Prevalence of Burnout Among Pain Medicine Physicians and Its Potential Effect upon Clinical Outcomes in Patients with Oncologic Pain or Chronic Pain of Nononcologic Origin.

Objective: To evaluate the prevalence of burnout among physicians treating patients with chronic pain and to assess the potential relationships between the presence of burnout and patients' clinical outcomes such as pain relief, satisfaction with pain control, and quality of life. Design: An observational, prospective, and noncomparative study. Setting: Pain medicine clinics. Subjects: Physicians from medical departments involved in the management of chronic pain. Patients aged ≥18 years who exhibited moderate chronic pain lasting at least three months. Methods: Physicians were evaluated with the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Patients were evaluated with the Charlson Comorbidity Index, the Brief Pain Inventory-Short Form (BPI-SF), the EuroQol-5D (EQ-5D), and ad hoc instruments for evaluating satisfaction with pain control, the extent to which the treatment met patients' expectations, and subjective impressions of improvement. Results: Of the 301 physician participants, 22 (7.3%, 95% confidence interval [CI] = 4.9 to 10.8) met the criteria of burnout. Burnout was higher among physicians from pain units, while none of the 35 primary care physicians reported burnout. The presence of burnout was positively associated with patients' pain relief (odds ratio [OR] = 1.423, 95% CI = 1.090 to 1.858) but not with satisfaction with pain control or quality of life. Of the remaining independent variables, being treated by pain unit physicians was significantly associated with worse pain relief (OR = 0.592, 95% CI = 0.507 to 0.691), lower satisfaction (ß = -0.680, 95% CI = -0.834 to -0.525), and worse quality of life (ß = -4.047, 95% CI = -5.509 to -2.585) compared with being treated by physicians from other specialties (e.g., traumatologists, oncologists, etc.). Conclusions: Our study shows a lack of negative or clinically relevant (as shown by the negligible to small effect sizes) impact of burnout on patient-reported outcomes (namely, pain relief, satisfaction, and quality of life) in patients with chronic pain who are treated by pain medicine physicians.

Diagnostic accuracy of an identification tool for localized neuropathic pain based on the IASP criteria.

OBJECTIVE: Based on the clear neuroanatomical delineation of many neuropathic pain (NP) symptoms, a simple tool for performing a short structured clinical encounter based on the IASP diagnostic criteria was developed to identify NP. This study evaluated its accuracy and usefulness. METHODS: A case-control study was performed in 19 pain clinics within Spain. A pain clinician used the experimental screening tool (the index test, IT) to assign the descriptions of non-neuropathic (nNP), non-localized neuropathic (nLNP), and localized neuropathic (LNP) to the patients' pain conditions. The reference standard was a formal clinical diagnosis provided by another pain clinician. The accuracy of the IT was compared with that of the Douleur Neuropathique en 4 questions (DN4) and the Leeds Assessment of Neuropathic Signs and Symptoms (LANSS). RESULTS: Six-hundred and sixty-six patients were analyzed. There was a good agreement between the IT and the reference standard (kappa =0.722). The IT was accurate in distinguishing between LNP and nLNP (83.2% sensitivity, 88.2% specificity), between LNP and the other pain categories (nLNP + nNP) (80.0% sensitivity, 90.7% specificity), and between NP and nNP (95.5% sensitivity, 89.1% specificity). The accuracy in distinguishing between NP and nNP was comparable with that of the DN4 and the LANSS. The IT took a median of 10 min to complete. CONCLUSIONS: A novel instrument based on an operationalization of the IASP criteria can not only discern between LNP and nLNP, but also provide a high level of diagnostic certainty about the presence of NP after a short clinical encounter.

Effects of whole body vibration therapy on main outcome measures for chronic non-specific low back pain: a single-blind randomized controlled trial.

OBJECTIVE: The aim of this study was to determine whether a 12-week course of low-frequency vibrating board therapy is a feasible therapy for non-specific chronic low back pain, and whether it improves the main outcome measures. DESIGN: Randomized controlled trial. PATIENTS: A total of 50 patients with non-specific low back pain were included. They were randomly assigned to either a vibrating plate via reciprocation therapy group (n = 25) or a control group (n = 25). METHODS: The 12-week vibration therapy programme consisted of a total of 24 training sessions (2 times/week, with 1 day of rest between sessions). Assessments of the main outcome measures for non-specific low back pain were performed at baseline and at 12 weeks. RESULTS: In the vibration therapy group there was a statistically significant improvement, of 20.37% (p = 0.031) in the Postural Stability Index (anterior-posterior); 25.15% (p = 0.013) in the Oswestry Index; 9.31% in the Roland Morris Index (p = 0.001); 8.57% (p = 0.042) in EuroQol 5D-3L; 20.29% (p = 0.002) in the Sens test; 24.13% (p = 0.006) in visual analogue scale back; and 16.58% (p = 0.008) in the Progressive Isoinertial Lifting Evaluation test. CONCLUSION: A 12-week course of low-frequency vibrating board therapy is feasible and may represent a novel physical therapy for patients with non-specific low back pain.