability, feasibility, and utility of an innovative VR program (Fruity Feet) for pediatric pain rehabilitation to facilitate increased upper and lower extremity engagement. The development team was an interdisciplinary group of pediatric experts, including physical therapists, occupational therapists, pain psychologists, anesthesiologists, pain researchers, and a VR software developer. We used a 4-phase iterative development process that engaged clinicians, parents, and patients via interviews and standardized questionnaires. RESULTS This study included 17 pediatric patients (13 female, 4 male) enrolled in an intensive interdisciplinary pain treatment (IIPT) program, with mean age of 13.24 (range 7-17) years, completing a total of 63 VR sessions. Overall reports of presence were high (mean 28.98; max 40; SD 4.02), suggestive of a high level of immersion. Among those with multisession data (n=8), reports of pain (<i>P</i>&lt;.001), fear (<i>P</i>=.003), avoidance (<i>P</i>=.004), and functional limitations (<i>P</i>=.01) significantly decreased. Qualitative analysis revealed (1) a positive experience with VR (eg, enjoyed VR, would like to utilize the VR program again, felt VR was a helpful tool); (2) feeling distracted from pain while engaged in VR; (3) greater perceived mobility; and (4) fewer clinician-observed pain behaviors during VR. Movement data support the targeted impact of the Fruity Feet compared to other available VR programs. CONCLUSIONS The iterative development process yielded a highly engaging and feasible VR program based on qualitative feedback, questionnaires, and movement data. We discuss next steps for the refinement, implementation, and assessment of impact of VR on chronic pain rehabilitation. VR holds great promise as a tool to facilitate therapeutic gains in chronic pain rehabilitation in a manner that is highly reinforcing and fun.

scholarly journals Pain assessment and registration in medical oncology clinics: operationalised through the lens of health care professionals and patients

2021 ◽  
Vol 4 ◽  
pp. 86
Author(s):  
Laserina O'Connor ◽  
Aileen Hassett ◽  
Noeleen Sheridan
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Cancer Treatment ◽  
Pain Assessment ◽  
Health Care Professionals ◽  
Healthcare Professionals ◽  
Medical Oncology ◽  
Pain Treatment ◽  
Self Report ◽  
Common Symptom

Background: Pain is a common symptom in patients who survive cancer and in those who live with progressive advanced disease. Systematic screening and documentation of pain are necessary to improve the quality of cancer pain treatment, because a key pain-related barrier is that patients are reluctant to discuss pain, due to fear that reporting pain will distract the healthcare professional from their cancer treatment. Methods: This study adopted an explanatory sequential mixed-methods design. Data collection incorporated three strands. The first strand involved a quantitative enquiry in which medical chart reviews of patients (n=100) attending the medical oncology outpatient clinic were examined. The second qualitative strand comprised of semi-structured interviews with patients (n=10) attending that service. The third strand was qualitative and consisted of focus group discussions with healthcare professionals (n=12). Results: All 100 patients had cancer. The quantitative findings confirmed the suboptimum assessment and subsequent recording of patient’s pain, that seemed to afford a reality check for all healthcare professionals. For patients, the outcomes of the anti-cancer treatment were their priority, and pain was perceived as inevitable, being associated with a cancer diagnosis. There were multifaceted complexities voiced amongst healthcare professionals associated with balancing the benefits and harms aligned with treating cancer pain. Conclusions: Pain assessment in medical records was not systematically recorded by healthcare professionals. Patients were reluctant to self-report pain during their medical oncology outpatient review. The expectation that patients will self-report pain can be accommodated by healthcare professionals if a personalized pain goal is part of the cancer pain management plan during each clinical encounter. Healthcare professionals reported a need to take distinct responsibility for supplementing their dearth of knowledge, skills and beliefs regarding assessing and managing patients’ cancer pain. Optimal pain management stems from an interprofessional approach that was applied in this study design.

scholarly journals Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study

10.2196/22620 ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e22620
Author(s):  
Anya Griffin ◽  
Luke Wilson ◽  
Amanda B Feinstein ◽  
Adeline Bortz ◽  
Marissa S Heirich ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Virtual Reality ◽  
Pain Management ◽  
Development Process ◽  
Pain Treatment ◽  
Functional Limitations ◽  
Great Promise ◽  
Movement Data ◽  
Iterative Development ◽  
Interdisciplinary Pain Treatment

Background In the field of pain, virtual reality (VR) technology has been increasingly common in the context of procedural pain management. As an interactive technology tool, VR has the potential to be extended beyond acute pain management to chronic pain rehabilitation with a focus on increasing engagement with painful or avoided movements. Objective We outline the development and initial implementation of a VR program in pain rehabilitation intervention to enhance function in youth with chronic pain. Methods We present the development, acceptability, feasibility, and utility of an innovative VR program (Fruity Feet) for pediatric pain rehabilitation to facilitate increased upper and lower extremity engagement. The development team was an interdisciplinary group of pediatric experts, including physical therapists, occupational therapists, pain psychologists, anesthesiologists, pain researchers, and a VR software developer. We used a 4-phase iterative development process that engaged clinicians, parents, and patients via interviews and standardized questionnaires. Results This study included 17 pediatric patients (13 female, 4 male) enrolled in an intensive interdisciplinary pain treatment (IIPT) program, with mean age of 13.24 (range 7-17) years, completing a total of 63 VR sessions. Overall reports of presence were high (mean 28.98; max 40; SD 4.02), suggestive of a high level of immersion. Among those with multisession data (n=8), reports of pain (P<.001), fear (P=.003), avoidance (P=.004), and functional limitations (P=.01) significantly decreased. Qualitative analysis revealed (1) a positive experience with VR (eg, enjoyed VR, would like to utilize the VR program again, felt VR was a helpful tool); (2) feeling distracted from pain while engaged in VR; (3) greater perceived mobility; and (4) fewer clinician-observed pain behaviors during VR. Movement data support the targeted impact of the Fruity Feet compared to other available VR programs. Conclusions The iterative development process yielded a highly engaging and feasible VR program based on qualitative feedback, questionnaires, and movement data. We discuss next steps for the refinement, implementation, and assessment of impact of VR on chronic pain rehabilitation. VR holds great promise as a tool to facilitate therapeutic gains in chronic pain rehabilitation in a manner that is highly reinforcing and fun.

scholarly journals Structural MRI Analysis of Chronic Pain Patients Following Interdisciplinary Treatment Shows Changes in Brain Volume and Opiate-Dependent Reorganization of the Amygdala and Hippocampus

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2765-2776
Author(s):  
Christine M Gagnon ◽  
Paul Scholten ◽  
James Atchison ◽  
Rami Jabakhanji ◽  
Kenta Wakaizumi ◽  
...  
Keyword(s):  
Pain Management ◽  
Outcome Measures ◽  
Relaxation Training ◽  
Brain Volume ◽  
Management Program ◽  
Interdisciplinary Treatment ◽  
Total Brain Volume ◽  
Pain Management Program ◽  
Interdisciplinary Pain Management ◽  
The Brain

Abstract Objective The present study examined pre- to post-treatment changes in volumes for brain structures known to be associated with pain processing (thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and accumbens) following an interdisciplinary pain management program. Design Twenty-one patients participating in a four-week interdisciplinary pain management program completed the study. The program consisted of individual and group therapies with the following disciplines: physical therapy, occupational therapy, pain psychology, biofeedback/relaxation training, nursing lectures, and medical management. All patients underwent functional magnetic resonance imaging of the brain before the start and at completion of the program. They also completed standard outcome measures assessing pain, symptoms of central sensitization, disability, mood, coping, pain acceptance, and impressions of change. Results Our results showed a significant increase in total brain volume, as well as increased volumes in the thalamus, hippocampus, and amygdala. As expected, we also found significant improvements in our standard outcome measures. The majority of patients rated themselves as much or very much improved. The increase in volume in the hippocampus was significantly associated with patient perceptions of change. However, the correlations were in the unexpected direction, such that greater increases in hippocampal volume were associated with perceptions of less improvement. Further exploratory analyses comparing patients by their opioid use status (use vs no use) showed differential program effects on volume increases in the hippocampus and amygdala. Conclusions These findings show that a four-week interdisciplinary pain management program resulted in changes in the brain, which adds objective findings further demonstrating program efficacy.

scholarly journals ABOUT THE PAIN IN CHILDREN

2019 ◽  
Vol 32 (2) ◽  
pp. 281-284
Author(s):  
Svetla Ivanova
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Pain Treatment ◽  
Emotional Experience ◽  
Behavioral Assessment ◽  
Age Groups ◽  
Diagnostic Procedures ◽  
Self Report ◽  
Pediatric Care ◽  
First Pain

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain for pediatric patients is more difficult to evaluate and treat than in adults. Its assessment and management are key components of pediatric care which aim to reduce subjective sensation and to improve the satisfaction of medical specialists and parents. The assessment of pain depends on the cognitive development of the child , the clinical context and the type of pain. Pain management in children improves physiological, behavioral and hormonal results, leads to faster recovery, less complications, and reduced healthcare resources. Ineffective and untimely treatment of pain in children can cause long-lasting physical and psychological consequences. This article aims to determine the importance of adequate pain control in children. For children over the age of 6, pain assessment is based on self-assessment, whereas children under the age of 6 require behavioral scales for pain assessment. Behavioral assessment scales include child monitoring as well as basic characteristics of pain such as intensity, location, duration. The nurses are in a position to meet the child's first pain caused by fear and anxiety in the hospital, but parents who take care of the child are an important assistant in assessing, especially in children with special needs. Some children may find it difficult to do a distinction between pain, anxiety and stress. Effective pain assessment leads to more satisfied children and families. Prolonged inadequate treatment of pain in children may be due to the lack of knowledge and failure of nurses to appreciate and manage pain effectively. Medical specialist should be able to detect the symptoms and signs of pain in different age groups and determine whether these symptoms are caused by pain or other factors. The methods used for pain assessment have proven clinical efficacy, reliability and usability, making them an integral part of the treatment and management of pain. Three are the ways to measure it in children: self-report, behavioral evidence, and physiological-clinical observations. After processing the collected information, the data are entered into the required documentation which provides continuous ,safe and qualified care. Documentation of the children’s pain is a key factor in pain managing. Low level of nurses’ knowledge of assessing pain, inappropriate use of pain scales or lack of documentation could affect pain treatment. Assessment is performed if a child complains of pain, after surgery, if a procedure would cause discomfort or at least once a shift to check if children have any pain. The main subject of pain management strategy is pain prevention and modification of techniques used for diagnostic procedures for infant.

Coping Style as a Mediator of the Relationship Between Depressive Symptoms and Deliberate Self-Harm

Crisis ◽  
2011 ◽  
Vol 32 (5) ◽  
pp. 272-279 ◽  
Author(s):  
Allison S. Christian ◽  
Kristen M. McCabe
Keyword(s):  
Depressive Symptoms ◽  
Undergraduate Students ◽  
Cross Sectional Study ◽  
Self Report ◽  
Hierarchical Regression ◽  
Cross Sectional ◽  
Deliberate Self Harm ◽  
Self Blame ◽  
Self Harm ◽  
The Relationship

Background: Deliberate self-harm (DSH) occurs with high frequency among clinical and nonclinical youth populations. Although depression has been consistently linked with the behavior, not all depressed individuals engage in DSH. Aims: The current study examined maladaptive coping strategies (i.e., self-blame, distancing, and self-isolation) as mediators between depression and DSH among undergraduate students. Methods: 202 students from undergraduate psychology courses at a private university in Southern California (77.7% women) completed anonymous self-report measures. Results: A hierarchical regression model found no differences in DSH history across demographic variables. Among coping variables, self-isolation alone was significantly related to DSH. A full meditational model was supported: Depressive symptoms were significantly related to DSH, but adding self-isolation to the model rendered the relationship nonsignificant. Limitations: The cross-sectional study design prevents determination of whether a casual relation exists between self-isolation and DSH, and obscures the direction of that relationship. Conclusions: Results suggest targeting self-isolation as a means of DSH prevention and intervention among nonclinical, youth populations.

scholarly journals Impact of a patient-specific national programme aimed at increasing the use of emollient moisturisers to reduce the risk of skin tears: a longitudinal cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039579
Author(s):  
Anna K Moffat ◽  
Kerrie P Westaway ◽  
Jemisha Apajee ◽  
Oliver Frank ◽  
Russell Shute ◽  
...  
Keyword(s):  
Interrupted Time Series ◽  
Self Report ◽  
Additional Patient ◽  
Patient Specific ◽  
Department Of Veterans Affairs ◽  
National Programme ◽  
Sustained Effect ◽  
Skin Tears ◽  
Comparison Groups ◽  
The Impact

ObjectivesTo evaluate the impact of a patient-specific national programme targeting older Australians and health professionals that aimed to increase use of emollient moisturisers to reduce to the risk of skin tears.DesignA prospective cohort intervention.ParticipantsThe intervention targeted 52 778 Australian Government’s Department of Veterans’ Affairs patients aged over 64 years who had risk factors for wound development, and their general practitioners (GPs) (n=14 178).Outcome measuresAn interrupted time series model compared the rate of dispensing of emollients in the targeted cohort before and up to 23 months after the intervention. Commitment questions were included in self-report forms.ResultsIn the first month after the intervention, the rate of claims increased 6.3-fold (95% CI: 5.2 to 7.6, p<0.001) to 10 emollient dispensings per 1000 patients in the first month after the intervention. Overall, the intervention resulted in 10 905 additional patient-months of treatment. The increased rate of dispensing among patients who committed to talking to their GP about using an emollient was six times higher (rate ratio: 6.2, 95% CI: 4.4 to 8.7) than comparison groups.ConclusionsThe intervention had a sustained effect over 23 months. Veterans who responded positively to commitment questions had higher uptake of emollients than those who did not.

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