Obstructive sleep apnea is common in patients with high-impact chronic pain – an exploratory study from an interdisciplinary pain center

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Dennis Boye Larsen ◽  
Laila Bendix ◽  
Karin Abeler ◽  
Kristian Kjær Petersen ◽  
Michael Sprehn ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Clinical Utility ◽  
Pain Treatment ◽  
Objective Assessment ◽  
High Impact ◽  
Sleep Monitoring ◽  
Predictive Values ◽  
Clinical Pain ◽  
Obstructive Sleep

Abstract Objectives Sleep disturbances are increasingly recognized as a major part of chronic pain pathology. Obstructive sleep apnea (OSA) is a common occurrence in patients with chronic pain attending specialized pain clinics, yet its prevalence remains unclear. Using screening tools such as the Berlin and STOP-BANG questionnaires may aid in early identification of OSA and improve clinical care. This study i) examined the frequency of OSA based on objective sleep monitoring in patients with high-impact chronic pain, ii) explored potential differences in self-reported pain and sleep characteristics between patients with and without OSA, and iii) tested the agreement between OSA classification based on objective assessment and two OSA screening questionnaires. Methods A consecutive cohort of 90 patients (71 women and 19 men; mean age: 47.1 ± 11.0 years) referred for interdisciplinary pain treatment, underwent one night of sleep monitoring using portable respiratory polygraphy (RP), and suspected OSA was confirmed with polysomnography (PSG). Self-reported data on clinical pain (severity, pain drawings and health-related quality of life), sleep characteristics (sleep quality insomnia, sleepiness), and risk of OSA (Berlin and STOP-BANG questionnaires) were collected the day before RP assessment. Results Forty-six (51.1%) patients were classified with OSA according to RP and verified with PSG. Twenty-eight patients (31.1%) had moderate or severe OSA (apnea-hypopnea index [AHI] >15). Patients with OSA reported lower sleep quality compared with patients without OSA. Scores on pain severity, disability, quality of life, insomnia and sleepiness were comparable between patients with and without OSA. Sensitivity and specificity were 78.6 and 45.2% respectively for the Berlin questionnaire, and 71.4 and 58.1% respectively for the STOP-BANG questionnaire. The agreement for both questionnaires with objective assessment was poor-to-fair. Both questionnaires had acceptable negative predictive values but low positive predictive values reducing the clinical utility to identify patients with low OSA-risk in this sample. Conclusions The current study demonstrates a high prevalence of OSA in patients with high-impact chronic pain referred to specialized pain treatment, however the clinical pain profiles were similar in patients with and without OSA. The Berlin and STOP-BANG questionnaires have poor specificity and low-to-fair agreement with RP/PSG questioning their clinical utility in identifying OSA in this sample.

scholarly journals Dorsal Root Ganglion (DRG) and Chronic Pain

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Amnon A. Berger ◽  
Yao Liu ◽  
HarLee Possoit ◽  
Anna C. Rogers ◽  
Warner Moore ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Dorsal Root ◽  
Randomized Trials ◽  
Pain Treatment ◽  
Common Condition ◽  
Significant Morbidity ◽  
Chronic Neuropathic Pain

Context: Chronic neuropathic pain is a common condition, and up to 11.9% of the population have been reported to suffer from uncontrolled neuropathic pain. Chronic pain leads to significant morbidity, lowered quality of life, and loss of workdays, and thus carries a significant price tag in healthcare costs and lost productivity. dorsal root ganglia (DRG) stimulation has been recently increasingly reported and shows promising results in the alleviation of chronic pain. This paper reviews the background of DRG stimulation, anatomical, and clinical consideration and reviews the clinical evidence to support its use. Evidence Acquisition: The DRG span the length of the spinal cord and house the neurons responsible for sensation from the periphery. They may become irritated by direct compression or local inflammation. Glial cells in the DRG respond to nerve injury, producing inflammatory markers and contribute to the development of chronic pain, even after the resolution of the original insult. While the underlying mechanism is still being explored, recent studies explored the efficacy of DRG stimulation and neuromodulation for chronic pain treatment. Results: Several reported cases and a small number of randomized trials were published in recent years, describing different methods of DRG stimulation and neuromodulation with promising results. Though evidence quality is mostly low, these results provide evidence to support the utilization of this technique. Conclusions: Chronic neuropathic pain is a common condition and carries significant morbidity and impact on the quality of life. Recent evidence supports the use of DRG neuromodulation as an effective technique to control chronic pain. Though studies are still emerging, the evidence appears to support this technique. Further studies, including large randomized trials evaluating DRG modulation versus other interventional and non-interventional techniques, are needed to further elucidate the efficacy of this method. These studies are also likely to inform the patient selection and the course of treatment.

scholarly journals Toward Gamified Pain Management Apps: Mobile Application Rating Scale–Based Quality Assessment of Pain-Mentor’s First Prototype Through an Expert Study

10.2196/13170 ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. e13170
Author(s):  
Alexandra Hoffmann ◽  
Corinna A Faust-Christmann ◽  
Gregor Zolynski ◽  
Gabriele Bleser
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Mobile Application ◽  
Rating Scale ◽  
Pain Treatment ◽  
Semistructured Interview ◽  
Content Quality ◽  
Management Techniques ◽  
Health Experts

Background The use of health apps to support the treatment of chronic pain is gaining importance. Most available pain management apps are still lacking in content quality and quantity as their developers neither involve health experts to ensure target group suitability nor use gamification to engage and motivate the user. To close this gap, we aimed to develop a gamified pain management app, Pain-Mentor. Objective To determine whether medical professionals would approve of Pain-Mentor’s concept and content, this study aimed to evaluate the quality of the app’s first prototype with experts from the field of chronic pain management and to discover necessary improvements. Methods A total of 11 health professionals with a background in chronic pain treatment and 2 mobile health experts participated in this study. Each expert first received a detailed presentation of the app. Afterward, they tested Pain-Mentor and then rated its quality using the mobile application rating scale (MARS) in a semistructured interview. Results The experts found the app to be of excellent general (mean 4.54, SD 0.55) and subjective quality (mean 4.57, SD 0.43). The app-specific section was rated as good (mean 4.38, SD 0.75). Overall, the experts approved of the app’s content, namely, pain and stress management techniques, behavior change techniques, and gamification. They believed that the use of gamification in Pain-Mentor positively influences the patients’ motivation and engagement and thus has the potential to promote the learning of pain management techniques. Moreover, applying the MARS in a semistructured interview provided in-depth insight into the ratings and concrete suggestions for improvement. Conclusions The experts rated Pain-Mentor to be of excellent quality. It can be concluded that experts perceived the use of gamification in this pain management app in a positive manner. This showed that combining pain management with gamification did not negatively affect the app’s integrity. This study was therefore a promising first step in the development of Pain-Mentor.

scholarly journals Socio-Demographics, Pain Characteristics, Quality of Life and Treatment Values Before and After Specialized Interdisciplinary Pain Treatment: Results from the Danish Clinical Pain Registry (PainData)

2021 ◽  
Vol Volume 14 ◽  
pp. 1215-1230
Author(s):  
Henrik Bjarke Vaegter ◽  
Lars Oxlund Christoffersen ◽  
Thomas Peter Enggaard ◽  
Dorte Elise Møller Holdggard ◽  
Tram Nguyen Lefevre ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Treatment ◽  
Treatment Results ◽  
Clinical Pain ◽  
Interdisciplinary Pain Treatment ◽  
Before And After ◽  
Pain Characteristics

Pharmacologic Management for Cancer Pain

2020 ◽  
Author(s):  
Casey A. Murphy ◽  
Randolph Roig ◽  
John Faciane Jr. ◽  
Harry J. Gould, III
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Pain Treatment ◽  
Evidence Base ◽  
Evidence Based ◽  
Cancer Pharmacology ◽  
Pharmacologic Management ◽  
Keywords Cancer ◽  
Pain Care

Chronic pain is a major factor that impairs functionality and compromises quality of life.  Unfortunately, this type of pain is often under-treated due to lack of education about the use and range of effective non-pharmacologic modalities, about how to use and monitor pharmacologic modalities, and the fear about real and imagined adverse effects that are associated with its management.  Cancer is diagnosed in approximately 40% of the population with up to 89% experiencing some form of pain in the later stages of the disease. Unfortunately, a significant portion of this population receives inadequate treatment for their pain.  Here we provide a review of the evidence-base for determining the best approach for managing the pain of malignancy in the hope of providing a basic framework for the physician to better utilize the pharmacological options that comprise an important component of comprehensive pain care for the cancer patient.   This review contains 2 figures, 7 tables, and 106 references. Keywords: Cancer pain, malignant pain, opioids, chronic pain, analgesic options, adjuvant options, cancer pharmacology, evidence-based pain treatment

Pharmacologic Management for Cancer Pain

2020 ◽  
Author(s):  
Casey A. Murphy ◽  
Randolph Roig ◽  
John Faciane Jr. ◽  
Harry J. Gould, III
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Pain Treatment ◽  
Evidence Base ◽  
Evidence Based ◽  
Cancer Pharmacology ◽  
Pharmacologic Management ◽  
Keywords Cancer ◽  
Pain Care

Chronic pain is a major factor that impairs functionality and compromises quality of life.  Unfortunately, this type of pain is often under-treated due to lack of education about the use and range of effective non-pharmacologic modalities, about how to use and monitor pharmacologic modalities, and the fear about real and imagined adverse effects that are associated with its management.  Cancer is diagnosed in approximately 40% of the population with up to 89% experiencing some form of pain in the later stages of the disease. Unfortunately, a significant portion of this population receives inadequate treatment for their pain.  Here we provide a review of the evidence-base for determining the best approach for managing the pain of malignancy in the hope of providing a basic framework for the physician to better utilize the pharmacological options that comprise an important component of comprehensive pain care for the cancer patient.   This review contains 2 figures, 7 tables, and 106 references. Keywords: Cancer pain, malignant pain, opioids, chronic pain, analgesic options, adjuvant options, cancer pharmacology, evidence-based pain treatment

scholarly journals Preliminary validity and test–retest reliability of two depression questionnaires compared with a diagnostic interview in 99 patients with chronic pain seeking specialist pain treatment

2020 ◽  
Vol 20 (4) ◽  
pp. 717-726
Author(s):  
Thuy Vy Kha ◽  
Elsebeth Stenager ◽  
Huong Hoang ◽  
Karin Bruun-Plesner ◽  
Kira Søndberg Fuglsang ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Major Depression ◽  
Pain Treatment ◽  
Diagnostic Interview ◽  
Clinical Depression ◽  
Depression Screening ◽  
Predictive Values ◽  
Retest Reliability ◽  
Screening Questionnaires ◽  
Test Retest Reliability

AbstractObjectivesDepression symptomatology is highly prevalent in patients with chronic pain, but accurate identification of major depression may be challenged due to time constraints and diagnostic interviews are therefore not routinely performed in clinical practice. Assessment of depression may be facilitated through the use of full-length depression screening questionnaires with acceptable construct validity and test-retest reliability. However, as previously indicated screening questionnaires may overestimate depression in patients with chronic pain, possibly due to overlapping symptoms. However, the failure to screen for depression may raise a concern for missing relevant cases with depression. The objectives of this study were to (1) quantify the validity of the 9-items Patient-Health Questionnaire (PHQ9) and the Major Depression Inventory (MDI) compared with a diagnostic interview in patients with chronic pain seeking specialist pain treatment, and (2) assess the relative test-retest reliability of PHQ9 and MDI over two weeks.MethodsResponses to the PHQ9 and MDI were compared with a Present-State-Examination (PSE) interview in 99 patients with chronic pain referred to interdisciplinary pain treatment. PHQ9 and MDI were completed twice over two weeks. Construct validity were assessed with the area under the curve (AUC) analysis, and performance characteristics derived from 2 × 2 contingency tables in which scores on the screening questionnaires were dichotomized and compared with the classification of clinical depression based on the diagnostic interview. Relative test-retest reliability was assessed with intraclass correlation coefficients (ICC).ResultsBased on the PSE interview, the prevalence of depression was 22.2%, and according to the PHQ9 and MDI questionnaires the prevalence was 26.3 and 34.3%, respectively. Compared with the diagnostic PSE, the PHQ9 and MDI questionnaires had areas under the curve of 0.83 and 0.88, respectively. Both questionnaires had high negative predictive values (PHQ9: cut-off of 11; MDI: cut-off of 26), but low positive predictive values for all possible scores. ICC values were excellent.ConclusionsThe PHQ9 and MDI questionnaires reliably identified chronic pain patients unlikely to have clinical depression, but showed limited validity identifying patients with clinical depression. These preliminary results may have clinical implications in depression screening in patients with chronic pain seeking specialist pain treatment. Clinicians in a specialty care pain clinic can use these screening questionnaires to identify patients without depression, but caution should be used when positive cases are identified by PHQ9 or MDI due to the risk of false positives.

scholarly journals Toward Gamified Pain Management Apps: Mobile Application Rating Scale–Based Quality Assessment of Pain-Mentor’s First Prototype Through an Expert Study (Preprint)

2018 ◽  
Author(s):  
Alexandra Hoffmann ◽  
Corinna A Faust-Christmann ◽  
Gregor Zolynski ◽  
Gabriele Bleser
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Mobile Application ◽  
Rating Scale ◽  
Pain Treatment ◽  
Semistructured Interview ◽  
Content Quality ◽  
Management Techniques ◽  
Health Experts

BACKGROUND The use of health apps to support the treatment of chronic pain is gaining importance. Most available pain management apps are still lacking in content quality and quantity as their developers neither involve health experts to ensure target group suitability nor use gamification to engage and motivate the user. To close this gap, we aimed to develop a gamified pain management app, Pain-Mentor. OBJECTIVE To determine whether medical professionals would approve of Pain-Mentor’s concept and content, this study aimed to evaluate the quality of the app’s first prototype with experts from the field of chronic pain management and to discover necessary improvements. METHODS A total of 11 health professionals with a background in chronic pain treatment and 2 mobile health experts participated in this study. Each expert first received a detailed presentation of the app. Afterward, they tested Pain-Mentor and then rated its quality using the mobile application rating scale (MARS) in a semistructured interview. RESULTS The experts found the app to be of excellent general (mean 4.54, SD 0.55) and subjective quality (mean 4.57, SD 0.43). The app-specific section was rated as good (mean 4.38, SD 0.75). Overall, the experts approved of the app’s content, namely, pain and stress management techniques, behavior change techniques, and gamification. They believed that the use of gamification in Pain-Mentor positively influences the patients’ motivation and engagement and thus has the potential to promote the learning of pain management techniques. Moreover, applying the MARS in a semistructured interview provided in-depth insight into the ratings and concrete suggestions for improvement. CONCLUSIONS The experts rated Pain-Mentor to be of excellent quality. It can be concluded that experts perceived the use of gamification in this pain management app in a positive manner. This showed that combining pain management with gamification did not negatively affect the app’s integrity. This study was therefore a promising first step in the development of Pain-Mentor. CLINICALTRIAL

scholarly journals Effects of COVID-19 Social Distancing Measures in Individuals with Chronic Pain Living in Spain in the Late Stages of the Lockdown

2021 ◽  
Vol 18 (22) ◽  
pp. 11732
Author(s):  
Jordi Miró ◽  
Elisabet Sánchez-Rodríguez ◽  
Alexandra Ferreira-Valente ◽  
José Pais-Ribeiro ◽  
Antonella Ciaramella
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Online Survey ◽  
Family Income ◽  
Pain Treatment ◽  
Negative Impact ◽  
Good Health ◽  
Social Distancing ◽  
Late Stages

Social distancing measures during the lockdown have had a negative impact on chronic pain patients’ function. Research, however, has only focused on the early stages of the first lockdowns. The aim of this study was to improve the understanding of the effects of COVID-19 social distancing measures on individuals with chronic pain living in Spain during the late stages of the lockdown. A group of 361 adults with pain participated in this study. They responded to an online survey and provided information on sociodemographic issues, pain, fatigue, perceived health, and quality of life. The data showed that most participants suffered moderate to severe pain and interferences with pain treatment and an increase in pain intensity during the lockdown. Most participants also informed us that fatigue had worsened during the lockdown (62%). Importantly, females with lower monthly family income and lower education have been found to be associated with greater levels of pain and fatigue. Despite this, participants perceived themselves as having good health and good quality of life. The findings from this study can be used to inform policy and specific responses for future COVID-19 waves and future pandemics where social distancing measures must be implemented.

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