Practical Advices for Treating Chronic Pain in the Time of COVID-19: A Narrative Review Focusing on Interventional Techniques

Background: Since the management of chronic pain has become even more challenging secondary to the occurrence of SARS-CoV-2 outbreaks, we developed an exhaustive narrative review of the scientific literature, providing practical advices regarding the management of chronic pain in patients with suspected, presumed, or confirmed SARS-CoV-2 infection. We focused particularly on interventional procedures, where physicians are in closer contact with patients. Methods: Narrative Review of the most relevant articles published between June and December of 2020 that focused on the treatment of chronic pain in COVID-19 patients. Results: Careful triage of patients is mandatory in order to avoid overcrowding of hospital spaces. Telemedicine could represent a promising tool to replace in-person visits and as a screening tool prior to admitting patients to hospitals. Opioid medications can affect the immune response, and therefore, care should be taken prior to initiating new treatments and increasing dosages. Epidural steroids should be avoided or limited to the lowest effective dose. Non urgent interventional procedures such as spinal cord stimulation and intrathecal pumps should be postponed. The use of personal protective equipment and disinfectants represent an important component of the strategy to prevent viral spread to operators and cross-infection between patients due to the SARS-CoV-2 outbreaks.

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The Role of Nutrient Supplementation in the Management of Chronic Pain in Fibromyalgia: A Narrative Review

Pain and Therapy ◽

10.1007/s40122-021-00266-9 ◽

2021 ◽

Author(s):

Hannah Waleed Haddad ◽

Nikita Reddy Mallepalli ◽

John Emerson Scheinuk ◽

Pranav Bhargava ◽

Elyse M. Cornett ◽

...

Keyword(s):

Chronic Pain ◽

Narrative Review ◽

Nutrient Supplementation

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Radiotherapy-Specific Chronic Pain Syndromes in the Cancer Population: An Evidence-Based Narrative Review

Advances in Therapy ◽

10.1007/s12325-021-01640-x ◽

2021 ◽

Author(s):

Jay Karri ◽

Laura Lachman ◽

Alex Hanania ◽

Anuj Marathe ◽

Mani Singh ◽

...

Keyword(s):

Chronic Pain ◽

Narrative Review ◽

Evidence Based ◽

Pain Syndromes ◽

Chronic Pain Syndromes

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(194) Qualitative investigation of a brief chronic pain screening tool in HIV-infected patients

Journal of Pain ◽

10.1016/j.jpain.2014.01.100 ◽

2014 ◽

Vol 15 (4) ◽

pp. S24 ◽

Cited By ~ 1

Author(s):

J. Merlin ◽

M. Walcott ◽

I. Herbey ◽

E. Chamot ◽

C. Ritchie ◽

...

Keyword(s):

Chronic Pain ◽

Screening Tool ◽

Qualitative Investigation

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Ultrasound-guided interventional procedures for chronic pain management

Pain Management ◽

10.2217/pmt.15.46 ◽

2015 ◽

Vol 5 (6) ◽

pp. 466-482 ◽

Cited By ~ 11

Author(s):

Samuel Korbe ◽

Esther N Udoji ◽

Timothy J Ness ◽

Mercy A Udoji

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Interventional Procedures ◽

Chronic Pain Management ◽

Ultrasound Guided

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Cardiovascular, carcinogenic and reproductive effects of nicotine exposure: A narrative review of the scientific literature

F1000Research ◽

10.12688/f1000research.20062.2 ◽

2020 ◽

Vol 8 ◽

pp. 1586

Author(s):

Leonie R. Price ◽

Javier Martinez

Keyword(s):

Cardiovascular Risk ◽

Cancer Progression ◽

Animal Studies ◽

Scientific Literature ◽

Human Cancer ◽

Narrative Review ◽

Nicotine Exposure ◽

Health Related

The emergence of new tobacco heating products and electronic nicotine delivery systems (ENDS) is changing the way humans are exposed to nicotine. The purpose of this narrative review is to provide a broad overview of published scientific literature with respect to the effects of nicotine on three key health-related areas: 1) cardiovascular risk, 2) carcinogenesis and 3) reproductive outcomes. These areas are known to be particularly vulnerable to the effects of cigarette smoke, and in addition, nicotine has been hypothesized to play a role in disease pathogenesis. Acute toxicity will also be discussed. The literature to February 2019 suggests that there is no increased cardiovascular risk of nicotine exposure in consumers who have no underlying cardiovascular pathology. There is scientific consensus that nicotine is not a direct or complete carcinogen, however, it remains to be established whether it plays some role in human cancer propagation and metastasis. These cancer progression pathways have been proposed in models in vitro and in transgenic rodent lines in vivo but have not been demonstrated in cases of human cancer. Further studies are needed to determine whether nicotine is linked to decreased fertility in humans. The results from animal studies indicate that nicotine has the potential to act across many mechanisms during fetal development. More studies are needed to address questions regarding nicotine exposure in humans, and this may lead to additional guidance concerning new ENDS entering the market.

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Management of Cardiac Implantable Electrical Devices in Patients Undergoing Radiofrequency Ablation for Spine Pain: Physician Survey and Review of Guidelines

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/e335 ◽

2020 ◽

Vol 4;23 (7;4) ◽

pp. E335-E342

Author(s):

Jason Friedrich

Keyword(s):

Decision Making ◽

Chronic Pain ◽

Radiofrequency Ablation ◽

Joint Pain ◽

Risk Mitigation ◽

Narrative Review ◽

Mitigation Strategies ◽

Web Based ◽

Electrical Devices ◽

Risk Mitigation Strategies

Background: More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. Objectives: To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. Study Design: Web-based provider survey and narrative review. Setting: Multispecialty pain clinic, academic medical center. Methods: A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. Results: A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. Limitations: Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. Conclusions: Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. Key words: Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain

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Chronic pain diagnoses and opioid dispensings among individuals with serious mental illness

10.21203/rs.2.12077/v1 ◽

2019 ◽

Author(s):

Ashli Owen-Smith ◽

Christine Stewart ◽

Musu M. Sesay ◽

Sheryl M. Strasser ◽

Bobbi Jo Yarborough ◽

...

Keyword(s):

Mental Health ◽

Chronic Pain ◽

Mental Illness ◽

Healthcare Utilization ◽

Serious Mental Illness ◽

Research Network ◽

Prescription Opioid ◽

Medical Comorbidities ◽

Pain Diagnosis ◽

Opioid Medications

Abstract Background Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia. Methods Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of MDD (N=65,750), BD (N=38,117) or schizophrenia or schizoaffective disorder (N=12,916) were identified and matched on age, sex and Medicare status to controls with no documented mental illness. CNCP diagnoses and prescription opioid medication dispensings were extracted for the matched samples. Multivariate analyses were conducted to evaluate (1) the odds of receiving a pain-related diagnosis and (2) the odds of receiving opioids, by separate mental illness diagnosis category compared with matched controls, controlling for age, sex, Medicare status, race/ethnicity, income, medical comorbidities, healthcare utilization and chronic pain diagnoses. Results Multivariable models indicated that having a MDD (OR=1.90; 95% CI=1.85–1.95) or BD (OR=1.71; 95% CI=1.66–1.77) diagnosis was associated with increased odds of a CNCP diagnosis after controlling for age, sex, race, income, medical comorbidities and healthcare utilization. By contrast, having a schizophrenia diagnosis was associated with decreased odds of receiving a chronic pain diagnosis (OR=0.86; 95% CI=0.82– 0.90). Having a MDD (OR=2.59; 95% CI=2.44–2.75) or BD (OR=2.12; 95% CI=1.97–2.28) diagnosis was associated with increased odds of receiving chronic opioid medications, even after controlling for age, sex, race, income, medical comorbidities, healthcare utilization and chronic pain diagnosis; having a schizophrenia diagnosis was not associated with receiving chronic opioid medications. Conclusions Individuals with serious mental illness, who are most at risk for developing opioid-related problems, continue to be prescribed opioids more often than their peers without mental illness. Healthcare providers need to be especially conservative in prescribing opioids – or avoid opioid therapy altogether – for this population. Mental health clinicians may be particularly well-suited to lead pain assessment and management efforts for these patients.

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I see you’re in pain – The effects of partner validation on emotions in people with chronic pain

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2014.07.003 ◽

2015 ◽

Vol 6 (1) ◽

pp. 16-21 ◽

Cited By ~ 17

Author(s):

Sara M. Edlund ◽

Maria L. Carlsson ◽

Steven J. Linton ◽

Alan E. Fruzzetti ◽

Maria Tillfors

Keyword(s):

Chronic Pain ◽

Negative Affect ◽

Negative Impact ◽

Positive Impact ◽

Training Session ◽

The Other ◽

Pain Level ◽

Interpersonal Interactions ◽

Post Intervention ◽

Promising Tool

AbstractBackground and aimsChronic pain not only affects the person in pain, but can also have a negative impact on relationships with loved ones. Research shows that chronic pain is associated with difficulties in marital relationships, which in turn is related to a variety of negative outcomes such as psychological distress and conflict within the family. This suggests that couples where chronic physical pain is present also struggle with emotional pain and relationship problems, and thus targeting relationship skills and interpersonal functioning might be helpful for these couples. Although studies in this area are promising, their numbers are few. In the present study, validation as a way of communicating is suggested for handling emotional expression in interpersonal interactions. Validation communicates understanding and acceptance of the other person’s experience, and it has been shown to have a down-regulating effect on negative emotions. It has previously been demonstrated to be important for these couples. However, the feasibility and effects of increasing partner validation in these couples are unknown. Therefore, the aim of the present study was to investigate if a brief training session in validation for spouses would result in more validating and fewer invalidating responses towards their partners with pain, and to investigate if changes in these behavioural responses were associated with changes in emotion and pain level in the partner with pain.MethodsParticipants were 20 couples where at least one partner reported chronic pain. The study employed a within-groups design in which spouses of people with pain received validation training (without their partner’s knowledge), and their validating and invalidating responses were rated pre- and post-intervention using a reliable observational scale. Also, positive and negative affect and subjective pain level in the persons with pain were rated pre- and post-intervention.ResultsResults showed that the validation training was associated with increased validating and decreased invalidating responses in the partners. Their spouses with chronic pain reported a decrease in negative affect from pre- to post-training.ConclusionsOur results indicate that the partner or closest family member, after brief validation training, increased validating responses and decreased invalidating responses towards the person with pain, which had an immediate positive impact on emotions in the other person.ImplicationsThis study suggests that using validation in interpersonal interactions is a promising tool for couples where chronic pain is present.

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