British Journal of Pain最新文献

{"title":"Intrathecal drug delivery for the management of pain and spasticity in adults: British Pain Society's recommendations for best clinical practice.","authors":"Sam Eldabe, Rui Duarte, Simon Thomson, Stana Bojanic, Paul Farquhar-Smith, Somnath Bagchi, Lis Farquhar, Bill Wetherill, Sue Copley","doi":"10.1177/20494637241280356","DOIUrl":"10.1177/20494637241280356","url":null,"abstract":"<p><p>The British Pain Society updated their recommendations on intrathecal drug delivery (ITDD) for the management of pain and spasticity in adults. The recommendations are primarily evidence based but where necessary comprise the consensus opinion of the working group. The recommendations are accompanied by information for patients and their carers, intended to inform and support patients in their decision making. The updated guidance includes recent evidence base of ITDD use in pain and spasticity, address the issues of drug pump compatibility following the latest manufacturer and Medicines and Healthcare products Regulatory Agency (MHRA) recommendations as well as provide an update on the indications and complication management particularly endocrine complications and intrathecal granuloma formation.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":" ","pages":"20494637241280356"},"PeriodicalIF":1.3,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent post-discharge opioid use and opioid stewardship: A single-centre retrospective cohort study.","authors":"Sandra Hapca, Louise Peet, Christine Gibson, Andrea Harvey, Patrice Forget","doi":"10.1177/20494637241276106","DOIUrl":"10.1177/20494637241276106","url":null,"abstract":"<p><p>Persistent post-operative opioid use is a public health concern contributing to population morbidity and mortality. Opioid stewardship is a strategy adopted to rationalise opioid prescribing and limit harmful use. We describe persistent post-discharge opioid use rates and risk factors in a single-centre cohort and describe the opioid stewardship role of our Acute Pain Service (APS). We conducted a retrospective 4-year cohort study of inpatients referred to the APS and discharged with new strong opioids prescribed. We investigated persistent post-discharge opioid use rates, risk factors and patterns of opioid use after community follow-up by APS. We found that 24% of patients discharged with new strong opioids developed persistent opioid use. Risk factors associated with persistent post-discharge opioid use in our cohort included female sex (Odds Ratios [95% confidence interval], <i>p</i> value, OR: 1.89 [1.11-3.22], <i>p</i> = 0.019), pre-admission mental health history (OR: 2.85 [1.64-4.95], <i>p</i> < 0.001) and pre-admission opioid use (OR: 1.79 [1.03-3.11], <i>p</i> = 0.004). A smaller proportion of patients with APS follow-up in community developed persistent opioid use (22%) compared to those without (32%). We conclude that having opioids prescribed at time of discharge can result in persistent opioid use in up to a quarter of patients. The APS has an important protective role in rationalising opioid use in hospital but also following discharge. Development of further opioid stewardship policies is needed including improvement of patient and staff awareness and pre-operative assessment of patients with recognised risk factors.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":" ","pages":"20494637241276106"},"PeriodicalIF":1.3,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in the relationship between pain and anxiety in total knee and hip arthroplasty: a longitudinal cross-lagged analysis mediated by depression and pain catastrophizing.","authors":"Ana Cristina Paredes, Patrício Costa, Márcia Costa, Patrícia Oliveira, Pedro Varanda, Armando Almeida, Patrícia R Pinto","doi":"10.1177/20494637241273905","DOIUrl":"10.1177/20494637241273905","url":null,"abstract":"<p><p>Acute postsurgical pain (APSP) is an important risk factor for pain chronification, with reports of being more intense after total knee arthroplasty (TKA) than after total hip arthroplasty (THA). Psychological variables have been associated with differences in postsurgical pain experience. This study aimed to analyse the longitudinal reciprocal association between pain and anxiety levels in patients undergoing TKA or THA, to investigate the moderator role of the type of surgery and to explore psychological mediators in the anxiety - pain association. Patients undergoing TKA (<i>n</i> = 120) or THA (<i>n</i> = 109) were evaluated before surgery and in the acute postsurgical period (48 h postsurgery). Presurgical assessment comprised sociodemographic, pain-related and psychological variables (anxiety, depression, pain catastrophizing, self-efficacy, optimism and satisfaction with life). Postsurgical assessment focused on pain frequency, pain intensity and anxiety. Longitudinal associations were explored using cross-lagged panel models that included the indirect effect paths through possible mediators (pain catastrophizing and depression). Multigroup analyses compared TKA and THA. In the global sample, higher APSP was predicted by higher presurgical pain and worse presurgical anxiety. Multigroup analyses revealed that worse APSP was predicted by higher presurgical anxiety in patients undergoing TKA and by higher presurgical pain in patients undergoing THA. Furthermore, there was a positive significant indirect effect of pain catastrophizing, but not depressive symptoms, in the relationship between presurgical anxiety and APSP in THA. Anxiety and APSP are differently interrelated in TKA and THA. Psychological characteristics could be managed before surgery to favour better APSP control and potentially prevent pain chronification after total joint arthroplasty.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":" ","pages":"20494637241273905"},"PeriodicalIF":1.3,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience of compassion-based practice in mindfulness for health for individuals with persistent pain.","authors":"Callum Gray, Fergal Jones, Alessio Agostinis, Julia Morris","doi":"10.1177/20494637241232555","DOIUrl":"10.1177/20494637241232555","url":null,"abstract":"<p><strong>Purpose of the study: </strong>Research indicates that acquiring compassion is an integral part to positive outcomes to Mindfulness-based interventions (MBI), yet there is both theoretic and empirical literature suggesting that people with persistent pain are more likely to experience challenges and distress when engaging compassion-based practices. Mindfulness for Health is a standardised MBI for people with persistent pain and health conditions. This study sought to explore the positive, neutral and difficult experiences of compassion-based practice and meditation for participants in Mindfulness for Health to further understand implications and risks for participants of MBI's.</p><p><strong>Method and design: </strong>A qualitative design using Interpretative Phenomenological Analysis was applied to explore how participants understood of the experience of compassion-based practice and the meaning they gave to it. Eight participants who had completed the Mindfulness for Health from four separate groups were interviewed about their experience.</p><p><strong>Results: </strong>Five master themes were identified 'turning away from self-with-pain', 'self-with-pain experienced as shameful', 'facilitating change', 'turning towards self-with-pain', and 'accepting self'. Participants identified both perceived positive changes and difficult emotional experiences during the meditation practice, which they related to the context of compassion in their past and present life.</p><p><strong>Conclusions: </strong>Developing compassion is an important part of Mindfulness for Health, which is salient for participants as both a challenging and potentially valuable experience. Acquisition of mindfulness skills, supporting group dynamics and modelling compassion are understood as helpful in overcoming personal barriers and challenging experiences. Further research is needed to understand processes involved and explore the experience of non-completers.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"18 4","pages":"337-353"},"PeriodicalIF":1.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehabilitation: The underutilised weapon for chronic pain management.","authors":"Lydia V Tidmarsh, Richard Harrison, Katherine A Finlay","doi":"10.1177/20494637241250239","DOIUrl":"10.1177/20494637241250239","url":null,"abstract":"<p><strong>Objective: </strong>Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, <i>psychological</i> prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to 'prehabilitate' patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions.</p><p><strong>Methods: </strong>Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed.</p><p><strong>Results: </strong>Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention.</p><p><strong>Conclusions: </strong>Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify <i>who</i> requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"18 4","pages":"354-364"},"PeriodicalIF":1.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interaction between psychological factors and conditioned pain modulation.","authors":"Kristian Kjær-Staal Petersen","doi":"10.1177/20494637241263306","DOIUrl":"10.1177/20494637241263306","url":null,"abstract":"","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"18 4","pages":"312-313"},"PeriodicalIF":1.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do threats and reassurances reside in the biological, psychological or social domain? A qualitative study in adults and young people with chronic pain.","authors":"Hannah Kennedy, Daniel S Harvie, Michel W Coppieters","doi":"10.1177/20494637241263291","DOIUrl":"10.1177/20494637241263291","url":null,"abstract":"<p><strong>Objective: </strong>Understanding biopsychosocial contributions to a sensitised pain system is a key target of many pain management programs. The 'Protectometer' is a freely available educational tool that guides people with chronic pain to explore their personal threats and reassurances, identifying them as 'DIMs' (danger in me) or 'SIMs' (safety in me), to guide personalised pain management. This study aimed to explore common types of DIMs and SIMs, and examine differences between adults and young people.</p><p><strong>Materials and methods: </strong>A retrospective qualitative study was conducted. Written DIMs (<i>n</i> = 504) and SIMs (<i>n</i> = 711) were collected from 96 participants with chronic pain (77 adults aged 18-85 years; 19 young people aged 9-17 years) across 15 multidisciplinary pain management groups. DIMs and SIMs were transcribed and analysed using deductive content analysis.</p><p><strong>Results: </strong>Four overarching themes were identified: 'Engaging with the environment', 'In my body', 'My emotional health', and 'Activities and behaviours'. Similarities in SIMs were found, with the greatest proportion of SIMs in the social domain (49% adults; 47% young people). While adult DIMs were fairly evenly spread across the biological (37%), psychological (27%) and social domains (36%), young people's DIMs were predominantly in the psychological (44%) and social (43%) domains.</p><p><strong>Discussion: </strong>These findings provide insights into common threats and reassurances people in pain perceive, and revealed age-related differences in biopsychosocial contributions to pain and pain relief. Findings also highlight the importance of social-based interventions as part of pain management therapies for both adults and young people.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":" ","pages":"20494637241263291"},"PeriodicalIF":1.3,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient safety of adjunct pre-operative intravenous S-ketamine for pain relief in third molar surgery - a randomised, placebo-controlled, double-blind trial.","authors":"Lars B Eriksson, Torsten Gordh, Rolf Karlsten, Andreas Thor, Åke Tegelberg","doi":"10.1177/20494637241262509","DOIUrl":"10.1177/20494637241262509","url":null,"abstract":"<p><strong>Purpose: </strong>To study patient safety in third molar surgery, where two different doses of S-ketamine were administered for pain relief and compared to a placebo (saline). The primary focus was capillary oxygen saturation of the blood (SpO₂) and secondarily, alterations in respiratory rate, blood pressure, pulse or adverse events.</p><p><strong>Methods: </strong>One hundred and sixty-eight subjects were included in a randomised, placebo-controlled, double-blind trial. The two subanaesthetic study drugs were low-dose S-ketamine (0.125 mg/kg) and high-dose S-ketamine (0.25 mg/kg). Every patient was sedated with midazolam prior to infusion of the investigational drug. The teeth were surgically removed according to a routine clinical procedure, under local anaesthesia.</p><p><strong>Results: </strong>Primary end-point for the safety aspects was capillary oxygen saturation (SpO₂) after administration of the investigational drug was finished. A significant difference was found between the placebo and the high-dose group at that point (<i>p</i> = .021), with a decrease of saturation in the high-dose group. The lowest saturation and the number of registrations of SpO₂ <90% did not show any difference between groups. Oxygen supplementation was given in circa 40% of the cases with no differences between the intervention groups. No other significant differences between groups regarding saturation or respiratory rate were noted.</p><p><strong>Conclusion: </strong>In this study, it was safe to use adjunct preoperative single-dose intravenous S-ketamine 0.25 mg/kg body weight for pain relief, in midazolam-sedated patients receiving third molar surgery. There were no serious adverse events or symptoms of overdose nor any clinically relevant effects on circulatory or respiratory parameters.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":" ","pages":"20494637241262509"},"PeriodicalIF":1.3,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rapid systematic review of breakthrough pain definitions and descriptions","authors":"K. Greenfield, D. Schoth, Richard Hain, Simon Bailey, Christine Mott, Dilini Rajapakse, Emily Harrop, Kate Renton, Anna-Karenia Anderson, Bernie Carter, Margaret Johnson, C. Liossi","doi":"10.1177/20494637231208093","DOIUrl":"https://doi.org/10.1177/20494637231208093","url":null,"abstract":"Breakthrough pain is common in life-limiting conditions and at end-of-life. Despite over 30 years of study, there is little consensus regarding the definition and characteristics of breakthrough pain. This study aims to update and expand a 2010 systematic review by Haugen and colleagues to identify (1) all definitions of breakthrough pain and (2) all descriptions and classifications of breakthrough pain reported by patients, caregivers, clinicians, and experts. This rapid systematic review followed the Cochrane Rapid Review Methods Group guidelines. A protocol is published on PROSPERO (CRD42019155583). CINAHL, MEDLINE, PsycINFO, and the Web of Science were searched for breakthrough pain terms from the inception dates of each database to 26th August 2022. We identified 65 studies that included data on breakthrough pain definitions, descriptions, or classifications from patients ( n = 30), clinicians ( n = 6), and experts ( n = 29), but none with data from caregivers. Most experts proposed that breakthrough pain was a sudden, severe, brief pain occurring in patients with adequately controlled mild-moderate background pain. However, definitions varied and there was no consensus. Pain characteristics were broadly similar across studies though temporal factors varied widely. Experts classified breakthrough pain into nociceptive, neuropathic, visceral, somatic, or mixed types. Patients with breakthrough pain commonly experienced depression, anxiety, and interference with daily life. Despite ongoing efforts, there is still no consensus on the definition of breakthrough pain. A compromise is needed on breakthrough pain nomenclature to collect reliable incidence and prevalence data and to inform further refinement of the construct.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"6 3","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139157581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and impact of a tailored eHealth resource on fibromyalgia patient’s self-management and self-efficacy: A mixed methods approach","authors":"Joanne O’Brien-Kelly, David Moore, Ian O’Leary, T. O’Connor, Zena Moore, D. Patton, L. Nugent","doi":"10.1177/20494637231221647","DOIUrl":"https://doi.org/10.1177/20494637231221647","url":null,"abstract":"To develop an eHealth resource to support fibromyalgia patients and explore it for usability and impact on their self-management and self-efficacy. Fibromyalgia is a complex, non-progressive chronic condition characterised by a bewildering array of symptoms for patients to self-manage. International guidelines recommend patients receive illness-specific information once diagnosed to promote self-management and improve health-related quality of life. A 3-phase mixed methods exploratory sequential design. Qualitative interviews explored the information and self-management needs of fibromyalgia patients attending a large tertiary hospital in Dublin. Identified themes together with an extensive review of the literature of interventions proven to be impactful by patients with fibromyalgia were utilised in the design and development of the eHealth resource. The resource was tested for usability and impact using pre and post-intervention outcomes measures. Patient interviews highlighted a lack of easy accessible evidenced information to support self-management implicating the urgent need for a practical solution through development of a tailored eHealth resource. Six themes emerged for inclusion; illness knowledge, primary symptoms, treatment options, self-management strategies, practical support and reliable resources. Forty-five patients who tested the site for usability and impact demonstrated a statistically significant improvement in self-efficacy after 4 weeks access with a medium positive effect size. Patients with the most severe fibromyalgia impact scores pre-intervention demonstrated the most improvement after 4 weeks. Patients gave the resource a System Usability Score A rating, highly recommending it for fellow patients diagnosed with fibromyalgia. The study demonstrated how the development of a novel eHealth resource positively impacted fibromyalgia patients’ self-efficacy to cope with this debilitating condition. This study suggests that access to eHealth can positively impact patients self-efficacy, has the potential to be a template for eHealth development in other chronic conditions, supporting advanced nurse practitioners working in chronic disease management.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"116 25","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138959063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}