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BACKGROUND: Innovations in technology offer potential solutions to address pain care inequities. To maximize impacts, greater understanding is needed regarding preferences and priorities of people experiencing or treating pain. OBJECTIVES: This study conducted focus groups to investigate the perspectives of people with pain and healthcare workers regarding online resources for pain management. Researchers asked about barriers to current pain management and what resources would be most desired in an online format to meet needs. METHODS: Participants were a randomly selected sub-sample of adults from a northwestern region of the United States who participated in an online, survey-based study. Eligible participants identified as either a person who had received treatment for pain or a healthcare worker who cared for people with pain. Of the 199 survey respondents, 30 participated in one of three focus group sessions. Focus groups were conducted using videoconferencing technology, then recorded, transcribed, and analyzed using thematic analysis. RESULTS: Focus group participants included 22 adults who identified as a person treated for pain of any type and 8 healthcare workers. Themes relating to eHealth use reflected desires for (1) freely accessible and vetted pain management information in one place, (2) reliable information tailored to need and pain type, and (3) easy-to-use resources. Findings revealed that some effective pain management resources do exist, yet obstacles including inflexible and inequitable healthcare practices and lack of knowledge about options may limit access to these resources. CONCLUSION: Including preferences of user groups can assist in creating resources that are likely to be useful for those with pain and their caregivers. Innovations are needed to address persisting gaps in care.
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BACKGROUND: The American Society for Pain Management Nursing (ASPMN) began as a nursing-focused pain organization in 1990 and has experienced fluctuations in membership over time. According to the literature, membership to many professional organizations, including ASPMN, are waning. New member recruitment and retention is crucial for maintaining viability and financial strength of an organization. AIM: This study explores ASPMN new member attitudes, perceptions, and experiences. The intention was to learn what inspired or influenced nurse participants to join ASPMN, what they expect gain from membership, and how the organization can help fulfill their professional pain management goals. METHOD: This IRB-exempted qualitative descriptive study offered participants opportunities to reflect upon and share their member experiences either individually or in small focus groups. Nurses were identified via ASPMN new member lists or referred from ASPMN Chapter leaders. Conversations were recorded and transcribed using virtual technology, validated, then analyzed for recurring themes. RESULTS: One key finding was that 0 of 11 participants were fully apprised of member benefits. Key themes were most had motivating factors which prompted their joining ASPMN, and many were seeking organization resources (networking, certification, and new knowledge). Challenging focus group recruitment was likely related to internal and external forces, including post-pandemic fatigue with virtual platforms, time constraints, and a general over-abundance of e-communications. CONCLUSIONS: Many professional organizations continue to struggle to recruit and retain members. While there were no material incentives, the focus group or individual interviews promoted collegiality, reinforced knowledge about ASPMN member benefits, and provided a platform to dialog about how the organization can grow while addressing member needs. Findings from this study may benefit ASPMN and other organizations by providing insight into what attracts and maintains new members, creating a platform to learn about members, and ideally, identifying new ways of engagement and initiatives.
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Dor , Sociedades , Humanos , Comunicação , Pesquisa Qualitativa , Grupos FocaisRESUMO
BACKGROUND: An opioid task force within an urban public health district sought to increase access to, and utilization of, non-opioid, nonpharmacologic alternatives for pain management. AIMS: The COMFORT (Community-engaged Options to Maximize and Facilitate Opioid ReducTion) study was designed to provide virtual multidimensional integrated nonpharmacologic therapies via a cloud-based videoconferencing platform over six weeks to adults with chronic pain who were prescribed an opioid to investigate measurable health improvements. METHODS: A qualitative descriptive analysis explored participants' experiences of a novel pain management intervention. A total of 19 participants consented to participate in the study and 15 completed six virtual consultations with either yoga, massage, chiropractic, or physical therapists. Semi-structured exit interviews were conducted, and data analyzed using content analysis. RESULTS: Five main themes were identified, including unmet pain needs, self-care practices, incentive for participation, perception of a virtual environment, and benefits of the intervention. All participants reported at least minor benefits, with about half reporting improvement in pain levels, and some were able to reduce their opioid use. A virtual environment posed challenges for a few participants who found it more difficult to engage with than in-person therapy; others found the platform easy to navigate. CONCLUSIONS: Participants with chronic pain were open and willing to try a novel way to access nonpharmacologic consultations to address unmet pain needs. Virtual consultations with pain management experts may increase access to, and utilization of, complementary and integrative treatment modalities.
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Terapia por Acupuntura , Dor Crônica , Yoga , Humanos , Adulto , Dor Crônica/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Manejo da Dor/métodosRESUMO
Appropriate care for patients with chronic pain is complex, requiring a thoughtful and holistic approach to pharmacologic intervention, as well as appropriate monitoring when opioids are employed as part of a multimodal regimen. The urine drug test has become an expected standard when longterm opioids are prescribed, but it should be remembered that this test is not intended to be punitive. It is ordered to promote patient safety (Dowell et al., 2022). Recent literature and events surrounding the effect of poppy seeds on urine drug test results have drawn attention to the risks of misinterpreting this test (Bloch, 2023; Lewis et al., 2021; Reisfield et al., 2023; Temple, 2023). Misinterpretation of urine drug tests creates a potential for unfounded accusations from health care workers toward patients, thus, undermining therapeutic relationships and intensifying stigma. Such circumstances may also preclude chances to offer patients needed interventions. Therefore, a valuable opportunity exists for nurses to mitigate untoward consequences by developing a robust understanding of urine drug testing, destigmatizing chronic pain and opioid use, advocating for patients, and enacting change at both an individual and a systems-level.
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Dor Crônica , Transtornos Relacionados ao Uso de Opioides , Papaver , Humanos , Dor Crônica/tratamento farmacológico , Analgésicos Opioides/efeitos adversosRESUMO
BACKGROUND: Novel strategies are needed to curb the opioid overdose epidemic. Smart home sensors have been successfully deployed as digital biomarkers to monitor health conditions, yet they have not been used to assess symptoms important to opioid use and overdose risks. AIM: This study piloted smart home sensors and investigated their ability to accurately detect clinically pertinent symptoms indicative of opioid withdrawal or respiratory depression in adults prescribed methadone. METHODS: Participants (n = 4; 3 completed) were adults with opioid use disorder exhibiting moderate levels of pain intensity, withdrawal symptoms, and sleep disturbance. Participants were invited to two 8-hour nighttime sleep opportunities to be recorded in a sleep research laboratory, using observed polysomnography and ambient smart home sensors attached to lab bedroom walls. Measures of feasibility included completeness of data captured. Accuracy was determined by comparing polysomnographic data of sleep/wake and respiratory status assessments with time and event sensor data. RESULTS: Smart home sensors captured overnight data on 48 out of 64 hours (75% completeness). Sensors detected sleep/wake patterns in alignment with observed sleep episodes captured by polysomnography 89.4% of the time. Apnea events (n = 118) were only detected with smart home sensors in two episodes where oxygen desaturations were less severe (>80%). CONCLUSIONS: Smart home technology could serve as a less invasive substitute for biologic monitoring for adults with pain, sleep disturbances, and opioid withdrawal symptoms. Supplemental sensors should be added to detect apnea events. Such innovations could provide a step forward in assessing overnight symptoms important to populations taking opioids.
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Transtornos Relacionados ao Uso de Opioides , Insuficiência Respiratória , Síndrome de Abstinência a Substâncias , Humanos , Adulto , Analgésicos Opioides/efeitos adversos , Apneia , Polissonografia , Insuficiência Respiratória/diagnóstico , Entorpecentes , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Síndrome de Abstinência a Substâncias/diagnósticoRESUMO
BACKGROUND: Substance use disorders (SUDs) are highly prevalent among adults with persistent pain. Yet, standard competencies for integrating pain and SUD content are lacking across health science student curricula. Additionally, pharmacotherapies to treat SUDs are underutilized. AIM: To address these gaps, a team of health science faculty created an interprofessional simulation activity using a standardized patient and evaluated learner outcomes related to assessment and treatment of comorbid persistent pain and substance use. METHODS: A total of 304 health science students representing nursing, medicine, pharmacy, and social work programs attended virtual learning sessions. Interprofessional student teams developed a team-based care plan for an adult with musculoskeletal pain who takes prescribed opioids while using alcohol. Pre- and post-activity surveys assessing knowledge and confidence were matched for 198 students. Descriptive statistics summarized survey data with inferential analysis of paired data. RESULTS: The largest significant improvements between pre- and post-activity knowledge were observed in items specific to pharmacotherapy options for alcohol and opioid use disorders. Similar gains were noted in students' confidence regarding pharmacotherapies. No significant differences were noted on pre-post-activity knowledge scores between the three main profession groups (medicine, nursing, and pharmacy). CONCLUSIONS: Students attending this interprofessional simulation demonstrated improved knowledge and confidence, particularly in pharmacotherapies for alcohol and opioid use disorders. Replication of such programs can be used to provide consistent content across health science disciplines to heighten awareness and receptivity to medications available to treat SUDs in people treated for persistent pain. The curriculum is freely available from the corresponding author.
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Educação Interprofissional , Transtornos Relacionados ao Uso de Opioides , Humanos , Adulto , Avaliação de Programas e Projetos de Saúde , Currículo , DorRESUMO
INTRODUCTION: With rising age, the incidence of physical and mental problems increases. Physiological and social changes occur across the lifespan that can affect an individual's health and ability. The present study was aimed to determine older adult's ability to recognize cognitive changes and its relation with mental health status. MATERIALS AND METHODS: A descriptive correlational design was used to recruit 423 older adults who were referred to health centers in Tabriz, Iran in 2019 to receive primary health care. A systematic random sampling method was used for selecting participants. Data collection tools included a demographic-social questionnaire, General Health Questionnaire for assessing mental health (with 4 subscales) and a questionnaire of ability to recognize cognitive changes (with 8 sub-scales). Data were analyzed using descriptive statistics and inferential statistics. RESULTS: The mean score of mental health of the older adults was 56.35 (8.40) which shows moderately impaired mental health. The most impaired aspect of mental health detected was the social function dimension 13.20 (2.67). The average of the total ability score was 41.19 (4.78) and the physical strength dimension had the highest average of 9.08 (1.80) and the empowerment obligation dimension had the lowest average of 3.06 (1.08). There was significant relationship between dimensions of depression (r = 0.21, p < 0.001), anxiety (r = 0.1, p = 0.04) and social functioning (r = 0.17), p < 0.001) with the ability to recognize cognitive changes of the older adults. CONCLUSION: Negative mood states and social functioning were associated with the ability to recognize cognitive changes in this population of older adults. This sample exhibited moderately impaired mental health status and relatively large burdens of untreated affective symptoms. Although causality cannot be determined with this cross-sectional design, use of social programs to keep older adults mentally active, as well as cognitive rehabilitation programs could be tested with longitudinal designs for their impact on cognitive change recognition.
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Ansiedade , Saúde Mental , Idoso , Cognição , Estudos Transversais , Humanos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Pain, drug cravings, and opioid withdrawal symptoms can interfere with substance use disorder or opioid tapering treatment goals. AIM: This pilot study investigated the feasibility of a protocol designed to test opioid withdrawal symptom relief relative to a sham condition after two consecutive days of hyperbaric oxygen therapy (HBOT) for adults prescribed daily methadone for opioid use disorder. METHOD: Using a double-blind protocol, eight adults were randomized to receive either a full 90-minute HBOT dose in a pressurized chamber with 100% oxygen at 2.0 atmospheres absolute (ATA) or a sham condition receiving 21% oxygen (equivalent to room air within the chamber) at a minimal pressure of ≤1.3 ATA. Measures included study retention, treatment satisfaction, and pre- and post-intervention effects for opioid withdrawal symptoms, drug cravings, pain intensity and interference, sleep quality, and mood. RESULTS: Study retention and treatment satisfaction was high. All measurements improved more, on average, for participants receiving full-dose HBOT treatment than among participants receiving sham treatments except for clinically observed withdrawal symptoms. The largest positive effects were observed in measurements of pain intensity and drug craving. CONCLUSIONS: These pilot results provide evidence to support a fully powered study of HBOT as a potential treatment adjunct for adults receiving methadone for opioid use disorder. Trends towards symptom improvements were detected from pre- to post-HBOT in the full treatment arm versus sham condition. More research into novel non-pharmacologic options to relieve distressing symptoms related to pain and opioid use disorder is essential to improve clinical outcomes.
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Oxigenoterapia Hiperbárica , Transtornos Relacionados ao Uso de Opioides , Síndrome de Abstinência a Substâncias , Adulto , Humanos , Analgésicos Opioides/efeitos adversos , Oxigenoterapia Hiperbárica/métodos , Metadona , Transtornos Relacionados ao Uso de Opioides/terapia , Oxigênio , Dor , Projetos Piloto , Síndrome de Abstinência a Substâncias/terapia , Manejo da DorRESUMO
The American Society for Pain Management Nursing and the International Nurses Society on Addictions hold the position that persons with co-occurring pain and substance use disorder have the right to be treated with dignity and respect, and receive evidence-based, high-quality assessment and management for both conditions using an integrated, holistic, multidimensional approach. Non-opioid and nonpharmacological approaches to pain management are recommended. Opioids should not be withheld from anyone if necessary to treat pain, and a team-based approach, including pain and addiction specialists, should be utilized when possible. Pain management should include interventions aimed at minimizing the risk for relapse or escalation of problematic substance use, and actively involve the person and their support persons in the plan of care. Institutions should establish policies and procedures that support this position statement.
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Transtornos Relacionados ao Uso de Opioides , Transtornos Relacionados ao Uso de Substâncias , Humanos , Manejo da Dor , Analgésicos Opioides/uso terapêutico , Dor , Transtornos Relacionados ao Uso de Substâncias/terapia , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológicoRESUMO
Assessing and managing pain while evaluating risks associated with substance use and substance use disorders continues to be a challenge faced by health care clinicians. The American Society for Pain Management Nursing and the International Nurses Society on Addictions uphold the principle that all persons with co-occurring pain and substance use or substance use disorders have the right to be treated with dignity and respect, and receive evidence-based, high quality assessment, and management for both conditions. The American Society for Pain Management Nursing and International Nurses Society on Addictions have updated their 2012 position statement on this topic supporting an integrated, holistic, multidimensional approach, which includes nonopioid and nonpharmacological modalities. Opioid use disorder is used as an exemplar for substance use disorders and clinical recommendations are included with expanded attention to risk assessment and mitigation with interventions targeted to minimize the risk for relapse or escalation of substance use. Opioids should not be excluded for anyone when indicated for pain management. A team-based approach is critical, promotes the active involvement of the person with pain and their support systems, and includes pain and addiction specialists whenever possible. Health care systems should establish policies and procedures that facilitate and support the principles and recommendations put forth in this article.
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Transtornos Relacionados ao Uso de Opioides , Manejo da Dor , Analgésicos Opioides/efeitos adversos , Humanos , Transtornos Relacionados ao Uso de Opioides/complicações , Dor/tratamento farmacológicoRESUMO
Objective: To determine if a 2-day protocol measuring pharmacokinetic and pharmacodynamic characteristics can demonstrate drug-drug interactions when smoked cannabis is added to orally administered hydrocodone/acetaminophen combination products. Case Summary: A 51-year-old non-Hispanic white male with chronic pain diagnoses participated in a 2-day pilot protocol. The participant attended two 7-hour in-lab days where he received 10 blood draws each day and completed self-administered pain and anxiety surveys. For both days, the participant took his prescribed dose of hydrocodone/acetaminophen (1/2 tablet of 7.5 mg/325 mg combination product) with the addition of 1 smoked pre-rolled marijuana cigarette (labeled as 0.5 g; 22.17% Δ9-tetrahydrocannabinol; 0.12% cannabidiol) on Day 2. Blood specimens were analyzed using mass spectrometry to quantify the difference of plasma hydrocodone levels between Day 1 and Day 2. Results: Compared to Day 1, lower levels of pain and anxiety were reported during Day 2 with the addition of cannabis to oral hydrocodone/acetaminophen. Day 2 pharmacokinetic analysis also revealed more rapid absorption and overall lower levels of hydrocodone in plasma. Discussion: Lower hydrocodone plasma levels in Day 2 may indicate cannabis's effect on metabolism and reduce the risk of opioid toxicity. The quicker absorption rate of hydrocodone could explain lower pain and anxiety scores reported on the second day. Conclusion and Relevance: A 2-day protocol was able to capture differences across time in pharmacokinetic and pharmacodynamic measurements. Larger studies can be designed to better characterize the potential drug-drug interaction of cannabis and opioids.
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BACKGROUND: Food bank users suffer high food insecurity. Food insecurity increases risk for chronic health conditions. However, chronic pain and its relation to food insecurity among food bank users is unknown. Knowledge about populations with chronic pain is important to direct appropriate public health nutritional strategies. METHODS: Participants completed a survey including sleep, pain, depressive symptoms and food insecurity measures. Descriptive statistics characterized the burden of chronic pain among the sample, and a series of chi-square and t-tests assessed for demographic differences between food bank users who reported pain compared to those who did not. Logistic regression tested for variables predicting food insecurity. RESULTS: Within the sample (N = 207), 53% reported a chronic pain diagnosis. Adults with pain were more likely to receive food stamps and to have a mental health condition than those without pain. Regression analyses revealed that depressive symptoms and chronic pain significantly predicted food insecurity when controlling for age and gender. CONCLUSIONS: Exploring the link between depression, pain and nutritional resources may enhance understanding of causal relationships driving food insecurity. Public health officials should address nutritional needs of adults including those with chronic pain who use food bank services.
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Dor Crônica , Depressão , Adulto , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Insegurança Alimentar , Abastecimento de Alimentos , HumanosRESUMO
BACKGROUND: The number of people managing chronic conditions is growing with the rapidly aging population. Visits to the emergency department are steadily rising, but little is known about the rationale of those seeking emergent care. AIMS: The goal of this study was to better understand, from the patients' perspective, the reasons for seeking care in an emergency department setting. DESIGN: A qualitative descriptive design was used to interview aging adults with at least two chronic conditions who made three or more visits to the emergency department within a year. PARTICIPANTS/SUBJECTS: The eight-person sample was 88% female and 75% white, with an average age of 54 years. METHODS: Participant interviews were conducted with a semistructured interview guide. Conventional content analysis was used to examine words and phrases in professionally transcribed documents. Qualitative methods for testing and confirming conclusions were performed. RESULTS: We discovered that aging adults visit the emergency department to seek relief from unrelenting pain and to overcome barriers to receiving treatment for pain in ambulatory settings. Participants reported feeling judged when seeking emergency department care for pain management. CONCLUSIONS: Participants described emergency department care as the only option in response to several barriers to healthcare access. Most commonly, emergency department care was sought when relief from persistent or acute pain was required. One way to reduce strain on EDs from pain-related visits is to manage patients with persistent pain more proactively in their community environment.
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Dor Aguda , Serviço Hospitalar de Emergência , Adulto , Idoso , Envelhecimento , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Recém-Nascido , Masculino , Manejo da DorRESUMO
OBJECTIVES: Gaps in research evidence and inconsistent policies regarding use of cannabis for pain and associated symptoms result in confusion for healthcare providers and patients. The objective of this review was to synthesize information on cannabis use for pain with legal and policy implications to create a shared decision-making model that can be used to guide patient care interactions. APPROACH: Current cannabis policies, state laws, research, and patient care practices related to medical and recreational cannabis in the United States were reviewed, along with best practices in shared decision-making. Reviewed literature was then synthesized to create a model that can be used by registered nurses and others to address cannabis use, where legal, for pain and related symptoms. RESULT AND CONCLUSIONS: Cannabis is a legal option for many patients with pain. To minimize harms and optimize benefits, nurses can play a key role when authorized by law in assisting with decision-making surrounding cannabis use.
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Dor , Analgésicos , Cannabis , Humanos , Maconha Medicinal/uso terapêutico , Dor/tratamento farmacológico , Estados UnidosRESUMO
BACKGROUND: Poorly managed pain can lead to substance use disorders, depression, suicide, worsening health, and increased use of health services. Most pain assessments occur in clinical settings away from patients' natural environments. Advances in smart home technology may allow observation of pain in the home setting. Smart homes recognizing human behaviors may be useful for quantifying functional pain interference, thereby creating new ways of assessing pain and supporting people living with pain. OBJECTIVE: This study aimed to determine if a smart home can detect pain-related behaviors to perform automated assessment and support intervention for persons with chronic pain. METHODS: A multiple methods, secondary data analysis was conducted using historic ambient sensor data and weekly nursing assessment data from 11 independent older adults reporting pain across 1-2 years of smart home monitoring. A qualitative approach was used to interpret sensor-based data of 27 unique pain events to support clinician-guided training of a machine learning model. A periodogram was used to calculate circadian rhythm strength, and a random forest containing 100 trees was employed to train a machine learning model to recognize pain-related behaviors. The model extracted 550 behavioral markers for each sensor-based data segment. These were treated as both a binary classification problem (event, control) and a regression problem. RESULTS: We found 13 clinically relevant behaviors, revealing 6 pain-related behavioral qualitative themes. Quantitative results were classified using a clinician-guided random forest technique that yielded a classification accuracy of 0.70, sensitivity of 0.72, specificity of 0.69, area under the receiver operating characteristic curve of 0.756, and area under the precision-recall curve of 0.777 in comparison to using standard anomaly detection techniques without clinician guidance (0.16 accuracy achieved; P<.001). The regression formulation achieved moderate correlation, with r=0.42. CONCLUSIONS: Findings of this secondary data analysis reveal that a pain-assessing smart home may recognize pain-related behaviors. Utilizing clinicians' real-world knowledge when developing pain-assessing machine learning models improves the model's performance. A larger study focusing on pain-related behaviors is warranted to improve and test model performance.
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Inteligência Artificial/normas , Aprendizado de Máquina/normas , Manejo da Dor/métodos , HumanosRESUMO
BACKGROUND: Cannabis has been linked to reduced opioid use, although reasons for cannabis use among adults prescribed opioids are unclear. AIMS: The purpose of this study was to determine whether motivations for cannabis use differ between adults prescribed opioids for persistent pain versus those receiving opioids as medication-assisted treatment for opioid use disorder. DESIGN: A cross-sectional survey design was used. PARTICIPANTS: Adults prescribed opioids for persistent pain (n = 104) or opioid use disorder (n = 139) were recruited from outpatient settings. METHODS: Data were collected on surveys asking about cannabis use and compared the two populations. A series of regression models examined population characteristics and cannabis use motivations using validated measures of the Marijuana Motives Measure scale. RESULTS: More than half the sample (n = 122) reported current, daily cannabis use and 63% reported pain as a motivation for use. Adults with persistent pain were more likely to be older, female, and have higher levels of education (p < .05). Adults with opioid use disorder were more likely to report "enhancement" (p < .01) and relief of drug withdrawal symptoms (p < .001) as motivations for cannabis use. The most common reasons for cannabis use in both populations were social and recreational use and pain relief. CONCLUSIONS: Both studied populations have unmet health needs motivating them to use cannabis and commonly use cannabis for pain. Persistent pain participants were less likely to use cannabis for euphoric effects or withdrawal purposes. Nurses should assess for cannabis use, provide education on known risks and benefits, and offer options for holistic symptom management.
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Abuso de Maconha/psicologia , Motivação , Transtornos Relacionados ao Uso de Opioides/complicações , Adulto , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Abuso de Maconha/epidemiologia , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Manejo da Dor/métodos , Manejo da Dor/psicologia , Manejo da Dor/normas , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Adults with persistent pain frequently report cannabis use to help manage their symptoms. The impact of cannabis use on cognition in the presence of concurrent symptoms of depression and anxiety is poorly understood. AIMS: Our study explored how cannabis use affects relationships among symptoms of depression, anxiety, and cognition. DESIGN: A cross-sectional survey study was conducted. SETTINGS: Surveys were distributed at outpatient clinics treating adults for pain in the Pacific Northwestern United States. PARTICIPANTS: A total of 150 adults prescribed an opioid medicine for persistent pain were recruited. METHODS: A pencil and paper survey was used to collect several self-reported ratings of cognition, symptoms of depression and anxiety, and the average potency of cannabis consumed as measured by the percentage of delta-9-tetrahydrocannibinol (THC) and cannabidiol (CBD), as well as frequency of cannabis use. RESULTS: Depression, anxiety and cognition significantly worsened as the reported percentage of CBD, THC and overall frequency of cannabis use in the past 30 days increased. Depression and anxiety both significantly predicted worsening cognition in the sample. The relationship between depressive symptoms and cognition was strengthened as reported percentages of CBD use increased. The relationship was the same for anxiety and cognition, although not as strong. CONCLUSIONS: More cannabis use, particularly high CBD products, may be linked with increased symptom burdens and may strengthen relationships between negative affect and cognition. Further cannabis research within persistent pain populations is warranted to add evidence that can assist patients in managing mood and mental processes. Nurses should evaluate how negative affective health symptoms may impact cognition among adults with persistent pain using prescription opioid medications, especially in the context of concurrent cannabis use.
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Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Cognição , Fumar Maconha/psicologia , Adulto , Idoso , Ansiedade/tratamento farmacológico , Ansiedade/psicologia , Dor Crônica/psicologia , Estudos Transversais , Depressão/tratamento farmacológico , Depressão/psicologia , Feminino , Humanos , Masculino , Fumar Maconha/efeitos adversos , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários , WashingtonRESUMO
BACKGROUND: Long-term use of prescription opioids for pain results in negative health outcomes. Overweight and pain are related, and adults with either condition commonly report poor sleep quality, high levels of depression, low levels of self-efficacy, and high pain interference and intensity. Insufficient research exists regarding how weight may influence pain outcomes in the context of common symptoms. PURPOSE: To investigate how body mass index (BMI) influences relationships between health factors and pain outcomes among adults with pain prescribed opioids. METHODS: The sample included 226 adults. Linear regression models tested relationships among variables and outcomes of pain intensity and pain interference. FINDINGS: BMI significantly strengthened relationships between health factors and pain interference but not pain intensity. DISCUSSION: Adults with persistent pain suffer worsened pain interference in the context of increased weight status. Nurses should consider addressing BMI as part of a holistic pain management care plan.
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Analgésicos Opioides/uso terapêutico , Índice de Massa Corporal , Dor Crônica/tratamento farmacológico , Dor Crônica/fisiopatologia , Obesidade/complicações , Manejo da Dor/métodos , Avaliação de Sintomas/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
INTRODUCTION: A bidirectional relationship exists between obesity and chronic pain. How the two variables influence one another is unclear, especially in the context of prescription opioid use. The current study aimed to explore the phenomenon of overeating in the context of chronic pain and obesity among adults prescribed opioids. METHODS: Adults with a self-reported pain condition taking a prescription opioid completed surveys for this exploratory study. Participants provided demographic data and reported appetite changes when in pain. Chi-square analyses and analyses of variances (ANVOAs) were conducted to establish baseline comparability among body mass index (BMI) groups. Relative risk ratios were calculated to determine risk for reporting an increased appetite among BMI groups. Participants' responses to an open-ended question on appetite when in pain were analyzed using qualitative descriptive analysis. RESULTS: In total, 219 participants' data were analyzed. Of these, 46.8% reported eating less, 38.2% reported an unchanged appetite, and 11.9% reported eating more to feel better when in pain. Adults with obesity were over three times more likely to report an increased appetite compared to adults with normal weight. Participants reported having either a nutritional or a non-food response to painful episodes. CONCLUSIONS: This preliminary study supports that some adults with chronic pain follow poor nutritional patterns when in pain which may make weight management difficult. Pain clinicians should assess and counsel clients for overeating or undereating risks to facilitate pain and weight management.