Effect of regional cooperative rescue systems based on chest pain centers for patients with acute myocardial infarction in a first-tier city in China.

Given the increasing burden of acute myocardial infarction (AMI) in China, regional cooperative rescue systems have been constructed based on chest pain centers (CPCs). This study evaluated the effects of these regional cooperative rescue systems on reperfusion time and prognosis of AMI patients. This study included 1937 AMI patients, divided into two groups according to the date of admission, group A (July 2017-June 2018) and group B (July 2018-June 2019). Reperfusion time, the fatality rate for any cause during hospitalization, and the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the 6 months following discharge were compared between the two groups. The proportion of patients treated within the guideline goals for first medical contact to balloon (FMC-to-B) time showed improvement from 40.7% in group A to 50.4% in group B (P = 0.005). The fatality rate for any cause (5.5% vs. 8.0%, P = 0.026) during hospitalization was lower in the B group compared to the A group. Multivariate logistic regression analysis revealed that the fatality rate for any cause (OR 0.614, 95% CI 0.411-0.918, P = 0.017) was significantly lower in group B compared with group A. No significant differences were detected between the two groups for the incidence of MACCE and death for any cause at 6 months using the log-rank test and multivariate Cox regression analysis. The improvement of regional cooperative rescue systems shortened system delays and reduced in-hospital deaths. Although the system has resulted in some substantial improvements, additional improvement is needed.

Spatiotemporal Analysis of the Association Between Pain Management Clinic Laws and Opioid Prescribing and Overdose Deaths.

Pain management clinic (PMC) laws were enacted by 12 states to promote appropriate opioid prescribing, but their impact is inadequately understood. We analyzed county-level opioid overdose deaths (National Vital Statistics System) and patients filling long-duration (≥30 day) or high-dose (≥90 morphine milligram equivalents per day) opioid prescriptions (IQVIA, Inc.) in the United States in 2010-2018. We fitted Besag-York-Mollié spatiotemporal models to estimate annual relative rates (RRs) of overdose and prevalence ratios (PRs) of high-risk prescribing associated with any PMC law and 3 provisions: payment restrictions, site inspections, and criminal penalties. Laws with criminal penalties were significantly associated with reduced PRs of long-duration and high-dose opioid prescriptions (adjusted PR = 0.82, 95% credible interval (CrI): 0.82, 0.82, and adjusted PR = 0.73, 95% CI: 0.73, 0.74 respectively) and reduced RRs of total and natural/semisynthetic opioid overdoses (adjusted RR = 0.86, 95% CrI: 0.80, 0.92, and adjusted RR = 0.84, and 95% CrI: 0.77, 0.92, respectively). Conversely, PMC laws were associated with increased relative rates of synthetic opioid and heroin overdose deaths, especially criminal penalties (adjusted RR = 1.83, 95% CrI: 1.59, 2.11, and adjusted RR = 2.59, 95% CrI: 2.22, 3.02, respectively). Findings suggest that laws with criminal penalties were associated with intended reductions in high-risk opioid prescribing and some opioid overdoses but raise concerns regarding unintended consequences on heroin/synthetic overdoses.

Suicidal risk and resilience in juvenile fibromyalgia syndrome: a cross-sectional cohort study.

BACKGROUND: To characterize suicidality among youth with juvenile fibromyalgia syndrome (JFMS) receiving treatment from pediatric rheumatologists at a tertiary care center in order to determine the prevalence of suicidality in JFMS and to explore risk factors for persistent suicidal ideation. METHODS: We performed a cross-sectional cohort study of children 12-17 years old with JFMS seen in a specialty pediatric rheumatology pain clinic from 7/2017-9/2019. All subjects completed patient-reported outcomes measures, complemented by retrospective chart review. Subjects who endorsed item 8 on the Children's Depression Inventory, 2nd Edition (CDI-2) were categorized as endorsing suicidal ideation. We assessed for differences between the suicidal and non-suicidal patients using Wilcoxon-rank sum test. Logistic regression modeling was performed to identify psychosocial factors associated with suicidality. RESULTS: Of the 31 subjects, more than one-quarter endorsed suicidality. Nearly 90% of teens with suicidal ideation were established in outpatient counseling. In bivariate analyses, suicidality was associated with lower resilience and greater depression and anxiety (all p < 0.05). Pain intensity trended towards a statistically significant positive association (OR: 1.16 [0.99-1.37]; p = 0.06). Lower resilience was independently associated with suicidality (OR: 0.90 [95% CI: 0.82-0.98]; p < 0.02). CONCLUSIONS: Suicidality was prevalent among youth with JFMS and persistent despite concurrent receipt of mental health services. Higher patient-level resilience was independently associated with a reduced odds of suicidality. Future work should examine the role of resilience training on reducing psychological distress and mitigating the risk of suicidality in JFMS.

Outpatient pain clinic and intranasal fentanyl to improve sickle cell disease outcomes.

BACKGROUND: Acute pain events are a leading complication for sickle cell patients. In an attempt to improve pain outcomes, we developed an outpatient pain clinic, and included intranasal fentanyl in the opioid emergency department (ED) pain order set. We evaluated admission rates and opioid administration for patients that attended both the outpatient pain clinic and ED within a 3-month period. METHODS: We recorded the admission rate, IV morphine equivalents, and time from triage for each opioid order and administration from both an outpatient pain clinic and ED visit within a 3-month period for an individual pediatric patient with sickle cell disease. RESULTS: Thirty patients received acute pain management in both settings. We identified a significant reduction in hospital admission when patients received care in the pain clinic as compared to the ED (17% vs 43%, P = .02). Additionally, outpatient pain clinic patients received significantly less IV morphine equivalents than patients received in the ED (5.6 vs 10.6 IV morphine equivalents, P < .0001). In the ED, intranasal fentanyl was administered in a significantly shorter time than patients ordered intravenous opioid (43 vs 75 min, P = .02). The mean time to receiving an opioid in the outpatient pain clinic was 57 min. CONCLUSION: The use of an outpatient pain clinic can reduce admission rates as compared to the ED. The use of intranasal fentanyl reduced the time to first opioid administration in the ED. Patient-centered research or quality improvement projects should continue to focus on novel approaches to acute pain event management.

Preliminary validity and test-retest reliability of two depression questionnaires compared with a diagnostic interview in 99 patients with chronic pain seeking specialist pain treatment.

Objectives Depression symptomatology is highly prevalent in patients with chronic pain, but accurate identification of major depression may be challenged due to time constraints and diagnostic interviews are therefore not routinely performed in clinical practice. Assessment of depression may be facilitated through the use of full-length depression screening questionnaires with acceptable construct validity and test-retest reliability. However, as previously indicated screening questionnaires may overestimate depression in patients with chronic pain, possibly due to overlapping symptoms. However, the failure to screen for depression may raise a concern for missing relevant cases with depression. The objectives of this study were to (1) quantify the validity of the 9-items Patient-Health Questionnaire (PHQ9) and the Major Depression Inventory (MDI) compared with a diagnostic interview in patients with chronic pain seeking specialist pain treatment, and (2) assess the relative test-retest reliability of PHQ9 and MDI over two weeks. Methods Responses to the PHQ9 and MDI were compared with a Present-State-Examination (PSE) interview in 99 patients with chronic pain referred to interdisciplinary pain treatment. PHQ9 and MDI were completed twice over two weeks. Construct validity were assessed with the area under the curve (AUC) analysis, and performance characteristics derived from 2 × 2 contingency tables in which scores on the screening questionnaires were dichotomized and compared with the classification of clinical depression based on the diagnostic interview. Relative test-retest reliability was assessed with intraclass correlation coefficients (ICC). Results Based on the PSE interview, the prevalence of depression was 22.2%, and according to the PHQ9 and MDI questionnaires the prevalence was 26.3 and 34.3%, respectively. Compared with the diagnostic PSE, the PHQ9 and MDI questionnaires had areas under the curve of 0.83 and 0.88, respectively. Both questionnaires had high negative predictive values (PHQ9: cut-off of 11; MDI: cut-off of 26), but low positive predictive values for all possible scores. ICC values were excellent. Conclusions The PHQ9 and MDI questionnaires reliably identified chronic pain patients unlikely to have clinical depression, but showed limited validity identifying patients with clinical depression. These preliminary results may have clinical implications in depression screening in patients with chronic pain seeking specialist pain treatment. Clinicians in a specialty care pain clinic can use these screening questionnaires to identify patients without depression, but caution should be used when positive cases are identified by PHQ9 or MDI due to the risk of false positives.

Self-reported traumatic etiology of pain and psychological function in tertiary care pain clinic patients: a collaborative health outcomes information registry (CHOIR) study.

Background and aims A sizable body of research has elucidated the significant role of psychological reactions to trauma on pain coping and outcomes. In order to best inform intervention development and clinical care for patients with both trauma and pain at the tertiary care level, greater clarity is needed regarding the magnitude of these effects and the specific pathways through which they may or may not function at the time of first presentation to such a treatment setting. To achieve this, the current study examined the cross-sectional relationships between traumatic etiology of pain, psychological distress (anger, depressive symptoms, and PTSD symptoms), and pain outcomes (pain catastrophizing, physical function, disability status). Methods Using a structural path modeling approach, analyses were conducted using a large sample of individuals with chronic pain (n = 637) seeking new medical evaluation at a tertiary pain management center, using the Collaborative Health Outcomes Information Registry (CHOIR). We hypothesized that the relationships between traumatic etiology of pain and poorer pain outcomes would be mediated by higher levels of psychological distress. Results Our analyses revealed modest relationships between self-reported traumatic etiology of pain and pain catastrophizing, physical function, and disability status. In comparison, there were stronger relationships between indices of psychological distress and pain catastrophizing, but a weaker pattern of associations between psychological distress and physical function and disability measures. Conclusions To the relatively small extent that self-reported traumatic etiology of pain correlates with pain-related outcomes, these relationships appear to be due primarily to the presence of psychiatric symptoms and manifest most notably in the context of psychological responses to pain (i.e. catastrophizing about pain). Implications Findings from this study highlight the need for early intervention for patients with traumatic onset of pain and for clinicians at tertiary pain centers to include more detailed assessments of psychological distress and trauma as a component of comprehensive chronic pain treatment.

A Study of Patient Satisfaction and Uncertainty in a Rapid Access Chest Pain Clinic.

BACKGROUND: A number of Australian hospitals are piloting outpatient rapid access chest pain clinics (RACC) as a new clinical pathway. These clinics aim to provide an alternative to inpatient care for timely access to specialist cardiology assessment whilst improving quality of care and experience. An understanding of overall patient satisfaction can be considered a marker of overall clinical success, contributes to cost-effectiveness, and is needed to develop improvement strategies. We aimed to evaluate uncertainty, satisfaction and experience among patients treated in a RACC. METHODS: All consecutive patients presenting with troponin negative intermediate risk chest pain treated in a new RACC in a public quaternary teaching hospital over a 12-month period, were invited to participate in two core components: A paper-based questionnaire, and a one-month follow-up telephone structured interview. Patient satisfaction and uncertainty were assessed by the short form of the Mishel Uncertainty in Illness Scale (MUIS) and Picker Dimensions of care. RESULTS: There was a 51.2% response rate (190/371). Patients ranged in age from 20 to 89 years (56.4±13.6 years) and 47% were female. Findings illustrated a global high level of satisfaction in all areas: care, comfort, communication and engagement, with low levels of uncertainty in illness experienced by patients. CONCLUSION: There were high levels of satisfaction and minimal uncertainty for patients related to their management and care in the RACC during the study period. These results have formed part of the formal cost-effectiveness assessment of the RACC used to support its transition from a pilot implementation to standard of care at the study centre.

Estudio cuasi experimental sobre la efectividad de la musicoterapia para reducir la ansiedad ante una técnica intervencionista en la unidad del dolor / Quasi-experimental study on effectiveness of music therapy to reduce anxiety before an interventional technique in the pain unit

OBJETIVOS: Valorar la eficacia de la musicoterapia en la disminución de la ansiedad en pacientes a los que se les realiza técnica intervencionista (TI) en la Unidad del Dolor (UD) del Hospital Universitario Sagrat Cor de Barcelona. MATERIAL Y MÉTODO: Estudio cuasi experimental con grupo control, prospectivo, pre y postintervención, transversal, no aleatorizado. Aprobado por el Comité Ético de Investigación IDC Salud Catalunya. Población estudio: pacientes programados para realización de TI en la UD. Criterios inclusión: > 18 años de edad. Indicación de TI. Criterios exclusión: trastorno psiquiátrico, incapacidad contestar variables de estudio. Grupo intervención: se ha realizado la TI reproduciéndose aleatoriamente la música elegida, libre de contaminación acústica. Grupo control: se ha realizado la TI sin musicoterapia. Se ha empleado la escala visual análoga modificada como instrumento de medida para valorar el nivel de ansiedad. RESULTADOS: 80 pacientes (71,6 % mujeres, media de edad 66,7 [SD 14] años, 49,4 % estudios medios, 64,2 % pensionistas). El 60,5 % no realiza tratamiento con ansiolíticos. El 59 % presenta lumborradiculalgia, se les realiza bloqueo epidural caudal. Al 33,3 % se les realiza técnica intervencionista por primera vez. En el grupo control el valor de EVA intra es de 5,83 (SD 3,2) y en el grupo de musicoterapia de 5,0 (SD 2,2), esta diferencia no es estadísticamente significativa (F = 1,614, p = 0,208). En el valor de EVA postintervención sucede lo mismo. En el grupo control el valor de EVA post es de 3,7 (SD 3,3) y en el grupo de musicoterapia de 3,1 (SD 2,4); esta diferencia no es estadísticamente significativa (F = 0,755, p = 0,387). En el grupo control el valor de la escala visual analógica intra es de 4,3 (SD 3,1) y en el grupo de musicoterapia de 3,0 (SD 2,0), esta diferencia sí es estadísticamente significativa (F = 4,83, p = 0,031). En el grupo control el valor de la escala visual analógica post es de 2,7 (SD 2,8) y en el grupo de musicoterapia de 1,3 (SD 1,5); esta diferencia también es estadísticamente significativa (F = 7,427, p = 0,008). El 81,5 % considera que ha recibido suficiente información sobre la técnica intervencionista y el 18,5 % están satisfechos. El 95,1 % considera que los profesionales le han aportado confianza y seguridad y el 4,9 % restante se consideran satisfechos. De los que han valorado (40 pacientes) si la música ha creado un ambiente relajado el 80 % se consideran muy satisfechos y el 20 % restante satisfechos. CONCLUSIÓN: Aunque el dolor no se ve mejorado significativamente en el grupo intervencionista sí lo hace la ansiedad tanto en la fase intra como en la post TI. Los pacientes se sienten muy satisfechos sobre la información recibida y consideran muy satisfactoria la confianza y seguridad que les aportan los profesionales. Además, el grupo de musicoterapia considera, en general, muy satisfactorio el ambiente relajado que les crea la música. La musicoterapia es una excelente herramienta terapéutica, fácil de usar, accesible y económica, que puede utilizarse como coadyuvante en las TI en la UD

OBJECTIVE: To assess the efficacy of music therapy in reducing anxiety in patients undergoing interventional technique (IT) in the Pain Unit (UD) of the University Hospital Sagrat Cor in Barcelona. MATERIAL AND METHOD: Quasi-experimental study with a control group, prospective, pre- and post-intervention, transversal, non-randomized. Approved by the Research Ethics Committee IDC Salud Catalunya. Study population: patients scheduled to perform IT in the UD. Inclusion criteria: > 18 years old. IT indication. Exclusion criteria: psychiatric disorder, inability to answer study variables. Intervention group: IT has been performed by randomly playing the chosen music, free of noise pollution. Control group: IT has been performed without music therapy. The modified analog visual scale has been used as a measuring instrument to assess the level of anxiety. RESULTS: 80 patients (71.6 % women, mean age 66.7 (SD 14) years, 49.4 % average studies, 64.2 % pensioners). 60.5 % do not perform treatment with anxiolytics. 59 % have low back pain, caudal epidural block is performed. 33.3 % underwent interventional technique for the first time. In the control group the value of intra VAS is 5.83 (SD 3.2) and in the music therapy group 5.0 (SD 2.2), this difference is not statistically significant (F = 1.614, p = 0.208). The same happens in the value of post-intervention EVA. In the control group the value of post VAS is 3.7 (SD 3.3) and in the music therapy group 3.1 (SD 2.4), this difference is not statistically significant (F = 0.755, p = 0.387). In the control group the value of the intra analog visual scale is 4.3 (SD 3.1) and in the music therapy group 3.0 (SD 2.0), this difference is statistically significant (F = 4, 83 p = 0.031). In the control group the value of the post analog visual scale is 2.7 (SD 2.8) and in the music therapy group 1.3 (SD 1.5), this difference is also statistically significant (F = 7.427, p = 0.008). 81.5 % consider that they have received enough information about the interventionist technique and 18.5 % are satisfied. 95.1 % consider that the professionals have given him confidence and security and the remaining 4.9 % are considered satisfied. Of those who have assessed (40 patients) if music has created a relaxed atmosphere, 80% are considered very satisfied and the remaining 20 % satisfied. CONCLUSION: Although pain is not significantly improved in the interventionist group, anxiety does in both the intra and post-IT phases. Patients feel very satisfied about the information received and consider the confidence and security provided by professionals very satisfactory. In addition, the music therapy group considers, in general, the relaxed atmosphere created by the music. Music therapy is an excellent therapeutic tool, easy to use, accessible and economical, which can be used as an adjunct in IT in the UD

Pre-consultation biopsychosocial data from patients admitted for management at pain centers in Norway.

Background and aims A bio-psycho-social approach has been recommended in multidisciplinary pain clinics, and in Norway patients with severe chronic nonmalignant pain (CNMP, defined as pain that has persisted for more than 3 months) might be treated at a regional multidisciplinary pain center. The specific aims of this study were (1) to describe characteristics of a sample of outpatients referred and accepted for treatment/management to three regional multidisciplinary pain centers in Norway, (2) to examine patient differences between the centers and (3) to study associations between symptom scores (insomnia, fatigue, depression, anxiety) and patient characteristics. Methods Patients, aged 17 years or older with CNMP admitted to and given a date for first consultation at one of three tertiary, multidisciplinary pain centers: St. Olavs Hospital Trondheim University Hospital (STO), Haukeland University Hospital (HUS) and University Hospital of North Norway (UNN), were included in the study. Data on demographics, physical activity, characteristics of pain, previous traumatic events, social network, Insomnia Severity Index (ISI), Chalder Fatigue Questionnaire (CFQ), Hopkins Symptom Checklist-25 (HSCL-25) and SF-36v2® were retrieved from the local quality registry at each pain center. Results Data from 1563 patients [mean age 42 (SD 15) years and 63% females] were available for analyses. Average years with pain were 9.3 (SD 9.1). Primary education as highest level of education was reported by 20%, being actively working/student/military by 32%, and no physical activity by 31%. Further, 48% reported widespread pain, 61% reported being exposed to serious life event(s), and 77% reported having a close friend to talk to. Non-worker status, no physical activity, lack of social network, reports of being exposed to serious life event(s) and widespread pain were all characteristics repeatedly associated with clinically high symptom scores. No significant differences between the centers were found in the proportions of patients reporting fatigue nor mean levels of insomnia symptoms. However, the proportion of patients reporting symptoms of anxiety and depression was a little lower at UNN compared with STO and HUS. Conclusions Analyses of registry data from three tertiary multidisciplinary pain centers in Norway support previous findings from other registry studies regarding patient characterized: A large proportion being women, many years of pain, low employment rate, low physical activity rate, and a large proportion reporting previous traumatic event(s). Characteristics such as non-work participation, no physical activity, lack of social network, have been exposed to serious life event(s), and chronic widespread pain were all associated with high clinical score levels of insomnia, fatigue, and mental distress. Health related quality of life was low compared to what has been reported for a general population and a range of other patient groups. Implications The findings of this study indicate that physical activity and work participation might be two important factors to address in the rehabilitation of patients with chronic non-malignant pain. Future studies should also explore whether pre consultation self-reported data might give direction to rehabilitation modalities.

Clinical outcomes of patients discharged from the Rapid Access Chest Pain Clinic with non-anginal chest pain: A retrospective cohort study.

BACKGROUND: The Rapid Access Chest Pain Clinic (RACPC) has become an important means of assessing patients who present with ischaemic or ischaemia-like symptoms of recent onset. Observations have shown that up to 70% are discharged with a diagnosis of non-anginal chest pain (NACP) and accordingly "reassured". This study aims to describe the actual clinical outcomes of this cohort of patients discharged from the RACPC. METHODS: We undertook a single centre retrospective cohort study at a tertiary cardiac hospital. The outcomes of unselected patients diagnosed with NACP and discharged from the RACPC between April 2010 and March 2013 at University Hospitals of Leicester (UHL) were recorded. Re-referrals to cardiology outpatient clinic and emergency hospital admissions for cardiovascular disease within 6 months, and the mortality rate at 12 months, were determined. RESULTS: 7066 patients were seen in the UHL RACPC during the 36-month period. 3253 (46.0%) were diagnosed with NACP and discharged. 7 (0.2%) were diagnosed with coronary artery disease (CAD) and 8 (0.25%) cases of acute coronary syndrome (ACS) identified during the review period. 11 (0.3%) patients died within 12 months of discharge from RACPC. No deaths were attributable to CAD. CONCLUSIONS: Comprehensive assessment using risk-stratification criteria in a nurse practitioner-led RACPC can accurately identify patients who are at low-risk for subsequent CAD. Despite contemporary National Institute for Health and Care Excellence (NICE) guidelines that shift focus away from a clinical judgement based approach, this strategy appears to robustly predict favourable outcomes in patients diagnosed with NACP.

Estudio de correlación entre oportunidad diagnóstica y severidad del dolor en pacientes con fibromialgia que ingresan a la Unidad de Dolor Crónico No Oncológico en el Hospital Clínico San Borja Arriarán / Correlation study between diagnostic opportunity and pain severity in patients with fibromyalgia who enter the Nononcological Chronic Pain Unit at the San Borja Arriarán Clinical Hospital

Objetivos: El objetivo principal es determinar si existe correlación entre el tiempo transcurrido para el diagnóstico de fibromialgia (FM) con la severidad del dolor que presentan los pacientes que ingresan a la Unidad de Dolor Crónico no Oncológico (UDCNO) del Hospital Clínico San Borja Arriarán. Los objetivos secundarios son caracterizar a la población que ingresa con diagnóstico FM y describir la severidad del dolor según intensidad y la discapacidad relacionada. Materiales y métodos: Estudio correlacional de pacientes que ingresan a la UDCNO con diagnóstico de FM, a los que se les evaluó al momento del ingreso dolor a través de la Escala Numérica del Dolor (END) y del Cuestionario de graduación del dolor Crónico (CGDC). Se obtuvieron datos para la caracterización de la población a través de la ficha clínica: escolaridad, situación laboral, consumo de tabaco, tratamientos farmacológicos y no farmacológicos indicados al momento del ingreso a la UDCNO. Además se obtuvieron datos de episodios de caídas en el último año. Resultados: De los 38 pacientes evaluados, el 100 % fueron mujeres, con una edad promedio de 56 años. El tiempo promedio para el diagnóstico fue de 36 meses (+/- 32,2 meses), con un tiempo de evolución al ingreso a UDCNO de 53,8 meses en promedio (+/- 36,4 meses). La intensidad del dolor medida por END fue en promedio 7,29 (+/- 2,02). No hubo asociación entre oportunidad diagnóstica e intensidad del dolor al momento del ingreso. El 94 % se encontraba en los grados 3 y 4 del CGDC, correspondientes a alta intensidad del dolor y limitación moderada a severa. Conclusiones: Según nuestro estudio la correlación entre el tiempo transcurrido al diagnóstico y la intensidad del dolor medida al momento del ingreso es baja y no estadísticamente significativa, que consideramos está dada por los múltiples aspectos que interfieren en la vivencia del dolor, que no dependen solo del tiempo de evolución. En ese sentido destaca un muy alto porcentaje de la población evaluada con alta intensidad de dolor y limitación moderada a severa

Objectives: The main objective is to determine if there is a correlation between the time elapsed for the diagnosis of fibromyalgia (FM) and the severity of pain in patients who enter the Non-Oncological Chronic Pain Unit (UDCNO) of the San Borja Arriarán Clinical Hospital. The secondary objectives are to characterize the population that enters with FM diagnosis, and to describe the severity of pain according to intensity and related disability. Materials and methods: correlational study of patients admitted to the UDCNO with a diagnosis of FM, who were evaluated at the time of admission pain through the Numerical Pain Scale (NDT) and the Chronic Pain Grade Questionnaire (CPGC). Data were obtained for the characterization of the population through the clinical record: schooling, employment status, tobacco consumption, pharmacological and non-pharmacological treatments indicated at the time of admission to the UDCNO. In addition, data on episodes of falls in the last year were obtained. Results: Of the 38 patients evaluated, 100 % were women, with an average age of 56 years. The average time for diagnosis was 36 months (+/- 32.2 months), with an evolution time at admission to UDCNO of 53.8 months on average (+/- 36.4 months). The intensity of the pain measured by NTD was on average 7.29 (+/- 2.02). There was no association between diagnostic opportunity and pain intensity at the time of admission. 94 % were in grades 3 and 4 of the CPGC, corresponding to high pain intensity and moderate to severe limitation. Conclusions: According to our study, the correlation between the time elapsed at diagnosis and the intensity of pain measured at admission is low and not statistically significant, which we consider is given by the multiple aspects that interfere in the experience of pain, which do not depend only of the evolution time. In this sense, a very high percentage of the population evaluated with high intensity of pain and moderate to severe limitation stands out

Multi-disciplinary interventions for chronic pain involving education: A systematic review.

BACKGROUND: There have been growing recommendations to include education in multi-disciplinary interventions targeting chronic pain management. However, effects of this strategy on short- and long-term self-management of chronic pain, remain largely unexplored. OBJECTIVES: 1. To provide an updated overview of studies that report on the impact of patient education in multi-disciplinary interventions, on self-management of chronic pain; 2. To explore associations between education and chronic pain self-management techniques; and 3. To identify the format and duration of suitable chronic pain interventions targeted at patient self-management. METHODS: Design: Narrative systematic literature review of randomised or controlled study designs. Data Sources: PubMed, CINAHL, EMBASE, PsycINFO. Participants: Adult patients with chronic pain of any aetiology participating in multi-disciplinary programs that included education. Main outcome measures: Assessments of level of pain, function, quality of life, self-efficacy, self-management, and any other relevant assessments. Study Appraisal and Synthesis Methods: PRISMA guidelines, Cochrane Risk of Bias tool, and TIDieR model. RESULTS: Database searching identified 485 potential papers. After removal of duplicates, and irrelevant articles by title and abstract, 120 full-text articles were reviewed and 27 studies were included in this systematic review. Studies were predominantly from the United States (n = 8; 29.6%). Over one hundred outcome measures were identified across all studies, with significant variation also observed in terms of how chronic pain duration was defined, and how education was delivered to participants. Overall, positive benefits of education were reported. CONCLUSIONS: Education, as part of multi-disciplinary programs, is likely to improve self-management and self-efficacy in people with chronic pain of any aetiology. Heterogeneity in terms of: chronic pain duration; educational resources; healthcare professionals; and outcome measures, were identified as limitations. Further research, in the form of Randomised Controlled Trials addressing these limitations, is recommended.

Los médicos que realizan su labor asistencial e investigadora en unidades de dolor en el uso de internet: identificación, caracterización y determinantes / The medical doctors who perform their care and research work in pain units in the use of the internet: identification, characterization and determinants

Objetivos: La información proporcionada por las Encuestas de Condiciones de Trabajo y Salud (ECTS) permite la formulación de programas de acción públicos que generen cambios, fijen prioridades y evalúen tendencias. Desde 1987 que se realizó la primera ECTS en España, este instrumento se ha ido consolidando como fuente de datos del sistema de las tecnologías de la información y la comunicación. Los resultados muestran la necesidad de establecer el avance de las innovaciones tecnológicas sanitarias y la investigación biomédica. Estos avances serán determinantes en la mejora de la salud, ya que supondrán nuevas formas de cuidados médicos que contribuyen al aumento de la esperanza de vida, la reducción del dolor y la gestión de las enfermedades. El objetivo de este estudio es valorar el nivel de aceptación de las nuevas tecnologías en médicos que traten el dolor a través de unidades específicas. Material y métodos: Se realizó un estudio para comprobar el uso de las TIC en médicos que realizan su labor asistencial y de investigación en Unidades de Dolor. Este estudio consta de una encuesta online, enviada a través de correo electrónico a los alumnos del máster en Tratamiento del Dolor de la Universidad de Salamanca. Tras la recogida sistemática de la información, se realizó el análisis estadístico abordando la frecuencia de las variables y las relaciones estadísticamente significativas relevantes para nuestro estudio. Posteriormente se realizó un análisis utilizando una metodología de regresión logística a través del modelo Logit binomial. Resultados: De los profesionales médicos que contestaron a nuestra encuesta, se obtuvo que aquellos que son varones y trabajan en Unidades del Dolor eran un 39,46 % y en Cuidados Paliativos eran un 21,35 %. Agregando estos datos obtenemos que el 75,94 % de los profesionales trabajan en entidades públicas, el 9,72 % en entidades privadas y el 11,05 % en ambas. Más del 55 % de los profesionales encuestados "Nunca utilizan ordenadores o Tecnologías de la Información y la Comunicación para la realización remota de evaluación diagnóstica o prescripción de medidas terapéuticas". Conclusiones: Los resultados obtenidos nos muestran que los médicos de unidades de dolor consideran un elemento relevante las aplicaciones de las Tecnologías de la Información y la Comunicación para la práctica clínica. Además, se constata, dada la experiencia clínica de los profesionales, la necesidad de cambios organizativos asociados a los nuevos sistemas informáticos

Objectives: The information provided by the Labor Conditions and Health Surveys (ECTS) allows for the formulation of public action programs that generate changes, set priorities and evaluate trends. Since 1987, when the first ECTS was carried out in Spain, this instrument has been consolidated as a data source for the information and communication technology system. The results show the need to establish the advance of the technological innovations in health and biomedical research. These advances will be decisive in the improvement of health, since they will involve new forms of medical care that contribute to the increase of life expectancy, the reduction of pain and the management of diseases. The objective of this study is to assess the level of acceptance of new technologies in physicians who treat pain through specific units. Matherial and method: A study was carried out to verify the use of ICTs in doctors who perform their care and research work in Pain Units. This study consists of an online survey, sent via email to the students of the Master's Degree in Pain Treatment at the University of Salamanca. After the systematic collection of the information, the statistical analysis was carried out, addressing the frequency of the variables and the statistically significant relationships relevant to our study. Subsequently, a factor analysis, a cluster analysis and new composite variables are constructed to synthesize the data, to which, finally, an analysis was made using a logistic regression methodology through the Binomial Logit model. Results: Of the medical professionals who answered our survey, it was obtained that those who are men and work in Pain Units were 39.46 % and in Palliative Care they were 21.35 %. Adding this data, we obtain that 75.94 % of professionals work in public entities, 9.72 % in private entities and 11.05 % in both. More than 55 % of the professionals surveyed "never use computers or Information and Communication Technologies for the remote realization of diagnostic evaluation or prescription of therapeutic measures". Conclutions: The results obtained show that Pain Units physicians consider the applications of Information and Communication Technologies to be a relevant element for clinical practice. In addition, given the clinical experience of professionals, the need for organizational changes associated with new computer systems is confirmed

Referral Pattern to a Tertiary Care Cancer Pain Clinic in India.

The study aimed to identify patterns of patient referral from oncology services, including pain severity, prior analgesics, impact of patient's literacy on referral, and adequacy of pain relief offered by the pain clinic. A retrospective analysis of pain clinic data from August 2014 to February 2015 at the Tata Memorial Hospital was carried out, wherein adult cancer patients referred for the first time to the pain clinic were included. Two thousand patients were included: 38.1% of the referred were at pretreatment stage, 28.8% advanced. Most referrals were from head and neck (27.3%), gastrointestinal (26.2%), and thoracic (18.3%) disease management groups (DMGs); The earliest referrals were from gastrointestinal and thoracic DMGs; 75%-80% had advanced disease. There were few referrals from hemato-oncology and medical oncology. Among the patients, 88% had moderate to severe pain, a third were on analgesics, and less than a fifth were on opioids. Pain scores were lower in the literate group, and this group were referred significantly earlier than the illiterate. Literacy could therefore hold the key to better awareness and compliance with pain management. Our findings demonstrate that pain as yet does not receive a much needed priority even at a tertiary care cancer centre.

Las tecnologías de la información y la comunicación aplicadas entre los profesionales de la medicina que realizan tratamiento del dolor / Information and communication technologies applied among medical professionals who perform pain treatment

Objetivos: La revolución de las tecnologías de la información y la comunicación es la base sobre la que se ha desarrollado el avance de las innovaciones tecnológicas sanitarias y la investigación biomédica. Estos avances han sido determinantes en la mejora de la salud, ya que han supuesto nuevas formas de cuidados médicos que contribuyen al aumento de la esperanza de vida, la reducción del dolor y la gestión de las enfermedades. Se pretende valorar el nivel de aceptación de las nuevas tecnologías en médicos que traten el dolor a través de unidades específicas. Material y métodos: Se llevó a cabo un estudio sobre el uso de las nuevas tecnologías de la información en médicos que realizan tratamiento del dolor en centros específicos. Los datos se obtuvieron a partir de la elaboración de un cuestionario online que ha sido enviado a través del correo electrónico a los alumnos del Máster en Tratamiento del Dolor de la USAL. Tras la recogida sistemática de la información, hemos realizado los análisis estadísticos abordando la frecuencia de las variables y las relaciones estadísticamente signifi cativas relevantes para nuestro estudio. Posteriormente realizamos un análisis de factores, análisis de clúster y la construcción de nuevas variables compuestas para sintetizar los datos. Tras esta identificación, el análisis de las relaciones estadísticamente significativas nos ha permitido caracterizar a estos individuos. Finalmente, hemos realizado un análisis utilizado una metodología de regresión logística a través del modelo Logit binomial. La herramienta utilizada para la realización de la encuesta online fue Google Sheets, herramienta englobada dentro de Google Docs, que está diseñada para trabajar a través de internet y de la web. Resultados: El 57 % de los profesionales médicos que contestaron a nuestra encuesta son hombres, mientras que el 43 % de las respuestas pertenecen a mujeres, de Unidad del Dolor (39,46 %), Cuidados Paliativos (21,35 %) y en los Centros de Atención Primaria (CAP). Agregando estos datos obtenemos que el 75,94 % de los profesionales trabajan en entidades públicas, el 9,72 % en entidades privadas y el 11,05 % en ambas. El 79,5 % de los profesionales encuestados no ofrecen su teléfono móvil a los pacientes. Más del 83 % de los profesionales encuestados utilizan muy frecuentemente (29,5 %) o frecuentemente (54,2 %) directrices/protocolos médicos en su práctica clínica; más del 55 % de los profesionales encuestados "Nunca utilizan ordenadores o tecnologías de la información y la comunicación para la realización remota de evaluación diagnóstica o prescripción de medidas terapéuticas". No obstante, un 40 % de los encuestados declaran que han realizado telemedicina. Conclusiones: En general, los datos nos muestran una concepción benefi ciosa de las aplicaciones de las tecnologías de la información y la comunicación para la práctica clínica en lo relativo a la digitalización y distribución de la información clínica. Además, se constata, dada la experiencia clínica de los profesionales, la necesidad de cambios organizativos asociados a los nuevos sistemas informáticos

Target: The revolution in information and communication technologies is the basis on which the advance of health technological innovations and biomedical research has been developed. These advances have been decisive in the improvement of health, since they have involved new forms of medical care that contribute to the increase in life expectancy, pain reduction and disease management. The aim is to assess the level of acceptance of new technologies in physicians who treat pain through specific units. Material and method: A study was carried out on the use of new information technologies in physicians who perform pain treatment in specifi c centers. The data was obtained from the elaboration of an online questionnaire that has been sent via email to the students of the Master in Pain Treatment of the USAL. After the systematic collection of information, we performed the statistical analyzes addressing the frequency of the variables and the statistically signifi cant relationships relevant to our study. Later, we carried out a factor analysis, cluster analysis and the construction of new compound variables to synthesize the data. After this identifi cation, the analysis of statistically significant relationships has allowed us to characterize these individuals. Finally, we performed an analysis using a logistic regression methodology through the Binomial Logit model. The tool used to carry out the online survey was Google Sheets, a tool included within Google Docs, which is designed to work through the Internet and the Web. Results: The 57 % of the medical professionals who answered our survey are men, while 43 % of the answers belong to women, of Pain Unit (39.46 %), Palliative Care (21.35 %) and in the Centers of Primary Care (CAP), Adding this data we obtain that 75.94 % of professionals work in public entities, 9.72 % in private entities and 11.05 % in both. 79.5 % of the surveying professionals do not offer their mobile phone to patients. More than 83 % of the professionals surveyed use very frequently (29.5 %) or Frequently (54.2 %) guidelines / medical protocols in their clinical practice; More than 55% of the professionals surveyed "never use computers or Information and Communication Technologies for the remote realization of diagnostic evaluation or prescription of therapeutic measures". However, 40 % of the respondents declare that they have done telemedicine. Conclusions: In general, the data show us a beneficial conception of the applications of Information and Communication Technologies for clinical practice in relation to the digitalization and distribution of clinical information. In addition, given the clinical experience of professionals, the need for organizational changes associated with new computer systems is confirmed

Interdisciplinary spinal pain clinics in primary care: Outcomes from one service

BACKGROUND AND OBJECTIVES: Management of spinal pain in Australia is a common problem that often requires input from a range of health providers. Interdisciplinary care can be difficult to access, and care can easily become fragmented. A novel approach of setting up an interdisciplinary clinic in a primary care setting was analysed in this study. METHODS: Follow-up of patients 2­3 years after attending the clinic was undertaken. Specialist general practitioners (GPs) referring to the clinic were invited to give feedback. RESULTS: Forty-three patients participated in the study. Approximately half of patients reported clinically significant reductions in their overall pain and disability levels. GPs and participants broadly supported the clinic approach. DISCUSSION: Complex spinal pain interdisciplinary assessment in a primary care setting shows reasonable long-term outcomes comparable to more intensive interventions. Further exploration and fine-tuning of this model would seem a sensible option as current models of care are under strain.

Epidemiology of Chronic Pain in the Latium Region, Italy: A Cross-Sectional Study on the Clinical Characteristics of Patients Attending Pain Clinics.

In Italy, chronic pain affects more than a quarter of the population, whereas the average European prevalence is 21%. This high prevalence might be due to the high percentage of Italian people who do not receive treatment, even after the passing of law 38/2010 (the right to access pain management in Italy), which created a regional network for the diagnosis and treatment of noncancer chronic pain. Italian epidemiologic studies on chronic pain are scanty, and this observational, multicenter, cross-sectional study is the first to investigate the clinical characteristics of patients who attended the pain management clinics in the Latium Region, Italy, for the management of their noncancer chronic pain. A total of 1,606 patients (mean age 56.8 years, standard deviation ± 11.4), 67% women, were analyzed. Severe pain was present in 54% of the sample. Women experienced pain and had it in two or more sites more often than men (57% vs. 50%, p = .02; and 55.2% vs. 45.9%, p < .001, respectively). Chronic pain was musculoskeletal (45%), mixed (34%), and neuropathic (21%). In more than 60% of the cases, chronic pain was continuous, and in 20% it had lasted for more than 48 months; long-lasting pain was often neuropathic. Low back (33.4%) and lower limbs (28.2%) were the main locations. Severe intensity of pain was statistically significantly associated with female gender (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.06-1.84); with International Classification of Diseases, Ninth Revision, codes for chronic pain syndrome (OR 2.14; 95% CI 1.55-2.95); and with continuous pain (OR 2.02; 95% CI 1.54-2.66). Neuropathic pain and mixed pain were significantly associated with number of sites, and a trend seemed to be present (OR 2.11 and 3.02 for 2 and 3 + sites; 95% CI 1.59-2.79 and 2.00-4.55, respectively).

Characteristics of children and adolescents at the Switzerland-wide first ambulatory interdisciplinary pain clinic at the University Children's Hospital Basel - a retrospective study.

AIMS OF THE STUDY: Given the long history of underestimating chronic pain in children and adolescents, we lack valid data on its assessment and treatment. The psychological and economic burden for patients, their families and society is substantial. The aim of this study was to assess patient characteristics of the first ambulatory interdisciplinary clinic for children and adolescents with chronic pain in Switzerland and compare them with data from other international centres. METHODS: All patients of the ambulatory interdisciplinary pain clinic at the University Children’s Hospital in Basel during the period from 4 January 2012 to 4 July 2016 were included in this retrospective study. Data were collected from the patients’ medical records and from a questionnaire, which the patients and their parents received and completed in advance of their first visit. Demographic information, pain, referral, social environment, therapies and school absences of the patients were statistically analysed with means, percentages, 95% confidence intervals (CIs) and standard deviations (SDs). RESULTS: Of the 135 patients included in this study, 80% were female and the mean age of all patients was 13.95 years (95% CI 13.5–14.4). The commonest pain presentations were: musculoskeletal (38%, 95% CI 0.30–0.46), back (25%, 95% CI 0.18–0.33), multiple regions (21%, 95% CI 0.15–0.28) and headache (7%, 95% CI 0.03–0.12). Mean duration of pain until the patients came to the clinic was 24.5 months (95% CI 19.82–29.22). Physiotherapy (71%, 95% CI 0.63–0.79) and non-opioids (50%, 95% CI 0.42–0.59) were the most used therapies before the first meeting. Psychotherapy (52%, 95% CI 0.44–0.61), most often using a psychosomatic therapeutic approach (psychosomatic therapy) 34% (95% CI 0.26–0.42), physiotherapy (36%, 95% CI 0.27–0.44) and non-opioids (33%, 95% CI 0.25–0.42) afterwards. The mean number of school absences during the last month before the first visit was 5.1 days per month (95% CI 3.48–6.73). The parents of our study participants suffered more often from psychiatric diseases than the mean Swiss population. CONCLUSIONS: The average of more than 2 years of pain before referral to the clinic seems to be a long time. Assuming that specialised support is mandatory for young patients with complex pain syndromes, the referral time should be reduced. Furthermore, patients with headache were underrepresented in Basel compared with other centres. Interestingly, in our study, patients’ parents suffered more often from psychiatric diseases than the mean Swiss population.

Evaluating the benefits of a rapid access chest pain clinic in Australia.

OBJECTIVES: To compare the outcomes and safety of a rapid access chest pain clinic (RACPC) in Australia with those of a general cardiology clinic. DESIGN: Prospective comparison of the outcomes for patients attending an RACPC and those of historical controls. SETTING: Royal Hobart Hospital cardiology outpatient department. PARTICIPANTS: 1914 patients referred for outpatient evaluation of new onset chest pain (1479 patients seen in the RACPC, 435 patients previously seen in the general cardiology clinic). MAIN OUTCOME MEASURES: Service outcomes (review times, number of clinic reviews); adverse events (unplanned emergency department re-attendances at 30 days and 12 months; major adverse cardiovascular events at 12 months, including unplanned revascularisation, acute coronary syndrome, stroke, cardiac death). RESULTS: Median time to review was shorter for RACPC than for usual care patients (12 days [IQR, 8-15 days] v 45 days [IQR, 27-89 days]). All patients seen in the RACPC received a diagnosis at the first clinic visit, but only 139 patients in the usual care group (32.0%). There were fewer unplanned emergency department re-attendances for patients in the RACPC group at 30 days (1.6% v 4.4%) and 12 months (5.7% v 12.9%) than in the control group. Major adverse cardiovascular events were less frequent among patients evaluated in the RACPC (0.2% v 1.4%). CONCLUSIONS: Patients were evaluated more efficiently in the RACPC than in a traditional cardiology clinic, and their subsequent rates of emergency department re-attendances and adverse cardiovascular events were lower.

The Effect of the Treatment at a Pain Clinic on the Patients' Assessment of Their Pain Intensity and the Incidence of Mental Disorders in the form of Anxiety, Depression, and Aggression.

The aim of the study was to analyze the effect of the treatment given to patients in a pain clinic on their assessment of pain intensity and the incidence of emotional disturbances in the form of anxiety, depression, and aggression. The study was conducted from January 2014 to April 2018 among patients under the care of two Warsaw pain clinics. The study tools were the Hospital Anxiety and Depression Scale-Modified Version (HADS-M) and the Numerical Rating Scale (NRS). The project enrolled 325 patients, with women comprising 60.62% of patients, and the age bracked of 65⁻79 years comprising 39.38% of patient. The major reasons for attending the pain clinic were osteoarticular pain (44.92%) and neuropathic pain (42.77%). The therapy applied lowered the patients' pain intensity (4.98 vs. 3.83), anxiety (8.71 vs. 8.12), aggression (3.30 vs. 3.08), and the overall HADS-M score (18.93 vs. 17.90), which shows that the treatment of both the pain symptoms and the associated emotional disturbances in the form of anxiety and aggression was effective. Sex is a factor affecting pain intensity. The level of mental disorders was influenced by the sex and age of the patients and how long they had been treated in the pain clinics.