Metamorphosis of Acute to Chronic Pain: A Novel Era of Discoveries in the Field of Pain Medicine

Objective: Wikipedia is commonly used to acquire information about various medical conditions such as chronic pain. Ideally, better online pain management content could reduce the burden of opioid use disorders. Our goal was to improve the quality of the content available on Wikipedia to make it more accurate and applicable to medical students and the general public while training medical students to practice evidence-based medicine and critically assess their sources of information. Methods: An elective class in Neuroscience, Pain, and Opioids composed of 10 medical students met biweekly to discuss landmark and practice-changing research articles in the fields of acute pain, chronic pain, and opioid management. The professor chose Wikipedia articles relevant to this course. Three independent viewers analyzed the quality of citations, anecdotal medical content, and content value for both patients and medical professionals. As part of their coursework, students then edited the Wikipedia articles. Results: Although some of the Wikipedia pain topic content (6.7% ± 2.0) was anecdotal, financially biased, or inconsistent with Western Medical Practice content, overall articles included primarily high-quality citations (85.6% ± 3.1). On a 0-5 Likert scale, students felt content would be moderately helpful for both medical students/professionals (3.4 ± 0.2) and laypersons (3.5 ± 0.2). Editing and adding citations was feasible, but novel material was often reverted. Conclusion: A significant amount of pain medicine content was relevant and amenable to student editing. Therefore, future use of this tactic could provide a unique opportunity to integrate evidence-based medicine into the medical curriculum and have a direct impact on the widely available medical information. Future refinement in the editorial process may also further improve online information.

Download Full-text

Predicting opioid use disorder in patients with chronic pain who present to the emergency department

Injury Prevention ◽

10.1136/injuryprev-2018-042723 ◽

2018 ◽

Vol 25 (5) ◽

pp. 386-391

Author(s):

Robert Andrew Gardner ◽

Kori L Brewer ◽

Dennis B Langston

Keyword(s):

Emergency Department ◽

Chronic Pain ◽

Opioid Therapy ◽

Opioid Use Disorder ◽

Small Sample ◽

Pain Medicine ◽

Dose Increase ◽

Emergency Physicians ◽

Opioid Use ◽

Prescription Monitoring

BackgroundEmergency department (ED) patients with chronic pain challenge providers to make quick and accurate assessments without an in-depth pain management consultation. Emergency physicians need reliable means to determine which patients may receive opioid therapy without exacerbating opioid use disorder (OUD).MethodsEighty-nine ED patients with a chief complaint of chronic pain were enrolled. Researchers administered questionnaires and reviewed medical and state prescription monitoring database information. Participants were classified as either OUD or non-OUD. Statistical analysis included a bivariate analysis comparing differences between groups and multivariate logistic regression evaluating ORs.ResultsThe 45 participants categorised as OUD had a higher proportion of documented or reported psychiatric diagnoses (p=0.049), preference of opioid treatment (p=0.005), current oxycodone prescription (p=0.043), borrowed pain medicine (p=0.004) and non-authorised dose increase (p<0.001). The state prescription monitoring database revealed the OUD group to have an increased number of opioid prescriptions (p=0.005) and pills (p=0.010). Participants who borrowed pain medicine and engaged in non-authorised dose increase were 5.2 (p=0.025, 95% CI 1.24 to 21.9) and 6.1 times (p=0.001, 95% CI 1.55 to 24.1) more likely to have OUD, respectively.LimitationsMajor limitations of our study include a small sample size, self-reported measures and convenience sample which may introduce selection bias.ConclusionPatients with chronic pain with OUD have distinguishable characteristics. Emergency physicians should consider such evidence-based variables prior to opioid therapy to ameliorate the opioid crisis and limit implicit bias.

Download Full-text

Pain medicine

10.1093/med/9780199609956.003.0026 ◽

2014 ◽

Author(s):

Jeremy Prout ◽

Tanya Jones ◽

Daniel Martin

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Management Strategies ◽

Multidisciplinary Management ◽

Pain Medicine ◽

Pain Pathways ◽

Patient Groups ◽

Chronic Pain Conditions ◽

Sites Of Action ◽

Specific Management

This chapter summarizes the assessment and management of acute and chronic pain for FRCA. Pain pathways and physiological consequences of pain are considered along with sites of action and the pharmacology of common analgesics. Assessment of pain for different patient groups and settings is explained. Pain management strategies, pharmacological, non-interventional and interventional techniques are described, including multidisciplinary management of chronic pain. Specific management of some common chronic pain conditions, such as trigeminal neuralgia, are discussed in more detail.

Download Full-text

The Demise of Interdisciplinary Chronic Pain Management and Its Relationship to the Scourge of Prescription Opioid Diversion and Abuse

10.1093/med/9780199981830.003.0010 ◽

2018 ◽

Cited By ~ 1

Author(s):

Michael E. Schatman

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Healthcare Providers ◽

Well Being ◽

Insurance Companies ◽

Prescription Opioid ◽

Pain Medicine ◽

Opioid Crisis ◽

Opioid Medications ◽

Opioid Diversion

Even though the efficacy of interdisciplinary pain management programs is supported, their numbers have decreased and the vast majority of Americans with chronic pain do not have access to them. Insurance companies do not want to pay for these services, hospitals believe they are financial losers, and the opioid crisis has placed a pall over the practice of pain medicine. The demise of these programs has left pain medicine in a fragmented state. Few healthcare providers who treat chronic pain patients have the time to coordinate care by multiple professionals The opioid crisis seen in certain areas, such as Appalachia, may be related to the lack of these interdisciplinary programs. There should be concerted efforts to increase access to and funding of these programs. Although they are not a panacea for all types of chronic pain, they can improve patients’ well-being and function and reduce their need for opioid medications.

Download Full-text

Chronic pain – the idea of mechanism orientated treatment

Ból ◽

10.5604/01.3001.0012.5319 ◽

2018 ◽

Vol 19 (1) ◽

pp. 42-49

Author(s):

Magdalena Kocot-Kępska ◽

Renata Zajączkowska ◽

Jan Dobrogowski ◽

Anna Przeklasa-Muszyńska

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Pain Treatment ◽

Current Knowledge ◽

Empiric Therapy ◽

Pain Medicine ◽

Significant Progress ◽

Pain Syndromes ◽

Pain Chronification ◽

Rational Mechanism

Understanding the neurobiological mechanisms underlying chronic pain syndromes is a significant progress in modern pain medicine. Understanding the basic differences between acute and chronic pain processes, learning about the mechanisms of transition from acute to chronic pain, allows us to change the approach to pain management from commonly used empirical approach to more rational mechanism-oriented pain treatment. In many patients with chronic pain, empiric therapy, which does not consider the mechanisms of pain, is not fully effective. Often, when planning pharmacotherapy, current knowledge about the pain etiology and mechanisms of pain chronification is not considered. Management based on already known mechanisms of pain, using rational pharmacotherapy and non-pharmacological methods, may improve the quality and effectiveness of pain management.

Download Full-text