Clinical Journal of Pain最新文献

{"title":"Psychological Treatment Targeting Acceptance and Compassion in Patients With Chronic Pain: A Randomized Controlled, Internet-delivered, Treatment Trial.","authors":"Monica Buhrman, Maria Tillfors, Fredrik Holländare, Emily Lekström, Alexander Håkansson, Katja Boersma","doi":"10.1097/AJP.0000000000001157","DOIUrl":"10.1097/AJP.0000000000001157","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition. Primary treatment outcomes were the Chronic Pain Acceptance Questionnaire, Self-Compassion Scale, and Pain Disability Index. Secondary outcomes were the Montgomery Åsberg Depression Rating Scale, Anxiety Sensitivity Index, Quality of Life Inventory, Multidimensional Pain Inventory, and Perseverative Thinking Questionnaire.</p><p><strong>Results: </strong>Missing data at postintervention were 22.5%. Intention-to-treat analyses were conducted using linear mixed models. The results revealed greater levels of acceptance and self-compassion for the treatment group, which were primary outcomes, with effect sizes ranging from small to large, and these results were maintained at 6-month follow-up. The rates of clinically significant improvements were also greater for the treatment group in comparison to the wait-list control group on acceptance and compassion. The treatment group also improved in the third primary outcome, pain disability. Significant differences were found in several of the secondary outcomes, in favor of the treatment group.</p><p><strong>Discussion: </strong>Internet-based Acceptance and Commitment Therapy with compassion-focused therapy components shows promise as a viable treatment option in the management of chronic pain.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":"672-685"},"PeriodicalIF":2.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10235374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric Properties of Patient-reported Outcome Measures to Assess Resilience in Individuals with Musculoskeletal Pain or Rheumatic Conditions: A COSMIN-based Systematic Review.","authors":"Dayana Patricia Rosa, Marc-Olivier Dubé, Jean-Sébastien Roy","doi":"10.1097/AJP.0000000000001162","DOIUrl":"10.1097/AJP.0000000000001162","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this systematic review was to provide a comprehensive overview of the measurement properties of patient-reported outcome measures (PROMs) used to assess resilience in individuals with musculoskeletal and rheumatic conditions.</p><p><strong>Methods: </strong>Four electronic databases (MEDLINE, CINAHL, PsycINFO, and Web of Science) were searched. Studies assessing any measurement property in the target populations were included. Two reviewers independently screened all studies and assessed the risk of bias using the COSMIN checklist. Thereafter, each measurement property of each PROM was classified as sufficient, insufficient, or inconsistent based on the COSMIN criteria for good measurement properties.</p><p><strong>Results: </strong>Four families of PROMs [Brief Resilient Coping Scale (BRCS); Resilience Scale (RS-18); Connor-Davidson Resilience Scale (CD-RISC-10 and CD-RISC-2); and Pain Resilience Scale (PRS-14 and PRS-12)] were identified from the 9 included studies. Even if no PROM showed sufficient evidence for all measurement properties, the PRS and CD-RISC had the most properties evaluated and showed the best measurement properties, although responsiveness still needs to be assessed for both PROMs. Both PROMs showed good levels of reliability (intraclass coefficient correlation 0.61 to 0.8) and good internal consistency (Cronbach's alpha ≥0.70). Minimal detectable change values were 24.5% for PRS and between 4.7% and 29.8% for CD-RISC.</p><p><strong>Discussion: </strong>Although BRCS, RS-18, CD-RISC, and PRS have been used to evaluate resilience in individuals with musculoskeletal and rheumatic conditions, the current evidence only supports the use of PRS and CD-RISC in this population. Further methodological studies are therefore needed and should prioritize the assessment of reliability and responsiveness.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":"695-706"},"PeriodicalIF":2.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Self-Harm Ideation Among Persons Treated With Opioids for Chronic Low Back Pain.","authors":"Robert N Jamison, Robert R Edwards, Roger Brown, Bruce P Barrett, Cindy A Burzinski, Robert P Lennon, Yoshio Nakamura, Tony Schiefelbein, Eric L Garland, Aleksandra E Zgierska","doi":"10.1097/AJP.0000000000001161","DOIUrl":"10.1097/AJP.0000000000001161","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic pain is a significant health concern that adversely affects all aspects of life, including emotional well-being. Opioids are prescribed for the management of refractory, severe chronic pain, although they have been associated with adverse effects, including addiction and overdose. The aim of this study was to examine factors that predict thoughts of self-harm among adults with chronic pain who are prescribed opioids.</p><p><strong>Materials and methods: </strong>Seven hundred sixty-five (N=765) persons with opioid-treated chronic lower back pain completed the Current Opioid Misuse Measure (COMM) and other validated questionnaires as part of a larger study. Response to 1 question from the COMM (\"How often have you seriously thought about hurting yourself?\") was used to assess suicide risk on a 5-point scale (0=never; 4=very often).</p><p><strong>Results: </strong>Participants were categorized into 3 groups according to their responses to the self-harm question: never (N=628; 82.1%), seldom or sometimes (N=74; 9.7%), and often or very often (N=63; 8.2%). Multivariate adjusted odds ratio (aOR) analyses indicated that reports of alcohol or drug overuse within the past month (aOR=1.41,[95% CI 1.11-1.78]), posttraumatic stress (PTSD; aOR=1.24,[1.07 to 1.44]), pain catastrophizing (aOR=1.03,[1.01 to 1.05]), not loving oneself (aOR=0.99,[.98-1.00]) and poor perceived mental health (aOR=0.94,[.92 to 97]) were most associated with thoughts of self-harm. Importantly, the ideation frequency of self-harm was highest among individuals treated with higher daily doses of opioids.</p><p><strong>Discussion: </strong>These results support the need for continued monitoring of adults treated with opioids for chronic pain, particularly among those on high-dose opioids who present with increased negative affect and concerns of substance misuse.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":"643-653"},"PeriodicalIF":2.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10695275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10247127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Transforaminal Epidural Corticosteroid Injections in Acute Sciatica: A Randomized Controlled Trial.","authors":"Bastiaan C Ter Meulen, Johanna M van Dongen, Esther Maas, Marinus H van de Vegt, Johan Haumann, Henry C Weinstein, Raymond Ostelo","doi":"10.1097/AJP.0000000000001155","DOIUrl":"10.1097/AJP.0000000000001155","url":null,"abstract":"<p><strong>Objective: </strong>Transforaminal epidural steroid injections (TESIs) are widely administered for sciatica. The aim of this trial was to evaluate the effectiveness of TESIs in patients with acute sciatica (<8 wk).</p><p><strong>Methods: </strong>This study was conducted in 2 Dutch hospitals. Participants (n=141) were randomly assigned to (1) usual care and TESI of 1 ml of 40 mg/ml Methylprednisolone plus 1 ml of 0.5% Levobupivacaine (intervention 1); (2) usual care and transforaminal epidural injection with 1 ml of 0.5% Levobupivacaine and 1 ml NaCl 0.9% (intervention 2); (3) usual care consisting of oral pain medication with or without physiotherapy (control). Co-primary outcomes were back pain and leg pain intensity, physical functioning, and recovery measured during 6-month follow-up.</p><p><strong>Results: </strong>There were no statistically significant mean differences in co-primary outcomes between groups during follow-up, except for leg pain when comparing intervention group 1 with control (-0.96 95%CI:-1.83 to -0.09). For secondary outcomes, some statistical significant between-group differences were found for treatment satisfaction and surgery, but only when comparing intervention group 2 to control. Post hoc analyses showed a statistically significant difference in response [50% improvement of leg pain (yes/no)] between intervention 1 and the control group at 3 months and that both intervention groups used less opioids.</p><p><strong>Discussion: </strong>Except for a statistically significant effect of TESI on leg pain for patients with acute sciatica compared with usual care, there were no differences in co-primary outcomes. Nonetheless, transforaminal epidural injections seem to be associated with less opioid use, which warrants further exploration.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":"654-662"},"PeriodicalIF":2.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10245608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for the Development of Multisite Pain in Children.","authors":"Chelsea M Kaplan, Andrew Schrepf, Kevin F Boehnke, Ying He, Tristin Smith, David A Williams, Rachel Bergmans, Terri Voepel-Lewis, Afton L Hassett, Richard E Harris, Daniel J Clauw, Adriene M Beltz, Steven E Harte","doi":"10.1097/AJP.0000000000001148","DOIUrl":"10.1097/AJP.0000000000001148","url":null,"abstract":"<p><strong>Objective: </strong>Chronic pain has economic costs on par with cardiovascular disease, diabetes, and cancer. Despite this impact on the health care system and increasing awareness of the relationship between pain and mortality, efforts to identify simple symptom-based risk factors for the development of pain, particularly in children, have fallen short. This is critically important as pain that manifests during childhood often persists into adulthood. To date, no longitudinal studies have examined symptoms in pain-free children that presage a new, multisite manifestation of pain in the future. We hypothesized that female sex, sleep problems, and heightened somatic symptoms complaints at baseline would be associated with the risk of developing new multisite pain 1 year later.</p><p><strong>Methods: </strong>Symptom assessments were completed by parents of youth (ages 9 to 10) enrolled in the Adolescent Brain Cognitive Development study. Multivariate logistic regression models focused on children who developed multisite pain 1 year later (n=331) and children who remained pain free (n=3335).</p><p><strong>Results: </strong>Female sex (odds ratio [OR]=1.35; 95% CI, 1.07, 1.71; P =0.01), elevated nonpainful somatic symptoms (OR=1.17; 95% CI, 1.06, 1.29; P <0.01), total sleep problems (OR=1.20; 95% CI, 1.07, 1.34; P <0.01), and attentional issues (OR=1.22; 95% CI, 1.10, 1.35; P <0.001) at baseline were associated with new multisite pain 1 year later. Baseline negative affect was not associated with new multisite pain.</p><p><strong>Discussion: </strong>Identifying symptom-based risk factors for multisite pain in children is critical for early prevention. Somatic awareness, sleep and attention problems represent actionable targets for early detection, treatment, and possible prevention of multisite pain in youth.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":"588-594"},"PeriodicalIF":2.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10592500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9977075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Effect of Pregabalin in the Treatment of Carpal Tunnel Syndrome: A Prospective, Randomized, Triple-Blinded, Placebo-controlled Trial.","authors":"Kumar Bismaya, Varun Kumar Singh, Abhishek Pathak, Anand Kumar, Vijaya Nath Mishra, Deepika Joshi, Rameshwar Nath Chaurasia","doi":"10.1097/AJP.0000000000001154","DOIUrl":"10.1097/AJP.0000000000001154","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine the effectiveness of pregabalin for the control of symptoms in mild to moderate idiopathic Carpal tunnel syndrome (CTS).</p><p><strong>Methods: </strong>In this randomized, placebo-controlled trial, 146 mild to moderate idiopathic CTS patients were randomized into pregabalin (n=74) and placebo groups (n=72). Per protocol, analysis was conducted with 131 patients; pregabalin (n=65) and placebo (n=66). The drug titration dose was 50 mg once daily for the first week, twice daily for the second week and thrice daily for the next 6 weeks. The primary outcome included a change in the Symptom Severity Scale and Functional Status Scale (FSS) of the Boston Carpal Tunnel Questionnaire after the eighth week. The secondary outcome was the change in clinical and electrophysiological grading after 8 weeks of therapy.</p><p><strong>Results: </strong>There was a statistically significant improvement in the mean Symptom Severity Scale (14.92±3.72 vs. 16.55±4.45; P =0.025) and FSS (10.77±2.64 vs. 12.0±2.55; P =0.007) in the pregabalin group after 8 weeks. Mean clinical and electrophysiological grading changed significantly from 2.3±0.7 to 2.1±0.8 ( P =0.001) and 1.9±0.7 to 1.8±0.8 ( P =0.020), respectively in the pregabalin group but not in the placebo group.</p><p><strong>Discussion: </strong>The results of this study demonstrates that pregabalin is effective in ameliorating symptoms and improving functional outcomes in mild to moderate idiopathic CTS.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":"604-610"},"PeriodicalIF":2.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10381644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Different Approaches of Quadratus Lumborum Block for Postoperative Analgesia After Cesarean Delivery: A Bayesian Network Meta-analysis of Randomized Controlled Trials.","authors":"Narinder P Singh, Jeetinder K Makkar, Samanyu Koduri, Preet Mohinder Singh","doi":"10.1097/AJP.0000000000001147","DOIUrl":"10.1097/AJP.0000000000001147","url":null,"abstract":"<p><strong>Objectives: </strong>Various approaches to quadratus lumborum block (QLB) have been found to be an effective analgesic modality after cesarean delivery (CD). However, the evidence for the superiority of any individual approach still needs to be demonstrated. Therefore, we conducted this network meta-analysis to compare and rank the different injection sites for QLB for pain-related outcomes after CD.</p><p><strong>Materials and methods: </strong>PubMed, EMBASE, SCOPUS, and the Cochrane Central Registers of Controlled Trials (CENTRAL) were searched for randomized controlled trials (RCTs) evaluating the role of any approach of QLB with placebo/no block for post-CD pain. The primary outcome was parenteral consumption of morphine milligram equivalents in 24 postoperative hours. The secondary end points were early pain scores (4 to 6 h), late pain scores (24 h), adverse effects, and block-related complications. We used the surface under cumulative ranking probabilities to order approaches. The analysis was performed using Bayesian statistics (random-effects model).</p><p><strong>Results: </strong>Thirteen trials enrolling 890 patients were included. The surface under cumulative ranking probability for parenteral morphine equivalent consumption in 24 hours was the highest (87%) for the lateral approach, followed by the posterior and anterior approaches. The probability of reducing pain scores at all intervals was highest with the anterior approach. The anterior approach also ranked high for postoperative nausea and vomiting reduction, the only consistent reported side effect.</p><p><strong>Discussion: </strong>The anterior approach QLB had a superior probability for most patient-centric outcomes for patients undergoing CD. The findings should be confirmed through large RCTs.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":"634-642"},"PeriodicalIF":2.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9778993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mobile Phone-Based Telemonitoring for Improving Adherence to Analgesic Treatment in Trauma Patients After Emergency Department Discharge: A Randomized Controlled Trial.","authors":"Khouloud Romdhane,&nbsp;Adel Sekma,&nbsp;Sarra Sassi,&nbsp;Hajer Yaakoubi,&nbsp;Rym Youssef,&nbsp;Mohamed Amine Msolli,&nbsp;Kaouthar Beltaief,&nbsp;Mohamed Habib Grissa,&nbsp;Hamdi Boubaker,&nbsp;Houda Ben Soltane,&nbsp;Zied Mezgar,&nbsp;Riadh Boukef,&nbsp;Wahid Bouida,&nbsp;Asma Belghith,&nbsp;Khaoula Bel Haj Ali,&nbsp;Asma Zorgati,&nbsp;Semir Nouira","doi":"10.1097/AJP.0000000000001145","DOIUrl":"10.1097/AJP.0000000000001145","url":null,"abstract":"<p><strong>Objective: </strong>To determine the impact of mobile-phone telemonitoring on patients' adherence and satisfaction with posttrauma pain treatment.</p><p><strong>Materials and methods: </strong>We conducted a prospective randomized clinical trial including patients with minor trauma discharged from the emergency department (ED) with analgesic treatment. Patients were randomized to one of 3 groups, the control group, where patients received a phone call on day-7, the short message service (SMS) group, where patients received a daily text message to remind them to take their treatment during 7 days, and the mobile-phone based telemonitoring (TLM) group. Patients' adherence to analgesic treatments using the Morisky Medication Adherence Scale, current pain by using a visual analogue scale, and patients' satisfaction were assessed. For the TLM group, the assessment was performed at day-2, 4 and 7.</p><p><strong>Results: </strong>Good adherence was observed in 418 patients (92.9%) in the TLM group versus 398 patients (88.6%) in the SMS group and 380 patients (84.8%) in the control group ( P <0.001). The factor mostly associated with adherence was telemonitoring (OR 2.40 95% CI 1.55-3.71). The decrease in pain visual analogue scale was highest in the TLM group compared with SMS and control groups ( P <0.001). The percentage of patients' satisfaction at 7 days post-ED discharge was 93% in the TLM group versus 88% in the SMS group and 84% in the standard group ( P =0.02).</p><p><strong>Discussion: </strong>Our findings suggest that mobile-phone-based telemonitoring is beneficial in the treatment of pain in trauma patients after ED discharge. This approach improved patients' adherence and satisfaction.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":"39 10","pages":"546-550"},"PeriodicalIF":2.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10576133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Predictors of Prolonged Opioid Use in the 6 Months After Total Knee Arthroplasty.","authors":"Daniel B Larach, Miklos D Kertai, Frederic T Billings, Sara B Anderson, Gregory G Polkowski, Andrew A Shinar, Ginger L Milne, Puneet Mishra, Stephen Bruehl","doi":"10.1097/AJP.0000000000001143","DOIUrl":"10.1097/AJP.0000000000001143","url":null,"abstract":"<p><strong>Objectives: </strong>Prolonged postoperative opioid use increases the risk for new postsurgical opioid use disorder. We evaluated preoperative phenotypic factors predicting prolonged postoperative opioid use.</p><p><strong>Methods: </strong>We performed a secondary analysis of a prospective observational cohort (n=108) undergoing total knee arthroplasty (TKA) for osteoarthritis with 6-week and 6-month follow-up. Current opioid use and psychosocial, pain, and opioid-related characteristics were assessed at preoperative baseline. Primary outcomes were days/week of opioid use at follow-up.</p><p><strong>Results: </strong>At 6 weeks, preoperative opioid use and greater cumulative opioid exposure, depression, catastrophizing, anxiety, pain interference, sleep disturbance, and central sensitization were significantly associated with more days/week of opioid use after controlling for contemporaneous pain intensity. Prior euphoric response to opioids were also significant predictors at 6 months. All 6-week predictors except anxiety remained significant after controlling for preoperative opioid use; at 6 months, cumulative opioid exposure, catastrophizing, pain interference, and sleep disturbance remained significant after this adjustment ( P <0.05). In multivariable models, a psychosocial factor reflecting negative affect, sleep, and pain accurately predicted 6-week opioid use (area under the curve=0.84). A combined model incorporating psychosocial factor scores, opioid-related factor scores, and preoperative opioid use showed near-perfect predictive accuracy at 6 months (area under the curve=0.97).</p><p><strong>Discussion: </strong>Overall, preoperative psychosocial, pain-related, and opioid-related phenotypic characteristics predicted prolonged opioid use after total knee arthroplasty.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":"39 10","pages":"516-523"},"PeriodicalIF":2.6,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10529895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10594329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpretation of the Patient Health Questionnaire 9 in High-Impact Chronic Pain: Do We Measure Depressive Symptoms the Way We Think?","authors":"Andrea Aagaard,&nbsp;Sophie Lykkegaard Ravn,&nbsp;Tonny Elmose Andersen,&nbsp;Henrik Bjarke Vaegter","doi":"10.1097/AJP.0000000000001142","DOIUrl":"10.1097/AJP.0000000000001142","url":null,"abstract":"<p><strong>Objectives: </strong>Depression is prevalent among patients with chronic pain and may impact pain management. An accurate assessment is, however, complicated by overlapping symptoms. This study investigated how patients with high-impact chronic pain interpreted and responded to the Patient Health Questionnaire 9 (PHQ-9) to identify problematic items and causes hereof.</p><p><strong>Materials and methods: </strong>Cognitive interviews using the Three-Step Test-Interview procedure were conducted during the completion of the PHQ-9 in 33 patients with high-impact chronic pain referred to interdisciplinary treatment. Responses were analyzed using 4 coding categories: (1) \"congruent\" (response consistent with intention); (2) \"incongruent\" (response not consistent intention); (3) \"ambiguous\" (response both congruent and incongruent or insufficient to evaluate congruency); and (4) \"confused\" (response with confused or misunderstood statements). Next, the content of responses to problematic items was analyzed to identify causes for noncongruency, and encountered response difficulties were identified across all items.</p><p><strong>Results: </strong>Three items (items 2, 6, and 9) performed as intended (>97% congruent responses), while 7 items (items 1, 3, 4, 5, 7, 8, and 10) were identified as problematic (<50% congruent responses). Problematic items had 1 or more issues: Responses were based on (1) pain-related issues or (2) other (non-pain) factors unrelated to depression, or item structure caused response difficulties due to wordings, reversion, or having 2 questions in 1.</p><p><strong>Discussion: </strong>Problematic items limit the construct validity of the PHQ-9, leaving an increased risk of inflated depression scores in high-impact chronic pain. Identified problems should guide future revisions to enhance validity and screening accuracy for the benefit of both research and clinical practice.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":"39 10","pages":"501-515"},"PeriodicalIF":2.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10594326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}