Articles: function.
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Randomized Controlled Trial
Psychological Treatment Targeting Acceptance and Compassion in Chronic Pain Patients: A Randomized Controlled, Internet Delivered, Treatment Trial.
Chronic pain is often associated with lower function. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing Acceptance and Commitment Therapy and compassion-focused therapy could improve psychological well-being and disability in individuals with chronic pain with high levels of self-criticism in comparison to a wait-list control group. ⋯ Internet-based Acceptance and Commitment Therapy with compassion-focused therapy components shows promise as a viable treatment option in the management of chronic pain.
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Randomized Controlled Trial
STRategies to Improve Pain and Enjoy life (STRIPE): results of a pragmatic randomized trial of pain coping skills training and opioid medication taper guidance for patients on long-term opioid therapy.
Because long-term opioid therapy (LtOT) for chronic pain has uncertain benefits and dose-dependent harms, safe and effective strategies for opioid tapering are needed. Adapting a promising pilot study intervention, we conducted the STRategies to Improve Pain and Enjoy life (STRIPE) pragmatic clinical trial. Patients in integrated health system on moderate-to-high dose of LtOT for chronic noncancer pain were randomized individually to usual care plus intervention (n = 79) or usual care only (n = 74). ⋯ We did not observe significant differences between intervention and usual care for MME (adjusted mean difference: -2.3 MME; 95% confidence interval: -10.6, 5.9; P = 0.578), the Pain, Enjoyment of Life, General Activity scale (0.0 [95% confidence interval: -0.5, 0.5], P = 0.985), or most secondary outcomes. The intervention did not lower opioid dose or improve pain or functioning. Other strategies are needed to reduce opioid doses while improving pain and function for patients who have been on LtOT for years with high levels of medical, mental health, and substance use comorbidity.
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Randomized Controlled Trial
A Pragmatic Randomized Prospective Trial of Cooled Radiofrequency Ablation of the Medial Branch Nerves versus Facet Joint Injection of Corticosteroid for the Treatment of Lumbar Facet Syndrome: 12 Month Outcomes.
Lumbar medial branch radiofrequency ablation (LRFA) and intraarticular facet steroid injections (FJI) are commonly performed for recalcitrant facet joint-mediated pain. However, no study has compared clinical outcomes of the two treatments in patients selected using dual medial branch blocks (MBBs) with an 80% relief threshold. ⋯ C-LRFA demonstrated superior success rates compared to FJI across pain and functional outcome domains.
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Observational Study
An Exploration of Physical Therapy Outcomes and Psychometric Properties of the Patient-Specific Functional Scale Following an Interdisciplinary Pain Management Program.
The Patient-Specific Functional Scale (PSFS) has been used to assess physical functioning in various chronic pain populations. There is a lack of evidence for its use with diverse pain populations who have high-impact chronic pain (HICP). The primary aim of this study was to assess the psychometric properties of the PSFS with a heterogeneous sample of patients with HICP. ⋯ The psychometric properties of the PSFS showed mixed support for construct validity but good support for the responsiveness of the PSFS when used with a heterogeneous sample of patients with HICP.
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Longitudinal total knee arthroplasty (TKA) studies indicate that a substantial percentage of patients continue to experience clinically significant pain and functional impairment after surgery. Insomnia has been associated with poorer surgical outcomes; however, previous work has largely focused on long-term postsurgical insomnia. This study builds on previous work by examining sleep and pain outcomes about perioperative insomnia trajectories. ⋯ The New Insomnia trajectory had notable long-term insomnia (6 weeks to 6 months) and acute (6 weeks) postoperative pain and physical functioning ( P' s < 0.05). Findings indicated a significant relationship between perioperative insomnia trajectory and postoperative outcomes. Results of this study suggest that targeting presurgical insomnia and preventing the development of acute postoperative insomnia may improve long-term postoperative outcomes, with an emphasis on persistent perioperative insomnia due to poorer associated outcomes.