scholarly journals Evidence-Based Risk Mitigation and Stratification during COVID-19 for Return to Interventional Pain Practice: American Society of Interventional Pain Physicians (ASIPP) Guidelines

2020 ◽  
Vol 4S;23 (8;4S) ◽  
pp. S161-S182
Author(s):  
Shalini Shah
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Chronic Pain ◽  
Risk Stratification ◽  
Risk Mitigation ◽  
Chronic Pain Patients ◽  
American Society ◽  
Pain Care ◽  
Pain Patients ◽  
Case Basis

Background: Chronic pain patients require continuity of care even during the COVID-19 pandemic, which has drastically changed healthcare and other societal practices. The American Society of Interventional Pain Physicians (ASIPP) has created the COVID-ASIPP Risk Mitigation and Stratification (COVID-ARMS) Return to Practice Task Force in order to provide guidance for safe and strategic reopening. Objectives: The aims are to provide education and guidance for interventional pain specialists and their patients during the COVID-19 pandemic that minimizes COVID-related morbidity while allowing a return to interventional pain care. Methods: The methodology utilized included the development of objectives and key questions with utilization of trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various regions, specialities, and groups. The literature pertaining to all aspects of COVID-19, specifically related to epidemiology, risk factors, complications, morbidity and mortality, and literature related to risk mitigation and stratification were reviewed. The principles of best-evidence synthesis of available literature and grading for recommendations as described by the Agency for Healthcare Research and Quality (AHRQ), typically utilized in ASIPP guideline preparation, was not utilized in these guidelines due to the limitation based on lack of available literature on COVID-19, risk mitigation and stratification. Consequently, these guidelines are considered evidence-informed with the incorporation of the best-available research and practice knowledge. Results: Numerous risk factors have emerged that predispose patients to contracting COVID-19 and/or having a more severe course of the infection. COVID-19 may have mild symptoms, be asymptomatic, or may be severe and life-threatening. Older age and certain comorbidities, such as underlying pulmonary or cardiovascular disease, have been associated with worse outcomes. In pain care, COVID-19 patients are a heterogeneous group with some individuals relatively healthy and having only a short course of manageable symptoms, while others become critically ill. It is necessary to assess patients on a case-by-case basis and craft individualized care recommendations. A COVID-19 ARMS risk stratification tool was created to quickly and objectively assess patients. Interventional pain specialists and their patients may derive important benefits from evidenceinformed risk stratification, protective strategies to prevent infection, and the gradual resumption of treatments and procedures to manage pain. Limitations: COVID-19 was an ongoing pandemic at the time these recommendations were developed. The pandemic has created a fluid situation in terms of evidence-informed guidance. As more and better evidence is gathered, these recommendations may be modified. Conclusions: Chronic pain patients require continuity of care, but during the time of the COVID-19 pandemic, steps must be taken to stratify risks and protect patients from possible infection to safeguard them from COVID-19-related illness and transmitting the disease to others. Pain specialists should optimize telemedicine encounters with pain patients, be cognizant of risks of COVID-19 morbidity, and take steps to evaluate risk-benefit on a case-by-case basis. Pain specialists may return to practice with lower-risk patients and appropriate safeguards. Key words: Cardiovascular disease, COVID-19, interventional pain management, COVID risk factors, diabetes, hypertension, interventional pain care, novel coronavirus, obesity, SARS-nCoV2, steroids

Children of chronic pain patients: risk factors for maladjustment

Pain ◽  
1993 ◽  
Vol 52 (3) ◽  
pp. 311-317 ◽  
Author(s):  
Deborah Y. Chun ◽  
Judith A. Turner ◽  
Joan M. Romano
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Chronic Pain Patients ◽  
Pain Patients

scholarly journals Ethical Insights to Rapprochement in Pain Care: Bringing Stakeholders Together in the Best Interest(s) of the Patient

2009 ◽  
Vol 4;12 (4;7) ◽  
pp. E265-E275
Author(s):  
James Giordano
Keyword(s):  
Chronic Pain ◽  
Intractable Pain ◽  
Best Interest ◽  
Key Words Pain ◽  
Hospital Administrators ◽  
Total Pain ◽  
Chronic Pain Patients ◽  
Ethics Policy ◽  
Pain Care ◽  
Pain Patients

Advances in medicine have produced an elongated lifespan often burdened by chronic disorders. Throughout the lifespan and at end of life such disorders can give rise to intractable pain. Although clear distinctions about the respective role(s) for pain therapeutics and palliative medicine remain debatable, both are involved in chronic pain care. Such care has reached a point of crisis fueled by tensions within and between clinical, administrative, and economic factors. We call for a strategy of rapprochement to reconcile these tensions as a means to facilitate more effective and ethically sound pain care. We describe roles and values of principal stakeholders: palliative- and pain-care physicians, chronic pain patients, insurance providers, and hospital administrators and elucidate how dissonances between these groups may contribute to inefficacy of the pain care system and sustain chronic, maldynic pain. We discuss how such values affect use of evidence and resources and explicate frameworks for an ameliorative rapprochement model that acknowledges and balances relative needs and values of all stakeholders. While we have tried to depict why rapprochement is necessary, and possible, the more difficult task is to determine how this process should be articulated and what shape a profession of total pain care might assume. Key words: Pain medicine, palliative care, ethics, policy, collaboration, rapprochement

Multidisciplinary pain treatment – Which patients do benefit?

2012 ◽  
Vol 3 (4) ◽  
pp. 201-207 ◽  
Author(s):  
Tarja Heiskanen ◽  
Risto P. Roine ◽  
Eija Kalso
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Employment Status ◽  
Psychiatric Comorbidity ◽  
Pain Interference ◽  
Pain Clinic ◽  
Chronic Pain Patients ◽  
Patient Groups ◽  
Pain Patients

AbstractBackgroundThe prevalence of chronic non-malignant pain in developed countries is high, ranging from 14% to 50%. Patients with chronic pain are active users of health-care services and they report impaired health-related quality of life (HRQoL) when compared with the general population. Psychological distress has been identified as one of the risk factors for pain chronicity. Depression, anxiety and negative beliefs are associated with pain interference and perceived disability. Multidisciplinary pain management (MPM) aims to rehabilitating chronic pain patients by addressing both physical, psychological, social and occupational factors related to the pain problem. MPM programmes have been shown to be effective in reducing pain and improving function in patients with diverse chronic pain states. However, MPM programmes are often heterogeneous and predicting MPM treatment results in different patients groups may be difficult.MethodsThe present study examined changes in HRQoL after MPM in 439 patients treated at a multidisciplinary pain clinic using the 15D HRQoL questionnaire. The characteristics of the 100 patients with the greatest improvement and the 100 patients with the largest decrease in HRQoL were examined more closely (demographics, characteristics of pain, pain interference, psychiatric comorbidity, employment status, details of MPM) after answering a follow-up 15D questionnaire at three years after their MPM had ended.ResultDuring MPM, HRQoL was significantly improved in 45.6% of the 439 patients, decreased in 30.7% of the patients and did not change in 23.7% of the patients. Patient-related factors that predicted a better HRQoL among the 100 patients with good MPM outcome compared with the 100 patients with poor MPM outcome were higher education and better employment status. Age, gender, marital status, duration of pain, number of pain sites, pain intensity or pain interference at baseline did not differ between the patient groups. Patient expectations regarding MPM were similar. A tendency towards more psychiatric comorbidity in the non-responder group was seen. The duration of MPM in the two patient groups was similar, as well as the number of medications started, the variety of specialists seen and psychiatric counselling with supportive therapy included. More non-responder than responder patients had died during the three-year follow-up period, some of the deaths were related to substance abuse.Conclusions and ImplicationsHRQoL in chronic pain patients was significantly improved during MPM compared with the baseline. Pain duration of several years, multiple pain sites and neuropathic pain were not discerning factors between the responders and non-responders of the present study, implying that a positive change in HRQoL may be achieved by MPM even in these pain patients. In agreement with previous studies, factors predicting poor treatment outcome in the non-responder group of chronic pain patients were not treatment related. To further improve MPM outcome even in pain patients with risk factors for less benefit of treatment such as low education and poor general health, more individualized MPM approaches with emphasis on analysis and treatment of psychological symptoms and patient beliefs is essential.

scholarly journals Comparing perspectives: patients’ and health care professionals’ views on spiritual concerns and needs in chronic pain care - a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joël Perrin ◽  
Nina Streeck ◽  
Rahel Naef ◽  
Michael Rufer ◽  
Simon Peng-Keller ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Health Care Professionals ◽  
Qualitative Content Analysis ◽  
Spiritual Dimension ◽  
Link Type ◽  
Chronic Pain Patients ◽  
Spiritual Issues ◽  
Pain Care ◽  
Pain Patients

Abstract Background The spiritual aspect of care is an often neglected resource in pain therapies. The aim of this study is to identify commonalities and differences in chronic pain patients’ (CPP) and health care professionals’ (HCP) perceptions on the integration of spiritual care into multimodal pain therapy. Methods We conducted a qualitative exploratory study with 42 CPPs and 34 HCPs who were interviewed in 12 separate groups in five study centres specialising in chronic pain within German-speaking Switzerland. The interviews were transcribed and subjected to a qualitative content analysis. Findings were generated by juxtaposing and analysing the statements of (a) HCP about HCP, (b) HCP about CPP, (c) CPP about HCP, and (d) CPP about CPP. Results Views on spiritual concerns and needs in chronic pain care can be described in three distinct dimensions: function (evaluating the need / request to discuss spiritual issues), structure (evaluating when / how to discuss spiritual issues) and context (evaluating why / under which circumstances to discuss spiritual issues). CPPs stress the importance of HCPs recognizing their overall human integrity, including the spiritual dimension, and would like to grant spiritual concerns greater significance in their therapy. HCPs express difficulties in addressing and discussing spiritual concerns and needs with chronic pain patients. Both parties want clarification of the context in which the spiritual dimension could be integrated into treatment. They see a need for greater awareness and training of HCPs in how the spiritual dimension in therapeutic interactions might be addressed. Conclusions Although there are similarities in the perspectives of HCPs and CPPs regarding spiritual concerns and needs in chronic pain care, there are relevant differences between the two groups. This might contribute to the neglect of the spiritual dimension in the treatment of chronic pain. Trial registration This study was part of a larger research project, registered in a primary (clinicaltrial.gov: NCT03679871) and local (kofam.ch: SNCTP000003086) clinical trial registry.

Pain Influences Several Levels of Attention

2005 ◽  
Vol 16 (4) ◽  
pp. 235-242 ◽  
Author(s):  
Astrid von Bueren Jarchow ◽  
Bogdan P. Radanov ◽  
Lutz Jäncke
Keyword(s):  
Chronic Pain ◽  
Divided Attention ◽  
Covert Attention ◽  
Attention Task ◽  
Attentional Deficits ◽  
Control Subjects ◽  
Chronic Pain Patients ◽  
Divided Attention Task ◽  
Pain Stimuli ◽  
Pain Patients

Abstract: The aim of the present study was to examine to what extent chronic pain has an impact on various attentional processes. To measure these attention processes a set of experimental standard tests of the “Testbatterie zur Aufmerksamkeitsprüfung” (TAP), a neuropsychological battery testing different levels of attention, were used: alertness, divided attention, covert attention, vigilance, visual search, and Go-NoGo tasks. 24 chronic outpatients and 24 well-matched healthy control subjects were tested. The control subjects were matched for age, gender, and education. The group of chronic pain patients exhibited marked deficiencies in all attentional functions except for the divided attention task. Thus, the data supports the notion that chronic pain negatively influences attention because pain patients` attention is strongly captivated by the internal pain stimuli. Only the more demanding divided attention task has the capability to distract the focus of attention to the pain stimuli. Therefore, the pain patients are capable of performing within normal limits. Based on these findings chronic pain patients' attentional deficits should be appropriately evaluated and considered for insurance and work related matters. The effect of a successful distraction away from the pain in the divided attention task can also open new therapeutic aspects.

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