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1.
Methods Mol Biol ; 2547: 491-504, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36068474

RESUMO

Pain affects approximately 100 million Americans. Pain harms quality of life and costs patients billions of dollars per year. Clinically, nonpharmacologic and pharmacologic therapies can alleviate acute and chronic pain suffering. Opioids are one type of medication used to manage pain. However, opioids can potentially create dependence and substance abuse, and the effects are not consistent in all patients. Pharmacogenomics is the study of the genome to understand the effects of drugs on individual patients based on their genetic information. Through pharmacogenomics, researchers can investigate genetic polymorphisms related to pain that maximize individual patient drug responses and minimize toxicity. This chapter discusses the pharmacogenomics of opioids to treat pain, including individual genetic differences to opioid treatments, opioid pharmacokinetics and pharmacodynamics, and the genetic polymorphisms associated with individual opioid medications.


Assuntos
Analgésicos Opioides , Dor Crônica , Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Dor Crônica/genética , Humanos , Manejo da Dor , Farmacogenética , Qualidade de Vida , Estados Unidos
2.
Methods Mol Biol ; 2547: 505-526, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36068475

RESUMO

Pharmacogenomics can improve pain management by considering individual variations in pain perception and susceptibility and sensitivity to medicines related to genetic diversity. Due to the subjective nature of pain and the fact that people respond differently to medicines, it can be challenging to develop a consistent and successful regimen for pain disorders. Numerous factors influence the outcome of pain treatment programs, but two stand out: altered perception of pain and varying responsiveness to analgesic medicines. Numerous polymorphisms in genes such as CYP2D6, OPRM1, and ABCB1 have been identified, culminating in a heterogeneous response to pain medication in people who have these genetic polymorphisms. Improved treatment regimens that factor in pharmacogenetic differences in patients would help reduce the risk of opioid dependency and help effectively treat postoperative pain.


Assuntos
Analgésicos Opioides , Farmacogenética , Analgésicos Opioides/uso terapêutico , Humanos , Manejo da Dor , Dor Pós-Operatória/induzido quimicamente , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/genética , Testes Farmacogenômicos
3.
BMC Anesthesiol ; 22(1): 283, 2022 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-36088297

RESUMO

BACKGROUND: The objective of this study was to compare analgesic efficacy of erector spinae plane block(ESPB) and thoracic paravertebral block(TPVB) combined with intercostal nerve block(ICNB) after video assisted thoracoscopic surgery(VATS). METHODS: Patients were enrolled into three groups according to analgesia technique as ICNB, TPVB + ICNB or ESPB + ICNB: respectively Group C(n = 58), Group T (n = 56) and Group E (n = 59). Patients were followed up by a trained data investigator at 2, 6, 8, 12, 24, 48 h after surgery, and the visual analog scale(VAS) at rest and coughing were recorded. The moderate and severe pain mean VAS ≥ 4 when coughing. The postoperative opioids consumption, incidence of postoperative nausea and vomiting (PONV), supplementary analgesic requirements within 48 h, length of stay in PACU, ambulation time, postoperative days in hospital and potential side effects, such as hematoma, hypotension, bradycardia, hypersomnia, uroschesis, pruritus and apnea were recorded. RESULTS: The incidence of moderate-to-severe pain was no significant difference between 3 groups in 24 h and 48 h (P = 0.720). There was no significant difference among the 3 groups in the resting pain intensity at 2, 6, 8, 12, 24 and 48 h after surgery(P > 0.05). In 2-way analysis of variance, the VAS when coughing in Group T were lower than that in Group C (mean difference = 0.15, 95%CI, 0.02 to 0.29; p = 0.028). While no difference was found when comparing Group E with Group C or Group T(P > 0.05). There was no difference between the three groups in the sufentanil consumption( within 24 h p = 0.472, within 48 h p = 0.158) and supplementary analgesic requirements(p = 0.910). The incidence of PONV and the length of stay in PACU, ambulation time and postoperative days in hospital were comparable in the 3 groups(P > 0.05). Two patients from Group T developed hematoma at the site of puncture. CONCLUSIONS: The present randomized trial showed that the analgesic effect of TPVB + ICNB was superior to that of INCB after VATS, the analgesic effect of ESPB was equivalent to that of TPVB and ICNB. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2100049578. Registered 04 Aug 2020 Retrospectively registered.


Assuntos
Bloqueio Nervoso , Cirurgia Torácica Vídeoassistida , Hematoma/complicações , Humanos , Nervos Intercostais , Bloqueio Nervoso/métodos , Manejo da Dor/efeitos adversos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Ultrassonografia de Intervenção/métodos
4.
PLoS One ; 17(9): e0273030, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36107861

RESUMO

BACKGROUND AND AIMS: Integration of care is lacking for chronic musculoskeletal pain patients. Network Pain Rehabilitation Limburg, a transmural health care network, has been designed to provide integrated rehabilitation care from a biopsychosocial perspective to improve patients' levels of functioning. This feasibility study aims to provide insight into barriers and facilitators for the development, implementation, and transferability. METHODS: This study was conducted with a three-phase iterative and incremental design from October 2017 to October 2018. The network comprises two rehabilitation practices, and three local primary care networks, with a general practitioner together with, a mental health practice nurse, and a physiotherapist or exercise therapist. These stakeholders with a random sample of participating patients took part in evaluations, consisting of interviews, focus groups, and observations. Field notes and observations were recorded during meetings. The Consolidated Framework for Implementation Research guided data collection and analysis. Results were used to refine the next phase. RESULTS: According to health care professionals, guidelines and treatment protocols facilitate consistency and transparency in collaboration, biopsychosocial language, and treatment. One mentioned barrier is the stigmatization of chronic pain by the general population. In regular care, approaches are often more biomedical than biopsychosocial, causing patients to resist participating. The current organization of health care acts as a barrier, complicating implementation between and within practices. Health care professionals were enthusiastic about the iterative, bottom-up development. A critical mass of participating organizations is needed for proper implementation. CONCLUSION: Network Pain Rehabilitation Limburg is feasible in daily practice if barriers are overcome and facilitators of development, implementation, and transferability are promoted. These findings will be used to refine Network Pain Rehabilitation Limburg. A large-scale process and effect evaluation will be performed. Our implementation strategies and results may assist other health care organizations aspiring to implement a transmural network using a similar model. TRAIL REGISTRATION: Registration number: NTR6654 or https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6654.


Assuntos
Dor Crônica , Manejo da Dor , Dor Crônica/terapia , Estudos de Viabilidade , Pessoal de Saúde , Humanos , Organizações , Manejo da Dor/métodos
5.
BMC Oral Health ; 22(1): 402, 2022 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109782

RESUMO

BACKGROUND: Uninformed opioid prescribing by dentists has contributed to the current opioid crisis. This report describes the development and implementation of an innovative, interactive, multidisciplinary, and participant-centric telementoring program "Pain Management and Substance Use Disorders Dental ECHO (Extension for Community Health Care Outcomes)". We disseminated information to dentists about appropriate opioid prescribing practices and engaged them with a focus on pain management and substance use disorders. The objective of this study was to assess the effectiveness of this program for self-reported: (1) change in knowledge and confidence related to clinical skills for dental pain management of patients with substance use disorders; (2) change in clinical behavior of dentists for safe opioids prescribing; and (3) change in clinic policies regarding safe opioids prescribing. METHODS: An interdisciplinary panel of experts in medicine, pharmacy, social work, and dentistry designed and led the "Pain Management and Substance Use Disorders Dental ECHO" for invited dental care providers and dental students. Six cohorts each consisting of six, 1-h-long sessions were conducted via the Zoom videoconference platform in years 2020 and 2021. Each session included a didactic expert presentation, a participant-presented patient case and discussion. Each participant completed pre- and post-program surveys to assess the program's influence on participant knowledge, clinical confidence and behavior change. RESULTS: The participants (N = 151) were dentists (n = 109), dental faculty (n = 15), dental residents (n = 6), dental hygienists/assistants (n = 13) and nurses and clinic administrators (n = 8). Self-reported perceived medication knowledge, confidence in identification, treatment and willingness to engage with substance use disorders patients, and reported compliance with Prescription Drug Monitoring Program (PDMP) checks increased significantly from before to after the sessions (p < 0.001). Overall, participants expressed high levels of satisfaction with the content and reported that the sessions provided high benefit. CONCLUSION: The Project ECHO model is effective in rapidly disseminating evidence-based information. Dentists viewed this model as having a high degree of benefit for the optimal management of dental pain and the recognition and treatment of substance use disorders.


Assuntos
Manejo da Dor , Transtornos Relacionados ao Uso de Substâncias , Analgésicos Opioides/uso terapêutico , Odontologia , Humanos , Modelos Educacionais , Padrões de Prática Odontológica , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/terapia
6.
An. pediatr. (2003. Ed. impr.) ; 97(3): 207.e1-207.e8, Sept. 2022. ilus, graf, tab
Artigo em Inglês, Espanhol | IBECS | ID: ibc-207808

RESUMO

El dolor en Pediatría es un síntoma con frecuencia infradiagnosticado y deficientemente tratado a pesar de su prevalencia, siendo el déficit de conocimientos de los pediatras una de las barreras para garantizar un manejo eficaz. El presente trabajo describe el escenario actual y los retos en el abordaje diagnóstico y terapéutico del dolor infantil por pediatras en nuestro medio. Los resultados se obtienen de un estudio transversal descriptivo que se realiza entre octubre de 2021 y marzo de 2022 mediante encuesta de difusión a pediatras españoles diseñada por el Grupo Español para el Estudio de Dolor Pediátrico. Se pone el foco especialmente en las oportunidades de formación en diferentes aspectos del dolor pediátrico. (AU)


Pain in children population is prevalent, but its proper diagnosis and management are frequently insufficient in pediatrics daily practice. Lack of knowledge of the professionals in charge is a recognized barrier to ensure an appropiate approach to pain in this population. Our present study reflects the current status of pain management and the challenges in diagnosis and treatment that pediatricians face in their daily work. This information is obtained from a survey made with a voluntary questionaire, desinged and distributed online by Grupo Español para el Estudio del Dolor Pediátrico to pediatricians in Spain from October 2021 to March 2022. The final objective of the questionaire was to shed some light into the problem and find out which areas of pain management knowledge are in need of improvement. (AU)


Assuntos
Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Manejo da Dor/tendências , Pediatria , Pediatras , Epidemiologia Descritiva , Estudos Transversais , Inquéritos e Questionários , Espanha
7.
Trials ; 23(1): 749, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064598

RESUMO

BACKGROUND: Spinal cord stimulation (SCS) has shown to be an effective treatment for patients with persistent spinal pain syndrome type 2 (PSPS Type 2). The method used to deliver electrical charge in SCS is important. One such method is burst stimulation. Within burst stimulation, a recharge pattern is used to prevent buildup of charge in stimulated tissues. Two variations of burst waveforms are currently in use: one that employs active recharge and one that uses passive recharge. It has been suggested that differences exist between active and passive recharge paradigms related to both efficacy of pain relief and their underlying mechanism of action. Active recharge has been shown to activate both the medial spinal pathway, engaging cortical sensorimotor areas involved in location and intensity of pain, and lateral pathway, reaching brain areas involved with cognitive-emotional aspects of pain. Passive recharge has been suggested to act via modulation of thalamic neurons, which fire in a similar electrical pattern, and thereby modulate activity in various cortical areas including those related to motivational and emotional aspects of pain. The objective of this randomized clinical trial is to assess and compare the effect of active versus passive recharge Burst SCS on a wide spectrum of pain in PSPS Type 2 patients. METHODS: This multicentre randomized clinical trial will take place in 6 Dutch hospitals. PSPS Type 2 patients (n=94) will be randomized into a group receiving either active or passive recharge burst. Following a successful trial period, patients are permanently implanted. Patients complete the Pain Catastrophizing Scale (PCS) (primary outcome at 6 months), Numeric Pain Rating Scale (NRS), Patient Vigilance and Awareness Questionnaire (PVAQ), Hospital Anxiety and Depression Scale (HADS), Quality of Life (EQ-5D), Oswestery Disability Index (ODI), Patient Global Impression of Change (PGIC) and painDETECT questionnaires (secondary outcomes) at baseline, after trial, 1, 3, 6 and 12 months following implantation. DISCUSSION: The BURST-RAP trial protocol will shed light on possible clinical differences and effectivity of pain relief, including emotional-motivational aspects between active and passive burst SCS in PSPS Type 2 patients. TRIAL REGISTRATION: ClinicalTrials.gov registration:  NCT05421273 . Registered on 16 June 2022. Netherlands Trial Register NL9194. Registered on 23 January 2021.


Assuntos
Estimulação da Medula Espinal , Humanos , Estudos Multicêntricos como Assunto , Dor , Manejo da Dor/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação da Medula Espinal/métodos , Resultado do Tratamento
8.
AACN Adv Crit Care ; 33(3): 240-243, 2022 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-36067257
10.
Syst Rev ; 11(1): 194, 2022 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-36071535

RESUMO

BACKGROUND: Postoperative pain after a cesarean section has negative consequences for the mother during the postoperative period. Over the years, various postoperative pain management strategies have been used following cesarean section. Opioid-based analgesics and landmark approaches have negative side effects, while ultrasound-based regional analgesia necessitates resources and experience, but various wound infiltration adjuvants are innovative with few side effects and are simple to use. The efficacy and safety of each adjuvant, however, are unknown and require further investigation. OBJECTIVE: This network meta-analysis is intended to provide the most effective wound infiltration drugs for postoperative management after cesarean section. METHOD: A comprehensive search will be conducted in PubMed/MEDLINE, Cochrane Library, Science Direct, CINHAL, and LILACS without date and language restrictions. All randomized trials comparing the effectiveness of wound infiltration drugs for postoperative pain management after cesarean section will be included. Data extraction will be conducted independently by two authors. The quality of studies will be evaluated using the Cochrane risk of bias tool, and the overall quality of the evidence will be determined by GRADEpro software. DISCUSSION: The rate of postoperative acute and chronic pain is very high which has a huge impact on the mother, family, healthcare practitioners, and healthcare delivery. It is a basic human right to give every patient with postoperative pain treatment that is realistic in terms of resources, technique, cost, and adverse event profile. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021268774.


Assuntos
Analgesia , Cesárea , Analgésicos Opioides/uso terapêutico , Cesárea/efeitos adversos , Cesárea/métodos , Feminino , Humanos , Metanálise como Assunto , Metanálise em Rede , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Gravidez , Revisões Sistemáticas como Assunto
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 4708-4711, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36086513

RESUMO

The societal and economic burden of unassessed and unmodeled postoperative pain is high and predicted to rise over the next decade, leading to over-dosing as a result of subjective (NRS-based) over-estimation by the patient. This study identifies how post-surgical trauma alters the parameters of impedance models, to detect and examine acute pain variability. Model identification is performed on clinical data captured from post-anesthetized patients, using Anspec-PRO prototype apriori validated for clinical pain assessment. The multisine excitation of this in-house developed device enables utilizing the complex skin impedance frequency response in data-driven electrical models. The single-dispersion Cole model is proposed to fit the clinical curve in the given frequency range. Changes in identified parameters are analyzed for correlation with the patient's reported pain for the same time moment. The results suggest a significant correlation for the capacitor component. Clinical Relevance- Individual model parameters validated on patients in the post-anesthesia care unit extend the knowledge for objective pain detection to positively influence the outcome of clinical analgesia management.


Assuntos
Analgesia , Dor Pós-Operatória , Impedância Elétrica , Humanos , Manejo da Dor , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia
12.
BMJ Case Rep ; 15(9)2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109091

RESUMO

Pemphigus is a rare autoimmune bullous disease which affects the mucous membranes and skin. Pemphigus vulgaris (PV) is the most prevalent type of pemphigus. PV presents with extremely painful, non-healing oral erosions. However, there are only a handful of reports addressing the pain management of PV. We would like to present a case of a painful PV, which was successfully managed.


Assuntos
Pênfigo , Humanos , Membrana Mucosa , Dor/etiologia , Manejo da Dor , Pênfigo/complicações , Pênfigo/tratamento farmacológico , Pele
14.
Neurosurg Rev ; 45(5): 3447-3455, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36074278

RESUMO

Recurrent trigeminal neuralgia (TN) after surgical procedures can be rather difficult to treat, and standardized treatment measures are not available yet. It is unclear whether percutaneous balloon compression (PBC) can be used as the preferred surgical treatment for postoperative recurrent TN. To determine the efficacy of PBC and identify the predictors of response of PBC for the treatment of recurrent TN following TN-related surgeries, we retrospectively collected and analyzed the data of patients with recurrent TN following surgical treatments who underwent PBC under three-dimensional computed tomography (3D-CT) guidance at the Department of Pain Management of Beijing Tiantan Hospital, Capital Medical University from January 2018 to January 2022. We found, within 1 month after PBC, that the total efficacy of PBC on recurrent TN following TN-related surgeries was 86.7%. Based on the effectiveness of PBC 1 month postoperatively, patients were divided into the effective group (130, 86.7%) and the ineffective group (20, 13.3%). Fourteen (10.8%) patients in the effective group had undergone RFT before, which was significantly lower than that in the ineffective group (6, 30%, p = 0.02). Multivariate logistic regression analysis showed that previous RFT alone (OR = 0.20, 95%CI 0.06-0.66, P = 0.01) was an independent predictor of the negative response of PBC. Thus, PBC was found to be a moderately effective and safe treatment for recurrent TN after TN-related surgery. However, previous RFT procedures may predict a slightly worse outcome after PBC.


Assuntos
Neuralgia do Trigêmeo , Humanos , Manejo da Dor , Estudos Retrospectivos , Tempo , Resultado do Tratamento , Neuralgia do Trigêmeo/cirurgia
15.
J Orthop Trauma ; 36(Suppl 5): S19-S24, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36121327

RESUMO

SUMMARY: Orthopaedic trauma patients have high rates of psychiatric disorders, which put them at risk for worse outcomes after injury and surgery, including worse pain. Mental health conditions, such as depression and anxiety, can affect the perception of pain. Pain can also exacerbate or contribute to the development of mental illness after injury. Interventions to address both mental health and pain among orthopaedic trauma patients are critical. Balancing safety and comfort amid a drug overdose epidemic is challenging, and many clinicians do not feel comfortable addressing mental health or have the resources necessary. We reviewed the literature on the complex relationship between pain and mental health and presented examples of scalable and accessible interventions that can be implemented to promote the health and recovery of our patients. Interventions described include screening for depression in the orthopaedic trauma clinic and the emergency department or inpatient setting during injury and using a comprehensive and evidence-based multimodal pain management regimen that blends pharmacologic alternatives to opioids and physical and cognitive strategies to manage pain.


Assuntos
Transtornos Mentais , Dor Musculoesquelética , Analgésicos Opioides/uso terapêutico , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Saúde Mental , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Manejo da Dor
16.
Pain Physician ; 25(6): 483-490, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36122257

RESUMO

BACKGROUND: Rib fractures occur most commonly because of blunt thoracic trauma and occur in up to 12% of all trauma patients. Adequate analgesia is paramount in enhancing pulmonary hygiene aimed at preventing atelectasis and pneumonia. Erector spinae plane block, one of the novel multiple thoracic ultrasound-guided techniques, can provide analgesia to both the anterior and posterior hemithorax, making it particularly useful in the management of pain after extensive thoracic trauma. OBJECTIVES: This work aimed to compare the analgesic efficacy and safety of ultrasound-guided erector spinae plane block versus ultrasound-guided thoracic paravertebral block in patients suffering multiple rib fractures. STUDY DESIGN: A double blinded randomized clinical trial. SETTING: A university hospital. METHODS: The study was conducted with 60 patients with multiple fracture ribs. Patients were randomly allocated into 2 equal groups of 30 patients. RESULTS: Both techniques were effective in reducing pain scores and opioid consumption with no significant difference between the 2 groups. Time to first analgesic administration was comparable between the 2 groups. Twenty patients in the thoracic erector spinae plane group required rescue morphine compared to 17 patients in the thoracic paravertebral block group (P > 0.05). Visual Analog Scale scores at rest and on coughing were also comparable between the groups at all measuring points except at 0.5 hours following the block performance. Occurrence of hypertension was higher in the thoracic paravertebral block group compared to the thoracic erector spinae plane group (P = 0.024). LIMITATIONS: There was no catheter inserted and we use intermittent injections, which is not the ideal, continuous block with fixed catheter is the ideal. We use dexamethasone as adjuvant with local anesthetics, which delay the need for booster dose of local anesthetics and make comparison between the 2 techniques not ideal. The sample size is small to some extent. We did not exclude addict patients. CONCLUSION: Ultrasound-guided thoracic erector spinae plane block was as effective as thoracic paravertebral block for pain alleviation in patients with unilateral multiple fractured ribs with a comparable duration of analgesic effect, reduction of opioid consumption, and stable hemodynamic profile. However, thoracic erector spinae plane block had the advantage of a lower adverse effect incidence. Clinicians could choose either of the 2 techniques according to their clinical experience and personal choice.


Assuntos
Bloqueio Nervoso , Fraturas das Costelas , Fraturas da Coluna Vertebral , Analgésicos Opioides , Anestésicos Locais/uso terapêutico , Dexametasona , Humanos , Morfina , Bloqueio Nervoso/métodos , Dor/etiologia , Manejo da Dor/métodos , Fraturas das Costelas/complicações , Fraturas das Costelas/terapia , Costelas , Fraturas da Coluna Vertebral/complicações
18.
BMJ Open Qual ; 11(3)2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36122995

RESUMO

BACKGROUND: The State of New York, along with the whole nation, is struggling to combat the opioid epidemic. Major authoritative bodies on chronic pain and addiction have advocated against the use of opioids long term for chronic pain. In the spring of 2021, our pain management clinic made the decision to discontinue chronic opioid prescriptions, offering instead a three-part intervention to provide patients with support for chronic pain during the process of discontinuing chronic opioid therapy (COT). Our goal was to provide safer and more evidence-based care for our chronic pain population. OBJECTIVES: To safely wean patients in our pain management clinic off of COT and offer alternative pain interventions in order to help them reach their health goals. INTERVENTION: Our three-part intervention included a unified plan for weaning patients off COT while simultaneously offering (1) expansion of integrated pain modalities, (2) Suboxone therapy and (3) a community health worker (CHW) support programme. RESULTS: Over the course of 8 months, our clinic successfully transitioned 380 patients off of COT while simultaneously expanding access to alternative pain management modalities, Suboxone therapy and CHW support services. CONCLUSION: Alternative pain management modalities, Suboxone therapy and CHW support all help to aid patients weaning off of COT while still adequately addressing their chronic pain. Our model may be adaptable to other pain management practices hoping to decrease inappropriate use of COT.


Assuntos
Analgésicos Opioides , Dor Crônica , Analgésicos Opioides/uso terapêutico , Combinação Buprenorfina e Naloxona , Dor Crônica/induzido quimicamente , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Humanos , Manejo da Dor , Melhoria de Qualidade
19.
BMJ Open ; 12(9): e057481, 2022 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-36123091

RESUMO

INTRODUCTION: The current manuscript presents a protocol for a systematic review and meta-analysis of the evidence regarding the determinants of responsiveness to multidisciplinary management of chronic pain, with pain intensity, pain-related interference, physical functioning and health-related quality of life as the main outcomes, with consideration to multiple secondary outcomes. METHODS AND ANALYSIS: To identify relevant studies, the Ovid MEDLINE, PubMed, Ovid PsycINFO, EBSCO CINAHL and Scopus databases will be searched for all studies exploring factors associated with responsiveness to multidisciplinary pain management from study inception to the present. Cohorts, case-control studies and randomised controlled trials will be included. Independent screening for eligible studies will be completed by a total of four researchers using defined criteria. Data extraction will be executed by two researchers. Study heterogeneity will be estimated using the I2 index. A meta-analysis will be performed using random effects models. Publication bias will be evaluated by means of funnel plots and Egger's test. ETHICS AND DISSEMINATION: The proposed study does not involve collection of primary data. Therefore, no ethical approval is required. The results of the systematic review and meta-analysis will be presented in a peer-reviewed journal and at conferences. PROSPERO REGISTRATION NUMBER: CRD42021236424.


Assuntos
Manejo da Dor , Qualidade de Vida , Humanos , Estudos Interdisciplinares , Metanálise como Assunto , Manejo da Dor/métodos , Revisões Sistemáticas como Assunto
20.
MMW Fortschr Med ; 164(16): 22-23, 2022 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-36123467
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