Conceptualizing Drug Addiction and Chronic Pain through a Biopsychosocial Framework to Improve Therapeutic Strategies

2021 ◽  
Author(s):  
Zachary S. Harmon ◽  
Emily N. Welch ◽  
Christina L. Ruby
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Drug Addiction ◽  
Management Practices ◽  
Opioid Analgesics ◽  
Positive Health ◽  
Biopsychosocial Perspective ◽  
Positive Health Outcomes

The recent surge in opioid-related deaths has brought poor pain management practices to the forefront of our nation’s collective consciousness. However, improving treatments for chronic pain, substance use disorders (SUD), and comorbid expression of both requires a better understanding of the pathophysiology involved in their development. In this chapter, the authors present the argument that chronic pain and SUD can be conceptualized similarly from a biopsychosocial perspective to inform a better approach to treatment. The authors describe the common neurobehavioral mechanisms of SUD and chronic pain, then discuss the efficacy of several psychotherapeutic methods employed to combat chronic pain, addiction, and related disorders. Such methods may contribute to positive health outcomes in managing chronic pain and curbing drug addiction by reducing the role of opioid analgesics for long-term pain management.

scholarly journals Clinical Challenges and Considerations in Management of Chronic Pain Patients During a COVID-19 Pandemic

2020 ◽  
Vol 49 (9) ◽  
pp. 669-673
Author(s):  
Diana XH Chan ◽  
Xu Feng Lin ◽  
Jane Mary George ◽  
Christopher W Liu
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Management Practices ◽  
Management Strategies ◽  
Chronic Pain Patient ◽  
Control Measures ◽  
Pain Patient ◽  
Chronic Pain Patients ◽  
Pain Patients

Since the coronavirus disease 2019 (COVID-19) was deemed a pandemic on 11 March 2020, we have seen exponential increases in the number of cases and deaths worldwide. The rapidly evolving COVID-19 situation requires revisions to clinical practice to defer non-essential clinical services to allocate scarce medical resources to the care of the COVID-19 patient and reduce risk to healthcare workers. Chronic pain patients require long-term multidisciplinary management even during a pandemic. Fear of abandonment, anxiety and depression may increase during this period of social isolation and aggravate pain conditions.Whilst physical consults for chronic pain patients were reduced, considerations including continuity of support and analgesia, telemedicine, allied health support and prioritising necessary pain services and interventions, were also taken to ensure biopsychosocial care for them. Chronic pain patients are mostly elderly with multiple comorbidities, and are more susceptible to morbidity and mortality from COVID-19. It is imperative to review pain management practices during the COVID-19 era with respect to infection control measures, re-allocation of healthcare resources, community collaborations, and analgesic use and pain interventions. The chronic pain patient faces a potential risk of functional and emotional decline during a pandemic, increasing healthcare burden in the long term. Clinical decisions on pain management strategies should be based on balancing the risks and benefits to the individual patient. In this commentary, we aim to discuss the basis behind some of the decisions and safeguards that were made at our tertiary pain centre over the last 6 months during the COVID-19 outbreak.

scholarly journals Evaluation of an Educational Outreach Campaign (IMPACT) on Pain Management Delivered to General Practices in Walsall

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i48-i49
Author(s):  
S Visram ◽  
J Saini ◽  
R Mandvia
Keyword(s):  
Data Analysis ◽  
Pain Management ◽  
Cancer Pain ◽  
Educational Intervention ◽  
Opioid Analgesics ◽  
Educational Outreach ◽  
Opioid Prescribing ◽  
Prescribing Trends ◽  
The Impact

Abstract Introduction Opioid class drugs are a commonly prescribed form of analgesic widely used in the treatment of acute, cancer and chronic non-cancer pain. Up to 90% of individuals presenting to pain centres receive opioids, with doctors in the UK prescribing more and stronger opioids (1). Concern is increasing that patients with chronic pain are inappropriately being moved up the WHO ‘analgesic ladder’, originally developed for cancer pain, without considering alternatives to medications, (2). UK guidelines on chronic non-cancer pain management recommend weak opioids as a second-line treatment, when the first-line non-steroidal anti-inflammatory drugs / paracetamol) ineffective, and for short-term use only. A UK educational outreach programme by the name IMPACT (Improving Medicines and Polypharmacy Appropriateness Clinical Tool) was conducted on pain management. This research evaluated the IMPACT campaign, analysing the educational impact on the prescribing of morphine, tramadol and other high-cost opioids, in the Walsall CCG. Methods Standardised training material was delivered to 50 practices between December 2018 and June 2019 by IMPACT pharmacists. The training included a presentation on pain control, including dissemination of local and national guidelines, management of neuropathic, low back pain and sciatica as well as advice for prescribers on prescribing opioids in long-term pain, with the evidence-base. Prescribing trends in primary care were also covered in the training, and clinicians were provided with resources to use in their practice. Data analysis included reviewing prescribing data and evaluating the educational intervention using feedback from participants gathered via anonymous questionnaires administered at the end of the training. Prescribing data analysis was conducted by Keele University’s Medicines Management team via the ePACT 2 system covering October 2018 to September 2019 (two months before and three months after the intervention) were presented onto graphs to form comparisons in prescribing trends of the Midland CCG compared to England. Results Questionnaires completed at the end of sessions showed high levels of satisfaction, with feedback indicating that participants found the session well presented, successful at highlighting key messages, and effective in using evidence-based practice. 88% of participants agreed the IMPACT campaign increased their understanding of the management and assessment of pain, and prescribing of opioids and other resources available to prescribers. The majority (85%) wished to see this form of education being repeated regularly in the future for other therapeutic areas. Analysis of the prescribing data demonstrated that the total volume of opioid analgesics decreased by 1.7% post-intervention in the Midlands CCG in response to the pharmacist-led educational intervention. As supported by literature, the use of educational strategies, including material dissemination and reminders as well as group educational outreach was effective in engaging clinicians, as demonstrated by the reduction in opioid prescribing and high GP satisfaction in this campaign. Conclusion The IMPACT campaign was effective at disseminating pain-specific guidelines for opioid prescribing to clinicians, leading to a decrease in overall prescribing of opioid analgesics. Educational outreach as an approach is practical and a valuable means to improve prescribing by continuing medical education. References 1. Els, C., Jackson, T., Kunyk, D., Lappi, V., Sonnenberg, B., Hagtvedt, R., Sharma, S., Kolahdooz, F. and Straube, S. (2017). Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. This provided the statistic of percentage receiving opioids that present to pain centres. 2. Heit, H. (2010). Tackling the Difficult Problem of Prescription Opioid Misuse. Annals of Internal Medicine, 152(11), p.747. Issues with prescriptions and inappropriate moving up the WHO ladder.

Pain Management in Context of Emotionally Unstable Personality Disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S500-S500
Author(s):  
E. Dobrzynska ◽  
N. Clementi
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Personality Disorder ◽  
English Language ◽  
Opioid Analgesics ◽  
Management Options ◽  
Cognitive Behavioural ◽  
Keywords Chronic Pain ◽  
Competing Interest ◽  
Emotionally Unstable Personality Disorder

IntroductionEmotionally unstable personality disorder (EUPD) is characterised by Pain Paradox. The response for acute, self-induced pain seems to be attenuated while chronic, endogenous pain is usually intolerable. Pain management of this group of patients poses many difficulties, including discrepancies between subjective and objective pain assessment, patients’ demands for strong analgesics and impact on relationship with other professionals.Objectives and aimsThe purpose of the study was to review pain management options for persons diagnosed with EUPD and complaining of chronic pain.MethodsMEDLINE and PsycINFO databases were searched for all English-language articles containing the keywords “chronic pain”, “pain management”, “borderline personality disorder”, and “emotionally unstable personality disorder”.ResultsSeventeen relevant papers were identified. Suggested first step in pain management was ongoing clarification with EUPD patients that analgesics are unlikely to fully treat their pain and support of non-pharmacological approaches to pain, including cognitive-behavioural strategies. Regarding pharmacology, liberal use of non-addicting analgesics was recommended with highly conservative use of opioid analgesics. Importance of evaluation and treatment of any underlying mood and/or anxiety syndromes was stressed as well as liaison with other professionals (e.g. psychologists, neurologists, orthopaedics, and physiotherapists).ConclusionsPatients with EUPD often report chronic pain, which can only be managed by close collaboration of professionals from different disciplines.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Optogenetics and photopharmacology in pain research and therapeutics

STEMedicine ◽  
2020 ◽  
Vol 1 (3) ◽  
pp. e43 ◽  
Author(s):  
Federico Iseppon ◽  
Manuel Arcangeletti
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Molecular Switches ◽  
Genetic Profiling ◽  
Pain Research ◽  
Recent Advances ◽  
Cellular Components ◽  
The Brain

Pain afflicts billions of people worldwide, who suffer especially from long-term chronic pain. This gruelling condition affects the nervous system at all levels: from the brain to the spinal cord, the Dorsal Root Ganglia (DRG) and the peripheral fibres innervating the skin. The nature of the different molecular and cellular components of the somatosensory modalities, as well as the complexity of the peripheral and central circuitry are yet poorly understood. Light-based techniques such as optogenetics, in concert with the recent advances in single-cell genetic profiling, can help to elucidate the role of diverse neuronal sub-populations in the encoding of different sensory and painful stimuli by switching these neurons on and off via optically active proteins, namely opsins.  Recently, photopharmacology has emerged from the efforts made to advance optogenetics. The introduction of azo-benzene-based light-sensitive molecular switches has been applied to a wide variety of molecular targets, from ion channels and receptors to transporters, enzymes and many more, some of which are paramount for pain research and therapy. In this Review, we summarise the recent advances in the fields of optogenetics and photopharmacology and we discuss the use of light-based techniques for the study of acute and chronic pain physiology, as well as their potential for future therapeutic use to improve pain treatment.

scholarly journals The Role of Opioid Analgesics in Geriatric Pain Management

2016 ◽  
Vol 32 (4) ◽  
pp. 725-735 ◽  
Author(s):  
Jennifer Greene Naples ◽  
Walid F. Gellad ◽  
Joseph T. Hanlon
Keyword(s):  
Pain Management ◽  
Opioid Analgesics ◽  
Geriatric Pain

Values of cancer survivors and the supportive role of recreational video games

2019 ◽  
pp. 135910531987166
Author(s):  
Maria Leonora (Nori) Comello ◽  
Diane B Francis ◽  
Laurie Hursting ◽  
Elizabeth Swarner ◽  
Laura H Marshall
Keyword(s):  
Content Analysis ◽  
Video Games ◽  
Health Outcomes ◽  
Cancer Survivors ◽  
Positive Health ◽  
Openness To Change ◽  
Supportive Role ◽  
Self Transcendence ◽  
Positive Health Outcomes

Value-affirming activities have been linked to positive health outcomes and improved ability to cope. For cancer survivors who regularly play video games, might the games have potential to affirm values? We surveyed gameplaying survivors and included an open-ended question asking about values and the extent to which they perceived gameplaying as supporting values. A content analysis of responses ( N = 533) using Schwartz’s value typology revealed that a majority perceived gameplaying as supporting values or offering other benefits. Self-transcendence followed by openness to change were the most frequently coded higher-order categories. The results contribute to a richer understanding of survivors who gameplay.

Comment on “Long-term decline of sugar maple following forest harvest, Hubbard Brook Experimental Forest, New Hampshire”

2019 ◽  
Vol 49 (7) ◽  
pp. 861-862
Author(s):  
Scott W. Bailey ◽  
Robert P. Long ◽  
Stephen B. Horsley
Keyword(s):  
New England ◽  
Acer Saccharum ◽  
Sugar Maple ◽  
Management Practices ◽  
Hubbard Brook Experimental Forest ◽  
Data Set ◽  
Hubbard Brook ◽  
Whole Tree

Cleavitt et al. (2018, Can. J. For. Res. 48(1): 23–31, doi: 10.1139/cjfr-2017-0233 ) report a lack of sugar maple (Acer saccharum Marsh.) regeneration in Hubbard Brook Experimental Forest (HBEF), Watershed 5 (W5), following whole-tree clearcut harvesting and purport that harvesting-induced soil calcium depletion contributed to regeneration failure of this species. In New England, clearcutting is a silvicultural strategy used to promote less tolerant species, especially birch (Betula spp.; Marquis (1969), Birch Symposium Proceedings, USDA Forest Service; Leak et al. (2014), doi: 10.2737/NRS-GTR-132 ), which is just the outcome that the authors report. While this study reports an impressive, long-term data set, given broad interest in sugar maple and sustainability of forest management practices, we feel that it is critical to more fully explore the role of nutrition on sugar maple dynamics, both prior to and during the experiment, and to more fully review the scientific record on the role of whole-tree clearcutting in nutrient-induced sugar maple dynamics.

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