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1.
PLoS One ; 15(8): e0236111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790685

RESUMO

A relationship between chronic pain and frailty has been reported. The early detection and prevention of frailty are recommended, in part because community-dwelling older adults in a pre-frailty state may return to a healthy state. The relationship between chronic pain and pre-frailty is not known. Toward the goal of promoting a reversible return to health from pre-frailty, we investigated the relationship between chronic pain and pre-frailty among community-dwelling older adults. We assessed the frailty and chronic pain of 107 older adults who were participating in community health checks. The status of physical frailty was based on the five components described by Fried (2001): muscle weakness shown by handgrip strength, slowness of gait speed, weight loss, low physical activity, and exhaustion. Chronic pain was assessed based on pain intensity, the Pain Catastrophizing Scale (PCS), the Japanese version of the Geriatric Depression Scale-15 (GDS-15), and the Central Sensitization Inventory (CSI). The prevalence of chronic pain with pre-frailty was 40.2%. A hierarchical analysis revealed that PCS-measured helplessness (odds ratio [OR]: 0.88) and the CSI (OR: 0.87) were significant factors associated with the presence of chronic pain with pre-frailty. The prevalence of chronic pain with pre-frailty was high, and chronic pain and pre-frailty were strongly related. New intervention or prevention programs that take into account both chronic pain and pre-frailty must be created as soon as possible.


Assuntos
Catastrofização/epidemiologia , Dor Crônica/epidemiologia , Fragilidade/prevenção & controle , Vida Independente , Debilidade Muscular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Catastrofização/psicologia , Dor Crônica/complicações , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Estudos Transversais , Feminino , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Fragilidade/etiologia , Avaliação Geriátrica , Força da Mão , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Medição da Dor , Prevalência
2.
Nat Commun ; 11(1): 3948, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769984

RESUMO

Thalamocortical dysrhythmia is a key pathology of chronic neuropathic pain, but few studies have investigated thalamocortical networks in chronic low back pain (cLBP) given its non-specific etiology and complexity. Using fMRI, we propose an analytical pipeline to identify abnormal thalamocortical network dynamics in cLBP patients and validate the findings in two independent cohorts. We first identify two reoccurring dynamic connectivity states and their associations with chronic and temporary pain. Further analyses show that cLBP patients have abnormal connectivity between the ventral lateral/posterolateral nucleus (VL/VPL) and postcentral gyrus (PoCG) and between the dorsal/ventral medial nucleus and insula in the less frequent connectivity state, and temporary pain exacerbation alters connectivity between the VL/VPL and PoCG and the default mode network in the more frequent connectivity state. These results extend current findings on thalamocortical dysfunction and dysrhythmia in chronic pain and demonstrate that cLBP pathophysiology and clinical pain intensity are associated with distinct thalamocortical network dynamics.


Assuntos
Córtex Cerebral/fisiopatologia , Dor Crônica/fisiopatologia , Núcleos Laterais do Tálamo/fisiopatologia , Dor Lombar/fisiopatologia , Núcleos Ventrais do Tálamo/fisiopatologia , Adulto , Mapeamento Encefálico , Estudos de Casos e Controles , Córtex Cerebral/diagnóstico por imagem , Dor Crônica/diagnóstico , Conjuntos de Dados como Assunto , Feminino , Humanos , Núcleos Laterais do Tálamo/diagnóstico por imagem , Dor Lombar/diagnóstico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Rede Nervosa/fisiopatologia , Medição da Dor , Núcleos Ventrais do Tálamo/diagnóstico por imagem , Adulto Jovem
3.
PLoS One ; 15(8): e0237508, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817710

RESUMO

OBJECTIVES: The FUTUREPAIN study develops a short general-purpose questionnaire, based on the biopsychosocial model, to predict the probability of developing or maintaining moderate-to-severe chronic pain 7-10 years into the future. METHODS: This is a retrospective cohort study. Two-thirds of participants in the National Survey of Midlife Development in the United States were randomly assigned to a training cohort used to train a predictive machine learning model based on the least absolute shrinkage and selection operator (LASSO) algorithm, which produces a model with minimal covariates. Out-of-sample predictions from this model were then estimated using the remaining one-third testing cohort to determine the area under the receiver operating characteristic curve (AUROC). An optimal cut-point that maximized sensitivity and specificity was determined. RESULTS: The LASSO model using 82 variables in the training cohort, yielded an 18-variable model with an out-of-sample AUROC of 0.85 (95% Confidence Interval (CI): 0.80, 0.91) in the testing cohort. The sum of sensitivity (0.88) and specificity (0.76) was maximized at a cut-point of 17 (95% CI: 15, 18) on a 0-100 scale where the AUROC was 0.82. DISCUSSION: We developed a short general-purpose questionnaire that predicts the probability of an adult having moderate-to-severe chronic pain in 7-to-10 years. It has diagnostic ability greater than 80% and can be used regardless of whether a patient is currently experiencing chronic pain. Knowing which patients are likely to have moderate-to-severe chronic pain in the future allows clinicians to target preventive treatment.


Assuntos
Algoritmos , Dor Crônica/diagnóstico , Aprendizado de Máquina , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
4.
Ther Umsch ; 77(3): 111-115, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32669074

RESUMO

Aversive childhood stress and its implications für expert reports using the example of chronic pain Abstract. Insurance-medical questions regarding the consequences of severe aversive childhood stress arise in the context of psychiatric and psychosomatic expert reports. In psychiatric expert reports, the insurance-medical weighting of disorders of thinking, feeling and behaviour is in the foreground. In psychosomatic expert reports the assessment of limited performance with regard to functional body symptoms are considered to be most important. The majority of expert reports in the psychosomatic field concern people with chronic pain disorders. Pain disorders can develop insidiously over the years or be triggered by accidents. For expert reports of chronic pain conditions, guidelines have been developed by the corresponding specialist bodies in Switzerland. These have been available in German and French since 2019 (www.sappm.ch). The following overview focuses on expert reports of chronic pain disorders and is based on the Swiss guidelines mentioned above. The demanding nature of writing such expert reports is also recognized by specialists in other European countries.


Assuntos
Dor Crônica/diagnóstico , Criança , Doença Crônica , Europa (Continente) , Humanos , Suíça
6.
PLoS Med ; 17(6): e1003108, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32502219

RESUMO

BACKGROUND: An estimated 87% of torture survivors experience chronic pain such as brachial plexopathy from upper extremity suspension or lumbosacral plexus injury from leg hyperextension. However, a vast majority of pain is undetected by evaluators due to a lack of diagnostic tools and confounding psychiatric illness. This diagnostic gap results in exclusive psychological treatment rather than multimodal therapies, substantially limiting rehabilitation. We hypothesized that the United Nations Istanbul Protocol (UNIP) would have a sensitivity of approximately 15% for pain detection, and that the use of a validated pain screen would improve its sensitivity by at least 29%, as compared to the reference standard (pain specialist evaluation). METHODS AND FINDINGS: This prospective blind-comparison-to-gold-standard study of survivors of torture, as defined by the World Medical Association, took place at Weill Cornell Medicine between February 1, 2017, and June 21, 2019. 11 women and 9 men, for a total of 20 participants, were included in the analysis. Five participants received 2 UNIP evaluations, for a total of 25 unique evaluations included in the analysis. Participants were representative of a global population, with home countries in Africa, Central America, South Asia, the Caribbean, and the Middle East. Methods of torture experienced were homogeneous, following the predictable pattern of systematic torture. Participants first received the standard evaluation protocol for torture survivors (UNIP) by a trained evaluator, and subsequently received a validated pain screen (Brief Pain Inventory-Short Form [BPISF]) followed by a noninvasive examination by a pain specialist physician (reference standard). The primary outcome was the diagnostic and treatment capability of the standard protocol (index test) versus the validated pain screen (BPISF), as compared to the reference standard. Trained evaluators performing the initial assessment with the UNIP (index test) were blinded to the study, and the pain specialist physician (reference standard) was blinded to the outcome of the initial UNIP evaluation and the BPISF; data from the initial UNIP assessment were not gathered by the principal investigator until all other study procedures were completed. Providers using only the UNIP captured pain in a maximum of 16% of evaluations, as compared to 85% of participants being diagnosed with pain by the reference standard. When employed, the validated pain screen had a sensitivity of 100% (95% CI 72%-100%) and a negative predictive value of 100%, as compared to a sensitivity of 24% (95% CI 8%-50%) and a negative predictive value of 19% (95% CI 5%-46%) for the index test. The difference in the sensitivity of the UNIP as compared to the BPISF was significant, with p < 0.001. No adverse events owing to participation in the study were reported by participants. Limitations of the study include small sample size, its single-site nature, and the exclusion of individuals who did not speak 1 of the 5 study languages. CONCLUSIONS: These data indicate that a validated pain screen can supplement the current global standard assessment of torture survivors, the UNIP, to increase the accuracy of pain diagnosis. TRIAL REGISTRATION: ClinicalTrials.gov NCT03018782.


Assuntos
Dor Crônica/diagnóstico , Medição da Dor/métodos , Refugiados/psicologia , Tortura/psicologia , Adulto , Dor Crônica/etiologia , Feminino , Humanos , Masculino , Medição da Dor/normas , Estudos Prospectivos , Refugiados/estatística & dados numéricos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Método Simples-Cego , Sobreviventes/psicologia , Sobreviventes/estatística & dados numéricos
7.
Ann Thorac Cardiovasc Surg ; 26(4): 196-201, 2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32493872

RESUMO

OBJECTIVE: To evaluate the effect of music therapy on the chronic pain and midterm quality of life of patients after mechanical valve replacement. METHODS: Patients were divided into two groups according to whether or not they received music therapy. The patients in the music group received 30 minutes of music therapy every day for 6 months after the operation. The patients in the control group received standard treatment and had 30 minutes of quiet rest time every day in the same period. The short-form of McGill Pain Questionnaire (SF-MPQ) was used to evaluate the degree of postoperative chronic pain, and the SF-36 was used to evaluate the midterm quality of life of patients. RESULTS: In terms of the degree of postoperative chronic pain, the score of the pain rating index (PRI) emotional item in the music group was significantly lower than that in the control group. In the evaluation of the postoperative midterm quality of life using the SF-36, the emotional function score in the music group was significantly higher than that in the control group. CONCLUSION: This study preliminarily showed that music therapy can effectively reduce chronic pain and improve midterm quality of life after surgery.


Assuntos
Valva Aórtica/cirurgia , Dor Crônica/terapia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Mitral/cirurgia , Musicoterapia , Dor Pós-Operatória/terapia , Qualidade de Vida , China , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Percepção da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/psicologia , Fatores de Tempo , Resultado do Tratamento
9.
Anesth Analg ; 131(2): 387-394, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32452905

RESUMO

BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic led to a significant disruption in the care of pain from chronic and subacute conditions. The impact of this cessation of pain treatment may have unintended consequences of increased pain, reduced function, increased reliance on opioid medications, and potential increased morbidity, due to the systemic impact of untreated disease burden. This may include decreased mobility, reduction in overall health status, and increase of opioid use with the associated risks. METHODS: The article is the study of the American Society of Pain and Neuroscience (ASPN) COVID-19 task force to evaluate the policies set forth by federal, state, and local agencies to reduce or eliminate elective procedures for those patients with pain from spine, nerve, and joint disease. The impact of these decisions, which were needed to reduce the spread of the pandemic, led to a delay in care for many patients. We hence review an emergence plan to reinitiate this pain-related care. The goal is to outline a path to work with federal, state, and local authorities to combat the spread of the pandemic and minimize the deleterious impact of pain and suffering on our chronic pain patients. RESULTS: The article sets forth a strategy for the interventional pain centers to reemerge from the current pandemic and to set a course for future events. CONCLUSIONS: The COVID-19 pandemic represents an overwhelming challenge to interventional pain physicians and their patients. In addition to urgent actions needed for disease mitigation, the ASPN recommends a staged return to pain management professionals' workflow.


Assuntos
Betacoronavirus/patogenicidade , Dor Crônica/terapia , Infecções por Coronavirus/terapia , Procedimentos Clínicos , Manejo da Dor , Pneumonia Viral/terapia , Dor Crônica/diagnóstico , Dor Crônica/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Nível de Saúde , Humanos , Manejo da Dor/efeitos adversos , Pandemias , Segurança do Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento
10.
J Surg Res ; 252: 222-230, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32289579

RESUMO

BACKGROUND: Investigate the diagnostic and therapeutic utility of laparoscopy in the management of patients with chronic abdominal pain of unknown origin. METHODS: Ovid MEDLINE, PubMed, and SCOPUS databases were queried to identify relevant published studies. Data on the diagnostic and therapeutic utility of laparoscopy were abstracted and summarized. RESULTS: Laparoscopy achieved a diagnosis in 65% to 94% of patients with chronic abdominal pain of unknown origin. Common intraoperative findings included adhesions, chronic appendicitis, hernias, and enlarged mesenteric lymph nodes. These findings corresponded with the therapeutic procedures that were performed, including laparoscopic adhesiolysis, appendectomy, and hernia repair. Therapeutic utility of laparoscopy based on pain relief, patient satisfaction, and quality of life ranged from 63% to 94%. CONCLUSIONS: Based on current available evidence, diagnostic laparoscopy (DL) is a safe and effective method for identifying organic causes of chronic abdominal pain. Laparoscopic treatment also resulted in substantial pain relief for a majority of patients. However, the efficacy of laparoscopic adhesiolysis remains controversial. We would recommend the use of DL as an early diagnostic tool, but more robust studies are needed to establish the breadth of its therapeutic utility in clinical practice.


Assuntos
Dor Abdominal/cirurgia , Apendicite/diagnóstico , Dor Crônica/cirurgia , Hérnia Abdominal/diagnóstico , Laparoscopia , Aderências Teciduais/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Apendicite/complicações , Apendicite/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Hérnia Abdominal/complicações , Hérnia Abdominal/cirurgia , Humanos , Medição da Dor , Aderências Teciduais/complicações , Aderências Teciduais/cirurgia , Resultado do Tratamento
12.
Orv Hetil ; 161(13): 502-509, 2020 Mar.
Artigo em Húngaro | MEDLINE | ID: mdl-32202148

RESUMO

Introduction: Based on international data, the prevalence of chronic pain is 25% among adolescents which is associated with poor quality of life, extensive use of healthcare, and overuse of pain medication. Little is known about the medication use and chronic pain in Hungary. Aim: To assess the prevalence and potential socio-demographic risk factors of chronic pain and medication use among Hungarian adolescents. Method: We conducted a cross-sectional epidemiological study at primary and secondary schools with 354 school-children. Adolescents responded to questionnaires about demographic variables, characteristics of chronic pain, use of health-care system and medication. Results: 110 adolescents (31.1%) suffered from chronic pain in our sample. Pain in extremities was the most prevalent pain type. 4.6% (n = 5) of children suffered from continuous pain. The prevalence was lower among boys (χ2 = 9.4; p = 0.002) and younger subjects (Mann-Whitney U = 10906.5; p = 0.004). Sleep disorder was more frequent among adolescents with chronic pain (χ2 = 8.9; p = 0.03). Time from onset, intensity, prevalence and duration of pain were associated with the prevalence of visits to physicians. 78% (n = 276) of the sample took medication in the previous 6 months, however, regular medication use was as high as 48.3% (n = 171). We found a significant association between medication use and older age, female sex, and the presence of chronic pain. Medication use against pain among adolescents with chronic pain was significantly higher (n = 83.0, 75.5%). Conclusion: The prevalence of chronic pain, medication use and visits to physicians is considerable among Hungarian adolescents. It is an important healthcare challenge with long-term consequences until adulthood. Orv Hetil. 2020; 161(13): 502-509.


Assuntos
Dor Crônica/etnologia , Serviços de Saúde/estatística & dados numéricos , Qualidade de Vida , Adolescente , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Estudos Transversais , Feminino , Humanos , Hungria/epidemiologia , Masculino , Prevalência , Fatores de Risco , Inquéritos e Questionários
13.
Schmerz ; 34(4): 332-342, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32157443

RESUMO

INTRODUCTION: The Mainz Pain Staging System (MPSS), which has been validated primarily in middle-aged and chronic low back pain patients, is designed to predict prognosis and control the use of resources at baseline. In multi-morbid and functionally impaired patients (geriatric patients) with multiple causes of pain, it is unclear whether this instrument can be implemented at all and whether it permits statements to be made on the severity of pain chronification. MATERIALS AND METHODS: Therefore, 173 consecutive patients with pain were classified in the second week of inpatient geriatric treatment according to the MPSS. For validation, the questions from the "Pain interview for geriatric patients" (SgP) were used. In addition, the MPSS was compared with the personal history of the duration of the main pain. RESULTS: With the exception of the questions on medication intake, the items in the MPSS could be collected predominantly by self-assessment. Even with current analgesic therapy, MPSS has significant correlations with sensory, affective, and emotional dimensions of pain from the SgP. The data on duration correlated with only one category of MPSS (spatial aspects of pain). CONCLUSION: MPSS can be used in multi-morbid and functionally impaired elderly patients undergoing inpatient treatment. Chronification features are more pronounced at higher stages than at lower levels. Only one category of the MPSS cannot be collected by self-assessment. The possibilities of prognosis estimation and resource control using the MPSS should be further investigated for these patients.


Assuntos
Dor Crônica , Dor Lombar , Idoso , Dor Crônica/diagnóstico , Humanos , Pacientes Internados , Pessoa de Meia-Idade , Medição da Dor , Prognóstico
14.
Pain Physician ; 23(2): E231-E240, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214308

RESUMO

BACKGROUND: Although the reliability of pain drawings (PDs) has been confirmed in people with chronic pain, there is a lack of evidence about the validity of the PD, that is, does the PD accurately represent the pain experience of the patient? OBJECTIVES: We investigate whether people with chronic neck pain (CNP) can recognize their own PD to support the validity of the PD in reporting the experience of pain. Moreover, we examined the association between their ability to recognize their own PD with their levels of pain intensity and disability and extent of psychosocial and somatic features. STUDY DESIGN: Experimental. SETTING: University Laboratory. METHODS: Individuals with CNP completed their PD on a digital body chart, which was then automatically modified with specific dimensions using a novel software, providing an objective range of distortion and eliminating errors, which could potentially occur in manually controlled visual-subjective based methods. Following a 10-minute break listening to music, a series of 20 PDs were presented to each patient in a random order, with only 2 being their original PD. For each PD, the patients rated its likeliness to their own original PD on a scale from 0 to 100, with 100 representing "this is my pain." RESULTS: Overall, the patients rated their original PD with a median score of 92% similarity, followed by 91.8% and 89.5% similarity when presented with a PD scaled down to 75% and scaled up by 150% of the original size, respectively; these scores were not significantly different to the ratings given for their original PD. The PD with horizontal translation by 40 pixels (8%) and vertical translation by 70 pixels (12.8%) were rated as the most dissimilar to their original PD; these scores were significantly different to their original PD scores. The Spearman correlation coefficient revealed a significant negative association between their ability to recognize their original PD and their Modified Somatic Perceptions Questionnaire scores. LIMITATIONS: The patients in the study presented with relatively mild CNP, and the results may not be generalized to those with more severe symptoms. CONCLUSIONS: People with CNP are generally able to identify their own PD but that their ability to recognize their original PD is negatively correlated with the extent of somatic awareness. KEY WORDS: Chronic pain, perception, pain drawings, somatic awareness.


Assuntos
Dor Crônica/diagnóstico , Dor Crônica/psicologia , Cervicalgia/diagnóstico , Cervicalgia/psicologia , Medição da Dor/psicologia , Reconhecimento Psicológico , Adulto , Feminino , Humanos , Medição da Dor/métodos , Reconhecimento Psicológico/fisiologia , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
15.
Value Health ; 23(2): 157-163, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32113620

RESUMO

OBJECTIVES: This prospective cohort study examines the clinical effectiveness of electronic medical record clinical decision support (EMR CDS) for opioid prescribing. METHODS: Data analysis included primary care patients with chronic opioid therapy for noncancer pain seen within an integrated health delivery system in Louisiana between January 2017 and October 2018. EMR CDS incorporated an opioid health maintenance tool to display the status of risk mitigation, and the medication order embedded the morphine equivalent daily dose (MEDD) calculator and a hyperlink to the Louisiana pharmacy drug monitoring program. Outcome measures included change in the average MEDD and rates of opioid risk mitigation, hospitalization, and emergency department use. RESULTS: Among 14 221 patients, 9% had prescriptions with an average MEDD ≥90 mg. There were no significant changes in MEDD after EMR CDS implementation. Increasing age, Charlson Comorbidity Index score, female sex, black non-Hispanic race, non-opioid pain medication co-prescriptions, and specialty referrals were associated with a lower odds of MEDD ≥90 (high-dose threshold). Medicare or self-pay, substance abuse history, and pain agreements were associated with increased odds of prescribing above this high-dose threshold. After incorporation of EMR CDS, patients had higher rates of urine drug screens (17% vs 7%) and naloxone prescriptions (3% vs 1%, all P < .001). In addition, specialty referrals to physical or occupational therapy, orthopedics, neurology, and psychiatry or psychology increased in the postintervention period. Although emergency department use decreased (rate ratio 0.92; 95% confidence interval 0.89-0.95), hospitalization rates did not change. CONCLUSIONS: EMR CDS improved adherence to opioid risk mitigation strategies. Further research examining which practice redesign interventions effectively reduce high-dose opioid prescribing is needed.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Sistemas de Apoio a Decisões Clínicas , Técnicas de Apoio para a Decisão , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Padrões de Prática Médica , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Dor Crônica/diagnóstico , Tomada de Decisão Clínica , Pesquisa Comparativa da Efetividade , Prescrições de Medicamentos , Registros Eletrônicos de Saúde , Feminino , Humanos , Louisiana , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/etiologia , Medição da Dor , Seleção de Pacientes , Atenção Primária à Saúde , Estudos Prospectivos , Medição de Risco , Fatores de Risco
16.
Pain Physician ; 23(1): E19-E30, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32013285

RESUMO

BACKGROUND: There is a dearth in our understanding of the factors that are predictive of successful spinal cord stimulator (SCS) trials and eventual conversion to permanent implants. Knowledge of these factors is important for appropriate patient selection and treatment optimization. OBJECTIVES: Although previous studies have explored factors predictive of trial success, few have examined the role of waveform in trial outcomes. This study sought to establish the relationship of neuraxial waveform and related measures to trial outcomes. STUDY DESIGN: This study used a retrospective chart review design. METHODS: Data were retrospectively collected on 174 patients undergoing SCS trials upon institutional review board approval of the study protocol. Indications for SCS were: complex regional pain syndrome, failed back surgery syndrome with radicular symptoms, peripheral neuropathy, and axial low back pain. Descriptive statistics and logistic regression analyses were used to assess the association of demographic and clinical variables with SCS trial outcomes. RESULTS: The study population comprised 56% women, had a median age of 55 (interquartile range [IQR], 44-64), and 32 of 174 (18%) patients failed SCS trials. Individuals with successful trials (>= 50% pain relief) were significantly younger and had a median age of 54 years (IQR, 42-60) compared to those who failed SCS trials (median age 66 years; IQR, 50-76; P = .005). Adjusting for age, gender, number of leads, pain category, and diagnoses: surgical history (odds ratio [OR] = 4.4; 95% confidence interval [CI], 1.3-15.8) and paresthesia-based tonic-stimulation (OR = 10.3; 95% CI, 1.7-62.0), but not burst or high frequency, were significantly associated with successful trials. Of note, the number of leads (whether dual or single), pain duration, characteristics, and category (nociceptive vs neuropathic) were not significant factors. An interaction between surgical spine history and lower extremity pain was significantly associated with a positive trial (P = .005). LIMITATIONS: This study was limited by its retrospective nature and focus on a patient population at a single major academic medical center. CONCLUSIONS: Paresthesia-based tonic stimulation, age, and surgical history have significant effects on SCS trials. Prospective and randomized controlled studies may provide deeper insights regarding impact on costs and overall outcomes.IRB Approval #: 2018P002216. KEY WORDS: Pain duration, pain location, spinal cord stimulator trial, stimulator waveform, surgical history.


Assuntos
Dor Crônica/terapia , Síndromes da Dor Regional Complexa/terapia , Síndrome Pós-Laminectomia/terapia , Dor Lombar/terapia , Seleção de Pacientes , Estimulação da Medula Espinal/métodos , Adulto , Fatores Etários , Idoso , Dor Crônica/diagnóstico , Síndromes da Dor Regional Complexa/diagnóstico , Síndrome Pós-Laminectomia/diagnóstico , Feminino , Humanos , Dor Lombar/diagnóstico , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
17.
Pain Physician ; 23(1): E41-E49, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32013287

RESUMO

BACKGROUND: Because of the subjective nature of current pain assessments, limited efficacy of treatment options and risks associated with opioid abuse and diversion, the need for objective data to assist with chronic pain management has never been greater. Successful identification of mechanistic biomarkers would not only improve our understanding and ability to accurately diagnose pain disorders but would also facilitate the development of disease-modifying pain drugs. OBJECTIVES: The objective of this study was to determine and evaluate the prevalence of abnormal biomarker findings in a population of patients with chronic pain. STUDY DESIGN: Retrospective, observational study. SETTING: Data analysis of biomarker test results was performed at a single industry site (Ethos Research & Development, Newport, KY) from clinical samples collected and analyzed from July to December 2018. METHODS: A novel, pain-specific biomarker test panel that evaluates biomarkers of systemic inflammation, oxidative stress, neurotransmitter turnover, and micronutrient status was employed to determine the prevalence of abnormal findings in 17,834 unique patient samples analyzed at a national reference laboratory (Ethos Laboratories, Newport, KY). Patient biomarker results were considered abnormal if they were outside of the 95% confidence interval reference ranges established using a healthy population of donors who had no history of chronic pain or opioid use. RESULTS: A total of 77% of patients with chronic pain exhibited at least one abnormal biomarker result (n = 13,765). The most common abnormal biomarker finding was elevated quinolinic acid, which was observed in 29% of patients (n = 5,107). Elevated pyroglutamate, indicative of glutathione depletion, was observed in 19% of patients (n = 3,314). Elevated xanthurenic acid, indicative of vitamin B6 insufficiency, was observed in 17% of patients (3,025). Elevated levels of the acrolein metabolite 3-hydroxypropyl mercapturic acid were observed in 21% of patients (n = 3,667). Elevated methylmalonic acid, indicative of a vitamin B12 deficiency, was observed in 10% of patients (n = 1,827), whereas abnormally low levels of neurotransmitter metabolites were observed in 8% of patients (n = 1,456). LIMITATIONS: Medications and/or conditions other than those associated with chronic pain were not evaluated as potential causes of abnormal biomarker findings. CONCLUSIONS: A novel biomarker assay that measures objective correlates to the neurobiological processes underlying chronic pain reveals a high prevalence of atypical biochemistry in a population of patients with pain. Abnormal biomarker findings presented here provide objective support for the role of cytokine-mediated inflammation, oxidative stress, abnormally low production of neurotransmitters, and micronutrient deficiencies in the development or worsening of chronic pain. This unique panel of functional pain biomarkers provides practitioners with novel, objective insight into the underlying causes of pain, which will pave the way for truly personalized pain medicine. Correcting abnormal biomarker findings with targeted, nonopioid therapies to improve patient function and alleviate pain potentially could lessen the opioid burden and drastically reduce health care costs. KEY WORDS: Biomarker, pain, inflamation, oxidative stress, neurotransmitter, micronutrient deficiency, Kynurenine Pathway.


Assuntos
Dor Crônica/sangue , Dor Crônica/diagnóstico , Medição da Dor/métodos , Analgésicos Opioides/uso terapêutico , Biomarcadores/sangue , Dor Crônica/tratamento farmacológico , Feminino , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Complexo Vitamínico B/sangue , Deficiência de Vitaminas do Complexo B/sangue , Deficiência de Vitaminas do Complexo B/diagnóstico , Deficiência de Vitaminas do Complexo B/tratamento farmacológico
18.
J Orthop Sports Phys Ther ; 50(1): 33-43, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892290

RESUMO

OBJECTIVE: Cervical sensorimotor outcomes have been suggested to be important in the assessment of individuals with neck pain. However, the large variety of sensorimotor control tests used in varying populations makes it difficult to draw conclusions about their clinical value. We aimed to compare cervical sensorimotor control outcomes between individuals with chronic idiopathic neck pain and asymptomatic individuals using a battery of recommended tests, and to investigate the correlation between cervical sensorimotor control outcomes and pain intensity and neck disability. DESIGN: Case-control study. METHODS: Fifty participants with chronic idiopathic neck pain and 50 age- and sex-matched asymptomatic controls completed 7 cervical sensorimotor control tests: joint position error (including joint position error torsion), postural balance, subjective visual vertical, head-tilt response, "the Fly," smooth pursuit neck torsion, and head steadiness. Between-group differences were investigated with the Mann-Whitney U test. Correlations between tests and levels of neck pain and disability were investigated using the Spearman rho. RESULTS: There were no differences in cervical sensorimotor outcomes between participants with chronic idiopathic neck pain and asymptomatic controls for any test (P = .203-.981). For each test, "poor performers" consisted of both individuals with and without neck pain. Correlations were weak between tests and levels of neck pain (r = 0.010-0.294) and neck disability (r = 0.007-0.316). CONCLUSION: These findings suggest that sensorimotor control disturbances in individuals with chronic idiopathic neck pain may not be present, spawning debate on the clinical usefulness of these tests. J Orthop Sports Phys Ther 2020;50(1):33-43. Epub 23 Aug 2019. doi:10.2519/jospt.2020.8846.


Assuntos
Dor Crônica/diagnóstico , Cervicalgia/diagnóstico , Exame Neurológico , Adulto , Estudos de Casos e Controles , Dor Crônica/etiologia , Dor Crônica/fisiopatologia , Estudos Transversais , Feminino , Cabeça/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Equilíbrio Postural/fisiologia , Propriocepção/fisiologia
19.
Sci Rep ; 10(1): 1432, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996705

RESUMO

Artificial intelligence provides the opportunity to reveal important information buried in large amounts of complex data. Electronic health records (eHRs) are a source of such big data that provide a multitude of health related clinical information about patients. However, text data from eHRs, e.g., discharge summary notes, are challenging in their analysis because these notes are free-form texts and the writing formats and styles vary considerably between different records. For this reason, in this paper we study deep learning neural networks in combination with natural language processing to analyze text data from clinical discharge summaries. We provide a detail analysis of patient phenotyping, i.e., the automatic prediction of ten patient disorders, by investigating the influence of network architectures, sample sizes and information content of tokens. Importantly, for patients suffering from Chronic Pain, the disorder that is the most difficult one to classify, we find the largest performance gain for a combined word- and sentence-level input convolutional neural network (ws-CNN). As a general result, we find that the combination of data quality and data quantity of the text data is playing a crucial role for using more complex network architectures that improve significantly beyond a word-level input CNN model. From our investigations of learning curves and token selection mechanisms, we conclude that for such a transition one requires larger sample sizes because the amount of information per sample is quite small and only carried by few tokens and token categories. Interestingly, we found that the token frequency in the eHRs follow a Zipf law and we utilized this behavior to investigate the information content of tokens by defining a token selection mechanism. The latter addresses also issues of explainable AI.


Assuntos
Bioestatística/métodos , Dor Crônica/diagnóstico , Aprendizado Profundo , Registros Eletrônicos de Saúde/normas , Aprendizado de Máquina , Inteligência Artificial , Biologia Computacional , Humanos , Redes Neurais de Computação , Fenótipo
20.
Curr Pain Headache Rep ; 24(2): 4, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31980957

RESUMO

PURPOSE OF REVIEW: Given the growing challenges in chronic pain management coupled with the ongoing consequences of the opioid epidemic, pain management practitioners are looking into more effective, innovative, and safer alternatives to treat pain. Cannabis-based medicine had been described for hundreds of years but only recently have we seen the more scientific, evidence-based approach to its use, and ongoing investigations continue to explore its potential medical benefits. While historically more attention has been paid to the psychoactive component of the cannabis plant Δ9-tetrahydrocannabinol (THC), there have been fewer scientific studies on the medical use of the cannabidiol (CBD) - a non-psychoactive component of the cannabis plant. RECENT FINDINGS: By examining recent literature, we investigated the use of CBD and its potential role in pain management. Since there are currently no approved pharmaceutical products that contain CBD alone for the management of pain, this review focused on nabiximols (which is a combined product of THC/CBD in a 1:1 ratio) as the only pharmaceutical product available that contains CBD and is being used for the management of pain. It is difficult to definitely attribute the therapeutic properties to CBD alone since it is always administered with THC. Based on the available literature, it is difficult to make a recommendation for the use of CBD in chronic pain management. It is also important to note that there are many CBD products currently available as supplements, but these products are non-pharmaceuticals and lack the appropriate clinical studies to support their efficacy claims.


Assuntos
Canabidiol/uso terapêutico , Dor Crônica/tratamento farmacológico , Medicina Baseada em Evidências/métodos , Manejo da Dor/métodos , Dor Crônica/diagnóstico , Medicina Baseada em Evidências/tendências , Humanos , Manejo da Dor/tendências
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