Further effort is needed to improve management of chronic pain in primary care. Results from the Arkys project

Treatment of chronic pain is challenging. The Arkys project was initiated in Italy to assist general practitioners (GPs) in the management of chronic pain. The main objective of this study was to determine the usefulness of Arkys for selecting new therapeutic strategies. An online interactive questionnaire for assessing pain and guiding therapeutic decisions was made available to GPs participating to Arkys. The GPs were invited to complete the questionnaire for each patient who presented moderate-severe chronic pain, and to decide on a new analgesic treatment based on the information provided by the questionnaire. Two hundred and forty four GPs participated with a total of 3035 patients. Patients (mean age 68.9 years) had mostly chronic non-cancer pain (87.7%). In 42.3%, pain had neuropathic components. Only 53.6% of patients were in treatment with analgesics (strong opioids, 38.9%; NSAIDs, 32.6%; weak opioids, 25.6%; anti-epileptics, 17.3%; paracetamol, 14.9%). Use of the questionnaire resulted in the prescription of analgesics to all patients and in increased prescription of strong opioids (69.7%). NSAID prescription decreased (12.8%), while anti-epileptics use remained stable. These findings show that current management of chronic pain in primary care is far from optimal and that efforts are needed to educate GPs and improve guideline implementation.

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Costs of moderate to severe chronic pain in primary care patients – a study of the ACCORD Program

Journal of Pain Research ◽

10.2147/jpr.s55388 ◽

2014 ◽

pp. 389 ◽

Cited By ~ 20

Author(s):

Lyne Lalonde ◽

Elisabeth Martin ◽

Djamal Berbiche ◽

Sylvie Perreault ◽

David Lussier ◽

...

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Primary Care Patients ◽

Severe Chronic Pain

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Improving Chronic Pain Management in Primary Care: Program Evaluation

PsycEXTRA Dataset ◽

10.1037/e661582012-001 ◽

2012 ◽

Author(s):

Rebecca M. Floyd ◽

Delilah O. Noronha ◽

Steven Lindley

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Program Evaluation ◽

Pain Management ◽

Care Program ◽

Chronic Pain Management ◽

Primary Care Program

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Managing Chronic Pain: Gaps Problematic in Primary Care

Clinical Psychiatry News ◽

10.1016/s0270-6644(06)71684-8 ◽

2006 ◽

Vol 34 (8) ◽

pp. 60

Author(s):

ROXANNE NELSON

Keyword(s):

Primary Care ◽

Chronic Pain

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Assessment of impact of ARIA guideline implementation vs routine care on rhinitis related quality of life in a primary care setting in Ireland

10.26226/morressier.5acc8ad0d462b8028d89ab27 ◽

2018 ◽

Author(s):

Anne Marie McGinley

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Care Setting ◽

Primary Care Setting ◽

Guideline Implementation ◽

Routine Care ◽

Related Quality

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Faculty Opinions recommendation of Severe chronic pain is associated with increased 10 year mortality. A cohort record linkage study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.3266958.2953055 ◽

2010 ◽

Author(s):

Michael Serpell

Keyword(s):

Chronic Pain ◽

Record Linkage ◽

Linkage Study ◽

Severe Chronic Pain

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Immune Actions on the Peripheral Nervous System in Pain

International Journal of Molecular Sciences ◽

10.3390/ijms22031448 ◽

2021 ◽

Vol 22 (3) ◽

pp. 1448

Author(s):

Jessica Aijia Liu ◽

Jing Yu ◽

Chi Wai Cheung

Keyword(s):

Chronic Pain ◽

Nervous System ◽

Peripheral Nervous System ◽

Immune Cells ◽

Molecular Mechanisms ◽

Process Integration ◽

Current Knowledge ◽

Therapeutic Strategies ◽

Lipid Mediators ◽

Cellular Changes

Pain can be induced by tissue injuries, diseases and infections. The interactions between the peripheral nervous system (PNS) and immune system are primary actions in pain sensitizations. In response to stimuli, nociceptors release various mediators from their terminals that potently activate and recruit immune cells, whereas infiltrated immune cells further promote sensitization of nociceptors and the transition from acute to chronic pain by producing cytokines, chemokines, lipid mediators and growth factors. Immune cells not only play roles in pain production but also contribute to PNS repair and pain resolution by secreting anti-inflammatory or analgesic effectors. Here, we discuss the distinct roles of four major types of immune cells (monocyte/macrophage, neutrophil, mast cell, and T cell) acting on the PNS during pain process. Integration of this current knowledge will enhance our understanding of cellular changes and molecular mechanisms underlying pain pathogenies, providing insights for developing new therapeutic strategies.

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Implementation of the Multidisciplinary Guideline on Chronic Pain in Vulnerable Nursing Home Residents to Improve Recognition and Treatment: A Qualitative Process Evaluation

Healthcare ◽

10.3390/healthcare9070905 ◽

2021 ◽

Vol 9 (7) ◽

pp. 905

Author(s):

Lizanne E. van den Akker ◽

Margot W. M. de Waal ◽

Paul J. E. M. Geels ◽

Else Poot ◽

Wilco P. Achterberg

Keyword(s):

Chronic Pain ◽

Nursing Home ◽

Guideline Implementation ◽

Nursing Home Residents ◽

Implementation Process ◽

Measurement Instruments ◽

Policy Document ◽

Multidisciplinary Meetings ◽

Qualitative Process Evaluation

The recognition and treatment of pain in nursing home residents presents challenges best addressed by a multidisciplinary approach. This approach is also recommended in the applicable Dutch guideline; however, translating guidelines into practical strategies is often difficult in nursing homes. Nevertheless, a better understanding of guideline implementation is key to improving the quality of care. Here we describe and qualitatively evaluate the implementation process of the multidisciplinary guideline ‘Recognition and treatment of chronic pain in vulnerable elderly’ in a Dutch nursing home. The researchers used interviews and document analyses to study the nursing home’s implementation of the guideline. The project team of the nursing home first filled out an implementation matrix to formulate goals based on preferred knowledge, attitudes, and behaviors for the defined target groups. Together with experts and organizations, pharmacotherapy audit meetings were organized, an expert pain team was appointed, a policy document and policy flowchart were prepared, and ‘anchor personnel’ were assigned to disseminate knowledge amongst professionals. Implementation was partially successful and resulted in a functioning pain team, a pain policy, the selection of preferred measurement instruments, and pain becoming a fixed topic during multidisciplinary meetings. Nevertheless, relatively few professionals were aware of the implementation process.

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Estimating the population health burden of musculoskeletal conditions using primary care electronic health records

Rheumatology ◽

10.1093/rheumatology/keab109 ◽

2021 ◽

Author(s):

Dahai Yu ◽

George Peat ◽

Kelvin P Jordan ◽

James Bailey ◽

Daniel Prieto-Alhambra ◽

...

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Electronic Health Records ◽

High Impact ◽

Low Back ◽

Musculoskeletal Health ◽

Health Records ◽

Electronic Health

Abstract Objectives Better indicators from affordable, sustainable data sources are needed to monitor population burden of musculoskeletal conditions. We propose five indicators of musculoskeletal health and assessed if routinely available primary care electronic health records (EHR) can estimate population levels in musculoskeletal consulters. Methods We collected validated patient-reported measures of pain experience, function and health status through a local survey of adults (≥35 years) presenting to English general practices over 12 months for low back pain, shoulder pain, osteoarthritis and other regional musculoskeletal disorders. Using EHR data we derived and validated models for estimating population levels of five self-reported indicators: prevalence of high impact chronic pain, overall musculoskeletal health (based on Musculoskeletal Health Questionnaire), quality of life (based on EuroQoL health utility measure), and prevalence of moderate-to-severe low back pain and moderate-to-severe shoulder pain. We applied models to a national EHR database (Clinical Practice Research Datalink) to obtain national estimates of each indicator for three successive years. Results The optimal models included recorded demographics, deprivation, consultation frequency, analgesic and antidepressant prescriptions, and multimorbidity. Applying models to national EHR, we estimated that 31.9% of adults (≥35 years) presenting with non-inflammatory musculoskeletal disorders in England in 2016/17 experienced high impact chronic pain. Estimated population health levels were worse in women, older aged and those in the most deprived neighbourhoods, and changed little over 3 years. Conclusion National and subnational estimates for a range of subjective indicators of non-inflammatory musculoskeletal health conditions can be obtained using information from routine electronic health records.

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