scholarly journals Moving towards a molecular understanding of pain management

2018 ◽  
Vol 87 (1) ◽  
pp. 49-51
Author(s):  
Logan Van Nynatten ◽  
Shafaz Veettil
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Molecular Medicine ◽  
Prescription Opioids ◽  
Pharmaceutical Treatment ◽  
Pharmacological Interventions ◽  
Drug Effectiveness ◽  
Pain Medications ◽  
Great Pressure ◽  
Promising Avenue

The management of chronic pain remains a challenging area in the practise of medicine. As our population ages, the incidence and prevalence of those living with chronic pain continues to increase. Hence, there is need for methods that promote optimal pain management. One promising avenue is that of “personalized and molecular pain management”. Indeed, a variety of genetic and molecular factors have been shown to impact metabolism of narcotics, limiting drug effectiveness. Furthermore, the prominence of polypharmacy can complicate the action of pain medications. Additional laboratory and diagnostic tests may be of benefit for risk stratifying patients at high risk of abusing pain medications from those at lower risk. Combining this with physician worry of worsening the opioid addiction crisis in North America via prescribing narcotics, there remains great pressure on physicians to limit their use of narcotics. Unfortunately, this may result in patients who are suitable candidates for prescription opioids receiving inadequate pharmaceutical treatment to complement non-pharmacological interventions. Moving forward, the implementation of molecular medicine approaches to pain management may provide unique solutions to these challenges.

scholarly journals Comparative Efficacy and Mechanisms of a Single Session Behavioral Medicine Class among Patients with Chronic Pain Taking Prescription Opioids: Study Protocol for a Randomized Controlled Trial

2020 ◽  
Author(s):  
Maisa Ziadni ◽  
Abby L. Chen ◽  
Tyler Winslow ◽  
Sean C. Mackey ◽  
Beth D. Darnall
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Health Education ◽  
Behavioral Medicine ◽  
Self Regulation ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Single Session ◽  
Comparative Efficacy ◽  
Treatment Needs

Abstract Background: Independent of pain intensity, pain-specific distress is highly predictive of pain treatment needs, including prescription opioids. Given the inherently distressing nature of chronic pain, there is a need to equip individuals with pain education and self-regulatory skills that are shown to improve adaptation and improve response to medical treatments. Brief, targeted behavioral medicine interventions may efficiently address the key individual factors, improve self-regulation in the context of pain, and reduce need for opioid therapy. This highlights the critical need for targeted, cost-effective interventions that efficiently address the key psychological factors that can amplify the need for opioids and increased risk for misuse. In this trial, the primary goal is to test the comparative efficacy of a single-session skills-based pain management class to a health education active control group among patients with chronic pain who are taking opioids. Methods: Our study is a randomized, double-blind clinical trial testing the superiority of our 2-hour single-session skills-based pain management class against a 2-hour health education class. We will enroll 136 adult patients with mixed etiology chronic pain who are taking opioid prescription medication and randomize 1:1 to one of the two treatment arms. We hypothesize superiority for the skills-based pain class for pain control, self-regulation of pain-specific distress, and reduced opioid use measured by daily morphine equivalent. Team researchers masked to treatment assignment will assess outcomes up to 12 months post-treatment. Discussion: This study aims to test the utility of a single-session, 2-hour skills-based pain management class to improve self-regulation of pain and reduce opioid use. Findings from our project have the potential to shift current research and clinical paradigms by testing a brief and scalable intervention that could reduce need for opioids and prevent misuse effectively, efficiently and economically. Further, elucidation of mechanisms of opioid use can facilitate refinement of more targeted future treatments.

scholarly journals The Examination of non-pharmacologic treatment of pain after spinal cord injury

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
J. A. Piatt ◽  
L. Eldridge ◽  
J. M. Baker
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Chronic Pain ◽  
Pain Management ◽  
Psychological Health ◽  
Management Strategies ◽  
Pharmacological Intervention ◽  
Pharmacological Interventions ◽  
Convenience Sample ◽  
Cord Injury

Background: One of the primary debilitating secondary health conditions experienced by individuals living with a spinal cord injury (SCI) is chronic pain. Approximately, over 30% of SCI patients endure chronic pain after sustaining the injury, and engage in opioid pharmacotherapy as the first form of treatment. The increase in use and misuse of prescribed opioids for chronic pain can lead to both physical and psychological health risks. This danger is exacerbated by the notion that a large percentage of the SCI population have a pre-existing condition of drug and alcohol abuse and addiction. This study will examine how pain is actually being addressed through non-pharmaceutical methods among the SCI adult population.  Experimental Design: Employing a cross-sectional web survey design with a convenience sample of adults with a SCI. A Qualtrics survey is currently being administered to known individuals with SCIs via email. The survey questions will illuminate what pain management strategies are being implemented in the SCI population within the US.   Anticipated Results: The results from the data will provide insight on what non-pharmacological interventions can be employed in place of or in combination with the pharmacological management. This will allow community-based rehabilitation therapies to incorporate appropriate pain management strategies.   Potential Impact: Non-pharmacological interventions may hold the answer in treating chronic pain in the SCI population by limiting or eliminating the use of opioids. This study will help develop the most appropriate non-pharmacological intervention to test in quasi-experimental clinical trials, and ultimately minimize the use of opioids for chronic pain.

Pain

2018 ◽  
pp. 463-484
Author(s):  
Maria Flynn ◽  
Dave Mercer
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Assessment Tools ◽  
Acute Injury ◽  
Summary Table ◽  
Pain Medications ◽  
Key Features ◽  
The Individual ◽  
Chronic Pain Conditions ◽  
Dressing Change

It is widely recognized that the experience of pain is unique to the individual, which makes caring for people in pain a challenge. The general hospital nurse is most likely to see people in pain due to an acute injury, an episode of ill health, following surgery, or at a wound dressing change. People living with chronic pain conditions will most often be in the care of community nurses or specialist pain management teams. In both acute and chronic pain conditions, it is important that general nurses can accurately assess, monitor, and treat pain. This chapter identifies the key features of acute and chronic pain and describes pain assessment tools which are in widespread use. It outlines common pharmacological and non-pharmacological approaches to pain management, along with a summary table of frequently prescribed pain medications. Key considerations in nursing practice and decision-making are outlined.

scholarly journals A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders

2017 ◽  
Vol 13 (1) ◽  
pp. 5 ◽  
Author(s):  
Sarina R. Isenberg, MA ◽  
Allysha C. Maragh-Bass, MPH, PhD ◽  
Kathleen Ridgeway, MSPH ◽  
Mary Catherine Beach, MD, MPH ◽  
Amy R. Knowlton, MPH, ScD
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Drug Use ◽  
Illicit Drug ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Illicit Drug Use ◽  
Prescription Opioids ◽  
Community Based Research ◽  
History Of

Objective: The study explored high-risk participants' experiences with pain management regarding clinical access to and use of prescription opioids.Design: Qualitative semistructured interviews and focus groups.Setting: Data were collected August 2014 to May 2015 at an urban community-based research facility in Baltimore City, MD.Participants: HIV participants with chronic pain and a history of illicit drug use.Methods: Qualitative coding and analysis used an iterative, inductive, and thematic approach and coders achieved inter-coder consistency.Results: The authors identified two major themes. First, participants had positive and negative interactions with healthcare providers regarding chronic pain treatment. Participants perceived that providers lacked empathy for their pain and/or were not adequately managing their pain. These interactions resulted in participants seeking new providers or mistrusting the medical system. Further, providers’ surveillance of participants’ pain treatment regimen contributed to distress surrounding pain management. The second theme centered on participants’ pain management experiences with prescribed opioid analgesics. Participants felt they were receiving dosages and classes of analgesics that did not sufficiently address their pain, and consequently modified their dosages or rationed prescription opioids. Other participants were reluctant to take analgesics due to their history of illicit drug use. Some participants relapsed to illicit drug use when they felt their prescription opioids did not adequately address their pain needs.Conclusions: Participant struggles with receiving and managing prescribed opioid analgesics suggest a need for: therapies beyond these medications; guidelines for providers specific to this population; and harm reduction trainings for providers.

Chronic pain experience and pain management in persons with spinal cord injury in Nepal

2018 ◽  
Vol 18 (2) ◽  
pp. 195-201
Author(s):  
Sagun Thapa ◽  
Luppana Kitrungrote ◽  
Jintana Damkliang
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Chronic Pain ◽  
Pain Management ◽  
Community Context ◽  
Cross Sectional ◽  
Data Set ◽  
Pain Experience ◽  
Pain Medications ◽  
Cord Injury

Abstract Background and aims: Chronic pain is the frequent and significantly challenging complications in persons with spinal cord injury (SCI). Socio-cultural background may lead people perceive and manage pain differently. The study aims to describe the chronic pain experience and pain management of SCI persons in Nepal. Methods: A descriptive cross sectional study was conducted among purposively selected sample of 120 SCI persons with chronic pain living in the eight districts of Bagmati Zone of Nepal. The data were collected using the International Spinal Cord Injury Pain Basic Data Set Version 2 (ISCIPBDS-2) and Open-ended Pain Management Questionnaire. The data were analyzed using descriptive statistics and content analysis method. Results: The back (n=84), lower legs/feet (n=63) and buttocks/hips (n=51) was found as the common pain locations. In common, the onset of pain was found within the first 6 month of the injury. Overall pain intensity and pain interference were found to be at the moderate level. The SCI persons used pain medications and non-pharmacological pain management. Ibuprofen was the commonly used pain medication and commonly used non-pharmacological pain management methods included physical support (e.g. massage, exercise), relaxation (e.g. distraction, substance abuse), coping (e.g. acceptance, praying), and traditional herbs. Conclusions: SCI persons had chronic pain experience which interfered with their daily living. They used pain medications and non-pharmacological pain management methods based on their beliefs, knowledge, and community resources in Nepal. Implications: This study provides some evidence to help the team of rehabilitation professional to plan and help SCI persons with chronic pain. Based on these findings, chronic pain management intervention for SCI persons should be developed and supported continuously from hospital to home based community context of Nepal.

Recruiting patients with advanced cancer to participate in a non-opioid intervention for chronic pain management.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14085-e14085
Author(s):  
Preethi Selvan ◽  
Katherine Myers-Coffman ◽  
Karolina Bryl ◽  
Jasmine Tenpa Lama ◽  
Brigette Sutton ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Music Therapy ◽  
Advanced Cancer ◽  
Research Participation ◽  
Future Research ◽  
Control Group ◽  
Pharmacological Interventions ◽  
Chi Square ◽  
Recruitment Methods

e14085 Background: Chronic pain related to advanced cancer is difficult to treat. In addition to traditional analgesics, non-pharmacological interventions, such as music therapy, may help alleviate pain in this population. Research studies to test the efficacy of these non-pharmacological interventions are necessary and important. However, recruiting patients with advanced cancer to participate in such interventions can be challenging. Identifying effective sources of referrals and barriers to participation may help increase recruitment rates in the future. Methods: We recruited patients with advanced cancer (stage III or IV) with chronic pain from two major hospital systems to participate in a pain management interventional study. The experimental group received individualized music therapy, while the control group received talk therapy. Participants attended six weekly sessions at the hospital and were compensated for time and travel. Recruitment methods included referrals from care teams, advertisement through flyers and posters, EMR chart reviews, and in-person recruitment at multiple infusion centers. Missing data was excluded from analyses. Chi-square tests assessed significant differences between groups. Results: Of 594 patients that were referred to the study, 7% enrolled (n = 40), 35% declined (n = 208), and 58% were ineligible (n = 346). Forty-seven percent (n = 19) of enrolled participants were female; race/ethnic distributions were the following: African American/Black (55%; n = 22), Caucasian/White (28%; n = 11), or other (17%; n = 7). The most effective recruitment method was through self-referral; of the 40 patients enrolled in the study, 9 (23%) were enrolled through this method. There were no statistically significant differences between referral source and enrollment. The top three reasons patients declined to participate included lack of interest (32%; n = 67), lack of time and/or energy (28%; n = 59), and lack of transportation (16%, n = 34). Conclusions: Although there were no differences in referral sources, more patients were enrolled through self-referral or in-person recruitment, showing the power of personal motivation and personal touch. While lack of participation due to interest, time, or energy are hard to overcome, future research should consider campaigns to reach patients who are motivated to participate. In addition to referrals, resources for in-person recruitment and transportation to help alleviate barriers to research participation should be considered.

scholarly journals What Works for Managing Chronic Pain: An Appreciative Inquiry Qualitative Analysis

2019 ◽  
Vol 10 ◽  
pp. 215013271988528 ◽  
Author(s):  
Jodi Summers Holtrop ◽  
Mary Fisher ◽  
Doreen E. Martinez ◽  
Matthew Simpson ◽  
Nida S. Awadallah ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Health Care Providers ◽  
Appreciative Inquiry ◽  
Dynamic Condition ◽  
Semistructured Interview ◽  
Care Providers ◽  
Pain Medications ◽  
Qualitative Descriptive

Background: Chronic pain is a prevalent and dynamic condition for both patients and providers. Learning how patients with chronic pain successfully manage their pain may prove helpful in guiding health care providers in their treatment of other patients with chronic pain. This research sought to identify successful strategies for managing chronic pain from interviews with individuals experiencing chronic pain who were able to do “most of what they want on most days.” Methods: Qualitative, descriptive study. Patients were from metro Denver, Colorado, USA and were recruited from community and health care settings. Appreciative inquiry (AI) was used as an approach to elicit stories of successful pain management. We conducted one-on-one, in person interviews using a semistructured interview guide. Analysis was completed using a grounded hermeneutic editing approach. Results: Twenty-four interviews were completed representing a range of adult ages, genders, race/ethnicities, and underlying reasons for chronic pain. Consistent themes were found in that all patients had developed multiple strategies for ongoing pain management and prevention, as well as a mental approach embedded with elements of positive beliefs and determination. Friends, family, support group members, and health care providers were key in support and ongoing management. Although 10 patients regularly used opioid pain medications, none were dependent, and all stated an active desire to avoid these medications. Conclusions: Successful chronic pain management seems possible as displayed from the patient narratives but requires persistence through individual trial and error. Recommendations for health care provider teams are made to apply these findings to assist patients with chronic pain.

scholarly journals An update on available pain medications

2018 ◽  
Vol 60 (3) ◽  
pp. 14-20
Author(s):  
Elzbieta Osuch ◽  
Andre Marais
Keyword(s):  
Chronic Pain ◽  
Pain Therapy ◽  
Persistent Pain ◽  
Medical Attention ◽  
Surgical Approaches ◽  
Pharmacological Interventions ◽  
Pharmacological Agents ◽  
Pain Syndromes ◽  
Pain Medications ◽  
Behavioural Factors

Pain is a complex interaction of sensory, emotional and behavioural factors. Chronic pain is among the most common reasons for seeking medical attention. In contrast to acute pain, where the goal is primary pain relief, the effective management of chronic pain is complex and not fully understood. Multimodal pain therapy is often required to treat chronic or persistent pain syndromes. These include pharmacological agents, physical interventions, behavioural changes and surgical approaches. Pharmacological interventions are the most widely used therapeutic options to treat acute and persistent pain.

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