The journal of pain : official journal of the American Pain Society
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We conducted a bidirectional Mendelian randomization study to examine the causal effects of six personality traits (anxiety, neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness) on back pain associated with health care use and the causal effect of back pain on the same risk factors. Genetic instruments for the personality traits and back pain were obtained from the largest published genome-wide association studies conducted in individuals of European ancestry. We used inverse weighted variance meta-analysis and Causal Analysis Using Summary Effect for primary analyses and sensitivity analyses to examine evidence for causal associations. ⋯ We found evidence for statistically significant bidirectional causal associations between neuroticism and back pain, with odds ratio 1.51 (95% confidence interval 1.37; 1.67) of back pain per neuroticism sum score standard deviation, P-value = 7.80e-16; and beta = .12, se = .04 of neuroticism sum score standard deviation per log odds of back pain, P-value = 2.48e-03. Other relationships did not meet our predefined criteria for causal association. PERSPECTIVE: The significant positive feedback loop between neuroticism and back pain highlights the importance of considering neuroticism in the management of patients with back pain.
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Randomized Controlled Trial
Cluster-Randomized Comparative Effectiveness Trial of Physician-Directed Clinical Decision Support vs. Patient-Directed Education to Promote Appropriate Use of Opioids for Chronic Pain.
We compared the effectiveness of physician-directed clinical decision support (CDS) administered via electronic health record versus patient-directed education to promote the appropriate use of opioids by conducting a cluster-randomized trial involving 82 primary care physicians and 951 of their patients with chronic pain. Primary outcomes were satisfaction with patient-physician communication consumer assessment of health care providers and system clinician and group survey (CG-CAHPS) and pain interference patient-reported outcomes measurement information system. Secondary outcomes included physical function (patient-reported outcomes measurement information system), depression (PHQ-9), high-risk opioid prescribing (>90 morphine milligram equivalents per day [≥90 mg morphine equivalent/day]), and co-prescription of opioids and benzodiazepines. ⋯ More evidence is needed to ascertain the relative cost-effectiveness between strategies. PERSPECTIVE: This article presents the results of a comparative-effectiveness study of 2 broadly used communication strategies to catalyze dialog between patients and primary care physicians around chronic pain. The results add to the decision-making literature and offer insights about the relative benefits of physician-directed versus patient-directed interventions to promote the appropriate use of opioids.
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Research exploring the specific manifestations of chronic pain (CP) public stigma is scarce. One potential factor influencing public stigma manifestations may be the CP type, that is, the presence (secondary CP) or absence (primary CP) of a clearly identifiable pathophysiology. Furthermore, patient gender may play a key role, whereby pain-related gender stereotypes may evoke distinct gender role expectations towards men and women experiencing CP. ⋯ The study contributes to the literature on CP stigma, as well as the psychometric examination of items assessing stigmatizing manifestations. PERSPECTIVE: This study examined the role of contextual factors chronic pain type and patient gender into cognitive, affective, and behavioral stigmatizing manifestations coming from the general population towards individuals with chronic pain through an experimental vignette study. The study contributes to the chronic pain stigma literature, as well as the psychometric examination of items assessing stigmatizing manifestations.
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This systematic review and meta-analysis investigated the effects of non-pharmacological manipulations on experimentally induced secondary hypersensitivity in pain-free humans. We investigated the magnitude (change/difference in follow-up ratings from pre-manipulation ratings) of secondary hypersensitivity (primary outcome), and surface area of secondary hypersensitivity (secondary outcome), in 27 studies representing 847 participants. Risk of bias assessment concluded most studies (23 of 27) had an unclear or high risk of performance and detection bias. ⋯ We discuss opportunities to improve methodological rigor including manipulation checks, structured blinding strategies, control conditions or time points, and public sharing of raw data. PERSPECTIVE: We described the effects of several non-pharmacological manipulations on experimentally induced secondary hypersensitivity in humans. By shedding light on the potential for non-pharmacological therapies to influence secondary hypersensitivity, it provides a foundation for the development and testing of targeted therapies for secondary hypersensitivity.
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While a range of work-related psychosocial factors has been associated with various pain disorders and early retirement, less is known about pain cognitions and their influence on premature exit from the labor market. Therefore, as a primary objective, this study investigates associations between pain control beliefs and risk of disability pension among Danish eldercare workers. In 2005, 2257 female eldercare workers with low-back and/or neck/shoulder pain>90 days within the previous 12 months, replied to a survey and were followed for 11 years in a national register of social transfer payments. ⋯ These results highlight the importance of evaluating not only bodily manifestations of pain, but also individual pain-related cognitions that may influence the experience of pain. PERSPECTIVE: This article addresses the complex experience of pain within an organizational context. We introduce the metrics of "pain control" and "pain influence" among workers with persistent pain, showing that the psychometric properties of these measures are prospectively associated with premature exit from the labor market.