scholarly journals Conceptualizing breakthrough pain

2021 ◽  
Vol 11 (12) ◽  
pp. 46
Author(s):  
Leslie Narain ◽  
Rida Naeem ◽  
Apurva Nemala ◽  
Daniel Linder ◽  
Zhuo Sun ◽  
...  
Keyword(s):  
Pain Management ◽  
Conceptual Model ◽  
Breakthrough Pain ◽  
The United States ◽  
Management Plan ◽  
Opioid Overdose ◽  
Health Economic Model ◽  
Conceptual Relationships ◽  
Pain Patients

The concept of breakthrough pain (BTP) is examined through the development of a conceptual model with a long-term goal of positively impacting the management of chronic pain patients who experience BTP when hospitalized. The model is based on a 2008 Health Economic Model of Breakthrough Pain developed by Abernethy, Wheeler, and Fortner, which will be referred to as the parent model. The conceptual model of BTP, titled, Novel Conceptual Model of Breakthrough Pain (NCMBP) shares a similar structure in regards to the relationships of major constructs. Like the parent model, the NCMBP is based on three major constructs which are analyzed and explained further with associated concepts. The NCMBP is primarily concerned with the importance of a pain management plan and the endpoint result of patient-perceived analgesia. The NCMBP is viewed as a necessary foundation for continuing safe and effective pain management in the setting of a current opioid overdose epidemic in the United States. The structure and conceptual relationships of the NCMBP are preliminary and will continue to undergo revision as conduction of research is attempted to test the model.

Monitoring outcomes during long-term opioid therapy for noncancer pain: Results with the Pain Assessment and Documentation Tool

2005 ◽  
Vol 1 (5) ◽  
pp. 257 ◽  
Author(s):  
Steven D. Passik, PhD ◽  
Kenneth L. Kirsh, PhD ◽  
Laurie Whitcomb, MA ◽  
Jeffrey R. Schein, PhD, MPH ◽  
Mitchell A. Kaplan, PhD ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Side Effects ◽  
Pain Assessment ◽  
The United States ◽  
Opioid Therapy ◽  
Chronic Pain Patients ◽  
Noncancer Pain ◽  
Documentation Tool ◽  
Pain Patients

The increasingly common practice of long-term opioid therapy for chronic noncancer pain must be guided by ongoing assessment of four types of outcomes: pain relief, function, side effects, and drug-related behaviors. Our objective was to gather initial pilot data on the clinical application of a specialized chart note, the Pain Assessment and Documentation Tool (PADT), which was developed and tested with 27 physicians. This pilot test provided the means to collect cross-sectional outcome data on a large sample of opioid-treated chronic pain patients. Each of the physician volunteers (located in a variety of settings across the United States) completed the PADT for a convenience sample of personally treated chronic pain patients who had received at least three months of opioid therapy. Completion of the PADT required a clinical interview, review of the medical chart, and direct clinical observation. Data from the PADTs were collated and analyzed. The results suggested that the majority of patients with chronic pain achieve relatively positive outcomes in the eyes of their prescribing physicians in all four relevant domains with opioid therapy. Analgesia was modest but meaningful, functionality was generally stabilized or improved, and side effects were tolerable. Potentially aberrant behaviors were common but viewed as an indicator of a problem (i.e., addiction or diversion) in only approximately 10 percent of cases. Using the PADT, physician ratings can be developed in four domains. In this sample, outcomes suggested that opioid therapy provided meaningful analgesia.

The Biology, Medical Management, and Podiatric Implications of Menopause

2002 ◽  
Vol 92 (8) ◽  
pp. 437-443 ◽  
Author(s):  
Arthur H. Friedlander ◽  
Lester J. Jones
Keyword(s):  
United States ◽  
Hormone Replacement ◽  
The United States ◽  
Management Plan ◽  
Estrogen Deprivation ◽  
Related Factors ◽  
Comprehensive Management ◽  
Age Related ◽  
Foot Biomechanics

Approximately 36 million women in the United States are in the postmenopausal phase of life, creating unique challenges for the provision of compassionate, comprehensive podiatric medical treatment. Long-term estrogen deprivation arising from menopause in association with age-related factors disproportionately increases the risk of ischemic heart disease, osteoporosis, and concomitant podiatric complications. This article discusses the physiologic basis of menopause, hormone replacement therapy and its effects on osteoporosis, and other podiatric implications of menopause. Podiatric physicians caring for larger numbers of peri- and postmenopausal women must formulate a comprehensive management plan for treating fractures that arise from a combination of estrogen-deprivation osteoporosis and abnormal foot biomechanics. (J Am Podiatr Med Assoc 92(8): 437-443, 2002)

scholarly journals Impact of the COVID-19 pandemic on chronic pain management

2021 ◽  
Vol 2 (3) ◽  
pp. 197-212
Author(s):  
Andrew Auyeung ◽  
Hank Wang ◽  
Iulia Pirvulescu ◽  
Nebojša Knežević
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Pain Management ◽  
The United States ◽  
Chronic Pain Management ◽  
Steroid Use ◽  
Chronic Pain Patients ◽  
Interventional Pain Management ◽  
Tools And Techniques ◽  
Pain Patients

Introduction: The COVID-19 pandemic has generated considerable turmoil in the interventional pain management (IPM) community. Due to IPM being classified as 'elective', numerous pain practices across the United States were forced to close during the pandemic, leaving chronic pain patients untreated for indefinite periods, and IPM physicians with increased stress and burnout. Results: In response to these detrimental effects, various re-opening tools and techniques have been created to facilitate a cautious resumption of in-person interventional pain practice. Due to their ability to minimize person-to-person contact, telehealth and pharmacotherapy played a more significant role in IPM during the pandemic, but their increased utilization has also led to the exacerbation of substance abuse and the opioid epidemic. The interplay between steroid use and its immunosuppressive effects, in relation to the COVID-19 infection and the COVID-19 vaccine, has also arisen as an issue of concern. Conclusion: As practices begin to safely re-open throughout the United States, the effects felt by chronic pain patients during the pandemic must be emphasized and not ignored. This review emphasizes the struggles pain patients have had to face during the pandemic and the need to update and redefine regulations regarding interventional and chronic pain management.

scholarly journals Exploring the Role of Awe in Architecture as a Pain Disruptor- A Call for New Research

2020 ◽  
Author(s):  
Miram Hoffman
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Pain Management ◽  
Pain Perception ◽  
The United States ◽  
Management Tool ◽  
Opioid Overdose ◽  
Contributing Factors ◽  
Diverse Range ◽  
The Impact

Chronic pain is a widespread and complex phenomenon, driven by a diverse range of factors. Pain management has become a significant concern over the past several decades in the United States as controversy has grown surrounding the use of opioids for chronic pain management, the use of which has led to abuse and addiction. The Centers for Disease Control and Prevention (CDC) reports that 128 people die in the United States every day from an opioid overdose, whether obtained illicitly or by prescription. While opioids remain one of the frontline methods for pain management, their long term safety and efficacy has come under scrutiny. As with any complex systemic issue, there are many contributing factors to chronic pain and pain management. This paper proposes that the experience of awe – specifically elicited by design of the built environment – can serve as an innovative, non-pharmacological pain management tool. Awe is an emotional response to perceptually vast stimuli, precipitating accommodation or a shift in existing mental structures. The author hypothesizes that awe can be used as a form of the proven self-regulating pain management method known as reappraisal. Pain reappraisal is cognitive reframing of the context and meaning of pain, changing the value that pain is assigned and resulting in decreased pain perception. This paper explores the pertinent intersection of emotions, neuroscience, and the impact of the physical environment on our health and wellbeing. The intention of this paper is to call for a new line of research and does not attempt to address methods or results at this time.

scholarly journals Hypothesizing in the Face of the Opioid Crisis Coupling Genetic Addiction Risk Severity (GARS) Testing with Electrotherapeutic Nonopioid Modalities Such as H-Wave Could Attenuate Both Pain and Hedonic Addictive Behaviors

2022 ◽  
Vol 19 (1) ◽  
pp. 552
Author(s):  
Ashim Gupta ◽  
Abdalla Bowirrat ◽  
Luis Llanos Gomez ◽  
David Baron ◽  
Igor Elman ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Opioid Analgesics ◽  
The United States ◽  
Opioid Overdose ◽  
Addictive Behaviors ◽  
Pain Clinics ◽  
Analgesic Agents ◽  
Addiction Risk ◽  
Affective Components

In the United States, amid the opioid overdose epidemic, nonaddicting/nonpharmacological proven strategies are available to treat pain and manage chronic pain effectively without opioids. Evidence supporting the long-term use of opioids for pain is lacking, as is the will to alter the drug-embracing culture in American chronic pain management. Some pain clinicians seem to prefer classical analgesic agents that promote unwanted tolerance to analgesics and subsequent biological induction of the “addictive brain”. Reward genes play a vital part in modulation of nociception and adaptations in the dopaminergic circuitry. They may affect various sensory and affective components of the chronic pain syndromes. The Genetic Addiction Risk Severity (GARS) test coupled with the H-Wave at entry in pain clinics could attenuate pain and help prevent addiction. The GARS test results identify high-risk for both drug and alcohol, and H-Wave can be initiated to treat pain instead of opioids. The utilization of H-Wave to aid in pain reduction and mitigation of hedonic addictive behaviors is recommended, notwithstanding required randomized control studies. This frontline approach would reduce the possibility of long-term neurobiological deficits and fatalities associated with potent opioid analgesics.

scholarly journals The Opioid Epidemic and Children's Living Arrangements in the United States, 2000-2018

2021 ◽  
Author(s):  
Mònica L. Caudillo ◽  
Andrés Villarreal ◽  
Philip N. Cohen
Keyword(s):  
Living Arrangements ◽  
Fixed Effects ◽  
Local Level ◽  
The United States ◽  
Vital Statistics ◽  
Opioid Overdose ◽  
Opioid Epidemic ◽  
Family Structures ◽  
Health And Wellbeing

The opioid epidemic has had devastating effects for the health and wellbeing of the U.S. population. However, we know little about how it has affected the structure of families where children are raised. Using the 5 percent sample of the 2000 Census, 2005-2018 American Community Survey (ACS) data and restricted Vital Statistics we assess the effect of the opioid epidemic at the local level on the rates of children living under different types of family arrangements: two married parents, two cohabiting parents, mother only, father only, or another configuration. Local fixed-effects models show that a greater intensity of the opioid epidemic, as measured by a higher opioid-overdose death rate, is associated with a lower rate of children living with two married parents, and a higher rate of children living with two cohabiting parents, with only a father, and with adults other than their parents. The opioid epidemic appears to increase the rates of children living in family structures that tend to be less stable, which has potential long term implications for the wellbeing of future generations.

scholarly journals Social Determinants of the Recent Decline in US Life Expectancy

2020 ◽  
Author(s):  
Sam Harper ◽  
Corinne Riddell ◽  
Nicholas King
Keyword(s):  
United States ◽  
Life Expectancy ◽  
The United States ◽  
Opioid Overdose ◽  
Recent Trends ◽  
And Gender ◽  
Gender Groups ◽  
The Life Course ◽  
Overdose Deaths

In recent years life expectancy has stagnated in the United States, followed by three consecutive years of decline. The decline is small in absolute terms, but is unprecedented and has generated considerable research interest and theorizing about potential causes. Recent trends show the decline has affected nearly all race-ethnic and gender groups, and the proximate causes of the decline are increases in opioid overdose deaths, suicide, homicide, and Alzheimer’s disease. A slowdown in the long-term decline in mortality from cardiovascular diseases has also prevented life expectancy from further improvements. Although a popular explanation for the decline is the cumulative decline in living standards across generations, recent trends suggest that distinct mechanisms for specific causes of death are more plausible explanations. Interventions to stem the increase in overdose deaths, reduce access to mechanisms that contribute to violent deaths, and decrease cardiovascular risk over the life course are urgently needed to improve mortality in the United States.

Depression Among Chronic Pain Patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S708-S708 ◽  
Author(s):  
I. Berrahal ◽  
B. Ayadi ◽  
M. Haddad
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Management Plan ◽  
Cross Sectional Study ◽  
Poor Quality ◽  
Cross Sectional ◽  
Psychological Therapies ◽  
Chronic Pain Patients ◽  
Prevalence Of Depression ◽  
Pain Patients

IntroductionPatients with chronic pain are more likely to develop depression, which is associated with decreased function, poorer treatment response and poor quality of life.ObjectiveThis study aimed to determine the prevalence of depression in patients with chronic pain.MethodsThis descriptive cross-sectional study was conducted among clinically diagnosed chronic pain patients from the pain management ward of La Rabta hospital in Tunisia over a period of six months.Sociodemographic and clinical data were obtained from patients’ interviews and medical records.The Beck depression inventory (BDI) was used for screening depression diagnoses and the Visual analogue scale (VAS) to assess the severity of pain.ResultsThe sample included 102 patients with a mean age of 46.4 ± 10.4 years. The majority of the patients were females (72.5%, n = 74), married (83.3%, n = 85) and being employed (58.8%, n = 60). The prevalence of depression was (40.1%, n = 41). The mean duration of pain was 3.6 ± 1.5 years. The severity of pain was mild in 28 cases (19.3%), moderate in 36 cases (31.3%) and severe in 38 cases (49.4%). Depression was significantly associated with the duration of pain (P < 0.01). A positive correlation was observed between pain severity assessed by VAS and BDI (r = 0.521, P = 001). Depression was significantly associated with the duration of pain (P < 0.01).ConclusionsDepression is frequent in patients who suffer from chronic pain and it was significantly associated with the duration and the severity of pain. Antidepressants and psychological therapies can be effective and should be delivered as part of a multidisciplinary pain management plan.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Exploring the Role of Awe in Architecture as a Pain Disruptor- A Call for New Research

2020 ◽  
Author(s):  
Miriam Hoffman
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Pain Management ◽  
Pain Perception ◽  
The United States ◽  
Management Tool ◽  
Opioid Overdose ◽  
Contributing Factors ◽  
Diverse Range ◽  
The Impact

Chronic pain is a widespread and complex phenomenon, driven by a diverse range of factors. Pain management has become a significant concern over the past several decades in the United States as controversy has grown surrounding the use of opioids for chronic pain management, the use of which has led to abuse and addiction. The Centers for Disease Control and Prevention (CDC) reports that 128 people die in the United States every day from an opioid overdose, whether obtained illicitly or by prescription. While opioids remain one of the frontline methods for pain management, their long term safety and efficacy has come under scrutiny. As with any complex systemic issue, there are many contributing factors to chronic pain and pain management. This paper proposes that the experience of awe – specifically elicited by design of the built environment – can serve as an innovative, non-pharmacological pain management tool. Awe is an emotional response to perceptually vast stimuli, precipitating accommodation or a shift in existing mental structures. The author hypothesizes that awe can be used as a form of the proven self-regulating pain management method known as reappraisal. Pain reappraisal is cognitive reframing of the context and meaning of pain, changing the value that pain is assigned and resulting in decreased pain perception. This paper explores the pertinent intersection of emotions, neuroscience, and the impact of the physical environment on our health and wellbeing. The intention of this paper is to call for a new line of research and does not attempt to address methods or results at this time.

Management of Malignant Peritoneal Mesothelioma Using Cytoreductive Surgery and Perioperative Chemotherapy

2016 ◽  
Vol 12 (10) ◽  
pp. 928-935 ◽  
Author(s):  
Paul H. Sugarbaker ◽  
Kiran K. Turaga ◽  
H. Richard Alexander ◽  
Marcello Deraco ◽  
Mary Hesdorffer
Keyword(s):  
Cytoreductive Surgery ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
The United States ◽  
Management Plan ◽  
Peritoneal Mesothelioma ◽  
Perioperative Chemotherapy ◽  
Malignant Peritoneal Mesothelioma ◽  
Peritoneal Space

Malignant peritoneal mesothelioma is a rare disease, with approximately 800 new patients per year in the United States. Its natural history is defined by progression restricted to the peritoneal space. In the past, patients with this disease had a limited lifespan of approximately 1 year. Numerous single-institution studies as well as a systematic review have reported median survival of 3 to 5 years with a combination of cytoreductive surgery and hyperthermic perioperative chemotherapy. These markedly improved survival statistics were achieved in experienced centers with 1% mortality and 20% morbidity rates. Data have shown that knowledgeable patient selection is required to prevent patients unlikely to benefit from undergoing these interventions. The conclusion is that patients with peritoneal mesothelioma can experience long-term progression-free survival or significant palliation with cytoreductive surgery plus hyperthermic perioperative chemotherapy. This management plan should be considered the standard of care for properly selected patients with malignant peritoneal mesothelioma at experienced centers around the world.

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