scholarly journals Factors Influencing the Application of a Biopsychosocial Perspective in Clinical Judgement of Chronic Pain: Interactive Management with Medical Students

2017 ◽  
Vol 6 (20;6) ◽  
pp. E951-E960 ◽  
Author(s):  
Christopher P. Dwyer
Keyword(s):  
Chronic Pain ◽  
Medical Students ◽  
Pain Treatment ◽  
Small Sample ◽  
Nominal Group ◽  
Clinical Judgement ◽  
Biopsychosocial Approach ◽  
Factors Influencing ◽  
Interactive Management ◽  
Biopsychosocial Perspective

Background: Though there is wide support for the application of biopsychosocial perspectives in clinical judgement of chronic pain cases, such perspectives are often overlooked due to either inadequate training or attitudes favoring a biomedical approach. Recent research has indicated that despite such explanations, both established general practitioners (GP) and medical students account for some psychosocial factors when making clinical judgements regarding chronic pain cases, but report not being likely to apply these in real-world, clinical settings due to numerous factors, including available time with patients. Thus, it is evident that a greater understanding of clinical judgement-making processes and the factors that affect application of these processes is required, particularly regarding chronic pain. Objectives: The aims of the current study were to investigate medical students’ conceptualizations of the factors that influence application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain using interactive management (IM), model the relationships among these factors, and make recommendations to chronic pain treatment policy in light of the findings. Study Design: The current study used IM to identify and model factors that influence the application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain, based on medical students’ conceptualizations of these factors. Setting: Two university classrooms. Methods: IM is a systems thinking and action mapping strategy used to aid groups in developing outcomes regarding complex issues, through integrating contributions from individuals with diverse views, backgrounds, and perspectives. IM commonly utilizes the nominal group technique and interpretive structural modeling, which in this context were employed to help medical students identify, clarify, and model influences on the application of biopsychosocial perspectives in treating chronic pain patients. Results: Results of IM group work revealed 7 core biopsychosocial approach application categories: GP attitudes, cost, GP knowledge, time, patient-doctor relationship, biomedical factors. and patient perception. GP attitudes was the most critical driver of all other competencies in the system, with cost and GP knowledge revealed as secondary drivers. Limitations: Potential differences in level of prior biopsychosocial perspective knowledge across participants and a potentially small sample size (though consistent with past research and appropriate for an exploratory study of this nature – for purposes of achieving the depth and richness of the deliberation and qualitative insights revealed by participants using the IM methodology). Conclusions: Results from this study may be used to both recommend further research on the identified factors influencing application of biopsychosocial perspectives in treatment of chronic pain and support amendment to extant health care policy, particularly with respect to cost, GP attitudes, and knowledge. Though this research claims neither that the influences identified are the only influences on biopsychosocial application, nor the order of their importance, the research does contribute to an ongoing effort to better understand the factors that influence doctors in their treatment of chronic pain.

scholarly journals Acute and Chronic Pain Learning and Teaching in Medical School—An Observational Cross-Sectional Study Regarding Preparation and Self-Confidence of Clinical and Pre-Clinical Medical Students

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 533 ◽  
Author(s):  
Kacper Lechowicz ◽  
Igor Karolak ◽  
Sylwester Drożdżal ◽  
Maciej Żukowski ◽  
Aleksandra Szylińska ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Medical Students ◽  
Acute Pain ◽  
Pain Treatment ◽  
Cross Sectional Study ◽  
Clinical Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Actual Knowledge

Background and objectives: Adequate pain management is a major challenge of public health. The majority of students graduating from medical schools has insufficient education and experience with patients suffering pain. Not enough is being taught regarding pain in non-verbal patients (children, critically ill in the intensive care unit, demented). Chronic pain is the most difficult to optimize and requires appropriate preparation at the level of medical school. Our aim was to evaluate attitudes, expectations and the actual knowledge of medical students at different levels of their career path regarding the assessment and treatment of acute and chronic pain. Materials and Methods: We performed an observational cross-sectional study that was based on a survey distributed among medical students of pre-clinical and post-clinical years at the Pomeranian Medical University in Szczecin, Poland. The survey included: demographic data, number of hours of formal pain teaching, actual knowledge of pain assessment, and pain treatment options in adults and children. Results: We received responses from 77/364 (21.15%) students and 79.2% of them rated the need to obtain knowledge regarding pain as very important (10/10 points). Post-clinical group declared having on average 11.51 h of acute pain teaching as compared to the 7.4 h reported by the pre-clinical group (p = 0.012). Graduating students also reported having significantly more classes regarding the treatment of chronic pain (6.08 h vs. 3.79 h, p = 0.007). The average level of comfort in the post-clinical group regarding treatment of acute pain was higher than in the pre-clinical group (6.05 vs. 4.26, p = 0.006), similarly with chronic pain treatment in adults (4.33 vs. 2.97, p = 0.021) and with pain treatment in children (3.14 vs. 1.97, p = 0.026). Conclusions: This study shows that education about pain management is a priority to medical students. Despite this, there continues to be a discrepancy between students’ expectations and the actual teaching and knowledge regarding effective pain management, including the vulnerable groups: chronic pain patients, children, and critically ill people.

Pain Management: Texas Legislative and Regulatory Update

1996 ◽  
Vol 24 (4) ◽  
pp. 328-337 ◽  
Author(s):  
David L. Ralston
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Medical Students ◽  
Pain Treatment ◽  
Policy Statement ◽  
Intractable Pain ◽  
Legal Environment ◽  
Policy Statements ◽  
Medical Examiners ◽  
Regulatory Update

My purpose is to provide an update on recent Texas regulatory and statutory changes adopted , since the passage in Texas of the Intractable Pain Treatment Act in 1989 (Pain Act) (see Table l). First, I describe the rules adopted by the Texas State Board of Medical Examiners (TSBME) that authorize physicians to prescribe opioids for the treatment of pain (Pain Rules) (see Table 2). Second, I detail recent statutory changes that pertain to education of physicians and medical students about pain treatment. All of these changes attempt to create a better legal environment for the treatment of chronic pain in Texas.Before describing the Pain Rules adopted in Texas, the question Why adopt rules, rather than simply ask TSBME to issue a policy statement? must be answered. Many states, most notably California, have issued policy statements that clarify for physicians the parameters within which they may treat pain? Policy statements, unlike administrative regulations, do not have the force of law.

scholarly journals Examining influential factors in providers’ chronic pain treatment decisions: a comparison of physicians and medical students

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Nicole A. Hollingshead ◽  
Samantha Meints ◽  
Stephanie K. Middleton ◽  
Charnelle A. Free ◽  
Adam T. Hirsh
Keyword(s):  
Chronic Pain ◽  
Medical Students ◽  
Pain Treatment ◽  
Treatment Decisions ◽  
Influential Factors ◽  
Chronic Pain Treatment

Yoga as an Effective Mind--Body Therapy in Chronic-Pain Treatment

2007 ◽  
Author(s):  
Malinda Breda ◽  
Richard Gevirtz ◽  
Melanie A. Greenberg ◽  
James L. Spira
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Body Therapy ◽  
Chronic Pain Treatment

scholarly journals Physical Activity Behavior from a Transdisciplinary Biopsychosocial Perspective: a Scoping Review

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Jannika M. John ◽  
Vanessa Haug ◽  
Ansgar Thiel
Keyword(s):  
Physical Activity ◽  
Scoping Review ◽  
Social Factors ◽  
Biopsychosocial Model ◽  
Scientific Work ◽  
Physical Activity Behavior ◽  
Biopsychosocial Approach ◽  
Scoping Reviews ◽  
Activity Behavior ◽  
Biopsychosocial Perspective

Abstract Background Physical activity behavior is a complex and multidimensional phenomenon. For its analysis, transdisciplinary biopsychosocial approaches yield great potential. In health research, the biopsychosocial model has experienced a renaissance. Researchers have tried to grasp the complex interplay of biological, psychological, and social factors. With this scoping review, we aimed to examine how the ‘biopsychosocial’ has been conceptualized in scientific work related to physical activity behavior. Methods The scoping review was informed by the PRISMA guidelines for scoping reviews (PRISMA-ScR). A systematic literature search was conducted in Web of Science, SportDiscus, PsycArticles, PsycInfo, and PubMed. Only articles published in peer-reviewed journals that contained all three components of a biopsychosocial approach (e.g., bio/physio/genetic, psycho/mental, and socio/cultural/environmental) were included. We only included articles in our narrative synthesis that integrated physical activity behavior into a biopsychosocial model, or investigated or described physical activity behavior on the basis of such a model. Results Thirteen studies met the inclusion criteria; eight articles pursued a biopsychosocial approach in the tradition of Engel, five employed a socio-ecological approach. The models in the analyzed articles referred to either correlates of physical activity behavior, or the influence of physical activity on health or aging. Only a minority of the articles, however, referred to interactions between biological, psychological, and social factors. Conclusions The included articles were quite heterogeneous in their approach to physical activity from a biopsychosocial perspective. The included articles illustrate that the adoption of a biopsychosocial perspective may assist to capture and understand the complex phenomenon of physical activity behavior and might inform future transdisciplinary physical activity research.

scholarly journals Sublingual Buprenorphine/Naloxone and Multi-Modal Management for High-Risk Chronic Pain Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 973
Author(s):  
Shane Kaski ◽  
Patrick Marshalek ◽  
Jeremy Herschler ◽  
Sijin Wen ◽  
Wanhong Zheng
Keyword(s):  
Chronic Pain ◽  
High Risk ◽  
Pain Score ◽  
Rating Scale ◽  
Pain Treatment ◽  
Pain Clinic ◽  
Sublingual Buprenorphine ◽  
Significant Downward Trend ◽  
Chronic Pain Patients ◽  
Pain Patients

Patients with chronic pain managed with opioid medications are at high risk for opioid overuse or misuse. West Virginia University (WVU) established a High-Risk Pain Clinic to use sublingual buprenorphine/naloxone (bup/nal) plus a multimodal approach to help chronic pain patients with history of Substance Use Disorder (SUD) or aberrant drug-related behavior. The objective of this study was to report overall retention rates and indicators of efficacy in pain control from approximately six years of High-Risk Pain Clinic data. A retrospective chart review was conducted for a total of 78 patients who enrolled in the High-Risk Pain Clinic between 2014 and 2020. Data gathered include psychiatric diagnoses, prescribed medications, pain score, buprenorphine/naloxone dosing, time in clinic, and reason for dismissal. A linear mixed effects model was used to assess the pain score from the Defense and Veterans Pain Rating Scale (DVPRS) and daily bup/nal dose across time. The overall retention of the High-Risk Pain Clinic was 41%. The mean pain score demonstrated a significant downward trend across treatment time (p < 0.001), while the opposite trend was seen with buprenorphine dose (p < 0.001). With the benefit of six years of observation, this study supports buprenorphine/naloxone as a safe and efficacious component of comprehensive chronic pain treatment in patients with SUD or high-risk of opioid overuse or misuse.

Still focusing on the “essential 2:1”: exploring student attitudes to extra-curricular activities

2015 ◽  
Vol 57 (2) ◽  
pp. 184-203 ◽  
Author(s):  
Paul Greenbank
Keyword(s):  
Labour Market ◽  
Student Attitudes ◽  
Student Participation ◽  
Small Sample ◽  
Peer Norms ◽  
Market Outcomes ◽  
Content Type ◽  
Factors Influencing ◽  
Extra Curricular Activities ◽  
Degree Classification

Purpose – In order to compete for positional advantage in the graduate labour market students need more than a good degree classification. The evidence suggests that participation in extra-curricular activities (ECAs) can have a significant influence on labour market outcomes. The purpose of this paper is to examine the extent to which undergraduates engage in ECAs during their studies and analyses the factors influencing their participation in such activities. Design/methodology/approach – This study is based on a sample of 21 undergraduates in the Business School at a “new” university. These students completed two questionnaires in their first year of study. These were followed-up by in-depth interviews which were carried out in their first and final year of study. Findings – The study found that many of these students were not participating in ECAs because they lacked an appreciation of the value of ECAs to graduate employers. The students were also influenced by social and peer norms, especially the fact that their peers were not engaging in ECAs. Finally, the students often exhibited an extrinsic locus of control and dependency which was not conducive to engagement in ECAs. Research limitations/implications – The generalisability of the findings may be seen as limited by the fact that the study is based on a relatively small sample of students from one university. This research, however, provides detailed insights into the factors influencing student participation in ECAs and adds new perspectives to this under-researched area. Practical implications – The paper concludes by suggesting a range of inter-related approaches that higher education institutions could adopt in order to improve student participation in ECAs. These include careers education at all stages of the students’ studies; the use of unfreezing techniques in conjunction with case studies; a more substantial role for personal tutors; and the development of an institutional habitus that encourages autonomy and agency. Originality/value – Despite the importance of ECAs to graduate employers there have been relatively few studies into the factors influencing undergraduate participation in such activities.

scholarly journals Telemedicine for chronic pain treatment during the COVID‐19 pandemic: Do pain intensity and anxiousness correlate with patient acceptance?

Pain Practice ◽  
2021 ◽  
Author(s):  
Michael Alexander Harnik ◽  
Larissa Blättler ◽  
Andreas Limacher ◽  
Florian Reisig ◽  
Martin Grosse Holtforth ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Pain Treatment ◽  
Patient Acceptance ◽  
Chronic Pain Treatment
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