scholarly journals Exploring the Role of Awe in Architecture as a Pain Disruptor- A Call for New Research

2020 ◽  
Author(s):  
Miriam Hoffman
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Pain Management ◽  
Pain Perception ◽  
The United States ◽  
Management Tool ◽  
Opioid Overdose ◽  
Contributing Factors ◽  
Diverse Range ◽  
The Impact

Chronic pain is a widespread and complex phenomenon, driven by a diverse range of factors. Pain management has become a significant concern over the past several decades in the United States as controversy has grown surrounding the use of opioids for chronic pain management, the use of which has led to abuse and addiction. The Centers for Disease Control and Prevention (CDC) reports that 128 people die in the United States every day from an opioid overdose, whether obtained illicitly or by prescription. While opioids remain one of the frontline methods for pain management, their long term safety and efficacy has come under scrutiny. As with any complex systemic issue, there are many contributing factors to chronic pain and pain management. This paper proposes that the experience of awe – specifically elicited by design of the built environment – can serve as an innovative, non-pharmacological pain management tool. Awe is an emotional response to perceptually vast stimuli, precipitating accommodation or a shift in existing mental structures. The author hypothesizes that awe can be used as a form of the proven self-regulating pain management method known as reappraisal. Pain reappraisal is cognitive reframing of the context and meaning of pain, changing the value that pain is assigned and resulting in decreased pain perception. This paper explores the pertinent intersection of emotions, neuroscience, and the impact of the physical environment on our health and wellbeing. The intention of this paper is to call for a new line of research and does not attempt to address methods or results at this time.

scholarly journals Exploring the Role of Awe in Architecture as a Pain Disruptor- A Call for New Research

2020 ◽  
Author(s):  
Miram Hoffman
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Pain Management ◽  
Pain Perception ◽  
The United States ◽  
Management Tool ◽  
Opioid Overdose ◽  
Contributing Factors ◽  
Diverse Range ◽  
The Impact

Chronic pain is a widespread and complex phenomenon, driven by a diverse range of factors. Pain management has become a significant concern over the past several decades in the United States as controversy has grown surrounding the use of opioids for chronic pain management, the use of which has led to abuse and addiction. The Centers for Disease Control and Prevention (CDC) reports that 128 people die in the United States every day from an opioid overdose, whether obtained illicitly or by prescription. While opioids remain one of the frontline methods for pain management, their long term safety and efficacy has come under scrutiny. As with any complex systemic issue, there are many contributing factors to chronic pain and pain management. This paper proposes that the experience of awe – specifically elicited by design of the built environment – can serve as an innovative, non-pharmacological pain management tool. Awe is an emotional response to perceptually vast stimuli, precipitating accommodation or a shift in existing mental structures. The author hypothesizes that awe can be used as a form of the proven self-regulating pain management method known as reappraisal. Pain reappraisal is cognitive reframing of the context and meaning of pain, changing the value that pain is assigned and resulting in decreased pain perception. This paper explores the pertinent intersection of emotions, neuroscience, and the impact of the physical environment on our health and wellbeing. The intention of this paper is to call for a new line of research and does not attempt to address methods or results at this time.

Understanding Characteristics Of Users With Signs Of Opioid Misuse On Twitter (Preprint)

2020 ◽  
Author(s):  
Haya Jarad ◽  
Junhua Yang ◽  
Abeed Sarker
Keyword(s):  
United States ◽  
Pain Management ◽  
Religious Orientation ◽  
The United States ◽  
Opioid Abuse ◽  
Management Tool ◽  
Opioid Misuse ◽  
Major Health Problem ◽  
Personal Traits ◽  
And Behaviors

BACKGROUND Opioid misuse is a major health problem in the United States, and can lead to addiction and fatal overdose. The United States is in the midst of an opioid epidemic; in 2018, an average of approximately 130 Americans died daily from an opioid overdose and 2.1 million have an opioid use disorder (OUD). In addition to electronic health records (EHRs), social media have also been harnessed for studying and predicting physical and behavioral outcomes of OUD. Specifically, it has been shown that on Twitter the use of certain language patterns and their frequencies in subjects’ tweets are indicative of significant healthcare outcomes such as opioid misuse/use and suicide ideation. We sought to understand personal traits and behaviors of Twitter chatters relative to the motive of opioid misuse; pain or recreational. OBJECTIVE . METHODS We collected tweets using the Twitter public developer application programming interface (API) between April 13, 2018 – and May 21, 2018. A list of opioid-related keywords were searched for such as methadone, codeine, fentanyl, hydrocodone, vicodin, heroin and oxycodone. We manually annotated tweets into three classes: no-opioid misuse, pain-misuse and recreational-misuse, the latter two representing misuse for pain or recreation/addiction. We computed the coding agreement between the two annotators using the Cohen’s Kappa statistic. We applied the Linguistic Inquiry and Word Count (LIWC) tool on historical tweets, with at least 500 words, of users in the dataset to analyze their language use and learn about their personality raits and behaviors. LIWC is a text processing software that analyzes text narratives and produces approximately 90 variables scored based on word use that pertain to phsycological, emotional, behavioral, and linguistic processes. A multiclass logistic regression model with backward selection based on the BIC criterion was used to identify variables associated with pain and recreational opioid misuse compared to the base class; no-opioid misuse.. The goal was to understand whether personal traits or behaviors differ across different classes. We reported the odd ratios of different variables in both pain and recreational related opioid misuse classes with respect to the no-opioid misuse class. RESULTS The manual annotation resulted in a total of 1,164 opioid related tweets. 229 tweets were assigned to the pain-related class, 769 were in the recreational class, and 166 tweets were tagged with no opioid misuse class. The overall inter-annotator agreement (IAA) was 0.79. Running LIWC on the tweets resulted in 55 variables. We selected the best model based on BIC. We examined the variables with the highest odd ratios to determine those associated with both pain and recreational opioid misuse as compared to the base class. Certain traits such as depression, stress, and melancholy are established in the literature as commonplace amongst opiod abuse indiviuals. In our analysis, these same characteristics, amongst others, were identified as significantly positively associated with both the Pain and Recreational groups compared to the no-opioid misuse group. Despite the different motivaions for opiod abuse, both groups present the same core personality traits. Interestingly, individuals who misuse opioids as a pain management tool exhibited higher odds ratios for psychological processees and personal traits based on their tweet language. These include a strong focus on discipline, as demonstrated by the variables “disciplined”, “cautious” and “work_oriented”. Their tweet language is also indicative of cheerfulness, a variable absent in the recreational misuse group. Variables associated with the reacreational misuse group revolve around external factors. They are generous and motivated by reward, while maintaining a religious orientation. Based on their tweet language, this group is also characterized as “active”; we understand that these individuals are more social and community focused . CONCLUSIONS To our best knowledge, this is the first study to investigate motivations of opioid abuse as it relates to tweet language. Previous studies utilizing Twitter data were limited to simply detecting opiod abuse likelihood through tweets. By delving deeper into the classes of opioid abuse and its motivation, we offer greater insight into opioid abuse behavior. This insight extends beyond simple identification, and explores patterns in motivation. We conclude that user language on Twitter is indicative of significant differences in personal traits and behaviors depending on abuse motivation: pain management or recreation.

scholarly journals Pain-Related Limitations in Daily Activities Following Thoracic Surgery in a United States Population

2017 ◽  
Vol 3 (20;3) ◽  
pp. E367-E378 ◽  
Author(s):  
Emine O. Bayman
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Thoracic Surgery ◽  
Response Rate ◽  
The United States ◽  
Daily Activities ◽  
Life Questionnaire ◽  
Internal Reliability ◽  
Statistical Measures ◽  
The Impact

Background: Ringsted et al created a statistically validated questionnaire to assess painrelated limitations in daily activities following thoracic surgery and translated it to English. We utilized the questionnaire to assess the impact of pain impairing certain daily activities in a United States thoracic surgery population. Objectives: Examine if the questionnaire developed and translated to English by Ringsted et al to assess the effects of chronic pain after thoracic surgery on daily activities would be applicable in a sample of thoracic surgery patients in the United States. Study Design: Cross-sectional study by mailed questionnaire. Setting: All patients who had thoracic surgery between 6 months and 3 years ago at a university hospital. Methods: We sent questionnaires to patients who had undergone thoracic surgery between 6 months and 3 years ago, yielding a sample of 349 eligible patients. Questionnaire results were statistically assessed for item fit, dimensionality, and internal reliability. Results: The response rate was 26.4%. Of the responders, 36% (95% CI: 26.1% to 46.5%) identified themselves as having chronic pain related to their thoracic surgery. Activities such as lying on the operated side, coughing, and carrying groceries were impaired in more than 50% of the patients who had thoracic surgery related pain (P < 0.05). Patients with chronic pain were more likely to report pain in other body locations. Few activities were limited in the patients identifying themselves as not having chronic pain. Statistical measures indicate high internal reliability. Limitations: This was a retrospective questionnaire with 26.4% response rate. Conclusions: Pain continues to impair the daily activities of a significant proportion of patients after thoracic surgery in a sample from the United States. Despite cultural differences, the Danish procedure-specific questionnaire provides an applicable and similar assessment of functional impairment after thoracic surgery in American patients. Key words: Thoracic surgery, chronic pain, impairment, daily life, questionnaire

Assessing the impact of clinical pharmacists on naloxone coprescribing in the primary care setting

2020 ◽  
Vol 77 (7) ◽  
pp. 568-573
Author(s):  
Alexandra Watson ◽  
Kyle Guay ◽  
Dara Ribis
Keyword(s):  
United States ◽  
Primary Care ◽  
Care Setting ◽  
The United States ◽  
Care Group ◽  
Healthcare Team ◽  
Opioid Overdose ◽  
Ambulatory Care Setting ◽  
Clinical Pharmacists ◽  
The Impact

Abstract Purpose Opioid use and overdose are epidemic in the United States. While there is concern regarding the abuse of illegal opioids, overdose is also strongly associated with prescription opioids. The Centers for Disease Control and Prevention supports coprescribing of naloxone with opioids; however, a review of naloxone prescriptions recorded within a primary care group indicated limited use of the reversal agent. Methods Through the collaboration of pharmacy and information services personnel, a report was created to identify all patients receiving chronic opioid therapy. To assess the risk of overdose, a validated risk scoring method was used. If patients were determined to be at high risk for overdose, outreach by a clinical pharmacist was conducted to educate them on the benefits of naloxone. For patients agreeable to receiving naloxone, prescriptions were entered into the electronic health record for primary care provider (PCP) verification. Contact was made following order verification to ensure patient understanding of proper naloxone use and naloxone accessibility. Results Prior to the project (ie, in calendar year 2016), only 5 prescriptions for naloxone had been prescribed within the medical group. During the naloxone coprescribing initiative, 230 patients were identified by clinical pharmacists as being at elevated risk for opioid overdose. Of these, 86 (37%) were deemed ineligible for naloxone. Out of the 144 patients determined to be eligible, 63 (44%) were agreeable to receiving naloxone. Further review determined that 7 additional patients were agreeable after a follow-up conversation with their PCP. Of the patients that agreed to receive naloxone, 48 (76%) confirmed that they had picked up naloxone from their pharmacy. Conclusion The naloxone coprescribing initiative was an innovative project that focused on an epidemic that affects communities across the United States. This program embraced the strengths of multiple departments for the good of the patient, in keeping with the idea of team-based care. The pharmacy-driven approach highlighted the importance of having pharmacists within an ambulatory care setting and allowed high-level pharmacist practice without adding to the workload of other members of the healthcare team.

scholarly journals An Analysis of Primary Care Clinician Communication About Risk, Benefits, and Goals Related to Chronic Opioid Therapy

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831989257
Author(s):  
Elizabeth C. Danielson ◽  
Olena Mazurenko ◽  
Barbara T. Andraka-Christou ◽  
Julie DiIulio ◽  
Sarah M. Downs ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Chronic Pain ◽  
The United States ◽  
Opioid Therapy ◽  
Opioid Overdose ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Limited Effectiveness ◽  
Pain Care

Background. Safe opioid prescribing and effective pain care are particularly important issues in the United States, where decades of widespread opioid prescribing have contributed to high rates of opioid use disorder. Because of the importance of clinician-patient communication in effective pain care and recent initiatives to curb rising opioid overdose deaths, this study sought to understand how clinicians and patients communicate about the risks, benefits, and goals of opioid therapy during primary care visits. Methods. We recruited clinicians and patients from six primary care clinics across three health systems in the Midwest United States. We audio-recorded 30 unique patients currently receiving opioids for chronic noncancer pain from 12 clinicians. We systematically analyzed transcribed, clinic visits to identify emergent themes. Results. Twenty of the 30 patient participants were females. Several patients had multiple pain diagnoses, with the most common diagnoses being osteoarthritis ( n = 10), spondylosis ( n = 6), and low back pain ( n = 5). We identified five themes: 1) communication about individual-level and population-level risks, 2) communication about policies or clinical guidelines related to opioids, 3) communication about the limited effectiveness of opioids for chronic pain conditions, 4) communication about nonopioid therapies for chronic pain, and 5) communication about the goal of the opioid tapering. Conclusions. Clinicians discuss opioid-related risks in varying ways during patient visits, which may differentially affect patient experiences. Our findings may inform the development and use of more standardized approaches to discussing opioids during primary care visits.

Pharmacist’s Role in Dispensing Opioids for Acute and Chronic Pain

2011 ◽  
Vol 25 (5) ◽  
pp. 497-502 ◽  
Author(s):  
Karen F. Marlowe ◽  
Richard Geiler
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Health Care Providers ◽  
Family Relationships ◽  
Health Care Professionals ◽  
The United States ◽  
Care Providers ◽  
Economic Productivity ◽  
The Impact

Pain continues to be a serious health care concern in the United States. Patients with chronic pain experience the impact of the disease throughout their lives including their social interactions, family relationships, and in many cases economic productivity. Multiple surveys have found that many pharmacists hold misconceptions regarding opioids, pain disease states, and their understandings of current regulations. Multiple barriers affect the ability of pharmacists to deliver care to patients' prescribed opioid therapy. Inadequate communication between health care professionals and patients is one of the hurdles, which prevents quality care. Increased communication between health care providers including access to health information is one step, which is crucial to improving provision of pharmacotherapy. Finally, the quality of educational opportunities relative to opioids and pain management specifically for pharmacists needs to be increased, and consideration needs to be given for making appropriate pain management education mandatory.

scholarly journals Impact of the COVID-19 pandemic on chronic pain management

2021 ◽  
Vol 2 (3) ◽  
pp. 197-212
Author(s):  
Andrew Auyeung ◽  
Hank Wang ◽  
Iulia Pirvulescu ◽  
Nebojša Knežević
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Pain Management ◽  
The United States ◽  
Chronic Pain Management ◽  
Steroid Use ◽  
Chronic Pain Patients ◽  
Interventional Pain Management ◽  
Tools And Techniques ◽  
Pain Patients

Introduction: The COVID-19 pandemic has generated considerable turmoil in the interventional pain management (IPM) community. Due to IPM being classified as 'elective', numerous pain practices across the United States were forced to close during the pandemic, leaving chronic pain patients untreated for indefinite periods, and IPM physicians with increased stress and burnout. Results: In response to these detrimental effects, various re-opening tools and techniques have been created to facilitate a cautious resumption of in-person interventional pain practice. Due to their ability to minimize person-to-person contact, telehealth and pharmacotherapy played a more significant role in IPM during the pandemic, but their increased utilization has also led to the exacerbation of substance abuse and the opioid epidemic. The interplay between steroid use and its immunosuppressive effects, in relation to the COVID-19 infection and the COVID-19 vaccine, has also arisen as an issue of concern. Conclusion: As practices begin to safely re-open throughout the United States, the effects felt by chronic pain patients during the pandemic must be emphasized and not ignored. This review emphasizes the struggles pain patients have had to face during the pandemic and the need to update and redefine regulations regarding interventional and chronic pain management.

scholarly journals The impact of the opioid crisis on U.S. state prison systems

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Christy K. Scott ◽  
Michael L. Dennis ◽  
Christine E. Grella ◽  
Allison F. Mischel ◽  
John Carnevale
Keyword(s):  
United States ◽  
Criminal Justice ◽  
Technical Assistance ◽  
Sampling Strategy ◽  
The United States ◽  
Opioid Overdose ◽  
Opioid Use ◽  
State Prison ◽  
Prison Systems ◽  
The Impact

Abstract Background Prior studies have documented limited use of medications to treat opioid use disorders (OUD) for people incarcerated within state prisons in the United States. Using the framework of the criminal justice OUD service cascade, this study interviewed representatives of prison systems in states most heavily impacted by opioid overdose regarding the provision of medications for OUD (MOUD). Methods A stratified sampling strategy included states with high indicators of opioid-overdose deaths. Two sampling strata targeted states with: 1) OUD overdose rates significantly higher than the per capita national average; or 2) high absolute number of OUD overdose fatalities. Interviews were completed with representatives from 21 of the 23 (91%) targeted states in 2019, representing 583 prisons across these states. Interviews assessed service provision across the criminal justice OUD service cascade, including OUD screening, withdrawal management, MOUD availability and provision, overdose prevention, re-entry services, barriers, and needs for training and technical assistance. Results MOUD (buprenorphine, methadone, or naltrexone) was available in at least one prison in approximately 90% of the state prison systems and all three medications were available in at least one prison in 62% of systems. However, MOUD provision was limited to subsets of prisons within these systems: 15% provided buprenorphine, 9% provided methadone, 36% provided naltrexone, and only 7% provided all three. Buprenorphine and methadone were most frequently provided to pregnant women or individuals already receiving these at admission, whereas naltrexone was primarily used at release. Funding was the most frequently cited barrier for all medications. Conclusion Study findings yield a complex picture of how, when, and to whom MOUD is provided across prisons within prison systems in states most heavily impacted by opioid overdose in the United States and have implications for expanding availability.

scholarly journals The DiSCover Project: Protocol and Baseline Characteristics of a Decentralized Digital Study Assessing Chronic Pain Outcomes and Behavioral Data

2021 ◽  
Author(s):  
Jennifer L Lee ◽  
Christian J Cerrada ◽  
Mai Ka Ying Vang ◽  
Kelly Scherer ◽  
Caroline Tai ◽  
...  
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Heart Rate ◽  
Chronic Pain ◽  
The United States ◽  
Behavioral Data ◽  
Behavioral Characteristics ◽  
Study Results ◽  
The Impact

Background: Chronic pain affects approximately 50 million adults in the United States and impacts mood, everyday functioning, and quality of life. The challenges of analgesic clinical trials and, therefore, the approval of new non-opioid analgesics, are based in part on a fundamental lack of understanding of those outcomes that are relevant to an individual's overall functioning. Objectives: To determine the behaviors and health outcomes associated with chronic pain. This manuscript presents an overview of the study design, baseline health and behavioral characteristics of our sample, and preliminary findings of how behavioral characteristics differ between individuals with and without chronic pain. Methods: The study is a decentralized digital longitudinal cohort study of 10,036 individuals (5,832 with chronic pain [CP] and 4,204 with no chronic pain [NCP), age 18 years or older, living in the United States. The study period was one year. Data were collected from wearable activity trackers and health or fitness mobile applications to capture passively collected behavioral data including steps, sleep, and heart rate. Patient-reported outcomes on mood and pain, including the BPI-SF, PHQ-9, and GAD-7, were collected at various timepoints during the study. Results: The data suggest greater levels of depression and anxiety, lower quality of life, less physical activity, more variable sleep, and higher resting heart rate are associated with CP. Conclusions: The longitudinal data from the larger study will yield substantial contributions to the body of literature in chronic pain, particularly in delineating relational and causal factors relevant to the impact of chronic pain, and potential development of a digital biomarker to assess and monitor patients' everyday experience with chronic pain.

scholarly journals Patient Perception of Pain Care in the United States: A 5-Year Comparative Analysis of Hospital Consumer Assessment of Health Care Providers and Systems

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. 369-377 ◽  
Author(s):  
Anita Gupta
Keyword(s):  
United States ◽  
Pain Management ◽  
Acute Care ◽  
Pain Perception ◽  
The United States ◽  
Critical Access Hospitals ◽  
Hospital Type ◽  
Pain Scores ◽  
Hospital Consumer Assessment ◽  
Consumer Assessment

Background: The necessity of aggressive pain management in the hospital setting is becoming increasingly evident. It has been shown to improve patient outcomes, and is now an avenue for Medicare to assess reimbursement. In this cohort analysis, we compared the March 2008 to the December 2012 Hospital Consumer Assessment of Health Plans Survey (HCAHPS) reports in order to determine if pain management has improved in the United States after this national standardized survey was created. Objective: To evaluate whether pain perception would improve in the 2012 report relative to the 2008 report. Study Design: Statistical analyses were conducted with the HCAHPS report to compare pain control in regards to hospital type, hospital ownership, and individual hospitals. Using the question, “How often is your pain controlled?,” T-tests were used to compare each hospital type. Hospital ownerships were assessed via analysis of variance (ANOVA) testing. T-tests were conducted to track the difference of hospital performance between the 2008 and the 2012 report. Paired management data were obtained from hospitals that participated in both reports and were assessed using paired T-tests. Setting: This survey was administered to a random sample of adult inpatients between 48 hours and 6 weeks after discharge from any hospital reporting to Centers for Medicare and Medicaid (CMS) across the US. Limitations: Limitations of this study include response bias, recall bias, and there may be bias related to types of people likely to respond to a survey, but this is inherent to data that is collected on a voluntary response. Additionally, a 3% increase in the number of patients rating their pain as always well-controlled, while statistically significant, admittedly may not be clinically significant. In addition, the raw data collected is adjusted for the effects of patient-mix. The statistical analyses performed to derive the final quarterly HCAHPS reports are unavailable to us and therefore we cannot comment on how individual factors such as age, sex, race, and education or the interaction of the aforementioned affect responses about the patient’s perception on how well their pain was controlled between 2008 and 2012. Results: Two thousand three hundred and ninety five hospitals reported pain management data in both 2008 and 2012. In 2012, hospitals improved their ability to “always control a patients pain” by 3.07% (P < 0.0001) in comparison to the baseline March 2008 report, which was statistically significant. According to the 2012 data, the discrepancy in pain management between acute care hospitals and critical access hospitals was 3.33% which was statistically significant (P < 0.05). Government hospitals were shown to manage pain better at baseline, but all 3 types of ownership improved their pain scores between the 2 reports which was shown to be statistically significant (P < 0.01). Discussion: The HCAHPS survey is a national public standardized report used as a way to compare care in the United States. Patient pain perception has improved between the 2008 and 2012 reports. Further studies are needed to evaluate critical care hospitals. Key words: HCAHPS, pain scores, patient perception, national comparison of hospitals, Agency for Healthcare Research and Quality (AHRQ), acute care hospitals, critical access hospitals, pain management:

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