The journal of pain : official journal of the American Pain Society
-
Several brain stimulation technologies are beginning to evidence promise as pain treatments. However, traditional versions of 1 specific technique, transcranial direct current stimulation (tDCS), stimulate broad regions of cortex with poor spatial precision. A new tDCS design, called high definition tDCS (HD-tDCS), allows for focal delivery of the charge to discrete regions of the cortex. We sought to preliminarily test the safety and tolerability of the HD-tDCS technique as well as to evaluate whether HD-tDCS over the motor cortex would decrease pain and sensory experience. Twenty-four healthy adult volunteers underwent quantitative sensory testing before and after 20 minutes of real (n = 13) or sham (n = 11) 2 mA HD-tDCS over the motor cortex. No adverse events occurred and no side effects were reported. Real HD-tDCS was associated with significantly decreased heat and cold sensory thresholds, decreased thermal wind-up pain, and a marginal analgesic effect for cold pain thresholds. No significant effects were observed for mechanical pain thresholds or heat pain thresholds. HD-tDCS appears well tolerated, and produced changes in underlying cortex that are associated with changes in pain perception. Future studies are warranted to investigate HD-tDCS in other applications, and to examine further its potential to affect pain perception. ⋯ This article presents preliminary tolerability and efficacy data for a new focal brain stimulation technique called high definition transcranial direct current stimulation. This technique may have applications in the management of pain.
-
This study examined the extent to which components of empathy (ie, empathic accuracy, empathic tendencies, and empathic responses) were correlated within the context of chronic pain couples. Additionally, the interrelationships between these empathy variables and spouse responses to pain were investigated. Participants were 57 couples in which at least 1 spouse reported chronic musculoskeletal pain. Each couple participated in a videotaped interaction about the impact of pain in their lives together, after which they completed an empathic accuracy procedure. The interactions were coded for the spouse's use of empathic responses. Couples also completed surveys about pain severity, pain interference, empathic tendencies, marital satisfaction, and perceived spousal responses (ie, solicitous and punishing responses) to pain. Spousal empathic responses and empathic accuracy were not related to one another nor were they related to spousal empathic tendencies, or solicitous spouse responses. Spousal punishing responses were negatively related to empathic responses. The association between solicitousness and empathic responses was moderated by spousal marital satisfaction. The findings suggest that there are not clear associations among these empathy variables. The results also indicate that the climate in which solicitousness is provided may influence the extent to which spouses display empathic responses. ⋯ The findings have implications for models of pain empathy and suggest that future research is needed to understand relations between aspects of empathy. Moreover, interventions aimed at addressing the empathic climate in which support is delivered may help spouses more empathically and effectively communicate with and assist partners with pain management.
-
Historical Article
Time series analysis of California's prescription monitoring program: impact on prescribing and multiple provider episodes.
Prescription monitoring programs (PMPs) are designed to reduce medication diversion by identifying individuals obtaining the same medication from multiple providers (termed multiple provider episodes [MPEs]). This study determined whether recent changes to California's PMP influenced: 1) the extent that practitioners issue prescriptions for a variety of Schedule II opioids; and 2) the incidence of MPEs involving these opioids. Intervention time series of California's PMP data was used to determine the effect of requiring practitioners to transition from using triplicate prescription forms for Schedule II medications to security forms for all controlled substances. Outcome measures included changes in number of prescriptions issued for Schedule II long-acting or short-acting (SA) opioids and the MPEs involving these medications. Requiring a security form was associated with a sustained prescribing increase for SA hydromorphone, meperidine, and SA oxycodone; no prescribing changes were found for SA fentanyl, methadone, and SA morphine, or for any long-acting opioids. The same policy change, however, increased MPEs involving all opioids. Further effort is required to determine how California's PMP can continue to ensure availability of prescription opioids for medical use while better mitigating their diversion. ⋯ Statistical model-building was used to evaluate the influence of changes to California's prescription monitoring program. The extent that practitioners prescribe Schedule II opioids and the incidence of people receiving prescriptions from multiple providers were measured. Such research illustrates the viability of evaluating drug control program impact on prescribing practice and potential diversion behaviors.
-
To assess the economic cost of chronic pain in Ireland, information was gathered from 140 people with chronic pain. Direct and indirect costs attributable to chronic pain and medical conditions of which chronic pain was a feature were recorded retrospectively for 12 months. Mean cost per chronic pain patient was estimated at €5,665 per year across all grades of pain, with mean costs increasing according to the severity of pain. A small proportion of patients account for the bulk of costs-the top 5% most expensive patients accounted for 26.4% of costs, with a mean cost per patient of €29,936, and the 10% most expensive patients were responsible for 42.8% of all costs. Total cost for individuals aged 20 and above was estimated at €5.34 billion per year, or 2.86% of Irish GDP in 2008. Those with clinically elevated depression scores had costs that were twice as high as people who scored below the depression cut-off score. Chronic pain services in Ireland are generally underresourced. Improved coordination and better management of patients via interdisciplinary pain rehabilitation program is essential and may offer a means of reducing the sizeable economic burden of chronic pain. ⋯ The cost of chronic pain per patient was €5,665 per year extrapolated to €5.34 billion or 2.86% of GDP per year. Those with clinically significant depression had costs twice as high as those without depression. The significant burden of chronic pain highlights the need for cost effective interventions to reduce long-term disability.
-
Both race and socioeconomic status (SES) contribute to disparities. We assessed the relative roles of neighborhood socioeconomic status (nSES) and race in the chronic pain experience for young adults (<50 years old). Data from a tertiary care pain center was matched to 2000 US Census data to examine the role of race and nSES on chronic pain and its sequelae in 3,730 adults (9.7% black, 61% female) 18 to 49 years old (37 ± 8 years). Blacks had significantly more pain and disability and lived in lower SES neighborhoods. Living in a lower SES neighborhood was associated with increased sensory, affective, and "other" pain, pain-related disability, and mood disorders. Race was independently associated with affective and "other" pain on the McGill Pain Questionnaire scales, and both disability factors. Racial disparities in sensory pain and mood disorders were mediated by nSES. In every case, race and neighborhood SES played important roles in the outcomes for chronic pain. Age was related to both disability outcomes. Gender was associated with voluntary disability and mood disorders, with men displaying worse outcomes. ⋯ Important racial- and SES-related variability in pain related outcomes in young adults with chronic pain were defined. Black race was associated with neighborhood SES, and black race plays an important role in pain outcomes beyond neighborhood SES.