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OBJECTIVE: Most studies on preoperative opioid use only describe whether or not patients use opioids without characterizing reasons for use. Knowing why patients use opioids can help inform perioperative opioid management. The objective of this study was to explore pain specific reasons for preoperative opioid use prior to total hip and knee arthroplasty (THA and TKA) and their association with persistent use. METHODS: This is a prospective study of 197 patients undergoing THA (n = 99) or TKA (n = 98) enrolled in the Analgesic Outcomes Study between December 2015 and November 2018. All participants reported preoperative opioid use. RESULTS: Reasons for preoperative opioid use were categorized as surgical site pain only (81 [41.1%]); pain in other body areas only (22 [11.2%]); and combined pain (94 [47.7%]). Compared to patients taking opioids for surgical site pain, those with combined reasons for use had 1.24 (P = .40) and 2.28 (P = .16) greater odds of persistent use at 3 and 6 months postoperatively, adjusting for relevant covariates. CONCLUSIONS: This study provides novel insights into the heterogeneity of reasons for presurgical opioid use in patients undergoing a THA or TKA. One key take away is that not all preoperative opioid use is the same and many patients are taking opioids preoperatively for more than just pain at the surgical site. Combined reasons for use was associated with long-term use, suggesting nonsurgical pain, in part, drives persistent opioid use after surgery. Future directions in perioperative care should focus on pain and non-pain reasons for presurgical opioid use to create tailored postoperative opioid weaning plans.
Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Analgesics, Opioid/therapeutic use , Arthroplasty, Replacement, Knee/adverse effects , Humans , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Prospective Studies , Retrospective StudiesABSTRACT
OBJECTIVE: The aim of this study was to determine preoperative patient characteristics associated with postoperative outpatient opioid use and assess the frequency of postoperative opioid overprescribing. SUMMARY BACKGROUND DATA: Although characteristics associated with inpatient opioid use have been described, data regarding patient factors associated with opioid use after discharge are lacking. This hampers the development of individualized approaches to postoperative prescribing. METHODS: We included opioid-naïve patients undergoing hysterectomy, thoracic surgery, and total knee and hip arthroplasty in a single-center prospective observational cohort study. Preoperative phenotyping included self-report measures to assess pain severity, fibromyalgia survey criteria score, pain catastrophizing, depression, anxiety, functional status, fatigue, and sleep disturbance. Our primary outcome measure was self-reported total opioid use in oral morphine equivalents. We constructed multivariable linear-regression models predicting opioids consumed in the first month following surgery. RESULTS: We enrolled 1181 patients; 1001 had complete primary outcome data and 913 had complete phenotype data. Younger age, non-white race, lack of a college degree, higher anxiety, greater sleep disturbance, heavy alcohol use, current tobacco use, and larger initial opioid prescription size were significantly associated with increased opioid consumption. Median total oral morphine equivalents prescribed was 600âmg (equivalent to one hundred twenty 5-mg hydrocodone pills), whereas median opioid consumption was 188âmg (38 pills). CONCLUSIONS: In this prospective cohort of opioid-naïve patients undergoing major surgery, we found a number of characteristics associated with greater opioid use in the first month after surgery. Future studies should address the use of non-opioid medications and behavioral therapies in the perioperative period for these higher risk patients.
Subject(s)
Analgesics, Opioid/therapeutic use , Pain, Postoperative/drug therapy , Practice Patterns, Physicians'/statistics & numerical data , Adult , Aged , Female , Humans , Male , Middle Aged , Pain Measurement , Pain, Postoperative/psychology , Phenotype , Prospective Studies , Self Report , Surveys and QuestionnairesABSTRACT
Heavy drinking in college increases risk for negative consequences. Among a national sample of high school abstainers and moderate drinkers, we hypothesized that the extent of heavy drinking among students on campus would be among the strongest predictors of first semester heavy drinking and consequences, relative to personal approval of alcohol use and sociability and impairment outcome expectancies. We expected these psychological factors to moderate effects of campus heavy drinking. Data from 90,455 abstainers and 97,168 moderate drinkers matriculating at 245 and 242 universities, respectively, were drawn from AlcoholEdu (EverFi, 2013), a web-based intervention completed by most first-year students at participating universities. Students reported alcohol use, approval, expectancies, and covariates prior to enrollment (Time 1). During the first semester (Time 2), abstinence, moderate drinking, or heavy drinking, and negative consequences experienced were reassessed. Campus heavy drinking reflected the percentage of other students attending the same school who engaged in heavy drinking at Time 2. In multilevel multinomial logistic regression models, campus heavy drinking was consistently among the strongest predictors of heavy drinking and consequences: It predicted an 83% and 82% increase in risk of heavy drinking and a 106% and 91% increase in risk of consequences among students who were abstainers and moderate drinkers at Time 1, respectively. There were few interactions among campus heavy drinking and psychological factors. Post hoc analyses supported that students did not self-select into heavier drinking environments. Campus heavy drinking is a key predictor of first semester alcohol use and an important intervention target. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Subject(s)
Alcohol Drinking in College/psychology , Peer Group , Students/psychology , Universities/statistics & numerical data , Adolescent , Female , Humans , Male , Prospective Studies , Risk Assessment , Students/statistics & numerical data , United StatesABSTRACT
BACKGROUND: This cohort study was designed to determine the discrepancy between the quantity of opioid prescribed vs that which was consumed after total knee arthroplasty (TKA) and total hip arthroplasty (THA) in opioid-naive patients. METHODS: Seven hundred twenty-three opioid-naive patients (426 TKAs and 297 THAs) from 7 hospitals in Michigan were contacted within 3 months of their surgery. Opioid prescribing and self-reported consumption was calculated in oral morphine equivalents (OMEs). Secondary outcomes included opioid refill in the first 90 days, pain in the first 7 days post-operatively, and satisfaction with pain care. RESULTS: For TKA, the mean prescribing was 632 mg OME (±229), and the mean consumption was 416 mg (±279). For THA, the mean prescribing was 584 mg OME (±335), and the mean consumption was 285 mg (±301). There were no associations between the amount of opioid prescribed and the likelihood of refill, post-operative pain, or satisfaction with pain control. The amount of opioid prescribed was associated with increased consumption, such that each increase of 1 pill was associated with approximately an additional half pill consumed after adjusting for other covariates. Moreover, 48.2% felt that they received "More" or "Much more" opioid than they needed. CONCLUSION: We recommend no more than 50 tablets of 5 mg oxycodone or its equivalent after TKA and 30 tablets after THA. Although dose reductions in other surgeries have not resulted in harm, continued assessment is needed to ensure that there are no unintended effects of opioid reduction, including worsened pain, decreased satisfaction, emergency department visits, or hospital readmissions. LEVEL OF EVIDENCE: Level III; Retrospective, cohort study.
Subject(s)
Analgesics, Opioid , Arthroplasty, Replacement, Knee , Arthroplasty, Replacement, Knee/adverse effects , Cohort Studies , Humans , Michigan/epidemiology , Pain, Postoperative/drug therapy , Pain, Postoperative/epidemiology , Practice Patterns, Physicians' , Retrospective StudiesABSTRACT
OBJECTIVE: Many studies suggest a strong familial component to fibromyalgia (FM). However, those studies have nearly all been confined to individuals with primary FM, i.e., FM without any other accompanying disorder. The current 2011 and 2016 criteria for diagnosing FM construct a score using a combination of the number of painful body sites and the severity of somatic symptoms (FM score). This study was undertaken to estimate the genetic heritability of the FM score across sex and age groups to identify subgroups of individuals with greater heritability, which may help in the design of future genetic studies. METHODS: We collected data on 26,749 individuals of European ancestry undergoing elective surgery at the University of Michigan (Michigan Genomics Initiative study). We estimated the single-nucleotide polymorphism-based heritability of FM score by age and sex categories using genome-wide association study data and a linear mixed-effects model. RESULTS: Overall, the FM score had an estimated heritability of 13.9% (SE 2.9%) (P = 1.6 × 10-7 ). Estimated FM score heritability was highest in individuals ≤50 years of age (23.5%; SE 7.9%) (P = 3.0 ×10-4 ) and lowest in individuals >60 years of age (7.5%; SE 8.1%) (P = 0.41). These patterns remained the same when we analyzed FM as a case-control phenotype. Even though women had an ~30% higher average FM score than men across age categories, FM score heritability did not differ significantly by sex. CONCLUSION: Younger individuals appear to have a much stronger genetic component to the FM score than older individuals. Older individuals may be more likely to have what was previously called "secondary FM." Regardless of the cause, these results have implications for future genetic studies of FM and associated conditions.
Subject(s)
Fibromyalgia/genetics , Adult , Age Factors , Aged , Female , Fibromyalgia/epidemiology , Humans , Male , Middle Aged , PhenotypeABSTRACT
A retrospective comparison study of the anterior-oblique and lateral approach to hip injection procedures suggests that the lateral approach may be a valuable interventional skill for those performing hip injections.
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INTRODUCTION: We hypothesized that patients with complex regional pain syndrome (CRPS) would describe a more negative pain phenotype including higher pain severity, more neuropathic pain descriptors, more centralized pain symptoms, poorer physical function, and more affective distress when compared with patients with neuropathic pain of the extremities not meeting CRPS criteria. MATERIALS AND METHODS: This was a retrospective cross-sectional study conducted at a tertiary pain center. The sample included 212 patients who met Budapest Criteria for CRPS and 175 patients with neuropathic pain of the extremities who did not meet criteria. All patients completed a packet of questionnaires before their initial visit containing validated outcome measures assessing pain severity, pain interference, physical functioning, depression, anxiety, and catastrophizing. RESULTS: Patients with CRPS reported higher physical disability (p=0.022) and more neuropathic pain symptoms (p=0.002) than patients not meeting CRPS criteria, but the groups did not otherwise differ significantly. There were no significant differences in pain severity or affective distress, despite power analyses suggesting the ability to detect small to medium effect sizes (d=0.29; w=0.14). Subanalyses of differences in neuropathic pain symptoms revealed that patients with CRPS, compared with patients not meeting CRPS criteria, were more likely to report pain with light touch (p=0.003), sudden pain attacks (p=0.003), pain with cold or heat (p=0.002), sensation of numbness (p=0.042), and pain with slight pressure (p=0.018). DISCUSSION: Counter to our hypothesis, the present study suggests that patients with CRPS do not have a worse clinical phenotype compared with patients not meeting CRPS criteria, with the exception of higher physical disability and more neuropathic pain symptoms. This corresponds to recent evidence that patients with CRPS are similar to other patient populations with chronic pain.
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Polygenic risk scores (PRS) are designed to serve as single summary measures that are easy to construct, condensing information from a large number of genetic variants associated with a disease. They have been used for stratification and prediction of disease risk. The primary focus of this paper is to demonstrate how we can combine PRS and electronic health records data to better understand the shared and unique genetic architecture and etiology of disease subtypes that may be both related and heterogeneous. PRS construction strategies often depend on the purpose of the study, the available data/summary estimates, and the underlying genetic architecture of a disease. We consider several choices for constructing a PRS using data obtained from various publicly-available sources including the UK Biobank and evaluate their abilities to predict not just the primary phenotype but also secondary phenotypes derived from electronic health records (EHR). This study was conducted using data from 30,702 unrelated, genotyped patients of recent European descent from the Michigan Genomics Initiative (MGI), a longitudinal biorepository effort within Michigan Medicine. We examine the three most common skin cancer subtypes in the USA: basal cell carcinoma, cutaneous squamous cell carcinoma, and melanoma. Using these PRS for various skin cancer subtypes, we conduct a phenome-wide association study (PheWAS) within the MGI data to evaluate PRS associations with secondary traits. PheWAS results are then replicated using population-based UK Biobank data and compared across various PRS construction methods. We develop an accompanying visual catalog called PRSweb that provides detailed PheWAS results and allows users to directly compare different PRS construction methods.
Subject(s)
Genetic Predisposition to Disease , Genomics , Multifactorial Inheritance/genetics , Skin Neoplasms/genetics , Biological Specimen Banks , Electronic Health Records , Genome-Wide Association Study , Genotype , Humans , Michigan/epidemiology , Phenotype , Polymorphism, Single Nucleotide/genetics , Risk Factors , Skin Neoplasms/pathology , United Kingdom/epidemiologyABSTRACT
BACKGROUND AND OBJECTIVES: We hypothesized that patients with characteristics of centralized pain (fibromyalgia (FM)-like phenotype) would be less likely to respond to radiofrequency ablation (RFA), which may explain some of the failures of this peripherally directed therapy. METHODS: We conducted a prospective, observational study of patients undergoing RFA using a number of validated self-report measures of pain, mood and function. The 2011 Fibromyalgia Survey Criteria were used to assess for symptoms of centralized pain and was the primary predictor of interest. We constructed multivariable linear regression models to evaluate covariates independently associated with change in pain 3 months after RFA. RESULTS: 141 patients scheduled for medial branch blocks were enrolled in the study; 55 underwent RFA (51 with complete 3 months' follow-up). Patients with higher FM scores had less improvement in overall body pain; however, this was not statistically significant (adjusted mean change in pain FM+0.41, FM-1.11, p=0.396). In a secondary analysis, the FM score was not associated with change in back pain (p=0.720), with both groups improving equally. This cohort also reported significant improvement in anxiety, physical function, catastrophizing, and sleep disturbance at 3 months after RFA. CONCLUSIONS: Although patients with high baseline centralized pain exhibited less improvement in overall pain, this trend was not statistically significant, possibly due to insufficient power. The same trend was not seen with change in spine pain with both groups improving equally. Centralized pain patients may have less improvement in overall pain but may have equal improvement in their site-specific pain levels after localized interventions.
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Health systems are stewards of patient electronic health record (EHR) data with extraordinarily rich depth and breadth, reflecting thousands of diagnoses and exposures. Measures of genomic variation integrated with EHRs offer a potential strategy to accurately stratify patients for risk profiling and discover new relationships between diagnoses and genomes. The objective of this study was to evaluate whether polygenic risk scores (PRS) for common cancers are associated with multiple phenotypes in a phenome-wide association study (PheWAS) conducted in 28,260 unrelated, genotyped patients of recent European ancestry who consented to participate in the Michigan Genomics Initiative, a longitudinal biorepository effort within Michigan Medicine. PRS for 12 cancer traits were calculated using summary statistics from the NHGRI-EBI catalog. A total of 1,711 synthetic case-control studies was used for PheWAS analyses. There were 13,490 (47.7%) patients with at least one cancer diagnosis in this study sample. PRS exhibited strong association for several cancer traits they were designed for, including female breast cancer, prostate cancer, melanoma, basal cell carcinoma, squamous cell carcinoma, and thyroid cancer. Phenome-wide significant associations were observed between PRS and many non-cancer diagnoses. To differentiate PRS associations driven by the primary trait from associations arising through shared genetic risk profiles, the idea of "exclusion PRS PheWAS" was introduced. Further analysis of temporal order of the diagnoses improved our understanding of these secondary associations. This comprehensive PheWAS used PRS instead of a single variant.
Subject(s)
Genetic Association Studies , Genomics , Multifactorial Inheritance/genetics , Neoplasms/genetics , Neoplasms/pathology , Calibration , Female , Genome-Wide Association Study , Humans , Male , Middle Aged , Neoplasms/diagnosis , Phenotype , Polymorphism, Single Nucleotide/genetics , Quantitative Trait, Heritable , Reproducibility of Results , Risk Factors , Time FactorsABSTRACT
OBJECTIVES: The present study evaluated the relationship between the 2011 American College of Rheumatology fibromyalgia (FM) survey criteria and quantitative sensory testing (QST). MATERIALS AND METHODS: Patients with knee osteoarthritis scheduled to undergo knee arthroplasty completed the FM survey criteria and self-report measures assessing clinical symptoms. Patients also underwent a battery of QST procedures at the surgical knee and remote body sites, including pressure algometry, conditioned pain modulation, and temporal summation. All assessments were completed before surgery. FM survey criteria were used to calculate a continuous FM score indicating FM severity. RESULTS: A total of 129 patients were analyzed. Of these, 52.7% were female, 93.8% were Caucasian, and 3.8% met the FM survey criteria for FM classification. Mean age for females (63.6 y) and males (64.7 y) was similar. Females and males differed significantly in nearly every outcome, including FM severity, clinical pain, anxiety, depression, and pressure pain sensitivity. In females, FM scores significantly correlated with pressure pain sensitivity, but not conditioned pain modulation or temporal summation, such that increased sensitivity was associated with greater FM severity at all body sites examined. In addition, as FM scores increased, the association between pain sensitivity at the surgical knee and pain sensitivity at remote body sites also increased. No relationship between FM score and QST was observed in males. DISCUSSION: We demonstrated an association between diffuse hyperalgesia as measured by QST and FM severity in females with knee osteoarthritis. These results suggest that the FM survey criteria may represent a marker of pain centralization in females with potential utility in clinical decision making.
Subject(s)
Fibromyalgia/complications , Hyperalgesia/complications , Osteoarthritis, Knee/complications , Adult , Aged , Cohort Studies , Female , Fibromyalgia/physiopathology , Humans , Hyperalgesia/physiopathology , Male , Middle Aged , Osteoarthritis, Knee/physiopathology , Pain Measurement , Pain Threshold , Pressure , Sex CharacteristicsABSTRACT
Objective: There is little empirical evidence supporting the long-term use of opioid therapy for chronic pain, suggesting the need to reevaluate the role of opioids in chronic pain management. Few studies have considered opioid use and opioid cessation from the perspective of the patient. Methods: This prospective structured interview study included 150 new patients seeking treatment for chronic pain at an outpatient tertiary care pain clinic. Results: Of the 150 patients, 56% (N = 84) reported current opioid use. Opioids users reported higher pain severity (t(137) = -3.75, P < 0.001), worse physical functioning (t(136) = -3.82, P < 0.001), and more symptoms of depression (t(136) = -1.98, P = 0.050) than nonusers. Among opioid users, 45.6% reported high pain (>7), 60.8% reported low functioning (>7), and 71.4% reported less than a 30% reduction in pain severity since starting opioids, suggesting that many patients are unlikely to be receiving adequate benefit. Overall, 66.3% of current opioid users reported moderate to high opioid-related difficulties on the prescribed opioids difficulties scale, and patients with depression were more likely to report greater difficulties. There was no association between helpfulness of opioids over the past month and opioid-related difficulties (r(75) = -0.07, P = 0.559), current pain severity (r(72)=0.05, P = 0.705), or current pain interference (r(72) = 0.20, P = 0.095). Conclusions: Despite clinical indicators that question the benefit, patients may continue to report that their opioids are helpful. Such discrepancies in patients' perceptions will likely pose significant barriers for implementing opioid cessation guidelines in clinical practice.
Subject(s)
Analgesics, Opioid/therapeutic use , Chronic Pain/drug therapy , Chronic Pain/epidemiology , Chronic Pain/psychology , Adult , Aged , Female , Humans , Male , Middle Aged , Motivation , Patient Reported Outcome Measures , Perception , Prospective Studies , Self ReportABSTRACT
OBJECTIVES: To assess changes in phenotype and pressure sensitivity in patients with suspected opioid-induced-hyperalgesia (OIH) after transitioning to buprenorphine. METHODS: Twenty patients with suspected OIH were enrolled to transition to buprenorphine therapy. Patients completed validated self-report measures at baseline and at 1, 4, 8 weeks, and 6 months after initiation of buprenorphine along with quantitative sensory testing including measures of pressure pain threshold, pain tolerance and Pain 50 (a pain intensity rating). RESULTS: 20 patients were enrolled, 17 were treated with buprenorphine and 11 completed all assessment points. We found that after transitioning to buprenorphine, patients on higher opioid doses (≥100mg oral morphine equivalents) had significant improvements for some measures including decreased pain severity and fibromyalgia survey scores, fewer neuropathic pain features, less catastrophizing, fewer depressive symptoms, and improved functioning 1-week after transitioning to buprenorphine with an eventual return back to baseline. Although not statistically significant, patients on high dose opioids (≥100mg OME) also showed a trend of decreased pressure sensitivity 1-week after transitioning to buprenorphine with a gradual return back to baseline. CONCLUSIONS: Our study is the first to look at pressure pain sensitivity in patients who were taking opioids and transitioned to buprenorphine. These results suggest that the patients most likely to benefit from buprenorphine therapy are those on higher doses. In addition, the eventual return back to baseline on measures of pain phenotype and pressure sensitivity suggests that buprenorphine may over time result in a return of the hyperalgesic effects of a full mu agonist.
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OBJECTIVE: To explore the clinical and financial implications of preoperative opioid use in major abdominal surgery. BACKGROUND: Opioids are increasingly used to manage chronic pain, and chronic opioid users are challenging to care for perioperatively. Given the epidemic of opioid-related morbidity and mortality, it is critical to understand how preoperative opioid use impacts surgical outcomes. METHODS: This was an analysis of nonemergent, abdominopelvic surgeries from 2008 to 2014 from a single center within the Michigan Surgical Quality Collaborative clinical registry database. Preoperative opioid use (binary exposure variable) was retrospectively queried from the home medication list of the preoperative evaluation. Our primary outcome was 90-day total hospital costs. Secondary outcomes included hospital length of stay, 30-day major complication rates, discharge destination, and 30-day hospital readmission rates. Analyses were risk-adjusted for case complexity and patient-specific risk factors such as demographics, insurance, smoking, comorbidities, and concurrent medication use. RESULTS: In all, 2413 patients met the inclusion criteria. Among them, 502 patients (21%) used opioids preoperatively. After covariate adjustment, opioid users (compared with those who were opioid-naïve) had 9.2% higher costs [95% confidence interval (CI) 2.8%-15.6%; adjusted means $26,604 vs $24,263; P = 0.005), 12.4% longer length of stay (95% CI 2.3%-23.5%; adjusted means 5.9 vs 5.2 days; P = 0.015), more complications (odds ratio 1.36; 95% CI 1.04-1.78; adjusted rates 20% vs 16%; P = 0.023), more readmissions (odds ratio 1.57; 95% CI 1.08-2.29; adjusted rates 10% vs 6%; P = 0.018), and no difference in discharge destination (P = 0.11). CONCLUSIONS: Opioid use is common before abdominopelvic surgery, and is independently associated with increased postoperative healthcare utilization and morbidity. Preoperative opioids represent a potentially modifiable risk factor and a novel target to improve quality and value of surgical care.
Subject(s)
Abdomen/surgery , Analgesics, Opioid/adverse effects , Digestive System Surgical Procedures/adverse effects , Hospital Costs , Postoperative Complications/epidemiology , Surgical Procedures, Operative/adverse effects , Abdomen/physiopathology , Aged , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/economics , Cohort Studies , Digestive System Surgical Procedures/economics , Digestive System Surgical Procedures/methods , Female , Follow-Up Studies , Humans , Male , Michigan , Middle Aged , Multivariate Analysis , Patient Readmission/economics , Patient Readmission/statistics & numerical data , Postoperative Complications/economics , Postoperative Complications/etiology , Preoperative Period , Registries , Regression Analysis , Retrospective Studies , Risk Assessment , Statistics, Nonparametric , Surgical Procedures, Operative/methods , Treatment OutcomeABSTRACT
BACKGROUND AND OBJECTIVES: We hypothesized that patients with complex regional pain syndrome (CRPS) with a longer time since their inciting event would demonstrate more symptoms of centralized pain. METHODS: We conducted a cross-sectional analysis of 160 patients with CRPS using validated measures of pain, negative mood, and functioning at the time of their new patient evaluation. The 2011 Fibromyalgia Survey Criteria is a validated self-report measure of widespread body pain and comorbid symptoms (eg, trouble thinking, headaches). The measure was used as a surrogate for centralized pain symptoms. Univariate analyses and multivariate linear regression models were used to assess the associations between patient characteristics and the duration of CRPS. RESULTS: The cohort was divided into tertiles based on the time since the inciting event (<12 months; 1-3 years; >3 years) for univariate comparisons. Unlike the other measures of pain, mood, and function, the fibromyalgia survey score was significantly associated with a longer duration of symptoms. In a multivariate model adjusting for age and sex, each year since the inciting event was associated with an increase of 0.28 in fibromyalgia survey score (Est 0.28; 95% confidence interval, 0.11-0.46; P = 0.002). The finding was distinct from self-reported spread of CRPS symptoms, which was not different based on time since the inciting event. CONCLUSIONS: Our findings suggest that the longer the patients have CRPS the more likely they are to report symptoms suggestive of centralized pain. These data may explain why some patients with a longer duration of CRPS do not respond to peripherally directed therapies.
Subject(s)
Complex Regional Pain Syndromes/etiology , Pain/etiology , Comorbidity , Complex Regional Pain Syndromes/physiopathology , Cross-Sectional Studies , Fibromyalgia , Humans , Time FactorsABSTRACT
Evidence suggests that pain patients who report lifetime abuse experience greater psychological distress, have more severe pain and other physical symptoms, and greater functional disability. The aim of the present study was to determine the associations between a history of lifetime abuse and affective distress, fibromyalgianess (measured using the 2011 Fibromyalgia Survey), pain severity and interference, and physical functioning. A cross-sectional analysis of 3,081 individuals presenting with chronic pain was performed using validated measures and a history of abuse was assessed via patient self-report. Multivariate logistic regression showed that individuals with a history of abuse (n = 470; 15.25%) had greater depression, greater anxiety, worse physical functioning, greater pain severity, worse pain interference, higher catastrophizing, and higher scores on the Fibromyalgia Survey criteria (P < .001 for all comparisons). Mediation models showed that the Fibromyalgia Survey score and affective distress independently mediate the relationship between abuse and pain severity and physical functioning (Ps < .001). Our mediation models support a novel biopsychosocial paradigm wherein affective distress and fibromyalgianess interact to play significant roles in the association between abuse and pain. We posit that having a centralized pain phenotype underlies the mediation of increased pain morbidity in individuals with a history of abuse. PERSPECTIVE: This article examines the associations between a history of lifetime abuse and affective distress, fibromyalgianess, pain severity and interference, and physical functioning in chronic pain patients. Our findings support a novel biopsychosocial paradigm in which affective distress and fibromyalgianess interact to play roles in the association between abuse and pain.
Subject(s)
Chronic Pain/etiology , Chronic Pain/psychology , Disaster Victims/psychology , Exercise/physiology , Fibromyalgia/complications , Mood Disorders/etiology , Adult , Aged , Catastrophization/physiopathology , Catastrophization/psychology , Chronic Pain/epidemiology , Cross-Sectional Studies , Female , Fibromyalgia/epidemiology , Fibromyalgia/psychology , Humans , Linear Models , Longitudinal Studies , Male , Middle Aged , Mood Disorders/epidemiology , Pain Measurement , Retrospective Studies , Severity of Illness IndexABSTRACT
BACKGROUND: Most existing performance measures focus on underuse of care, but there is growing interest in identifying and reducing overuse. OBJECTIVE: We aimed to develop a valid and reliable electronic performance measure of overuse of screening colonoscopy in the Veterans Affairs Health Care System (VA), and to quantify overuse in VA. DESIGN: This was a cross-sectional study with multiple cross-sections. SUBJECTS: U.S. Veterans who underwent screening colonoscopy between 2011 and 2013. MAIN MEASURES: Overuse of screening colonoscopy, using a validated electronic measure developed by an expert workgroup. KEY RESULTS: Compared to results obtained from manual record review, the electronic measure was highly specific (97 %) for overuse, but not sensitive (20 %). After exclusion of diagnostic and high-risk screening or surveillance procedures, the validated electronic measure identified 88,754 average-risk screening colonoscopies performed in VA during 2013. Of these, 20,530 (23 %) met the definition for probable (17 %) or possible (6 %) overuse. Substantial variation in colonoscopy overuse was noted between Veterans Integrated Care Networks (VISNs) and between facilities, with a nearly twofold difference between the maximum and minimum rates of overuse at the VISN level and a nearly eightfold difference at the facility level. Overuse at the VISN and facility level was relatively stable over time. CONCLUSIONS: Overuse of screening colonoscopy can be measured reliably and with high specificity using electronic data, and is common in a large integrated healthcare system. Overuse measures, such as those we have specified through a consensus workgroup process, could be combined with underuse measures to improve the appropriateness of colorectal cancer screening.
Subject(s)
Colonoscopy/trends , Delivery of Health Care, Integrated/trends , Early Detection of Cancer/trends , Electronic Health Records/trends , United States Department of Veterans Affairs/trends , Veterans Health/trends , Adult , Aged , Aged, 80 and over , Colonoscopy/methods , Cross-Sectional Studies , Delivery of Health Care, Integrated/methods , Early Detection of Cancer/methods , Female , Humans , Male , Middle Aged , United StatesABSTRACT
We developed the Michigan Body Map (MBM) as a self-report measure to assess body areas where chronic pain is experienced and to specifically quantify the degree of widespread body pain when assessing for centralized pain features (eg, fibromyalgia-like presentation). A total of 402 patients completed the measure in 5 distinct studies to support the validation of the original and a revised version of the MBM. Administration is rapid 39 to 44 seconds, and errors for the original MBM were detected in only 7.2% of the possible body areas. Most errors underestimated the number of painful areas or represented confusion in determining the right vs left side. The MBM was preferred (P = 0.013) and felt to better depict pain location (P = 0.001) when compared with the Widespread Pain Index checklist of the 2011 Fibromyalgia Survey Criteria, but participants did not express any preference between the MBM and Brief Pain Inventory body map. Based on the data from the first 3 studies, a revised version of the MBM was created including a front and back body image and improved guidance on right-sidedness vs left. The revised MBM was preferred when compared with the original and was more accurate in depicting painful body areas (P = 0.004). Furthermore, the revised MBM showed convergent and discriminant validity with other self-report measures of pain, mood, and function. In conclusion, the MBM demonstrated utility, reliability, and construct validity. This new measure can be used to accurately assess the distribution of pain or widespread bodily pain as an element of the fibromyalgia survey score.