scholarly journals Addressing the Adequacy of Current MPN Pain Management Strategies: An International Survey of 502 Patients By the MPN Quality of Life Study Group

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4298-4298
Author(s):  
Holly L. Geyer ◽  
Robyn M. Scherber ◽  
Gina Mazza ◽  
Blake T. Langlais ◽  
Ruben A. Mesa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Pain Management ◽  
Research Funding ◽  
Bone Pain ◽  
Abdominal Discomfort ◽  
Study Group ◽  
Life Study ◽  
History Of

Abstract Introduction: MPN-related pain, including abdominal discomfort (53.2%), and bone pain (48.5%), is a prevalent complaint within the disorder and is associated with impaired patient quality of life, reduction in most functional domains and overall poor prognosis. Non-targeted treatments for MPN disorders have been previously shown to provide little symptomatic relief for MPN pain. To date, little is known about patient viewpoints on MPN pain, its relationship to other chronic pain syndromes and the impact of pharmacologic and non-pharmacologic pain therapies. In this study, we performed an international survey of MPN patients to better understand the prevalence and management of MPN pain. Methods: This study was performed by the MPN Quality of Life Study Group. A survey was designed by a team of MPN investigators experienced with MPN symptomatology. Survey content included the Barriers Questionnaire II (BQII), a 27-item survey validated to assess patient belief barriers to optimal management of cancer pain measured on a 0 (do not agree at all) to 5 (agree very much) scale (Pain. 2002 Oct;99(3):385-96.). Patients also completed the MPN-10, a 10-item survey of MPN symptoms completed on a 0 (absent) to 10 (worst imaginable) scale (Blood. 2011 Jul 14;118(2):401-8). The survey was posted on high-traffic MPN-related webpages focused on patient education and advocacy (MPN Forum, MPN Net, MPN Research Foundation, MPN Voice) for a total of 28 days. Survey questions evaluated patient demographics, pain histories, current and prior treatment strategies, as well as satisfaction with and barriers to available treatment options. Results: Demographics A total of 502 MPN patients (MF 26.9%, PV 44.2%, ET 28.9%) completed the survey. Patients were of expected mean age (60.5 years) and primarily female (74.9%). Most were from the United States (66.7%) and primarily English speaking (92.2%). Patients described being diagnosed with their MPN 3 to 10 years (35.4%) or >10 years ago (30.8%). Splenic enlargement was vocalized by 36.5% of patients and few patients had had a known history of blood clots (25.4%), severe bleeding (13.3%), conversion to acute leukemia (0.4%) or prior bone marrow transplant (1.4%). Patients described a treatment history of a variety of MPN therapies including aspirin (82.7%), hydroxyurea (60.6%), phlebotomy (40.6%), ruxolitinib (25.9%), interferon (18.5%), anagrelide (17.3%), active clinical trial (5.0%) and radiation treatment (0.4%). Pain Severity, Prevalence and Treatments Among surveyed patients, the MPN-10 mean was 28.3. Mean individual symptom scores and prevalence were 3.1 and 65.6% for abdominal discomfort and 3.0 and 60.4% for bone pain, respectively indicating a low to moderate symptom burden. Most patients had no prior history of chronic pain prior to their MPN diagnosis (47.1%), with chronic abdominal pain and chronic bone/muscle pain noted prior to MPN development in 5.6% and 20.8% of patients, respectively. Most patients felt that their chronic pain has either stayed the same (26.2%), worsened (28.3%) or significantly worsened (14.5%) since their MPN diagnosis. Many patients found pharmacologic and non-pharmacological therapies efficacious for individual pain symptoms, and 42.1% described regularly taking medication to control their pain (Table 1). Barriers to Pain Management Overall, 42.3% of MPN patients reported being unsatisfied with their current pain management plan. Despite this, only 43.5% of patients stated that their MPN providers discussed pain during office visits. Palliative Care (3.1%) and Pain Management (7.3%) were infrequently engaged. On the BQII, patients described being confident that cancer can cause pain (mean 4.2, SD 1.1) but did not necessarily expect to have pain following their MPN diagnosis (mean 2.2, SD 1.8). Conclusion Chronic pain (abdominal, bone) is a prevalent and undermanaged feature of MPN disorders. Chronic non-MPN pain is further complicated by the development of the disorder. Many MPN patients lack understanding on its prevalence and furthermore feel ill-equipped to manage it. Patients have, however, found symptomatic benefit from various pharmacological and non-pharmacological treatment modalities that require further exploration. Results from this study suggest MPN patients should be assessed regularly for pain and offered early referral to specialized services for evaluation, source identification and treatment. Table 1. Table 1. Disclosures Scherber: Incyte: Consultancy; Orphan Pharmaceuticals: Honoraria. Mesa:Ariad: Consultancy; Galena: Consultancy; CTI: Research Funding; Incyte: Research Funding; Promedior: Research Funding; Gilead: Research Funding; Novartis: Consultancy; Celgene: Research Funding. Dueck:Bayer: Employment; Pfizer: Honoraria; Phytogine: Employment. Palmer:Novartis: Research Funding.

scholarly journals Prevalence and Risk Factors for Opioid-Related Complications in Patients with Myeloproliferative Neoplasms: An International Survey of 502 Patients By the MPN Quality of Life Study Group

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4297-4297
Author(s):  
Holly L. Geyer ◽  
Robyn M. Scherber ◽  
Gina Mazza ◽  
Blake Langlais ◽  
Leslie Padrnos ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Research Funding ◽  
Pain Treatment ◽  
Symptom Burden ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Life Study ◽  
History Of

Abstract Introduction: Myeloproliferative Neoplasm (MPN) patients encounter debilitating pain syndromes as a result of their disorder. Opioids are frequently employed in cancer-related pain but have been increasingly recognized for their risk profiles including accidental overdose, addiction and death. With many MPN patients facing near-normal life expectancies, chronicity of opioid use may increase the risk of adverse events. In this survey, we evaluated the prevalence of MPN opioid use, risk factors for negative outcomes and compared the features of this population to MPN patients not receiving opioid therapy. Methods: This study was performed by the MPN Quality of Life Study Group. A survey was designed by a team of MPN investigators experienced with MPN symptomatology. Patients completed the MPN-10, a 10 item survey of MPN symptoms completed on a 0 (absent) to 10 (worst imaginable) scale (Blood. 2011 Jul 14;118(2):401-8). Other surveyed tools included the Opioid Risk Tool (ORT) as well as DSMV criteria for Opioid Use Disorder (OUD). The survey was posted on high-traffic MPN-related webpages focused on patient education and advocacy (MPN Forum, MPN Net, MPN Research Foundation, MPN Voice)for a total of 28 days. Patients currently receiving opioids were compared to patients not receiving opioids and statistical significance was defined as p<0.05. Results Demographics A total of 416 patients completed the survey and were compared by active opioids use (n=69) vs. no active opioid use (n=347). Patients described a history of myelofibrosis (MF, 28.8%), polycythemia vera (PV, 44.2%) and essential thrombocythemia (ET, 26.9%). Most MPNs were diagnosed between 1-3 years ago (22.2%), 3-10 years ago (35.0%) or >10 years ago (30.4%). Patients were furthermore of expected mean age (60.7), primarily female (75.0%) and from the United States (66.6%). Few patients had a history of transformation to acute leukemia (0.5%), severe bleeding (12.3%) or blood clot (26.5%). Mean individual symptom scores and prevalences were 3.0 and 65.6% for abdominal discomfort and 3.3 and 59.4% for bone pain, respectively, indicating a low to moderate symptom burden. Patients Receiving Opioid Therapy Patients on opioid therapy (n=69) displayed a number of high risk features for adverse outcomes including a personal history of substance abuse (20.2%), respiratory disease (33%) and mental health disorders (60.1%). By DSMV criteria, 5.9% of opioid patients scored 'mild' and 2.9% scored 'moderate' for OUD (total 8.8%), consistent with prevalence in the general population. Approximately 24.6% of opioid-using patients scored moderate to high risk on the ORT but despite this, did not appear more likely to meet criteria for OUD (p=0.81). Palliative care and pain management were involved in only 34.3% of patients and side effects of opioids were discussed in only 70.1% of all cases. Opioid vs. Non-Opioid Patients Compared to patients not receiving opioid therapy, patients currently on opioid treatment were more likely to describe more frequent and/or more severe abdominal discomfort (88.4% vs. 61.0%, p<0.001; mean 5.0 vs. 2.6, p<0.001), bone pain (87.0% vs. 53.9%, p<0.001; mean 5.6 vs. 2.4, p<0.001), unintentional weight loss (41.2% vs. 21.4%, p=0.001), inactivity (94.2% vs. 71.5%, p<0.001), early satiety (84.1% vs. 58.2%, p<0.001), and impaired quality of life (mean 4.9 vs. 6.6, p<0.001). They were also more likely to describe regularly taking pain medications (85.5% vs. 34.5%, p<0.001) as well as attempt non-pharmacological treatments to manage symptoms (Figure 1). Despite more aggressive pain treatment approaches, only 42% of opioid patients reported satisfaction with their current pain plan vs. 62.2% of patients not receiving opioid therapy. Conclusions: MPN patients face significant symptom burden despite often limited reduction in life expectancy. Patients furthermore demonstrate a high prevalence of risk factors for opioid-related complications including overdose and substance misuse. Despite aggressive pain regimens, opioid patients are less likely to voice adequate symptom control or satisfaction with their pain treatment plans. Providers should be cognizant of opioid-related complications and consider subspecialty pain management referrals or adaptation of the JCO Clinical Practice Guidelines for Management of Chronic Pain in Survivors of Adult Cancers (J Clin Oncol. 2016 Sep 20;34(27):3325-45). Disclosures Scherber: Orphan Pharmaceuticals: Honoraria; Incyte: Consultancy. Palmer:Novartis: Research Funding. Dueck:Phytogine: Employment; Pfizer: Honoraria; Bayer: Employment. Mesa:Gilead: Research Funding; Novartis: Consultancy; CTI: Research Funding; Galena: Consultancy; Incyte: Research Funding; Promedior: Research Funding; Ariad: Consultancy; Celgene: Research Funding.

scholarly journals Group Interprofessional Chronic Pain Management in the Primary Care Setting: A Pilot Study of Feasibility and Effectiveness in a Family Health Team in Ontario

2013 ◽  
Vol 18 (5) ◽  
pp. 237-242 ◽  
Author(s):  
Ricardo N Angeles ◽  
Dale Guenter ◽  
Lisa McCarthy ◽  
Martha Bauer ◽  
Miriam Wolfson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Resource Utilization ◽  
Health Resource ◽  
Health Resource Utilization ◽  
Significant Difference ◽  
The Mean

BACKGROUND: Approximately 18.9% of Canadians live with chronic pain. Primary care reform in Ontario presents unique opportunities to assess approaches to help these patients.OBJECTIVE: To assess the feasibility of an interprofessional primary care-based program for patients living with chronic pain, and to examine the potential impact of such a program on quality of life and health resource utilization.METHODS: >An embedded mixed-methods evaluation (randomized controlled trial with waiting list control and semistructured interviews) of an eight-week series of small group sessions exploring multifactoral aspects of pain management was performed. Participants were randomly assigned to early intervention (EI) or delayed intervention (DI) groups. All participants received the intervention; the DI group served as a control group for comparison with the EI group. Outcomes included the Short Form-36 Health Survey version 2 (SF-36v2), medication use and health care utilization. Qualitative interviews were conducted to identify areas for program improvement.RESULTS: A total of 240 patients were recruited and 63 agreed to participate. The mean (± SD) age of the participants was 55±14.1 years and 62.3% were female. There was no significant difference in the mean change in SF-36v2 summary scores between the EI and DI groups. However, the SF-36v2 subscale score for bodily pain was significantly improved in the EI group compared with the DI group after six months of observation (mean difference = 13.1 points; P<0.05). There was also significant improvement in this score when both groups were pooled and aggregate preintervention and postintervention scores were compared. There was a significant decrease in the mean number of clinic visits in the six-month period following the intervention compared with the six-month period before the intervention (P=0.043).CONCLUSION: An interprofessional program in primary care for patients living with chronic pain may lead to improvements in quality of life and health resource utilization. The challenges to the feasibility of the program and its evaluation are recruitment and retention of patients, leading to the conclusion that the program, as it was conducted in the present study, is not appropriate for this setting.

Yoga and Chronic Pain Management—Telling Our Story

2004 ◽  
Vol 14 (1) ◽  
pp. 59-67
Author(s):  
Ginger Wood
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Pain Management ◽  
Psychological Health ◽  
Emotional Health ◽  
Body Awareness ◽  
Chronic Pain Management ◽  
Subjective Quality Of Life ◽  
Yoga Therapy

Purpose: To examine the effects of an 18-month period of Yoga therapy on a single student suffering from chronic pain, specifically fibromyalgia, and to determine what measures are needed to report improvements. Improvements documented over a specific time period in a controlled setting can further the case for using Yoga as a primary means for managing fibromyalgia and chronic pain and also provide a background to establish a working dialogue with practitioners of Western medicine. Study Design: Using case-study research methods, an 18-month period of gentle Iyengar-based Yoga was implemented 1–2x/week in a woman suffering from fibromyalgia and chronic pain. Findings: The findings showed that the student steadily improved in many measures, including pain, body awareness, medications dose/type, body weight, cholesterol, hypertension, bone density, and subjective quality of life measures(increased confidence, improved body image). Conclusions:The information collected during this study provides positive evidence that can assist in the future development of chronic pain management with Yoga therapy. As Yoga therapists, we have a professional obligation to document the changes and improvements our Yoga students are experiencing in a controlled Yoga studio environment. Collecting this information is vital to establishing an open dialogue between practitioners of Western and Eastern medicine. Future case studies and research should include more diverse populations of chronic pain sufferers as well as the use of tools that quantify a student's intangible concerns and complaints(i.e., pain level, quality of life, psychological health,emotional health, ease of daily activity completion, etc.).

scholarly journals Validation of the WHOQOL-100: Pain Management Improves Quality of Life for Chronic Pain Patients

2001 ◽  
Vol 17 (3) ◽  
pp. 264-275 ◽  
Author(s):  
Suzanne M. Skevington ◽  
Marlene S. Carse ◽  
Amanda C. de C. Williams
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Pain Management ◽  
Chronic Pain Patients ◽  
Pain Patients

Unconventional Pain Management for People With Systemic Lupus Erythematosus: A Systematic Literature Review

2020 ◽  
Vol 51 (1) ◽  
pp. 3-15
Author(s):  
Viviana Garza
Keyword(s):  
Quality Of Life ◽  
Systemic Lupus Erythematosus ◽  
Chronic Pain ◽  
Pain Management ◽  
Mental Health Professionals ◽  
Lupus Erythematosus ◽  
Expressive Writing ◽  
Treatment Plan ◽  
Systemic Lupus

People with chronic pain account for 65% of the population diagnosed with systemic lupus erythematosus (SLE). SLE is a fast-growing medical autoimmune disease responsible for 16,000 new cases yearly. More than 60% experience chronic pain due to arthritis related conditions causing daily distress and an overall diminished quality of life. Methods of pain management have helped relieve the psychosocial and physical effects pain causes on individuals. The purpose of this review was to explore methods of pain interventions used among people with SLE. A systematic literature search was conducted to examine methods of pain management among people with SLE. Seven articles met the inclusion and exclusion criteria. Findings suggest that pain management methods such as cognitive behavior therapy, education interventions, physical exercise, expressive writing, benefit finding writing, and acupuncture have been helpful in pain management among people with SLE. Benefits of utilizing these pain management methods include improved physical activity, social function, pain reduction, better sleep, and improved overall quality of life. Health and mental health professionals can consider these methods when developing a comprehensive pain treatment plan for people with SLE.

scholarly journals Patient Satisfaction with Spanish Pain Centers: Observational Study with More than 3,000 Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Juan Antonio García García ◽  
Patricia Hernández-Puiggròs ◽  
Javier Tesedo Nieto ◽  
María Pilar Acín Lázaro ◽  
Alfredo Carrera González ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Patient Satisfaction ◽  
Pain Management ◽  
Pain Control ◽  
Short Form ◽  
Waiting Times ◽  
Brief Pain Inventory ◽  
Management Approach

Chronic pain is a serious problem in Spain. This multicenter, epidemiological 3-month follow-up study investigates pain management efficacy in Spanish centers using patient satisfaction criteria. 3,414 eligible adult patients (65,6% female) with moderate to severe chronic pain from 146 pain centers were included. Patient satisfaction was assessed based onto question 18 of Spanish healthcare barometer-CSI. Pain evolution (Brief Pain Inventory-Short Form (BPI-SF) and visual analog scale (VAS)), quality of life/EuroQol-5, and pain control expectations fulfillment were also assessed. Mean age was 61.3 years. 64.4% of participating centers employed multidisciplinary pain management approach. After 3 months, mean patient satisfaction was 7.8 (1–10) on the CIS barometer. Medical staff received the highest scores, whereas waiting for tests, appointment request to appointment date time, and waiting times at the center the lowest. Mean pain decreased from 7.4 to 4.0; BPI-SF intensity decreased from 6.5 to 3.8; pain control expectations were met in 78.7% of patients; EuroQoL-5D utility index increased from 0.37 to 0.62, p<0.001, and health status (VAS) from 40.6 to 61.9, p<0.001. Chronic pain patients (90%) are satisfied with Spanish centers care; 80% had their pain control expectations met. Quality of life improved remarkably: 71% felt moderately to significantly better. However, waiting times need improvement.

scholarly journals Chronic Pain Management Among Older Adults: A Scoping Review

2019 ◽  
Vol 5 ◽  
pp. 237796081987425
Author(s):  
Ampicha Nawai
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Chronic Pain ◽  
Pain Management ◽  
Outcome Measures ◽  
Scoping Review ◽  
Roy Adaptation Model ◽  
Chronic Pain Management ◽  
Adaptation Model

Chronic pain is a significant problem for older adults. The effect of chronic pain on older people’s quality of life needs to be described and identified. For a decade, the Roy Adaptation Model has been used extensively to explain nursing phenomena and guide nursing research in several settings with several populations. The objective of this study was to use the Roy Adaptation Model to describe chronic pain and present a systematic scoping review of the literature about the middle-range theory of chronic pain among older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses model guided a scoping review search method. A literature search was undertaken using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Ovid, and ProQuest. The search terms were “chronic pain,” “pain management,” “older adult,” “Roy Adaptation Model,” and “a scope review.” The search included articles written in English published for the period of 2004–2017. All articles were synthesized using concepts of Roy’s Adaptation Model. Twenty-two studies were considered for the present review. Twenty-one articles were reports of quantitative studies, and one was a report of a qualitative study. Two outcome measures were found in this systematic scoping review. The primary outcomes reported in all articles were the reduction of pain due to interventions and an increase in coping with chronic pain. The secondary outcome measures reported in all studies were the improvement of physical function, quality of life, sleep disturbance, spiritual well-being, and psychological health related to pain management interventions among older adults. Many interventions of all studies reported improvement in chronic pain management among older adults. However, to improve chronic pain management, nurses need to understand about nursing theories, the context which instruments work, and develop empirical instruments based on the conceptual model.

scholarly journals Effectiveness of a Peer-Led Pain Management Program in Relieving Chronic Pain and Enhancing Pain Self-Efficacy Among Older Adults: A Clustered Randomized Controlled Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Mimi M. Y. Tse ◽  
Shamay S. M. Ng ◽  
Paul H. Lee ◽  
Xue Bai ◽  
Raymond Lo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Pain Management ◽  
Self Efficacy ◽  
Nursing Home Residents ◽  
Management Program ◽  
Control Group ◽  
Pain Management Program ◽  
Experimental Group

Chronic pain is common in nursing home residents, who may have difficulty seeking out pain management strategies. Peer support model show promise as a strategy for managing chronic conditions. This was a clustered randomized controlled trial. A peer-led pain management program was provided for the experimental group. Pain situation, depression, quality of life, non-drug strategies used, and pain knowledge were measured. A total of 262 participants joined the study (146 were allocated as experimental group and 116 as control group). Before our intervention, the mean pain score reported was as high as 6.36 on a 10-point Likert Scale. The high intensity of their pain very much interfered with the daily activities of the participants. Pain interference was high and the participants had poor coping as indicated by the low pain self-efficacy. Depression and a low quality of life score was found. Upon completion of our PAP, there was a significant increase in pain self-efficacy, pain interference as well as quality of life for the participants in the experimental group and not in the control group, and this improvement sustained in 3-month follow up. The present study used a peer support models and proven to be effective in managing pain and pain related situations for nursing home residents with chronic pain. The peer volunteers involved in the pain management program taught relevant pain knowledge and pain management strategies to help our participants.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03823495, NCT03823495.

scholarly journals Non-venereal genital dermatoses and their impact on quality of life—A cross-sectional study

2021 ◽  
Vol 0 ◽  
pp. 1-6
Author(s):  
N. Vinay ◽  
P. S. S. Ranugha ◽  
Jayadev B. Betkerur ◽  
Veeranna Shastry ◽  
P. K. Ashwini
Keyword(s):  
Quality Of Life ◽  
Dermatology Life Quality Index ◽  
Quality Index ◽  
Life Quality ◽  
Unprotected Sex ◽  
Study Group ◽  
Lichen Simplex Chronicus ◽  
History Of ◽  
Life Quality Index

Background: Lesions on the external genitalia could be venereal or non-venereal. Non-venereal genital dermatoses are common and may cause considerable anxiety to patients, particularly if noticed after sexual intercourse. However, this aspect has not been studied much till now. Objectives: Our study proposes to describe the profile of non-venereal genital dermatoses and determine their impact on quality of life both social and sexual, using the dermatology life quality index questionnaire. Methods: We recruited patients aged 18 years and above, who were diagnosed to have non-venereal genital dermatoses during the study period. A detailed history was obtained and clinical examination done with relevant investigations when necessary. The dermatology life quality index was assessed and graded in all patients using Finlay dermatology life quality index questionnaire. Results: A total of 293 patients with non-venereal genital dermatoses were seen and 25 different dermatoses were observed. Men 242(82.6%) outnumbered women. The commonest age group affected was 31–50 years 144(50%). Chronic inflammatory dermatoses 135(41.6%) constituted the majority of cases. Scrotal dermatitis 46(15.7%), lichen simplex chronicus 37(12.6%), vitiligo 31(10.6%) were seen most frequently. In the study group, 111(37.9%) patients had moderate and 133(45.4%) had large impact on the quality of life. Erectile dysfunction was seen in 48(19.8%) men and 9(3.7%) had premature ejaculation. A significant effect on dermatology life quality index was found with increasing age (P = 0.007), positive marital status (P = 0.006), history of unprotected sex (P < 0.001), history of recurrences (P = 0.002) and venereophobia. (P = 0.008). Limitations: The number of women in the study group was less compared to men and we could not ascertain the type of sexual dysfunction in them. Conclusion: Non-venereal genital dermatoses are common, more so among men. They have a significant impact on the quality of life of the individual. Recognizing and addressing this problem will help in managing these patients effectively.

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