The journal of pain : official journal of the American Pain Society
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Review Meta Analysis
The Efficacy of Motivational Interviewing in adults with Chronic Pain: A Meta-Analysis and Systematic Review.
Motivational interviewing (MI) has become a popular approach for increasing adherence. In this study we investigated whether MI is effective in improving adherence, and pain and physical function for patients with chronic pain. A literature search of randomized controlled trials identified 7 eligible studies with 962 participants with chronic pain. There was a small to moderate overall effect of MI on increased adherence to treatment from baseline to after intervention, but not from baseline to follow-up. Although significant short-term effects of MI were also observed for pain intensity, analyses revealed that this finding might be due to publication bias. There were insufficient studies to examine physical functioning meta-analytically, however, none of the 3 available studies showed that MI resulted in gains in physical function compared with the control group. These results indicate that MI can probably increase short-term adherence to chronic pain treatments, although publication bias cannot be ruled out. Further, it is as yet unclear whether these effects result in improvements in patient function. Although the studies were methodologically strong, they investigated MI in relation to a number of treatments for chronic pain. Future research on the efficacy of MI on adherence to evidence-based self-management interventions for chronic pain is needed. ⋯ MI significantly increased adherence to prescribed chronic pain treatments in the short term, however, effect sizes were small to moderate and publication bias was likely. MI showed some promise in promotion of adherence to pain treatments, but more research is required to confirm its efficacy.
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Multicenter Study
Increased Risk of Depression Recurrence After Initiation of Prescription Opioids in Noncancer Pain Patients.
Several studies have shown that chronic opioid analgesic use is associated with increased risk of new-onset depression. It is not known if patients with remitted depression are at increased risk of relapse after exposure to opioid analgesics. A retrospective cohort design using patient data from the Veterans Health Administration (VHA; n = 5,400), and Baylor Scott & White Health (BSWH; n = 842) was performed with an observation period in the VHA from 2002 to 2012 and in the BSWH from 2003 to 2012. Eligible patients had a diagnosis of depression at baseline and experienced a period of remission. Risk of depression recurrence was modeled in patients that either started taking an opioid or continued without opioid prescriptions before or during remission. Cox proportional hazard models were used to measure the association between opioid use and depression recurrence controlling for pain, and other confounders. Patients exposed to an opioid compared with those unexposed had a significantly greater risk of depression recurrence in both patient populations (VHA: hazard ratio [HR] = 2.17, 95% confidence interval [CI], 2.01-2.34; BSWH: HR = 1.77; 95% CI, 1.42-2.21). These results suggest opioid use doubles the risk of depression recurrence even after controlling for pain, psychiatric disorders, and opioid misuse. Further work is needed to determine if risk increases with duration of use. Repeated screening for depression after opioid initiation may be warranted. ⋯ In 2 large patient cohorts with large differences in demographic characteristics and comorbidity, patients with remitted depression who were exposed to opioid analgesics were 77% to 117% more likely to experience a recurrence of depression than those who remained opioid -free. Routine, not just at initiation of treatment, screening for depression is warranted.