Articles: chronic-pain.
-
Pain is a common presenting symptom to consultant physicians, both in the hospital and in the clinic or rooms. Biologically, pain serves as warning of tissue damage. But this is no longer the case when pain is present for months or years, especially when it has been fully investigated. ⋯ The response to the so-called 'opioid epidemic' has led to a renewed focus on how chronic pain should be managed. The aim of this article is to update fellows and trainees on the assessment and management of chronic pain in adult medical patients. In particular, we address the role of pharmacotherapy post-opioid epidemic (primarily antidepressants and anticonvulsants in neuropathic pain), the place of interventional procedures and the nature and effectiveness of pain self-management training in people with chronic pain, many of whom have had pain for a year or more and failed other treatments.
-
Observational Study
Adolescent predictors of substance use in young adulthood among individuals with childhood-onset chronic pain: A follow-up study.
Adolescent chronic pain is a substantial public health problem, and pain symptoms often persist into adulthood. Young adults with chronic pain are at elevated risk for more frequent tobacco, alcohol and cannabis use, and cross-sectional research highlights the importance of psychosocial vulnerability factors. Limited research has examined how adolescent predictors, including mental health symptoms, pain, sleep and family functioning, impact later, young adult substance use. ⋯ This prospective observational study of young adults with childhood-onset chronic pain identified adolescent depression and sleep quality as vulnerability factors associated with substance use. Given the increasing risk for substance use during adolescence and young adulthood, these findings highlight the potential importance of early intervention to reduce substance use among young adults with childhood-onset chronic pain.
-
In addition to the usual evaluation approach (usually a clinical randomized trial in the sense of the question: does an intervention work), complex interventions require further systematic investigations to prove their effectiveness. The role of the context in which the intervention is delivered is essential here, as is consideration of the question of why an intervention works (or does not work). ⋯ In an effectiveness model, concrete, verifiable assumptions are formulated as to how an intervention produces changes that are reflected in the endpoint. This article provides a brief introduction to methodological approaches to effectiveness research on complex interventions and uses the PAIN 2.0 project (01NVF20023) to describe in concrete terms what an effectiveness model for interdisciplinary multimodal pain therapy for the prevention of chronic pain in an outpatient setting might look like.
-
Health services research looks at a form of care under contextual conditions. Often, and especially in the treatment of recurrent or chronic pain, these forms of care are complex interventions. Ensuring internal validity for subsequent interpretability of the results achieved as an essential requirement for studies in health services research therefore presents researchers with the challenge that they have to develop complex study protocols and implement and monitor them in clinical care. ⋯ On the one hand, health services research provides appropriate recommendations for the planning, implementation and evaluation of studies on complex interventions under contextual conditions, which can be of great importance for further research into the effectiveness of IMST. On the other hand, experience from interdisciplinary pain research can also help to successfully plan and conduct studies on complex interventions. This article introduces the understanding of interdisciplinarity (and interprofessionalism) in pain medicine and research, outlines possible key points for study planning and implementation using the example of two health services research studies and concludes by discussing gaps in research on interdisciplinary collaboration in pain medicine and research.
-
Complex regional pain syndrome (CRPS) is often associated with severe mental impairments. Initial pain-related fears in particular appear to be negative predictors for long-term therapy results. Procedures for cognitive behavioral therapy are an important component of treatment. ⋯ Behavioral analyses are used to uncover dysfunctional coping patterns, such as a fear avoidance coping strategy. In this case the use of graded activity treatment approach is indicated, in which the activity level is gradually increased. In the transfer phase psychotherapy supports affected patients in (re)designing their professional and private environments.