The journal of pain : official journal of the American Pain Society
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Analyses of health care data can reveal utilization of treatment options that comprise a multidisciplinary approach to chronic pain management. This retrospective cohort study aimed to characterize treatments among commercially versus Medicaid-insured adults with incident episodes of chronic pain. We used MarketScan data to identify patients with diagnoses for conditions associated with chronic pain, assess procedure codes that align with broad categories of treatment options, and compare receipt of treatments by insurance type. ⋯ Disparities in the provision, patterns, and timing of treatments by insurance suggest differential access to the full range of treatment options early during the course of care and identify opportunities to align coverage and reimbursement policies with current practice guidelines. PERSPECTIVE: This analysis of medical claims for patients with incident chronic pain episodes found disparities in the provision, patterns, and timing of treatments by insurance type. These results suggest differential access to evidence-based treatment options early during care and identify opportunities to align coverage and reimbursement policies with current practice guidelines.
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Monitoring recovery during acute pain episodes is useful for identifying youth at risk for pain persisting. Subjective and objective measures can assess function postinjury, but associations among these different measures and pain patterns in the acute period are unknown. To fill this gap, we examined associations among self-reported activity limitations, objectively measured physical activity, and pain intensity in 176 youth (age 11-17, 46% male) seeking health care for acute musculoskeletal pain. ⋯ Future work should examine how physical activity and activity limitations change longitudinally and predict pain persistence. PERSPECTIVE: This study examined daily associations between pain intensity, self-reported activity limitations, and objectively assessed physical activity in youth during the acute recovery period following a musculoskeletal injury. Self-reported activity limitations and objective physical activity represent 2 distinct, yet related, aspects of physical functioning that are associated with pain.
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Among the methods for cognitive control of pain, the suggestions for analgesia-direct or indirect-have been widely and successfully used in experimental and clinical trials. The primary aim of this study was to contribute to the debate about the difference in the effectiveness of indirect and direct suggestions for the management of experimental pain in the ordinary state of consciousness. The secondary aim of the study was to ascertain the role of hypnotizability and expectation of pain relief in the suggestions' effect. ⋯ The results showed that both direct and indirect suggestions increase the threshold of experimental pain and that the expectation of pain relief is relevant only to the effect of direct suggestions. PERSPECTIVE: Although the reported findings cannot be extended to clinical pain, they suggest that indirect suggestions can be effective independently from the expectation of pain relief, thus evading the possible negative effects of traits such as catastrophism or reactance. Thus, indirect suggestions should be preferred in clinical contexts.
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Many adults with sickle cell disease experience chronic, nonvaso-occlusive pain that can benefit from nonpharmacological interventions available for use in the home setting. Virtual reality (VR) has been shown to be effective in decreasing pain in chronic pain conditions and may be useful for home-based self-management of chronic pain in sickle cell. However, the literature lacks studies examining this potential. ⋯ However, further investigations are warranted to mitigate the challenges and limitations associated with using VR in this capacity. PERSPECTIVE: Few evidence-based, nonpharmacological interventions exist for chronic pain in adults with sickle cell disease. This first qualitative, pilot study of in-home VR for chronic pain in adults with sickle cell disease suggests that VR interventions need further exploration as a nonpharmacological strategy for mitigating their pain in the home setting.
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Previous studies have investigated the association of gender roles with pain outcomes in healthy individuals. However, little is known about this association in those with musculoskeletal (MSK) disorders. Therefore, this mixed-methods systematic review aimed to investigate the association of sociocultural gender roles on pain outcomes in adults with MSK disorders. ⋯ There is a need for pain management to evolve to acknowledge the individual pain experience through exploration of an individual's gender identity and roles. PERSPECTIVE: This article demonstrates that gender roles have a multidimensional influence on the pain experience in those with MSK disorders. These findings support the development of gender-sensitive, patient-centered approaches to pain management, acknowledging each individual's important roles and identities.