scholarly journals A Systematic Review of Early Prognostic Factors for Persistent Pain Following Acute Orthopedic Trauma

2012 ◽  
Vol 17 (1) ◽  
pp. 35-44 ◽  
Author(s):  
Fiona J Clay ◽  
Wendy L Watson ◽  
Stuart V Newstead ◽  
Roderick J McClure
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Prognostic Factors ◽  
Injury Severity ◽  
Current Knowledge ◽  
Developed Countries ◽  
Persistent Pain ◽  
Orthopedic Trauma ◽  
Acute Trauma ◽  
Pain Outcomes

Persistent or chronic pain is prevalent in many developed countries, with estimates ranging from 10% to higher than 50%, and is a major economic burden to individuals and societies. However, the variation in pain outcomes after acute orthopedic trauma and treatment confronts treating physicians with uncertainty in providing prognostic advice regarding long-term recovery. Although several previous reviews have addressed the determinants of chronic pain outcomes secondary to acute trauma, they have primarily focused on specific injury samples and, furthermore, lack consistency with respect to the important prognostic factors, which limits the generalizability of findings. This review, however, aimed specifically to identify the early prognostic factors associated with variation in persistent pain outcomes following acute orthopedic trauma presenting with a spectrum of pathologies.BACKGROUND: Acute orthopedic trauma contributes substantially to the global burden of disease.OBJECTIVES: The present systematic review aimed to summarize the current knowledge concerning prognostic factors for the presence of persistent pain, pain severity and pain-related disability following acute orthopedic trauma involving a spectrum of pathologies to working-age adults.METHODS: The Ovid MEDLINE and EMBASE databases were searched for level II prognostic studies published between January 1996 and October 2010. Studies that were longitudinal and reported results with multivariate analyses appropriate for prognostic studies were included. Studies that addressed two specific injury types that have been the subject of previous reviews, namely, injuries to the spinal column and amputations, were excluded.RESULTS: The searches yielded 992 studies; 10 studies met the inclusion criteria and were rated for methodological quality. Seventeen factors were considered in more than one cohort. There was strong evidence supporting the association of female sex, older age, high pain intensity, preinjury anxiety or depression, and fewer years of education with persistent pain outcomes. There was moderate evidence supporting the association between postinjury depression or anxiety with persistent pain, and that injury severity was not a risk factor for ongoing pain.CONCLUSION: Many individuals experience persistent pain following acute trauma. Due to the lack of studies, the use of different constructs to measure the same factor and the methodological limitations associated with many of the studies, the present review was only able to reliably identify a limited set of factors that predicted persistent pain. Recommendations for the conduct of future methodologically rigorous studies of persistent pain are provided.

scholarly journals Prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: A systematic review

2019 ◽  
Vol 42 ◽  
pp. 13-37 ◽  
Author(s):  
Martine Verwoerd ◽  
Harriet Wittink ◽  
Francois Maissan ◽  
Edwin de Raaij ◽  
Rob J.E.M. Smeets
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Neck Pain ◽  
Persistent Pain ◽  
First Episode

Interdisciplinary management for chronic pain in central neurological disorders: a retrospective study

2020 ◽  
Vol 27 (1) ◽  
pp. 1-7
Author(s):  
Jamie Young ◽  
Steven Mantopoulos ◽  
Megan Blanchard ◽  
Hilarie Tardif ◽  
Malcolm Hogg ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Retrospective Study ◽  
Pain Management ◽  
Outcome Measures ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Persistent Pain ◽  
Interdisciplinary Management ◽  
Management Service ◽  
Pain Outcomes

Background/aims Chronic pain in central neurological disorders is common and the current management of chronic pain is through an interdisciplinary approach. The aim of this study was to compare outpatient interdisciplinary-based treatment for chronic pain in patients with central neurological disorders to those without central neurological disorders. Methods This was a retrospective study and pain-related outcome measures were collected from a clinical outcomes registry (electronic Persistent Pain Outcomes Collaboration). This registry contained data on people who attended a pain management service who, for the purpose of this study, were categorised into those with a central neurological disorder and those without a central neurological disorder. The two sample t-test was used to determine the significance of the difference between the groups and statistical significance was defined as P<0.05. Outcome measures compared included the Brief Pain Inventory, Depression, Anxiety and Stress Scale 21, Patient Self-efficacy Questionnaire and Patient Catastrophisation Scale. Results There was a total of 1924 participants with a central neurological disorder. The electronic Persistent Pain Outcomes Collaboration registry shows that after engagement with an interdisciplinary pain management service, there was a reduction in pain severity scores, interference, mean depression, anxiety and stress in both groups at end of an episode of care compared to referral. There was a significant difference in mean changes for pain catastrophising between those with a central neurological disorder (−10.3) and those without (−7.8). Conclusions This study shows that people with central neurological disorders can also benefit from interdisciplinary management and have similar results to those without these conditions.

Use of multidomain management strategies by community dwelling adults with chronic pain: evidence from a systematic review

2019 ◽  
Vol 19 (1) ◽  
pp. 9-23 ◽  
Author(s):  
David R. Axon ◽  
Mira J. Patel ◽  
Jennifer R. Martin ◽  
Marion K. Slack
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Pain Management ◽  
Adverse Events ◽  
Management Strategies ◽  
Community Dwelling ◽  
Controlled Vocabulary ◽  
Self Management ◽  
Patient Reported ◽  
Pain Outcomes

AbstractBackground and aimsMultidomain strategies (i.e. two or more strategies) for managing chronic pain are recommended to avoid excessive use of opioids while producing the best outcomes possible. The aims of this systematic review were to: 1) determine if patient-reported pain management is consistent with the use of multidomain strategies; and 2) identify the role of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) in patient-reported pain management.MethodsBibliographic databases, websites, and reference lists of included studies were searched to identify published articles reporting community-based surveys of pain self-management from January 1989 to June 2017 using controlled vocabulary (and synonyms): pain; self-care; self-management; self-treatment; and adult. Two independent reviewers screened studies and extracted data on subject demographics, pain characteristics, pain self-management strategies, and pain outcomes. Pain self-management strategies were organized according to our conceptual model. Included studies were assessed for risk of bias. Differences between the researchers were resolved by consensus.ResultsFrom the 3,235 unique records identified, 18 studies published between 2002 and 2017 from 10 countries were included. Twenty-two types of pharmacological strategies were identified (16 prescription, six non-prescription). NSAIDs (15 studies, range of use 10–72%) and opioids (12 studies, range of use 5–72%) were the most commonly reported prescription pharmacological strategies. Other prescription pharmacological strategies included analgesics, acetaminophen, anticonvulsants, antidepressants, anxiolytics, salicylates, β-blockers and calcium channel blockers, disease-modifying anti-rheumatic drugs and steroids, muscle relaxants, topical products, triptans, and others. Twenty-two types of non-pharmacological strategies were identified: four medical strategies (10 studies), 10 physical strategies (15 studies), four psychological strategies (12 studies), and four self-initiated strategies (15 studies). Medical strategies included consulting a medical practitioner, chiropractic, and surgery. Physical strategies included exercise, massage, hot and cold modalities, acupuncture, physical therapy, transcutaneous electrical nerve stimulation, activity modification or restriction, assistive devices, and altering body position/posture. Psychological strategies included relaxation, prayer or meditation, therapy, and rest/sleep. Self-initiated strategies included dietary or herbal supplements, dietary modifications, and complementary and alternative medicine. Overall, the number of strategies reported among the studies ranged from five to 28 (out of 44 identified strategies). Limited data on pain outcomes was reported in 15 studies, and included satisfaction with pain management strategies, pain interference on daily activities, adverse events, lost work or restricted activity days, emergency department visits, and disabilities.ConclusionsA wide variety and large number of pharmacological and non-pharmacological strategies to manage chronic pain were reported, consistent with the use of multidomain strategies. High levels of use of both NSAIDs and opioids also were reported.ImplicationsComprehensive review and consultation with patients about their pain management strategies is likely needed for optimal outcomes. Additional research is needed to determine: how many, when, and why multidomain strategies are used; the relationship between opioid use, multidomain management strategies, and level of pain; how multidomain strategies relate to outcomes; and if adding strategies to a pain management plan increases the risk of adverse events or interactions, and increases an individuals pain management burden.

scholarly journals Using Mediation Analysis to Understand How Treatments for Paediatric Pain Work: A Systematic Review and Recommendations for Future Research

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 147
Author(s):  
Hayley B. Leake ◽  
G. Lorimer Moseley ◽  
Tasha R. Stanton ◽  
Lauren C. Heathcote ◽  
Joshua W. Pate ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Treatment Effect ◽  
Mediation Analysis ◽  
Future Research ◽  
Functional Abdominal Pain ◽  
Mediation Analyses ◽  
Intermediate Variable ◽  
Pain Outcomes ◽  
Irritable Bowel

Clinicians have an increasing number of evidence-based interventions to treat pain in youth. Mediation analysis offers a way of investigating how interventions work, by examining the extent to which an intermediate variable, or mediator, explains the effect of an intervention. This systematic review examined studies that used mediation analysis to investigate mechanisms of interventions on pain-relevant outcomes for youth (3–18 years) with acute or chronic pain, and provides recommendations for future mediation research in this field. We searched five electronic databases for clinical trials or observational longitudinal studies that included a comparison group and conducted mediation analyses of interventions on youth and assessed pain outcomes. We found six studies (N = 635), which included a total of 53 mediation models examining how interventions affect pain-relevant outcomes for youth. Five studies were secondary analyses of randomized controlled trials of psychological interventions for chronic pain; one was a longitudinal observational study of morphine for acute pain. The pain conditions studied were irritable bowel syndrome, functional abdominal pain, juvenile fibromyalgia, mixed chronic pain, and post-operative pain. Fourteen putative mediators were tested, of which three partially mediated treatment effect; seven did not significantly mediate treatment effect and four had mixed results. Methodological and reporting limitations were common. There are substantial gaps in the field with respect to investigating, and therefore understanding, how paediatric interventions work.

scholarly journals Teaming In Interdisciplinary Chronic Pain Management Interventions In Primary Care: A Systematic Review Protocol

2021 ◽  
Author(s):  
Karleen F. Giannitrapani ◽  
Natalie B. Connell ◽  
Sophia N. Zupanc ◽  
Pallavi Prathivadi ◽  
Sara J. Singer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Interdisciplinary Teams ◽  
Cochrane Library ◽  
Management Interventions ◽  
Patient Reported ◽  
Pain Outcomes ◽  
Interdisciplinary Interventions

Abstract BackgroundPatients with chronic cancer or non-cancer pain often struggle with physical, emotional, and psychological problems not easily addressed by a single clinician. Current pain management recommendations emphasize leveraging interdisciplinary teams. We aim to describe how we intend to identify key features of interdisciplinary team structures and processes associated with improved pain outcomes for patients experiencing chronic pain in primary care settings. Methods We will include randomized studies and systematic reviews of interventions involving teaming that address chronic or cancer-related pain. A systematic review of articles published in English and after 2009 in PubMed, EMBASE, CINAHL, and Cochrane Library will be conducted. The primary outcome will be a numeric, patient-reported pain score. Extracted data will include details about the team structures and processes used in the interdisciplinary interventions based in primary care. DiscussionThe intended systematic review will examine interventions that incorporate teamwork or teaming to manage chronic pain and will synthesize evidence as to which team structures and processes may help facilitate improved pain management, and thus improved pain outcomes. Results of this systematic review may help inform how to organize teams within primary care that will be most beneficial to chronic pain patients and highlight opportunities for future, high-quality randomized controlled trials exploring teaming models in primary care.Systematic review registration: PROSPERO #CRD42020191467

Prevention of the development and maintenance of pediatric chronic pain and disability

2021 ◽  
pp. 47-56
Author(s):  
Brittany N. Rosenbloom ◽  
M. Gabrielle Pagé ◽  
Anna Huguet ◽  
Joel Katz
Keyword(s):  
Chronic Pain ◽  
Prognostic Factors ◽  
Protective Factors ◽  
Theoretical Models ◽  
Persistent Pain ◽  
Predisposing Factors ◽  
Clinical Implications ◽  
Pediatric Pain ◽  
Essential Step ◽  
Pediatric Chronic Pain

Understanding the predisposing factors that confer a greater or lesser risk of developing chronic, or persistent, pain is an essential step in chronic pain prevention and management. This chapter focuses on current theoretical models that can inform prevention of pediatric pain and disability. We review the literature on known risk/protective factors, markers, correlates, and prognostic factors for the transition to chronic pain and disability across a variety of pain conditions. We distinguish between primary, secondary, and tertiary levels of pain prevention and discuss the clinical implications of this distinction.

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