British Journal of Pain最新文献

{"title":"Does opioid therapy enhance quality of life in patients suffering from chronic non-malignant pain? A systematic review and meta-analysis","authors":"Karl V. L. Kraft, Teresa Backmund, Leopold Eberhart, Ann-Kristin Schubert, Hanns-Christian Dinges, Maria K. Hagen, Markus Gehling","doi":"10.1177/20494637231216352","DOIUrl":"https://doi.org/10.1177/20494637231216352","url":null,"abstract":"Chronic pain is associated with a poor health-related quality of life (HRQL). Whereas the prescription rate of opioids increased during the last decades, their use in chronic non-malignant pain remains unclear. However, there is currently no clinical consensus or evidence-based guidelines that consider the long-term effects of opioid therapy on HRQL in patients with chronic non-cancer pain. This systematic review aims to address the question of whether opioid therapy improves HRQL in patients with chronic non-malignant pain and provide some guidance to practitioners. PubMed, EMBASE and CENTRAL were searched in June 2020 for double-blind, randomized trials (RCTs), comparing opioid therapy to placebo and assessed a HRQL questionnaire. The review comprises a qualitative vote counting approach and a meta-analysis of the Short Form Health Survey (SF-36), EQ-5D questionnaire and the pain interference scale of the Brief pain inventory (BPI). 35 RCTs were included, of which the majority reported a positive effect of opioids for the EQ-5D, the BPI and the physical component score (PCS) of the SF-36 compared to placebo. The meta-analysis of the PCS showed a mean difference of 1.82 [confidence interval: 1.32, 2.32], the meta-analysis of the EQ-5D proved a significant advantage of 0.06 [0.00, 0.12]. In the qualitative analysis of the mental component score (MCS) of the SF-36, no positive or negative trend was seen. No significant differences were seen in the MCS (MD: 0.65 [-0.43, 1.73]). A slightly higher premature dropout rate was found in the opioid group (risk difference: 0.04 [0.00, 0.07], p = .07). The body of evidence is graded as low to medium. Opioids have a statistically significant, but small and clinical not relevant effect on the physical dimensions of HRQL, whereas there is no effect on mental dimensions of HRQL in patients with chronic non-malignant pain during the initial months of treatment. In clinical practice, opioid prescriptions for chronic non-cancer pain should be individually assessed as their broad efficacy in improving quality of life is not confirmed. The duration of opioid treatment should be determined carefully, as this review primarily focuses on the initial months of therapy.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"1 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139235722","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":"Investigating self-report and neuropsychological assessments of cognitive flexibility in people with and without persistent pain: An online, cross-sectional, observational study","authors":"Caitlin A. Howlett, Tyman Stanford, Carolyn Berryman, E. L. Karran, V. Bellan, Scott Coussens, S. Miles, G. L. Moseley","doi":"10.1177/20494637231215260","DOIUrl":"https://doi.org/10.1177/20494637231215260","url":null,"abstract":"People with persistent pain experience problems modifying their cognition and behaviours when task or environmental demands change – abilities otherwise known as cognitive flexibility. However, limitations and inconsistent results of previous studies raise concerns over the quality of that evidence. We aimed to determine whether people with and without persistent pain differ on two assessments that are commonly used to assess cognitive flexibility. We also examined the relationship between the two assessments and explored whether people with and without persistent pain are distinguishable based on their scores on these assessments. Participant demographics and symptoms of anxiety and depression were assessed. Participants completed the Cognitive Flexibility Inventory (CFI) and the Wisconsin Card Sorting Test (WCST). Multiple linear regression on the two outcome variables: CFI (total score) and WCST (% perseverative responses) was applied using backward stepwise selection. Both outcomes were calculated as a standardised proportion of the outcome scale and log-odds transformed to meet the model assumptions. Correlation analysis and logistic regression were used to investigate our secondary and exploratory aims. Data were available from 128 participants with persistent pain and 68 pain-free controls. After adjusting for covariates, no differences were found between people with and without persistent pain on either assessment of cognitive flexibility. No significant correlations were detected between the two assessments in either group. The probability of having persistent pain was also not associated with scores on either or both assessments. ‘Cognitive flexibility’ appears similar in people with and without persistent pain.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"38 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139251140","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":"Treated versus self-reported prevalence of chronic pain and costs of patients’ health services utilization: a population-based study of health administrative databases","authors":"Nguyen Xuan Thanh, Elena Lopatina, Lori S Montgomery, Magali Robert, Robert L Tanguay, Tracy Wasylak","doi":"10.1177/20494637231209928","DOIUrl":"https://doi.org/10.1177/20494637231209928","url":null,"abstract":"Objectives To compare treated to self-reported prevalence of chronic pain (CP) and to estimate health services utilization (HSU) costs of patients treated for CP in Alberta, Canada. Methods Patients treated for CP were identified by the physician billing codes of health services for CP from the practitioner claims database in fiscal year 2021/22. The treated prevalence of CP (number of these patients divided by the population) was compared to the self-reported prevalence of CP previously estimated (doi:10.1371/journal.pone.0272638). Costs of patients’ HSU included costs for general practitioner (GP), specialist, inpatient, emergency department, outpatient clinic services, and prescription drugs. Results The treated prevalence of CP was 6.0% (4.4% among males and 7.8% among females) which was 30% to 41% of the self-reported prevalence. The highest treated prevalence (7.2%) was found in the age group of 18–64 years, followed by age groups of >64 years (7.0%) and <18 years (2.1%). The average cost per patient per year was $5096 ($5878 for males and $4652 for females), of which hospitalizations accounted for 65.0%, outpatient clinic visits 16.4%, ED visits 9.5%, prescription drugs 4.7%, GP visits 3.9%, and specialist visits 0.4%. The total cost of patients with CP for the health system was $1.37 billion (∼7% of total health expenditure), of which males accounted for 41.7% and females for 58.3%. Discussion Our findings suggest that the economic burden of CP is considerable and that many people with self-reported CP do not use the public healthcare services. This can be multifactorial, including lack of availability and accessibility of publicly funded services, people’s lack of awareness of available services, lower utilization due to COVID-19 pandemic, and reliance on self-management, private services, and alternative treatments. Further studies are warranted to inform future policies and health system initiatives aiming to reduce the burden of CP and improve lives of people living with it.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"83 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135432958","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":"Confidence of practitioners to support self-management of pain: A multidisciplinary survey","authors":"Chris Penlington, Pattramon Pornsukjantra, Paul Chazot, Frances Cole, Diarmuid Denneny","doi":"10.1177/20494637231212748","DOIUrl":"https://doi.org/10.1177/20494637231212748","url":null,"abstract":"Background Supported self-management is an important component of management for persistent pain according to current recommendations and guidelines. However, it is unclear whether staff from differing disciplines who may be in early contact with people with established or developing persistent pain are confident to introduce and support self-management for this patient group. Aim To determine the confidence of staff across professional disciplines to introduce and support self-management. Design and Setting Cross-sectional online survey. Methods Charts were constructed to represent information on professional grouping, prior training in self-management and confidence in supporting key components of self-management for persistent pain. Analysis of variance was used to test for differences between groups. Results Overall, 165 practitioners reported confidence to support self-management below the midpoint of a ten-point scale and 93 above. There were few differences between different professions apart from in explaining pain (f = 6.879 p < .001), managing activity levels (f = 6.340 p < .001) and supporting healthy habits (f = 4.700, p = .001) in which physiotherapists expressed higher confidence than other professional groups. There was no difference in confidence expressed between staff who had or had not received previous training in self-management (f = 1.357, p = .233). Conclusions Many front-line staff who might be expected to introduce and deliver self-management support for persistent pain lack the confidence and skills to do so. This is consistent with a known lack of education about pain across disciplinary boundaries in primary and community-based care. In order to meet treatment priorities for persistent pain there is an urgent need to upskill the workforce by providing access to good quality training and resources.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"11 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135774514","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":"<i>VirtualPain</i>. Preliminary findings from a group-based digital therapeutics intervention for fibromyalgia","authors":"Ferran Vilalta-Abella, Bruno Porras-Garcia, Alexandra Ghiţă, Montserrat Vacas-Moreira, Mónica Prat-Galbany, José Gutiérrez-Maldonado","doi":"10.1177/20494637231210391","DOIUrl":"https://doi.org/10.1177/20494637231210391","url":null,"abstract":"Introduction Fibromyalgia (FM) is a disorder characterized by chronic pain, with significant medical, psychological, and socio-economic implications. Although there is limited evidence, cognitive-behavioral therapy (CBT) has shown to be effective in improving FM symptoms. An alternative to enhance CBT effectiveness is to incorporate digital therapeutics (DTx). Aim We conducted a pilot study to investigate whether the addition of a DTx intervention ( VirtualPain) to cognitive-behavioral group therapy (CBGT) can reduce pain perception and associated symptoms in patients with FM. Method Ten patients with FM were initially recruited from a public hospital in Barcelona. The treatment consisted of 6 weeks of VirtualPain group sessions and 16 weeks of CBGT. Measures of catastrophizing, self-efficacy, and coping were recorded before, during, and after the protocol. In the DTx sessions, pain intensity was recorded before and after each session. Results The program (DTx and CBGT) showed a significant improvement in pain-related self-efficacy and relaxation measures. Improvement in pain perception was observed only after the DTx intervention. Conclusions This study provides preliminary results regarding the added value of DTx ( VirtualPain) as part of a CBGT for FM. The use of the program has facilitated a significant reduction in pain perception in each of the VirtualPain sessions, which provides further evidence of how this technology can be beneficial for improving FM treatments.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"3 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135873756","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":"Healthcare resource utilisation and economic burden attributable to back pain in primary care: A matched case-control study in the United Kingdom","authors":"Dawit T Zemedikun, Jesse Kigozi, Gwenllian Wynne-Jones, Alessandra Guariglia, Krishnarajah Nirantharakumar, Tom Marshall, Tracy Roberts","doi":"10.1177/20494637231208364","DOIUrl":"https://doi.org/10.1177/20494637231208364","url":null,"abstract":"Objective Incremental healthcare costs attributed to back pain, and characterisation by patient and clinical factors have rarely been documented. This study aimed to assess annual healthcare resource utilisation and costs associated with back pain in primary care. Methods Using the IQVIA Medical Research Data (IMRD), patients with back pain were identified (study period: 01 January 2006 to 31 December 2015) using diagnostic records and analgesics prescriptions ( n = 133,341), and propensity score matched 1:1 to patients without back pain. The annual incremental costs of back pain associated with consultations and prescriptions were estimated and extrapolated to a national level. Sensitivity analysis was conducted by restricting the study population to the most recent diagnosis of back pain. Variations in cost were assessed stratified by gender, age-groups, deprivation, and comorbidity categories. Results The mean age was 57 years, and 62% were females in both the case and control groups. The total incremental healthcare costs associated with back pain was £32.5 million in 2015 (£35.9 million in 2020), with per-patient cost of £244 (£265 in 2020) per year. On a national level, this translated to an estimated £3.2 billion (£3.5 billion in 2020). Eighty percent of the costs were attributed to consultations; and female gender, older age, higher deprivation, and higher comorbidity were all associated with increased mean healthcare costs of patients with back pain. Conclusion Our findings confirm the substantial healthcare costs attributed to back pain, even with primacy care costs only. The data also revealed significant cost variations across socio-demographic and clinical factors.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"19 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135618443","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":"Does a diagnosis of depression influence observer ratings of pain severity? The mediating role of causal attributions of pain and pain genuineness","authors":"Kara Turcotte, Susan Holtzman","doi":"10.1177/20494637231206541","DOIUrl":"https://doi.org/10.1177/20494637231206541","url":null,"abstract":"Researchers have been increasingly investigating observer and patient characteristics that may influence the assessment of pain in others. While rates of psychiatric conditions are high in chronic pain populations, surprisingly little attention has been given to if (and why) a comorbid psychiatric diagnosis may influence the estimation of pain in others. Using an experimental vignette paradigm, the current study examined whether a diagnostic label of major depressive disorder (MDD) would impact observer pain estimates of a woman with chronic pain, and whether causal attributions of pain and pain genuineness might help explain these effects. Participants ( n = 188) were given a vignette describing a female patient with chronic pain (who either had MDD or no mental health concerns), viewed a brief video clip of the patient, and then were asked to provide a variety of ratings about the woman’s pain. Results of a serial multiple mediation analysis revealed that participants in the MDD condition made greater psychological attributions for the woman’s pain, which was associated with lower perceptions of pain genuineness, which was then associated with lower estimates of pain intensity. These findings suggest that a diagnosis of depression may indirectly influence observer estimates of another person’s pain by heightening psychological attributions of pain, and making their pain seem less genuine. Further research is needed to elucidate the complex processes underlying pain estimation, including patient and observer characteristics, biases, and heuristics, in order to improve quality of care for those living with persistent pain.’","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135825367","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":"‘I felt part of the solution’. A qualitative study about the interface between lived experience advocates, professionals and organisations in the field of persistent pain","authors":"Cameron Hartley, Chris Penlington","doi":"10.1177/20494637231208095","DOIUrl":"https://doi.org/10.1177/20494637231208095","url":null,"abstract":"Objectives To elicit perspectives of people with persistent pain about their experiences working with pain management professionals and services as patient advocates and to consider implications for current models of involving patients in service development and research. Design reflexive thematic analysis from a critical realist perspective. Methods Online interviews were conducted individually with 10 participants who had acted as patient advocates in the field of persistent pain. Participants were recruited through purposive and snowball sampling. Data were analysed and organised into themes and are presented descriptively. Results The relationship between patient advocates and the organisations they help is conceptualised as ‘an unequal partnership’. Participants described positive and affirming experiences with individual health professionals and research teams (Respect). This often occurred within a context of inflexible organisational policies that presented barriers to participation including a lack of financial compensation and expectation to work to inflexible deadlines. As a result, patient advocates could experience a lack of value attributed to their experiences and voices (unmet needs from institutions). Conclusion People with personal experience of engaging with services for persistent pain are in a strong position to contribute to service improvement. Although this contribution is recognised as valuable, it appears to be devalued by organisational barriers. Organisational policies around payment may lead to a lack of representation of those experiencing higher levels of disadvantage. As a result, services and policy makers may be missing out on insights that could be important for service development.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135825365","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":"Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews","authors":"Neetu Bansal, Sheanne Ang, Li-Chia Chen","doi":"10.1177/20494637231204549","DOIUrl":"https://doi.org/10.1177/20494637231204549","url":null,"abstract":"Background Chronic post-surgical pain (CPSP) and persistent post-operative opioid use (PPOU) are inconsistently defined in published literature. This review comprehensively summarised their definitions, prevalence and determinants from existing systematic reviews or meta-analyses. Methods Systematic reviews or meta-analyses evaluating the prevalence of CPSP and PPOU in adults after surgeries were retrieved from an electronic database search applying structured search strategies in PubMed, MEDLINE, Embase, CINAHL Plus and Cochrane Database of Systematic Reviews from inception to 31 December 2022. Two reviewers selected systematic reviews, extracted data regarding the definition, prevalence and risk factors of CPSP and PPOU and assessed the quality using the AMSTAR 2 tool. Results The study identified 6936 records related to chronic pain and persistent opioid use in patients after surgery, of which 24 articles were identified for full-text review. Eighteen systematic reviews were included in this umbrella review, of which five systematic reviews assessed chronic pain in patients who had undergone a surgical procedure, and 13 reviews assessed persistent opioid use after surgery. Despite considerable variations in patient characteristics (from age ≥18 years), types of surgeries, follow-up duration and the definitions of measures, most reviews were of medium to good quality (fulfilled 9-11/16 AMSTAR 2 criteria). The prevalence of CPSP and PPOU, commonly synthesised at 3, 6 or 12 months after surgeries, varied from 5%–58% and 2%–65%, respectively, despite various terminologies, definitions and timing of measures and associated determinants. The prevalence of neuropathic pain in CPSP was obtainable for four surgeries, with 9%–74%. Conclusion To inform future practice and policy to optimise pain management and opioid safety, consensus on standardising measurements and further studies assessing risk factors associated with CPSP, PPOU and adverse outcomes are needed.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135993272","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":"Implanted intrathecal drug delivery systems may be associated with improved survival in patients with cancer","authors":"Alison Mitchell, Lesley Somerville, Nicola Williams, Jonathan McGhie, Alex McConnachie, Gordon McGinn, Jiyoung Lee","doi":"10.1177/20494637231202089","DOIUrl":"https://doi.org/10.1177/20494637231202089","url":null,"abstract":"Background Intrathecal Drug Delivery Systems (IDDS) are underused in the management of cancer-related pain despite evidence of both efficacy and survival benefit. There is currently limited evidence to indicate which patients might benefit most from IDDS. Aim The aim of the study was to describe the baseline characteristics and survival outcomes of patients who accepted IDDS, patients who declined IDDS and patients who wished to go ahead with IDDS but whose condition deteriorated before they could do so. Design/participants The survival data for 75 consecutive patients who had been offered intrathecal drug delivery were examined as part of a retrospective cohort study. Survival data was compared between three groups: those who accepted intrathecal drug delivery and went on to receive it ( n = 41), those who accepted it but whose condition deteriorated before it commenced ( n = 17) and those who declined this treatment modality ( n = 17). Results Patients who received IDDS survived significantly longer after assessment compared to those who declined IDDS (hazard ratio (HR) for the IDDS group relative to the declined group 0.29 (95% CI 0.16 to 0.53), and 0.23 (95% CI 0.12 to 0.44) after adjustment for gender and baseline functional status. In patients who accepted IDDS but who were unable to commence treatment, survival after assessment was not significantly different from those who declined the IDDS (HR for the deteriorated group relative to the declined group 1.28 (95% CI 0.65 to 2.53), and 0.80 (95% CI 0.65 to 2.53) after adjustment for gender and baseline functional status). Conclusion In this retrospective analysis, an improvement in survival may be associated with patients who accept ongoing pain management with an implanted intrathecal drug delivery system compared to those patients who either declined intrathecal drug delivery or deteriorated before it could be commenced.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"16 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136142514","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}