scholarly journals Pain Characteristics and Demographics of Patients Attending a University-Affiliated Pain Clinic in Toronto, Ontario

2007 ◽  
Vol 12 (2) ◽  
pp. 93-99 ◽  
Author(s):  
Angela Mailis-Gagnon ◽  
Balaji Yegneswaran ◽  
SF Lakha ◽  
Keith Nicholson ◽  
Amanda J Steiman ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Tertiary Care ◽  
Pain Clinic ◽  
Pain Clinics ◽  
Chronic Pain Patients ◽  
Musculoskeletal Problems ◽  
Pain Duration ◽  
Study Population ◽  
Age Range ◽  
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.

scholarly journals Use of a Modified Comprehensive Pain Evaluation Questionnaire: Characteristics and Functional Status of Patients on Entry to a Tertiary Care Pain Clinic

2012 ◽  
Vol 17 (2) ◽  
pp. 75-82
Author(s):  
Jennifer M Nelli ◽  
Keith Nicholson ◽  
S Fatima Lakha ◽  
Ada F Louffat ◽  
Luis Chapparo ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Tertiary Care ◽  
Pain Clinic ◽  
Fourth Edition ◽  
Statistical Manual ◽  
Text Revision ◽  
Diagnostic And Statistical Manual ◽  
Pain Evaluation ◽  
Chronic Pain Patients ◽  
Pain Patients

BACKGROUND: With increasing knowledge of chronic pain, clinicians have attempted to assess chronic pain patients with lengthy assessment tools.OBJECTIVES: To describe the functional and emotional status of patients presenting to a tertiary care pain clinic; to assess the reliability and validity of a diagnostic classification system for chronic pain patients modelled after the Multidimensional Pain Inventory; to provide psychometric data on a modified Comprehensive Pain Evaluation Questionnaire (CPEQ); and to evaluate the relationship between the modified CPEQ construct scores and clusters withDiagnostic and Statistical Manual, Fourth Edition – Text RevisionPain Disorder diagnoses.METHODS: Data on 300 new patients over the course of nine months were collected using standardized assessment procedures plus a modified CPEQ at the Comprehensive Pain Program, Toronto Western Hospital, Toronto, Ontario.RESULTS: Cluster analysis of the modified CPEQ revealed three patient profiles, labelled Adaptive Copers, Dysfunctional, and Interpersonally Distressed, which closely resembled those previously reported. The distribution of modified CPEQ construct T scores across profile subtypes was similar to that previously reported for the original CPEQ. A novel finding was that of a strong relationship between the modified CPEQ clusters and constructs withDiagnostic and Statistical Manual, Fourth Edition – Text RevisionPain Disorder diagnoses.DISCUSSION AND CONCLUSIONS: The CPEQ, either the original or modified version, yields reproducible results consistent with the results of other studies. This technique may usefully classify chronic pain patients, but more work is needed to determine the meaning of the CPEQ clusters, what psychological or biomedical variables are associated with CPEQ constructs or clusters, and whether this instrument may assist in treatment planning or predict response to treatment.

scholarly journals Sublingual Buprenorphine/Naloxone and Multi-Modal Management for High-Risk Chronic Pain Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 973
Author(s):  
Shane Kaski ◽  
Patrick Marshalek ◽  
Jeremy Herschler ◽  
Sijin Wen ◽  
Wanhong Zheng
Keyword(s):  
Chronic Pain ◽  
High Risk ◽  
Pain Score ◽  
Rating Scale ◽  
Pain Treatment ◽  
Pain Clinic ◽  
Sublingual Buprenorphine ◽  
Significant Downward Trend ◽  
Chronic Pain Patients ◽  
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.

Codetron in Rehabilitation of Chronic Pain Patients

1989 ◽  
Vol 6 (2) ◽  
pp. 54-56 ◽  
Author(s):  
Angelica Fargas-Babjak
Keyword(s):  
Clinical Trial ◽  
Chronic Pain ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Modern Medicine ◽  
Pain Clinic ◽  
The Novel ◽  
Technological Changes ◽  
Electrical Nerve Stimulation ◽  
Chronic Pain Patients ◽  
Pain Patients

Acupuncture is one of the oldest healing methods which is used in traditional medicine. in modern medicine we are witnessing a renaissance of this ancient treatment applied mainly in the management of chronic pain. A number of modern technological changes are being applied to replace, or modify, the classical needle treatment Among many of the modalities used at present are light, in the form of laser, and electrical stimulation. CODETRON TENS, the novel addition to Transcutaneous Electrical Nerve Stimulation (TENS), has been evaluated in a clinical trial, over a two year period, in a multidisciplinary pain clinic on patients who came for acupuncture therapy. Indications, effectiveness and experiences with this form of treatment are presented.

scholarly journals The Classification of Patients with Chronic Pain: Age and Sex Differences

2001 ◽  
Vol 6 (3) ◽  
pp. 142-151 ◽  
Author(s):  
Andrew J Cook ◽  
Dania C Chastain
Keyword(s):  
Chronic Pain ◽  
Sex Differences ◽  
Perceived Disability ◽  
Pain Disability ◽  
Clinical Presentations ◽  
Chronic Pain Patients ◽  
Pain Duration ◽  
Pain Patients ◽  
Age And Sex

OBJECTIVE: To further develop an empirically based classification system for chronic pain patients through the examination of age and sex differences, and incorporation of pain duration in the grouping algorithm.SUBJECTS: Three hundred seventy-four chronic pain patients (300 aged 13 to 59 years; 74 aged 60 to 89 years) assessed at an outpatient, multidisciplinary pain management centre.METHODS: Patients completed measures of demographic and descriptive information, pain intensity (box rating scale), perceived disability (modified Pain Disability Index) and affective distress (Symptom Checklist-90 Revised) before multidisciplinary treatment. Standardized scores from the assessment measures were entered into a series of hierarchical, multivariate cluster analyses to identify underlying patient subgroups.RESULTS: Age-based patient groupings from prior research were partially replicated. Significant differences in clinical presentations were observed across age and sex groups. Pain duration was found to make an important contribution to the patient groupings. 'Good control' (low pain, disability, distress) and variants of 'chronic pain syndrome' (elevated pain, disability, distress) groupings were identified across all analyses. Two variants of a 'stoic' profile were identified among older patients, with low levels of distress relative to pain and perceived disability. One of these profiles was associated with long pain duration and was found only among males. Several unique clinical profiles were identified for female patients.CONCLUSIONS: There are important age and sex differences in the clinical presentations of chronic pain patients. Some older patients present with unique clinical profiles that may reflect cohort differences, and/or physiological or psychological adjustment processes. There appears to be a greater number of distinct chronic pain presentations among females. Research on the classification of chronic pain patients within homogeneous diagnostic subgroups is needed.

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

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.

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

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.

scholarly journals An Objective Pain Score for Chronic Pain Clinic Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Agnes K. Pace ◽  
Melanio Bruceta ◽  
John Donovan ◽  
Sonia J. Vaida ◽  
Jill M. Eckert
Keyword(s):  
Chronic Pain ◽  
Construct Validity ◽  
Concurrent Validity ◽  
Interrater Reliability ◽  
Pain Scale ◽  
Pain Clinic ◽  
Positive Correlation ◽  
Pain Scales ◽  
Chronic Pain Patients ◽  
Pain Patients

Objectives. Although numerous studies have looked at the numeric rating scale (NRS) in chronic pain patients and several studies have evaluated objective pain scales, no known studies have assessed an objective pain scale for use in the evaluation of adult chronic pain patients in the outpatient setting. Subjective scales require patients to convert a subjective feeling into a quantitative number. Meanwhile, objective pain scales utilize, for the most part, the patient’s behavioral component as observed by the provider in addition to the patient’s subjective perception of pain. This study aims to examine the reliability and validity of an objective Chronic Pain Behavioral Pain Scale for Adults (CBPS) as compared to the traditional NRS. Methods. In this cross-sectional study, patients were assessed before and after an interventional pain procedure by a researcher and a nurse using the CBPS and the NRS. Interrater reliability, concurrent validity, and construct validity were analyzed. Results. Interrater reliability revealed a fair-good agreement between the nurse’s and researcher’s CBPS scores, weighted kappa values of 0.59 and 0.65, preprocedure and postprocedure, respectively. Concurrent validity showed low positive correlation for the preprocedure measurements, 0.34 (95% CI 0.16–0.50) and 0.47 (95% CI 0.31–0.61), and moderate positive correlation for the postprocedure measurements, 0.68 (95% CI 0.56–0.77) and 0.67 (95% CI 0.55–0.77), for the nurses and researchers, respectively. Construct validity demonstrated an equally average significant reduction in pain from preprocedure to postprocedure, CBPS and NRS median (IQR) scores preprocedure (4 (2–6) and 6 (4–8)) and postprocedure (1 (0–2) and 3 (0–5)), p < 0.001 . Discussion. The CBPS has been shown to have interrater reliability, concurrent validity, and construct validity. However, further testing is needed to show its potential benefits over other pain scales and its effectiveness in treating patients with chronic pain over a long-term. This study was registered with ClinicalTrial.gov with National Clinical Trial Number NCT02882971.

scholarly journals Depression Among Non-Cancer Chronic Pain Patients at a Tertiary Hospital in Malaysia

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
Rajesh Kumar Muniandy ◽  
T Kumaravadivel Dharmalingam
Keyword(s):  
Chronic Pain ◽  
Psychological Treatment ◽  
Severe Depression ◽  
Pain Clinic ◽  
Health Concern ◽  
Queen Elizabeth Hospital ◽  
Mild Depression ◽  
Chronic Pain Patients ◽  
Prevalence Of Depression ◽  
Pain Patients

INTRODUCTION: Pain is as important public health concern. Chronic pain patients most frequently present with depression, and this needed to be treated. The aim of the study was to find the prevalence of depression among non-cancer chronic pain patients attending a Pain Clinic in Malaysia, and discuss possible treatment methods to help these patients. MATERIAL AND METHODS: Inclusion criteria were all non- cancer chronic pain patients who visited the Pain Clinic of Queen Elizabeth Hospital (QEH), Kota Kinabalu, Sabah from 2013 till 2017. All patients were required to fill a PainDetect form and a Patient Health Questionnaire-9 (PHQ-9). RESULTS: Two hundred and fifty-four patient’s case notes were analysed. The results show that 29.6 % patients had mild depression, with 34.4% of patients had moderate to severe depression. There was a significant correlation between pain scores and depression. There was also a significant correlation between PainDetect scores and depression. CONCLUSION: There is a high prevalence of depression among non-cancer chronic pain patients. This study shows that psychological treatment for all chronic pain patients is needed.

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