The journal of pain : official journal of the American Pain Society
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Observational Study
Pills to pot: observational analyses of cannabis substitution among medical cannabis users with chronic pain.
Chronic pain is common, costly, and challenging to treat. Many individuals with chronic pain have turned to cannabis as an alternative form of pain management. We report results from an ongoing, online survey of medical cannabis users with chronic pain nationwide about how cannabis affects pain management, health, and pain medication use. ⋯ Perspective: This article presents results that confirm previous clinical studies suggesting that cannabis may be an effective analgesic and potential opioid substitute. Participants reported improved pain, health, and fewer side effects as rationale for substituting. This article highlights how use duration and intentions for use affect reported treatment and substitution effects.
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The effectiveness of pain-reducing interventions in newborns can only be determined if pain measurement instruments are responsive; that is, able to detect a decrease in pain intensity after the pain-reducing intervention. This review assesses the methodologic quality of studies on this measurement property-the responsiveness. We searched the literature published until January 2018 for validation studies of pain measurement instruments focusing on responsiveness to pain-reducing treatment in neonates. ⋯ PERSPECTIVE: This review focuses on the property of measurement instruments to detect changes in pain intensity after a pain-reducing intervention in neonates. We concluded that this property-the responsiveness-is under studied and that the methodologic quality of the included studies was low. Future high-quality validation studies should focus on responsiveness.
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Parents play a critical role in children's experience of, and recovery from, chronic pain. Although several parental factors have been linked to child pain and functioning, these factors are typically examined in isolation or as moderators or mediators. Structural equation modeling affords the opportunity to examine the extent to which parental factors are interrelated, and if there are differential associations among parental factors and child outcomes. ⋯ Findings support the inclusion of parent chronic pain status and physical and psychological functioning as part of a comprehensive assessment of youth with chronic pain and may inform new parental intervention targets to improve child outcomes. PERSPECTIVE: A unified structural equation model indicated parents' own chronic pain characteristics and physical and psychological functioning represent important factors associated with child pain and functioning. Current family-based interventions that often primarily focus on parent responses to child pain may need to be adapted to more comprehensively address parental factors.
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We used data from the nationally representative Medical Expenditure Panel Survey to determine the 18-year trends in the overall rates of noncancer pain prevalence and pain-related interference, as well as in health care use attributable directly to pain management. The proportion of adults reporting painful health condition(s) increased from 32.9% (99.7% confidence interval [CI] = 31.6-34.2%;120 million adults) in 1997/1998 to 41.0% (99.7% CI = 39.2-42.4%; 178 million adults) in 2013/2014 (Ptrend < .0001). Among adults with severe pain-related interference associated with their painful health condition(s), the use of strong opioids specifically for pain management more than doubled from 11.5% (99.7% CI = 9.6-13.4%) in 2001/2002 to 24.3% (99.7% CI = 21.3-27.3%) in 2013/2014 (Ptrend < .0001). ⋯ PERSPECTIVE: Our data illustrate changes in the management of painful health conditions over the last 2 decades in the United States. Strong opioid use remains high, especially in those with severe pain-related interference. Additional education of health care providers and the public concerning the risk/benefit ratio of opioids appears warranted.
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Sensorimotor cortical activity is altered in both the immediate acute and chronic stages of musculoskeletal pain. However, these changes are opposite, with decreased cortical activity reported in experimentally induced acute pain (lasting minutes to hours), and increased cortical activity in chronic, clinical pain (lasting >6 months). It is unknown whether sensorimotor cortical activity is altered in acute, clinical musculoskeletal pain (lasting <4 weeks). ⋯ However, individual variation was high, suggesting individual adaptation of cortical plasticity in acute pain. PERSPECTIVE: This is the first study to examine sensorimotor cortical activity in the acute stage of clinical LBP. This information is critical for understanding the neurophysiology of acute LBP.