Article

Pain as a reason to visit the doctor: A study in Finnish primary health care

February 2001
Pain 89(2-3):175-80

DOI:10.1016/S0304-3959(00)00361-4

Source
PubMed

Authors:

Pekka Mäntyselkä

University of Eastern Finland

Riitta Ahonen

University of Eastern Finland

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This study aims to demonstrate the prevalence of pain as a reason for seeing a physician in primary care. We also performed an analysis of the localization, duration and frequency of pains, as well as the diagnoses of patients having pain. A total of 28 physicians at 25 health centers in Finland collected the data, comprising 5646 patient visits. Pain was identified as the reason for 2237 (40%) of the visits. The most common localizations were in the lower back, abdomen and head. One-fifth of the pain patients had experienced pain for over six months. Analysis of the diagnoses revealed half of the pains to be musculoskeletal. Patients experienced considerable limitations in various activities of life due to pain. A quarter of the pain patients of active working age received sick leave. Our results confirm that pain is a major primary health care problem, which has an enormous impact on public health.

Unidad de Tratamiento de Dolor

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Apr 2024

josé Luis Bernal

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Mar 2025

Background Palliative care aims to alleviate suffering and improve the quality of life for patients with life‐limiting illnesses through effective pain management with opioids. Despite its global importance, opioid use in palliative care faces significant challenges, particularly in resource‐poor settings like Bangladesh. In Bangladesh, opioid use is notably low, with disparities between urban and rural areas. Cultural stigmas, strict regulations, and inadequate healthcare provider training further obstruct effective pain management. Objective This study aims to explore the challenges healthcare providers face regarding opioid use in both hospital and home‐based palliative care settings. Method A descriptive cross‐sectional study was conducted using face‐to‐face semistructured interviews with 135 licensed healthcare providers from August to September 2022. Results The respondents, predominantly young (57% aged 20–39) and female (68.9%), primarily manage late‐stage cancer patients (98.5%), with pain (100%) being the primary symptom treated. Morphine syrup is commonly used (68.1%), whereas oxycodone and buprenorphine are unavailable. Side effects such as deep sedation (43.7%) and addiction (34.1%) highlight the need for careful monitoring. Limited awareness (10.4%) of national opioid policies results in inconsistent practices (p = 0.001) and (p = 0.004). Prescribing restrictions (60.7%) and dispensing rights issues contribute to operational challenges, affecting patient access to pain management. Misconceptions about palliative care (32.6%) and inter‐departmental non‐cooperation (38.5%) hinder patient referrals (p = 0.001) and continuity of care. Conclusion Inconsistent awareness of opioid policies causes varied practices and attitudes. Addressing referral challenges and prescribing restrictions requires interdisciplinary solutions, enhanced education, better policy dissemination, and standardized guidelines for effective palliative care opioid management.

Dolor y cuidados paliativos: el conocimiento de los estudiantes de medicina y las brechas de graduación.Pain and palliative care: medical students' knowledge and graduation gaps.: Publicado originalmente en: Rev Dor. São Paulo, 2017 oct-dec; 18 (4): 307-10. Traducción: Noelia Sosa Echeverría.Publicado originalmente en: Rev Dor. São Paulo, 2017 oct-dec; 18 (4): 307-10. Translation: Noelia Sosa Echeverría.

Article

Full-text available

Apr 2018

Actualmente la carrera de medicina no brinda la educación completa en manejo del dolor y también está desprovista de disciplinas que abordan la tanatología en la atención paliativa. El objetivo de este estudio fue evaluar el conocimiento sobre el dolor y los cuidados paliativos de los estudiantes de medicina y su percepción sobre cómo estos temas se enseñan durante la carrera de graduación.

Pain and Its Management in Patients Referred to a Geriatric Outpatient Clinic

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Sep 2023

(1) Background: A major problem affecting geriatric patients is pain. In addition to pain, a significant problem of old age is dementia and depression, which can hinder the diagnosis and treatment of pain. The aim of this study was to analyse the prevalence of pain in patients treated in a geriatric outpatient clinic and the treatment used. (2) Methods: The analysis was based on the records of 937 patients who visited the Geriatric Outpatient Clinic in Dobre Miasto between 2015 and 2020. Based on records containing data dating back to their first visit to the hospital, patients’ experiences of pain, the presence of depressive symptoms and dementia, and the pharmacological treatment used for pain (analgesics and coanalgesics) were analysed. (3) Results: Pain complaints were reported by 311 patients (33.2% of the study group), 76% of the complaints were from females. The mean age of the patients was 78 years (SD = 8.45). At least one analgesic drug was taken by 107 patients (34.4%). The most commonly used analgesics were opioids (63 patients, 58.87%), especially tramadol. Of the potential coanalgesics, the largest number of patients used an antidepressant. (4) Conclusions: Despite the widespread prevalence of pain among the elderly, only about one-third of them were taking pain medication, mainly in the form of weak opioids. Patients with symptoms of dementia were found to report pain less frequently.

Pseudo-labeling based adaptations of pain domain classifiers

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Apr 2025

Introduction Each human being experiences pain differently. In addition to the highly subjective phenomenon, only limited labeled data, mostly based on short-term pain sequences recorded in a lab setting, is available. However, human beings in a clinic might suffer from long painful time periods for which even a smaller amount of data, in comparison to the short-term pain sequences, is available. The characteristics of short-term and long-term pain sequences are different with respect to the reactions of the human body. However, for an accurate pain assessment, representative data is necessary. Although pain recognition techniques, reported in the literature, perform well on short-term pain sequences. The collection of labeled long-term pain sequences is challenging and techniques for the assessment of long-term pain episodes are still rare. To create accurate pain assessment systems for the long-term pain domain a knowledge transfer from the short-term pain domain is inevitable. Methods In this study, we adapt classifiers for the short-term pain domain to the long-term pain domain using pseudo-labeling techniques. We analyze the short-term and long-term pain recordings of physiological signals in combination with electric and thermal pain stimulation. Results and conclusions The results of the study show that it is beneficial to augment the training set with the pseudo labeled long-term domain samples. For the electric pain domain in combination with the early fusion approach, we improved the classification performance by 2.4% to 80.4% in comparison to the basic approach. For the thermal pain domain in combination with the early fusion approach, we improved the classification performance by 2.8% to 70.0% in comparison to the basic approach.

Needs of older adults in Kazakhstan: analysis and psychometric properties of the localized version of the EASYCare standard 2010 instrument

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Feb 2025

Background Studies about the needs of older individuals in Central Asia are very sparse. Thus, this study aimed to evaluate the needs of older adults in Kazakhstan with the EASYCare Standard 2010 (EC) questionnaire. Methods The study involved 524 participants aged 65 and older from various regions in Kazakhstan. Data were collected by trained research staff, and the participants’ needs were examined using median split with the three summarizing indexes of the EC system (Independence score, Risk of breakdown in care, and Risk of falls). Results Subjects with primary education had approximately double odds of scoring above the median compared to those with higher education in Independence score (p < 0.01) and Risk of breakdown in care (p < 0.01). Individuals with primary education also had 60% higher odds of scoring above the Risk of falls scale threshold, indicating a risk in this category (p < 0.05). For the Risk of falls scores, financial situation was also significant; individuals having not enough to make ends meet had 75% higher odds than the remaining ones (p < 0.01). Conclusion Our analysis highlights the importance of tailored interventions to address the unmet needs of the Kazakh population, particularly among those with lower education and those with financial concerns. The study also underscores the need for sustainable, comprehensive eldercare policies in Kazakhstan that account for the growing older population.

Exploring musculoskeletal pain among Italian olive pickers: A cross-sectional investigation into prevalence, attitudes, expectations, and beliefs

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Jan 2025
Work

Background Olive pickers confront ergonomic hazards when performing work activities that may lead to musculoskeletal pain (MSK) that must be adequately managed. The success of MSK pain prevention and treatment strategies is linked to olive pickers’ state of empowerment, shaped by expectations and beliefs. Objective This study highlighted the prevalence of MSK pain among Italian olive pickers and explored their attitudes, expectations, and beliefs about MSK pain prevention and care. Methods A web-based cross-sectional survey instrument was developed to collect data from an Italian olive pickers’ cohort in the Liguria region. The survey investigated the sample on (1) MSK pain prevalence and characteristics, (2) preventive and treatment activities for MSK pain, (3) expectations about MSK pain treatments, and (4) beliefs about their job and MSK pain onset. Results From January to July 2021, we collected data from 127 participants (78% men); mean age 52 ± 13). Prevalence of MSK pain over one month, six months, and one year was 61.6%, 77.8%, and 84.8%, respectively. The most affected joints were the lumbar spine (61%), the shoulders (57%), and the cervical spine (46%). To prevent the onset of MSK pain, 44% of participants did nothing, and 94% of them never attended any preventive physical activity. Conclusions MSK pain strongly impacts Ligurian olive pickers, as three out of four experienced it during the last six months. Participants emphasised the need to be educated on working ergonomics and the perceived importance of physical activity for health.

Evaluation of a New Mobile Virtual Reality Setup to Alter Pain Perception: Pilot Development and Usability Study in Healthy Participants Corresponding Author

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Dec 2024

Background: Chronic pain presents a significant treatment challenge, often leading to frustration for both patients and therapists due to the limitations of traditional methods. Research has shown that synchronous visuo-tactile stimulation, as used in the rubber hand experiment, can induce a sense of ownership over a fake body part and reduces pain perception when ownership of the fake body part is reported. The effect of the rubber hand experiment can be extended to the full body, for example, during the full-body illusion, using both visuo-tactile and cardiovisual signals. Objective: This study first aimed to evaluate the usability and accuracy of a novel, mobile virtual reality (VR) setup that displays participants' heartbeats as a flashing silhouette on a virtual avatar, a technique known as the cardiovisual full-body illusion. The second part of the study investigated the effects of synchronous cardiovisual stimulation on pain perception and ownership in 20 healthy participants as compared with asynchronous stimulation (control condition). Methods: The setup comprised a head-mounted display (HMD) and a heart rate measurement device. A smartphone-based HMD (Samsung Galaxy S8+) was selected for its mobility, and heart rates were measured using smartwatches with photo-plethysmography (PPG). The accuracy of 2 smartwatch positions was compared with a 5-point electrocardiogram (ECG) standard in terms of their accuracy (number and percent of missed beats). Each participant underwent two 5-minute sessions of synchronous cardiovisual stimulation and two 5-minute sessions of asynchronous cardiovisual stimulation (total of 4 sessions), followed by pain assessments. Usability, symptoms of cybersickness, and ownership of the virtual body were measured using established questionnaires (System Usability Scale, Simulator Sickness Questionnaire, Ownership Questionnaire). Pain perception was assessed using advanced algometric methods (Algopeg and Somedic algometer). Results: Results demonstrated high usability scores (mean 4.42, SD 0.56; out of 5), indicating ease of use and acceptance, with minimal side effects (mean 1.18, SD 0.46; out of a possible 4 points on the Simulator Sickness Questionnaire). The PPG device showed high heart rate measurement precision, which improved with optimized filtering and peak detection algorithms. However, compared with previous work, no significant effects on body ownership and pain perception were observed between the synchronous and asynchronous conditions. These findings are discussed in the context of existing literature on VR interventions for chronic pain.

Transcranial Direct Current Stimulation Reduces Pressure Pain Sensitivity in Patients with Non-Malignant Chronic Pain

Article

Sep 2024
CLIN J PAIN

Objectives Non-malignant chronic pain is a clinical challenge because pharmacological treatment often fails to relieve pain. Transcranial direct current stimulation (tDCS) is a treatment that could have the potential for pain relief and improvement in quality of life. However, there is a lack of clinical trials evaluating the effects of tDCS on the pain system. The aim of the present study was to evaluate the effect of 5 days of anodal tDCS treatment on the pain system in chronic non-malignant pain patients using quantitative sensory testing (QST) and quality of life questionnaires: (1) Brief Pain Inventory-short form (BPI-sf), (2) European Organization for Research and Treatment of Life Questionnaire (EORTC-C30), and (3) Hospital Anxiety Depression Scale (HADS). Methods Eleven non-malignant chronic pain patients (51±13.6 years old, 5M) participated in the study. Anodal tDCS was applied for five consecutive days, followed by sham stimulation after a washout period of at least two weeks. Pressure pain thresholds (PPT) and pain tolerance thresholds (PTT) were assessed in different body regions on days 1 and 5. Results Anodal tDCS appeared to maintain PTT at C5 (clavicle) on day 5, but sham stimulation decreased PTT ( P =0.007). Additionally, anodal tDCS increased PTT compared to sham at day 5 at Th10 ventral dermatomes ( P =0.014). Both anodal and sham tDCS decreased the BPI-sf total and interference scores, and the EORTC-C30 fatigue score, but no interaction effect was observed. Discussion This study adds to the evidence in the literature that tDCS may be a potential therapeutic tool for the management of non-malignant chronic pain.

Evaluation of a new mobile virtual reality setup to alter pain perception: A pilot study in healthy subjects (Preprint)

Article

Full-text available

Aug 2023

Background Chronic pain presents a significant treatment challenge, often leading to frustration for both patients and therapists due to the limitations of traditional methods. Research has shown that synchronous visuo-tactile stimulation, as used in the rubber hand experiment, can induce a sense of ownership over a fake body part and reduces pain perception when ownership of the fake body part is reported. The effect of the rubber hand experiment can be extended to the full body, for example, during the full-body illusion, using both visuo-tactile and cardiovisual signals. Objective This study first aimed to evaluate the usability and accuracy of a novel, mobile virtual reality (VR) setup that displays participants’ heartbeats as a flashing silhouette on a virtual avatar, a technique known as the cardiovisual full-body illusion. The second part of the study investigated the effects of synchronous cardiovisual stimulation on pain perception and ownership in 20 healthy participants as compared with asynchronous stimulation (control condition). Methods The setup comprised a head-mounted display (HMD) and a heart rate measurement device. A smartphone-based HMD (Samsung Galaxy S8+) was selected for its mobility, and heart rates were measured using smartwatches with photoplethysmography (PPG). The accuracy of 2 smartwatch positions was compared with a 5-point electrocardiogram (ECG) standard in terms of their accuracy (number and percent of missed beats). Each participant underwent two 5-minute sessions of synchronous cardiovisual stimulation and two 5-minute sessions of asynchronous cardiovisual stimulation (total of 4 sessions), followed by pain assessments. Usability, symptoms of cybersickness, and ownership of the virtual body were measured using established questionnaires (System Usability Scale, Simulator Sickness Questionnaire, Ownership Questionnaire). Pain perception was assessed using advanced algometric methods (Algopeg and Somedic algometer). Results Results demonstrated high usability scores (mean 4.42, SD 0.56; out of 5), indicating ease of use and acceptance, with minimal side effects (mean 1.18, SD 0.46; out of a possible 4 points on the Simulator Sickness Questionnaire). The PPG device showed high heart rate measurement precision, which improved with optimized filtering and peak detection algorithms. However, compared with previous work, no significant effects on body ownership and pain perception were observed between the synchronous and asynchronous conditions. These findings are discussed in the context of existing literature on VR interventions for chronic pain. Conclusions In conclusion, while the new VR setup showed high usability and minimal side effects, it did not significantly affect ownership or pain perception. This highlights the need for further research to refine VR-based interventions for chronic pain management, considering factors like visual realism and perspective.

A UTILIZAÇÃO DE CANABINOIDES NO TRATAMENTO DA NEVRALGIA TRIGEMINAL

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Jan 2024

ABSTRACT: Trigeminal neuralgia (TN) is a condition characterised by intense, paroxysmal pain, i.e. sudden, intermittent attacks in the orofacial region innervated by the branches of the trigeminal nerve. Episodes of pain generally occur spontaneously, but can be triggered by stimuli that are innocuous to most individuals, such as the touch of a finger on a specific area of the face or even habitual tasks such as putting on make-up, brushing teeth, chewing and even talking. The limited knowledge about the aetiology and pathophysiology of trigeminal neuralgia means that its treatment remains a major challenge for health professionals. Early and accurate diagnosis of TN is fundamental to the success of therapeutic interventions and can reduce or eliminate pain episodes. Pharmacological therapy is usually the first option, but it must be individualised and tailored to the patient's particularities and general condition. Some studies have shown the effectiveness of cannabinoids in promoting analgesia in chronic pain of various etiologies, especially neuropathic pain associated with diabetes, human immunodeficiency virus, multiple sclerosis, severe rheumatoid arthritis and fibromyalgia. They have also shown satisfactory results for controlling pain of oncological origin, post-traumatic pain, post-surgical pain, neuropathic pain and peripheral neuropathies. Over the last decade, interest in cannabis in medicine and dentistry has increased, and several countries, including the United States and Canada, have produced their own legislation on it and cannabis-based medicines. This study aimed to carry out a scoping review of the available literature, taking into account the efficacy, indications and doses used of cannabinoids in the NT. The databases used were Pubmed, ScienceDirect and LILACS. Articles were included in English, Portuguese and Spanish, with no year restriction. A total of 70 relevant articles were identified, however after excluding duplicates, 49 articles were selected for title evaluation and were submitted for reading. After screening, 5 full-text articles were evaluated. One article was excluded because it was a literature review and three studies met the eligibility criteria and were included in the review for data extraction and evaluation. The studies analysed highlight the therapeutic potential of cannabinoids in the management of TN and other forms of neuropathic pain. They emphasise the efficacy of both synthetic and natural cannabinoids in mitigating pain sensitivity in patients diagnosed with multiple sclerosis and post-stroke pain syndrome with associated TN. Although they suggest that cannabinoids may represent an alternative for cases of neuropathic pain that are refractory to conventional treatments, among others NT. Scientific evidence on this therapeutic agent is still insufficient, although some studies have shown benefits. However, more clinical trials are needed to raise the level of evidence about the benefits of this treatment, to fully understand its long-term effects and to establish the best dosage and safety practices. KEYWORDS: Trigeminal neuralgia; Cannabinoids

Women’s experiences with continuity for effective coordination during maternal and neonatal continuum in Kenya: An interpretive phenomenology

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Full-text available

Aug 2024

Background: Embracing women’s experiences in decision-making is imperative for continuity in effective coordination of maternal and neonatal health (MNH); women are the end users within the care ecosystem. Through women’s continuous feedback, skilled birth attendants (SBAs) and the healthcare system get to understand emerging issues based on their needs and preferences.Aim: The purpose of this article is to describe women’s experiences of continuity for effective coordination of care through the transitions in the MNH continuum in Kenya.Setting: The study was conducted in selected counties of Kenya based on birth rates per woman as follows: Wajir (7.8) Narok (6.0) Kirinyaga (2.3) and Nairobi (2.7) (1). The clients were interviewed concerning their experiences of the MNH continuum of care in English and Kiswahili.Methods: An interpretive hermeneutic phenomenological approach was used to construct the experiences of women of continuity during transitions in the MNH continuum for effective care coordination. Twelve participants were interviewed between January and April 2023. Atlas ti 22 software was used for data analysis.Results: Four women experiences were highlighted: Women unawareness of preconception care, use of prenatal care, labour, birthing and postpartum flow and the women’s view on the MNH continuum.Conclusion: The women reported their segmental and transitional experience of the MNH continuum as one that did not consistently meet their needs and preferences in order for them to fully agree that the continuum enhanced continuity for effective coordination. They felt that they experienced continuity in some segments while in some they did not.Contribution: The embrace of women’s experience of their needs and preferences through the MNH continuum (segments and transitional segments) through the lens of continuity for effective coordination is timely towards the improvement of maternal and neonatal care by 2030.

Study on the Mechanism of Acupuncture and Moxibustion Regulating the Central Nervous System of Osteoarthritis

Article

Full-text available

Jul 2024

OA is considered a non lethal chronic progressive disease with a particularly complex pathogenesis. Current treatment methods mainly aim to delay the progression of the disease, alleviate pain, and improve bone and joint functional activity. Arthritis pain is the most common cause of OA, which is not only related to pathological changes of bone and joint, but also involves complex neural mechanisms. Clarifying this point has guiding significance for the treatment of osteoarthritis. This article will describe the central nervous mechanism of acupuncture and moxibustion regulating chronic pain in OA.

Factors affecting functional disability in patients with non-specific chronic low back pain: a cross-sectional study

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Full-text available

May 2024

Background Knowledge about factors affecting functional disability in patients with non-specific chronic low back pain (NSCLBP) is helpful in guiding treatment, but there has been little systematic research on this topic. This study aimed to identify independent factors contributing to functional disability in NSCLBP patients especially the impact of sagittal parameters and body postures in work, learning, and daily life. Methods Sociodemographic data, sagittal parameters, Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), and 36-item Short Form Health Survey (SF-36) of NSCLBP patients were collected. Patients were divided into a low-functional disability group (ODI ≤ 20) and a high-functional disability group (ODI > 20), and the ODI was converted to ranked ODI (RODI) accordingly. Sociodemographic data, sagittal parameters, NRS, and SF-36 were compared by univariate analysis between both groups. A correlation analysis of the aforementioned factors with the RODI was conducted. The sociodemographic data and sagittal parameters related to the RODI were analyzed by logistic regression to select potential RODI-associated factors. The level of significance was set at P < 0.05. Results Age, educational background, daily main posture while working or learning (DMPWL), daily standing time while working or learning (DSTTWL), daily sitting time while resting (DSITR), sacral slope–pelvic tilt (SS-PT), spinosacral angle (SSA), NRS, and SF-36 (except mental health, MH) were different between the two groups (P < 0.05). Correlation analysis showed that they were related to the RODI (P < 0.05). The logistic regression analysis indicated that the regression coefficients of a college degree, postgraduate diploma, DSITR, and SSA were (B = −0.197; P = 0.003), (B = −0.211; P = 0.006), (B = −0.139; P = 0.039), and (B = −0.207; P = 0.001), respectively, and the odds ratio (OR) and 95% confidence interval (CI) were 0.489 (0.308; 0.778), 0.299 (0.125; 0.711), 0.875 (0.772; 0.993), and 0.953 (0.925; 0.981), respectively. Conclusion Educational background, DSITR, and SSA are independent factors affecting functional disability in NSCLBP patients. NSCLBP patients with a lower educational background, shorter DSITR, or smaller SSA should be taken into account in clinical practice and therapeutic choices. Extending sitting time for rest and the avoidance of a forward-leaning standing position are beneficial for reducing functional disability in NSCLBP.

Enhancing Chronic Non-Cancer Pain Management: A Systematic Review of Mindfulness Therapies and Guided Imagery Interventions

Article

Full-text available

Apr 2024
MED LITH

Background and Objectives: There has been an increasing interest in the use of non-pharmacological approaches for the multidimensional treatment of chronic pain. The aim of this systematic review was to assess the effectiveness of mindfulness-based therapies and Guided Imagery (GI) interventions in managing chronic non-cancer pain and related outcomes. Materials and Methods: Searching three electronic databases (Web of Science, PubMed, and Scopus) and following the PRISMA guidelines, a systematic review was performed on Randomized Controlled Trials (RCTs) and pilot RCTs investigating mindfulness or GI interventions in adult patients with chronic non-cancer pain. The Cochrane Risk of Bias Tool was utilized to assess the quality of the evidence, with outcomes encompassing pain intensity, opioid consumption, and non-sensorial dimensions of pain. Results: Twenty-six trials met the inclusion criteria, with most of them exhibiting a moderate to high risk of bias. A wide diversity of chronic pain types were under analysis. Amongst the mindfulness interventions, and besides the classical programs, Mindfulness-Oriented Recovery Enhancement (MORE) emerges as an approach that improves interoception. Six trials demonstrated that mindfulness techniques resulted in a significant reduction in pain intensity, and three trials also reported significant outcomes with GI. Evidence supports a significant improvement in non-sensory dimensions of pain in ten trials using mindfulness and in two trials involving GI. Significant effects on opioid consumption were reported in four mindfulness-based trials, whereas one study involving GI found a small effect with that variable. Conclusions: This study supports the evidence of benefits of both mindfulness techniques and GI interventions in the management of chronic non-cancer pain. Regarding the various mindfulness interventions, a specific emphasis on the positive results of MORE should be highlighted. Future studies should focus on specific pain types, explore different durations of the mindfulness and GI interventions, and evaluate emotion-related outcomes.

Clinicians diagnosing virtual patients with the classification algorithm for chronic pain in the ICD-11 (CAL-CP) achieve better diagnoses and prefer the algorithm to standard tools: An experimental validation study

Article

Apr 2024
EUR J PAIN

Background The ICD‐11 classification of chronic pain comprises seven categories, each further subdivided. In total, it contains over 100 diagnoses each based on 5–7 criteria. To increase diagnostic reliability, the Classification Algorithm for Chronic Pain in the ICD‐11 (CAL‐CP) was developed. The current study aimed to evaluate the CAL‐CP regarding the correctness of assigned diagnoses, utility and ease of use. Methods In an international online study, n = 195 clinicians each diagnosed 4 out of 8 fictitious patients. The clinicians interacted via chat with the virtual patients to collect information and view medical histories and examination findings. The patient cases differed in complexity: simple patients had one chronic pain diagnosis; complex cases had two. In a 2 × 2 repeated‐measures design with the factors tool (algorithm/standard browser) and diagnostic complexity (simple/complex), clinicians used either the algorithm or the ICD‐11 browser for their diagnoses. After each case, clinicians indicated the pain diagnoses and rated the diagnostic process. The correctness of the assigned diagnoses and the ratings of the algorithm's utility and ease of use were analysed. Results The use of the algorithm resulted in more correct diagnoses. This was true for chronic primary and secondary pain diagnoses. The clinicians preferred the algorithm over the ICD‐11 browser, rating it easier to work with and more useful. Especially novice users benefited from the algorithm. Conclusions The use of the algorithm increases the correctness of the diagnoses for chronic pain and is well accepted by clinicians. The CAL‐CP's use should be considered in routine care and research contexts. Significance Statement The ICD‐11 has come into effect in January 2022. Clinicians and researchers will soon begin using the new classification of chronic pain. To facilitate clinicians training and diagnostic accuracy, a classification algorithm was developed. The paper investigates whether clinicians using the algorithm—as opposed to the generic tools provided by the WHO—reach more correct diagnoses when they diagnose standardized patients and how they rate the comparative utility of the diagnostic instruments available.

Relationship Between Chronic Pain and Dependency Level in Activities of Daily Living Among Long-Lived Institutionalized Elderly: A Suggested Educational Intervention

Article

Full-text available

Jan 2017

Pain negatively impact physical, psychological, social and spiritual health among long-lived institutionalized elderly. Thus, pain assessment is an imperative part of nursing role that helps long-lived institutionalized elderly to perform activity of daily livings (ADLs) independently. The study aimed to assess the relationship between chronic pain and dependency level in activities of daily living among long-lived institutionalized elderly and to suggest an educational intervention for improving their activities of daily livings. A descriptive exploratory cross-sectional research design was utilized in this study. A convenient sample of 60 male and female long-lived institutionalized elderly was selected from two geriatric homes. Data collection: Four tools were used: 1) Personal data sheet, 2) Brief Pain Inventory to assess elderly pain, 3) Katz Index of activity of daily livings to assess elderly dependency level related to functional activity of daily Livings. 4) Lawton-Brody scale to assess elderly instrumental activity of daily livings. Results revealed that the mean age of elderly was 80 years. A significant relationship was found between pain categories and dependency level in activities of daily living at 0.031 as measured by Katz index scale. Also, a significant relationship was detected between categories of pain and functional level as measured by Lawton-Brody scale at 0.001. There were significant relationships between ADLs and age, sex, chronic illnesses and marital status of elderly.Conclusion: the study concluded that long-lived institutionalized elderly suffered from moderate to severe chronic pain that negatively interfered with their dependency level related to activities of daily living. Recommendations: incorporating pain and ADLs assessment into routine nursing care, dissemination of the educational intervention in different nursing homes and replication of the study on large sample size in different settings in order to generalize research findings.

Can pain be self-managed? Pain change in vulnerable participants to a health education programme

Article

Mar 2024
INT J HEALTH PLAN M

Chronic pain exerts a significant impact on the quality of life, giving rise to both physical and psycho‐social vulnerabilities. It not only leads to direct costs associated with treatments, but also results in indirect costs due to the reduced productivity of affected individuals. Chronic conditions can be improved by reducing modifiable risk factors. Various educational programs, including the Chronic Disease Self‐Management Programme (CDSMP), have demonstrated the advantages of enhancing patient empowerment and health literacy. Nevertheless, their efficacy in addressing pain symptoms has received limited attention, especially concerning vulnerable populations. This research aims to assess the effectiveness of the CDSMP in alleviating pain among socio‐economically vulnerable participants with chronic conditions. By accounting for a wide range of variables, and using data from the EFFICHRONIC project (EU health programme), we investigated the changes in pain levels after the intervention, among 1070 participants from five European countries. Our analyses revealed a significant reduction in pain following the intervention. This finding supports the notion that training programs can effectively ameliorate pain and alleviate its impact on the quality of life, particularly in vulnerable populations. Younger participants, as well as those with higher education levels and individuals experiencing higher levels of pain at baseline, were more likely to experience a reduction in their pain levels. These findings underscore the importance of recognising the social determinants of health. The study was registered at ClinicalTrials.gov (ISRCTN70517103).

A Giant Frontal Sinus Mucocele in an Opium Addict Patient: A Case Report

Article

Full-text available

Jan 2023

Mucocele is a benign soft tissue mass that could occur in all accessory glands. Mucocele can also occur in paranasal sinuses. It is mostly placed in the frontal sinus and barely grows larger than 1.5 centimeters(cm). Based on the affected site, it could cause facial pain and headache. Analgesics like opioids could relieve and potentially make patients ignore the headache and cause giant frontal mucocele. This article discusses a patient with giant frontal sinus mucocele (7×8×8 cm) and opium addiction that presented with severe and intolerable pain. A 32 yr old man came to Rajaee Trauma Hospital, Shiraz, Iran with a severe headache and a large swelling of the face frontal region that developed gradually. In physical examination, the mass was non-tender, non-pulsatile, and free from the overlying normal skin. Computed tomography (CT) scan and magnetic resonance imaging (MRI) demonstrated a frontal sinus mucocele. The operation was planned, and the patient was discharged after two days. Subsequently, the 6-month follow-up of the patient was normal. Two different hypotheses are declared in this article. First, the potential role of opium addiction as a risk factor for giant mucoceles was noted, then the analgesic non-responsiveness of sinus mucoceles was described. The latter hypothesis is more likely. So, we should consider that if the patient had an analgesic-resistant headache, one differential diagnosis could be sinus mucocele. Moreover, the pos sible psychological effect of addiction on discounting face beauty was acknowledged.

A Giant Frontal Sinus Mucocele in an Opium Addict Patient: A Case Report

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Manejo Farmacológico del Dolor en Pancreatitis Aguda en Pacientes Adultos

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Full-text available

Dec 2023

La pancreatitis aguda (PA) una amplia variedad de cursos clínicos. El síntoma que más predomina es el dolor abdominal(de-Madaria et al., 2021); es una prioridad el tratamiento del dolor en la PA, sin embargo, la evidencia científica actual es poco clara, encontrando déficit en cuanto a la descripción concisa sobre un protocolo analgésico eficaz. Este trabajo tiene como objetivo realizar una revisión detallada de las terapias farmacológicas actuales descritas en la evidencia científica para el tratamiento de la PA en adultos, basándonos en diversas plataformas científicas y bases de datos especializadas internacionales y nacionales en idioma español e inglés, incluyendo alrededor de 32 artículos actualizados que brindan esta información pertinente. Se observó que el manejo del dolor en la PA es una prioridad, que se debe personalizar el tratamiento con base en la escala analgésica de la Organización Mundial de la Salud (OMS) que incluye los Antiinflamatorios no esteroideos (AINES), paracetamol, opiáceos fuertes o débiles tomando en cuenta los comórbidos, tolerabilidad e intensidad del dolor presente en el paciente; por otra parte la nueva terapia basada en analgesia epidural muestra ser bastante prometedora, sin embargo, consideramos que aún se requieren investigaciones científicas con cohortes más grandes.

SOMAScience: A novel platform for multidimensional, longitudinal pain assessment (Preprint)

Article

Full-text available

Mar 2023

Chronic pain is one of the most significant health issues in the United States, affecting more than 20% of the population. Despite its contribution to the increasing health crisis, reliable predictors of disease development, progression, or treatment outcomes are lacking. Self-report remains the most effective way to assess pain, but measures are often acquired in sparse settings over short time windows, limiting their predictive ability. In this paper, we present a new mobile health platform called SOMAScience. SOMAScience serves as an easy-to-use research tool for scientists and clinicians, enabling the collection of large-scale pain datasets in single- and multicenter studies by facilitating the acquisition, transfer, and analysis of longitudinal, multidimensional, self-report pain data. Data acquisition for SOMAScience is done through a user-friendly smartphone app, SOMA, that uses experience sampling methodology to capture momentary and daily assessments of pain intensity, unpleasantness, interference, location, mood, activities, and predictions about the next day that provide personal insights into daily pain dynamics. The visualization of data and its trends over time is meant to empower individual users’ self-management of their pain. This paper outlines the scientific, clinical, technological, and user considerations involved in the development of SOMAScience and how it can be used in clinical studies or for pain self-management purposes. Our goal is for SOMAScience to provide a much-needed platform for individual users to gain insight into the multidimensional features of their pain while lowering the barrier for researchers and clinicians to obtain the type of pain data that will ultimately lead to improved prevention, diagnosis, and treatment of chronic pain.

Real-world outcomes in spinal cord stimulation: predictors of reported effect and explantation using a comprehensive registry-based approach

Article

Full-text available

Nov 2023

Introduction Despite advancements in implanted hardware and development of novel stimulation paradigms in Spinal Cord Stimulation (SCS), real world evidence suggests a large variation in patient reported outcomes and a proportion of patients are later explanted due to loss of analgesia. Possible predictors for outcome have been explored in smaller short-term evaluations, but few clinically applicable robust measures for long term outcome have emerged. Methods We performed a comprehensive retrospective study based on an assembled patient-level aggregated database from multiple local and national registries in Sweden. Variables associated with risk of explantation (due to insufficient analgesia) and analgesic effect was analyzed using a Cox regression analysis and an ordered logit regression model, respectively. Results We found the accumulated risk of explantation due to loss of analgesia to be 10% and 21% at two and ten years follow up, respectively. The use of 10 kHz spinal cord stimulation (compared with Tonic waveform; p = 0.003), and being 60 years or older (reference 18-40 years; p = 0.003) were associated with an increased risk of explantation. At a mean follow up at 1 year, 48% of patients reported a pain intensity reduction from baseline of at least 30%. Secondary (p = 0.030) and post-secondary (p = 0.001) education (compared with primary education) was associated with an increased probability of successful patient reported outcomes. Conclusion This study suggests that a higher educational level and being employed are associated with successful treatment outcome in patients with chronic pain treated with SCS in Sweden.

The Interconnection Between Social Support and Emotional Distress Among Individuals with Chronic Pain: A Narrative Review

Article

Full-text available

Oct 2023

Chronic pain is a public health concern affecting over 100 million U.S. adults. Because chronic pain is multifactorial, it requires a biopsychosocial approach to understand how biological, psychological, and social factors contribute to both the development and maintenance of pain. On average, individuals with chronic pain report higher levels of emotional distress compared to pain-free individuals. Research has demonstrated that social support is associated with better pain outcomes and less emotional distress. It has been proposed that social support may improve pain outcomes by reducing the influence of stressors. However, the majority of research exploring the relationships between social support and pain-related outcomes has focused on the direct relationship between these variables, largely overlooking the process by which social support has a positive influence on pain. This narrative review synthesizes research on how chronic pain, emotional distress, and social support are highly interconnected, yet research investigating chronic pain and emotional distress within a social context is limited. We then highlight disparities in chronic pain, such that the burden of chronic pain is unequal between demographic groups. Next, we discuss existing evidence for the use of group-based interventions to address pain-related outcomes. Lastly, we summarize limitations of prior research studies and highlight gaps in the current literature. Overall, longitudinal research comprehensively investigating the distinct nuances in the measurement of social support and how these nuances relate to emotional distress and pain outcomes is needed and may provide insight into the unique needs of individuals or subgroups. Further, demographically diverse randomized controlled trials are needed to identify the process by which group-based interventions improve pain outcomes and whether these interventions are more effective for particular groups in order to personalize treatment approaches and address inequities in pain care.

A Giant Frontal Sinus Mucocele in an Opium Addict Patient: A Case Report A Giant Frontal Sinus Mucocele in an Opium Addict Patient: A Case Report

Article

Full-text available

Jan 2021

Converging circuits between pain and depression: the ventral tegmental area as a therapeutic hub

Article

Full-text available

Oct 2023

Chronic pain and depression are highly prevalent pathologies and cause a major socioeconomic burden to society. Chronic pain affects the emotional state of the individuals suffering from it, while depression worsens the prognosis of chronic pain patients and may diminish the effectiveness of pain treatments. There is a high comorbidity rate between both pathologies, which might share overlapping mechanisms. This review explores the evidence pinpointing a role for the ventral tegmental area (VTA) as a hub where both pain and emotional processing might converge. In addition, the feasibility of using the VTA as a possible therapeutic target is discussed. The role of the VTA, and the dopaminergic system in general, is highly studied in mood disorders, especially in deficits in reward-processing and motivation. Conversely, the VTA is less regarded where it concerns the study of central mechanisms of pain and its mood-associated consequences. Here, we first outline the brain circuits involving central processing of pain and mood disorders, focusing on the often-understudied role of the dopaminergic system and the VTA. Next, we highlight the state-of-the-art findings supporting the emergence of the VTA as a link where both pathways converge. Thus, we envision a promising part for the VTA as a putative target for innovative therapeutic approaches to treat chronic pain and its effects on mood. Finally, we emphasize the urge to develop and use animal models where both pain and depression-like symptoms are considered in conjunction.

Do Electrical Stimulation Devices Reduce Pain and Improve Function?—A Comparative Review

Article

Full-text available

Sep 2023

Multiple forms of electrical stimulation (ES) potentially offer widely varying clinical benefits. Diminished function commonly associated with acute and chronic pain lessens productivity and increases medical costs. This review aims to compare the relative effects of various forms of ES on functional and pain outcomes. A comprehensive literature search focused on studies of commonly marketed forms of ES used for treatment of pain and improvement of function. Peer-reviewed manuscripts were categorized as “Important” (systematic review or meta-analysis, randomized controlled trial, observational cohort study) and “Minor” (retrospective case series, case report, opinion review) for each identified form of ES. Varying forms of ES have markedly different technical parameters, applications, and indications, based on clinically meaningful impact on pain perception, function improvement, and medication reduction. Despite being around for decades, there is limited quality evidence for most forms of ES, although there are several notable exceptions for treatment of specific indications. Neuromuscular electrical stimulation (NMES) has well-demonstrated beneficial effects for rehabilitation of selective spinal cord injured (SCI), post-stroke, and debilitated inpatients. Functional electrical stimulation (FES) has similarly shown effectiveness in rehabilitation of some stroke, SCI, and foot drop outpatients. H-Wave® device stimulation (HWDS) has moderate supportive evidence for treatment of acute and refractory chronic pain, consistently demonstrating improvements in function and pain measures across diverse populations. Interestingly, transcutaneous electrical nerve stimulation (TENS), the most widely used form of ES, demonstrated insignificant or very low levels of pain and functional improvement. Ten of 13 reviewed forms of ES have only limited quality evidence for clinically significant reduction of pain or improvement of function across different patient populations. NMES and FES have reasonably demonstrated effectiveness, albeit for specific clinical rehabilitation indications. HWDS was associated with the most clinically significant outcomes, in terms of functional improvement combined with reduction of pain and medication use. More rigorous long-term clinical trials are needed to further validate appropriate use and specific indications for most forms of ES. II.

Chronic Pain, Enactivism, & the Challenges of Integration

Chapter

Sep 2023

Chronic pain is one of the most disabling conditions globally, yet we are still missing a satisfying theoretical framework to guide research and clinical practice. This is highly relevant as research and practice are not taking place in a vacuum but are always shaped by a particular philosophy of pain, that is, a set of implicitly or explicitly prevailing assumptions about what chronic pain is and how it is to be addressed. In looking at recent history, we identify a promising trend from neuro-centrism to the application of the biopsychosocial model. Unfortunately, due to its limited theoretical foundation, the biopsychosocial model is too often implemented in a reductionist, fragmented, and linear manner. In particular, it remains too vague concerning the relationship between involved biological, psychological, and social processes. Sanneke de Haan prominently labeled this the integration problem. In this paper, we introduce five different facets of the integration problem that every philosophy of pain needs to address: (i) ontological, (ii) conceptual, (iii) explanatory, (iv) methodological, and (v) therapeutic. We develop an enactive theory of chronic pain and outline how far it provides solutions to these different integration challenges.

The Use of Virtual Reality as a Non-Pharmacological Approach for Pain Reduction During the Debridement and Dressing of Hard-to-Heal Wounds

Article

Jun 2025

Background/Objectives: Pain management during minor surgical procedures in wound care across various etiologies is often underestimated in daily clinical practice. Pharmacotherapy remains the most effective and efficient method for pain reduction. However, growing concerns regarding the side effects of traditional analgesics and distressing psychosomatic experiences highlight the need for innovative non-pharmacological pain management strategies. The use of virtual reality (VR) has been suggested as a potential method to alleviate pain during medical procedures. The aim of this study was to assess the feasibility of virtual reality as a non-pharmacological approach to pain reduction during the debridement and dressing of hard-to-heal vascular wounds. Methods: This prospective observational study included a cohort of 100 patients who were consulted and treated at a specialized wound care clinic in the Podkarpacie region, Poland. Participant selection was based on predefined inclusion criteria. Patients were assigned to two groups: Group A, in which VR goggles were used, and Group B, in which standard care without VR was provided. All wounds were pre-treated with Lignocaine 2% gel for approximately 3–5 min before tissue debridement. Pain intensity was measured before the procedure, during the procedure, and 10 min after completion. A structured research questionnaire was used for data collection, consisting of two parts: sociodemographic data, functional assessment, wound characteristics, clinical scales, and the Numeric Rating Scale (NRS) for pain assessment before, during, and after the procedure. Results: A total of 100 participants voluntarily took part in the study, of whom 49.0% (n = 49) were male and 51.0% (n = 51) were female. The age of participants ranged from 43 to 89 years, with a mean age of 68.02 ± 10.0 years. A statistically significant difference in pain perception was observed between the pre-procedure and intra-procedure phases of wound debridement. The average pain increase in the Group with VR was lower than in the Group without VR (p = 0.006, effect size = 0.32). Conclusion: Pain occurrence and intensity during wound debridement are common challenges in clinical practice. The visual perception of a bleeding and treated wound may contribute to the psychogenic pain component. Virtual reality may serve as a simple adjunctive method to medical procedures by diverting attention away from surgical interventions. Further research, including psychological aspects of non-pharmacological pain management, is necessary in the context of wound care prevention and treatment.

Suzetrigine Approval Breaks a 25-Year Silence: A New Era in Non-Opioid Acute Pain Management

Article

Full-text available

Jun 2025

Pain management remains a critical priority in clinical practice. Meanwhile, traditional analgesics, including non-opioid and opioid medications, often pose substantial risks, including adverse effects and potential for addiction. The recent approval of Suzetrigine by the US Food and Drugs Administration (FDA) represents a pivotal advancement in non-opioid analgesia for the treatment of moderate-to-severe acute pain. Suzetrigine, a selective NaV1.8 sodium channel inhibitor, provides effective pain relief by targeting peripheral pain pathways, minimizing the risk of addiction commonly associated with opioids, and has good safety profile according to clinical trials. Given the growing concerns surrounding opioid use, Suzetrigine offers a promising therapeutic alternative in acute pain management, with future research needed to assess its long-term effectiveness in diverse populations.

Atitudes dos médicos das Unidades de Dor dos hospitais portugueses acerca da prescrição e utilização de canabinoides no tratamento da dor crónica

Article

Mar 2025

Effectiveness of a pain science education programme in middle school students: a randomised controlled trial

Article

Full-text available

Jan 2025

Introduction Chronic pain in childhood is a prevalent issue affecting approximately 20% of young people aged 8–16 years. This condition negatively impacts their quality of life, as well as their physical, psychological, and social functioning. In recent years, Pain Science Education has emerged as a promising strategy to enhance the conceptualization of pain and mitigate maladaptive pain-related behaviours in children and teenagers. The primary aim of this study is to assess the effectiveness of the Pain Science Education programme called “Learning Pain” in improving the conceptualization of pain amongst 11–13-year-old children enrolled in their first year of middle school. Materials and methods A randomised controlled trial with single-blind parallel groups was conducted. Five participating institutes were randomly assigned to either the experimental group, which received the Pain Science Education intervention through the “Learning Pain” programme consisting of two sessions spaced 1 month apart, or the control group, which underwent only study assessments. Both groups underwent initial assessment and follow-up evaluations at 1 month (short term), 7 months (medium-term), and 13 months (long-term). The main outcome measure was the conceptualization of pain, assessed using the Conceptualization of Pain Questionnaire (COPAQ). Results The “Learning Pain” programme, a specific Pain Science Education intervention, demonstrated effectiveness in improving the conceptualization of pain at 1, 7, and 13 months follow-up assessments. Discussion The “Learning Pain” programme, a specific Pain Science Education intervention, enhances the conceptualization of pain in adolescents aged 11–13 years over short, medium, and long-term periods.

Unspecified Pain, Chronic Pain and High-Impact Chronic Pain in Lesotho, Southern Africa: a Population-based Cross-sectional study

Preprint

Full-text available

Jan 2025

Background . Pain and its associated disorders are among the most common causes of disability and contributors to healthcare costs globally. Pain is understudied in Africa and there are no data on high-impact chronic pain from this region. In a population-based survey in Lesotho, Southern Africa, we assessed the prevalence of unspecified pain, chronic pain and high-impact chronic pain, and their determinants. Method . We conducted a household-based, cross-sectional survey among adults ≥18 years old in 120 randomly sampled villages across Butha Buthe and Mokhotlong districts in Lesotho. Unspecified pain, chronic pain, and high-impact chronic pain were defined as current or recurrent pain regardless of duration; pain on most days of the week lasting for 3 or more months; and chronic pain with restriction of routine activities, respectively. Result . Among the 6039 adults included, the median age was 39 years (interquartile range: 27-58), 3153/6039 (52.2%) were female. Overall, 1194 (19.8%) had unspecified pain (95% confidence interval [CI]: 18.8 – 20.8); 909 (15.1%) had chronic pain (95% CI: 14.2 – 16.0); and 428 (7.1%) had high-impact chronic pain (95% CI: 6.5 – 7.8) corresponding to 47.1% among the participants with chronic pain. Higher age groups were associated with increasing odds of unspecified pain, chronic pain and high-impact chronic pain. Male participants were less likely to have unspecified pain (adjusted odds ratio [aOR], 0.68; 95% CI: 0.56 – 0.82; p < 0.001). There was no association between sex and chronic pain or high-impact chronic pain. Participants living in less wealthy households had higher odds of high-impact chronic pain. Furthermore, high-impact chronic pain was associated with hypertension (aOR, 1.47; 95% CI: 1.14 – 1.90; p = 0.003), diabetes mellitus (aOR, 1.86; 95% CI: 1.27 – 2.74; p = 0.002), moderate to high risk of depression (aOR, 4.93; 95% CI: 2.75 – 8.86; p < 0.001), and moderate to high risk of generalized anxiety disorder (aOR, 2.85; 95% CI: 1.18 – 6.92; p = 0.023). Conclusion . Prevalence of chronic pain, including high impact chronic pain was high in this population-based survey in Lesotho. Its association with further non-communicable chronic conditions, such as hypertension and diabetes, supports the need for health systems to provide integrated chronic care, including the management of chronic pain.

Stimulation of dorsal root ganglion with low-intensity focused ultrasound ameliorates pain responses through the GABA inhibitory pathway

Article

Dec 2024
LIFE SCI

Relationship Between Psychological Factors and Health-Related Quality of Life in Patients with Chronic Low Back Pain

Article

Full-text available

Dec 2024

Background: Low back pain has frequently been mentioned as the most common sort of chronic pain, and numerous studies have confirmed its influence on the health-related quality of life (HRQoL). Despite a great deal of research demonstrating the important part that psychological factors play in explaining HRQoL, a therapeutic setting that prioritizes the physical domain still predominates. For this reason, the aim of this study is to assess the relationship between age, pain intensity, pain catastrophizing, depression, anxiety, pain-related anxiety, chronic pain acceptance and the psychological and physical dimensions of HRQoL in patients with chronic low back pain (CLBP). Methods: Data were collected from 201 patients with CLBP using sociodemographic data, the SF-36 Health Status Questionnaire (SF-36), the Hospital Anxiety and Depression Scale (HADS), the Pain Anxiety Symptoms Scale Short Form 20 (PASS-20), the Pain Catastrophizing Scale (PCS), the Chronic Pain Acceptance Questionnaire (CPAQ-8) and the Numeric Pain Rating Scale (NRS). The linear regression model for the dependent variable of Physical Health (SF-36 PhyH) was statistically significant (F (7, 201) = 38.951, p < 0.05), explaining 57.6% of the variance regarding the Physical Health dimension of HRQL in patients with CLBP. Results: The linear regression model for the dependent variable of Psychological Health (SF-36 PsyH) was statistically significant (F (7, 200) = 39.049, p < 0.05), explaining 57.7% of the variance regarding the Psychological Health dimension of HRQL in patients with CLBP. Conclusions: The findings of this study confirm that age, pain intensity, depression, pain-related anxiety and chronic pain acceptance are significant predictors of the physical dimension of HRQoL, while pain intensity, anxiety and depression proved to be significant predictors of the psychological dimension of HRQoL in patients with CLBP.

Современная концепция хронической боли: обзор литературы (часть 1): Chronic Pain Syndrome and Its Components: A Literature Review (Part 1)

Article

Dec 2024

В обзоре поднимаются вопросы хронической боли и ее компонентов. Хроническая боль является широко распространенной проблемой, оказывающей существенное негативное влияние на пациента, его семью и общество. До 80% пациентов с хронической болью не удовлетворены результатами терапии и заявляют о значительном снижении качества жизни. Боль является итогом взаимодействия ноцицептивной и антиноцицептивной систем. На формирование индивидуального ощущения боли как страдания оказывают влияние не только биологические факторы, такие как характер повреждения, пол, возраст и генетические особенности, определяющие болевую реакцию. Большое значение имеют психологические и социальные характеристики пациента, поэтому в настоящий момент боль рассматривается в рамках биопсихосоциальной модели. Для успешной коррекции болевого синдрома специалисту необходимо понимать механизмы формирования ноцицептивной, невропатической и ноципластической (дисфункциональной) боли и уметь определять представленность этих компонентов в составе смешанной хронической боли. Отдельное внимание в обзоре уделяется способам выявления дисфункционального компонента боли, а также обсуждению протоколов лечения и нерешенных вопросов коррекции фармакорезистентных невропатических болевых синдромов в Республике Беларусь и мире. The review highlights issues of chronic pain and its components. Chronic pain is a widespread issue having a significant negative impact on patients, their families and the society as a whole. Up to 80% of patients with chronic pain are not satisfied with therapy outcomes and report a substantial decline in their quality of life. The pain is the result of an interaction between the nociceptive and antinociceptive systems. The pain sensation as an individual suffering experience is shaped by not only biological factors, such as damage pattern, sex, age and genetic characteristics, determining pain response, also by both psychological and social factors To successfully correct pain syndrome, professionals need to understand mechanisms underlying nociceptive, neuropathic and nociplastic (dysfunctional) pain, and they should be able to identify these components within mixed chronic pain. The review pays particular attention to the ways of detecting the dysfunctional component of pain, and discusses treatment protocols and unresolved issues of managing pharmacoresistant neuropathic pain syndromes in the Republic of Belarus and worldwide.

Assessing the feasibility of the GOTT (Gabapentinoid and Opioid Tapering Toolkit) in a primary care setting in North-East England

Article

Oct 2024

Objective To assess the feasibility and possible impacts of implementation of systematic non-pharmacological interventions to reduce the level of prescribing of opioid and gabapentinoid analgesics for chronic non-cancer pain (CNCP), particularly high-dose prescriptions, through a proof-of-concept study in a deprived area (second lowest decile) primary care practice in North-East England. Participant Twenty-five primary care staff (clinical and non-clinical) of which 18 clinicians received the intervention. Intervention used in this study practice known as GOTT (Gabapentinoid and Opioid Toolkit) All clinicians received an educational skills programme to support patient pain self-management, tailored on the clinicians’ self-assessment of their learning needs, embedding both clinician skill learning and patient self-care resources for rapid access within consultations into a GP clinical management computer system. Outcome measures Clinical staff completed questionnaires before and after the GOTT intervention to assess levels of knowledge and confidence in their own skills to support chronic pain self-management across several domains. Prescription data were used to measure changes in opioid and gabapentinoid prescribing at the practice across the 12-month intervention and 30-month follow-up period. Results Prescribing of opioid and gabapentinoid/pregabalin decreased substantially in the practice across the intervention period (c. 90% in high-dose opioid [ p = .0118], and 15% gabapentin/pregabalin prescriptions, respectively), over a one-year period during the COVID-19 pandemic. Follow-up analysis showed 100% and c.50% reductions, respectively, in December 2022. The questionnaire data showed an increase in clinician confidence in skills to enable self-management over the intervention period, overall ( p = .044) and, specifically across three of the five domains measured: supporting behavioural change ( p = .028), supporting self-care ( p = .008), and managing difficult consultations ( p = .011). Conclusion The GOTT intervention program provided some initial evidence of a proof-of-concept for the implementation of a systematic non-pharmacological pain management skills and resources programme addressing lack of confidence in skills to introduce and support self-management and reduce use of strong opioids and gabapentinoids.

(Re)Development of Pain Target Competencies in a Contemporary, Multi-Centre Undergraduate Medical Curriculum: The Importance of Local Cultural Requirements

Article

Oct 2024
J PAIN

Depression and Pain: Bidirectional Relationship and Changes with Psychological Treatment

Chapter

Sep 2024

Lisa Renee Miller-Matero

To fully understand the opioid epidemic, it is necessary to elucidate the role of depression in mutually reinforcing relationships with pain and prescription opioid use. By bringing together contributions from neuroscience, pain psychiatry, clinical epidemiology, pharmacoepidemiology, clinical trials, and research on social determinants of health, this volume integrates currently siloed areas of investigation and clinical knowledge. Readers will come to understand the central role of depression, other psychiatric disorders, and social determinants that contribute to pain management outcomes, the opioid epidemic, and our response to opioid dependence and opioid use disorder. By taking a multidisciplinary approach to compiling what is known about the relationships between pain, depression, other psychiatric disorders, and opioids, this work serves as a valuable resource for trainees and clinicians working in a range of healthcare settings while also spawning new directions for researchers.

Pain and cognitive function in Korean older adults aged 60 years or more: A retrospective longitudinal study

Article

Oct 2024

To elucidate the relationship between pain and cognitive decline in adults aged ≥60 years using data from the Korean Longitudinal Study of Aging survey. We included 3,287 older adults aged ≥60 years with a Korean Mini-Mental State Examination score ≥24. We assessed the presence of pain and pain interference using self-administered questionnaires. Pain interference was determined based on whether the pain limited the participants’ activities of daily living. According to this assessment, participants were categorized as no pain, low-impact pain, and high-impact pain. Cognitive function was assessed using the Mini-Mental State Examination and classified into 3 groups: normal, cognitive impairment, and suspected dementia. Potential confounding factors, including pain × survey year, were adjusted in the analyses. We also performed subgroup analyses of participants experiencing pain to elucidate the association between pain interference, suspected dementia, and cognitive impairment. A significant difference in the Mini-Mental State Examination scores was observed between individuals with and without pain ( P < .001). Pain remained negatively associated with the Mini-Mental State Examination score through the first to the eighth wave even after adjusting for confounding factors (β = ‐1.170, 95 % confidence interval (CI): −0.243, −0.097). Compared to the absence of pain, the presence of pain increased the odds of suspected dementia and cognitive impairment by approximately 1.6 and 1.4 times, respectively (odds ratio [OR] = 1.56, 95% CI: 1.26, 1.93; OR = 1.36, 95% CI: 1.20, 1.54). Compared to low-impact pain, high-impact pain increased the odds of suspected dementia and cognitive impairment by approximately 2.1and 1.5 times, respectively (OR = 2.12, 95% CI: 1.76, 2.56; OR = 1.47, 95% CI: 1.31, 1.65). Pain was negatively associated with Mini-Mental State Examination scores in Korean older adults aged ≥60 years and increased the odds of suspected dementia and cognitive impairment. Furthermore, individuals with high-impact pain exhibited higher risks of both suspected dementia and cognitive impairment than those with low-impact pain.

Dépistage des troubles posturaux en consultation douleur

Article

Sep 2024
Douleurs

L’optimisation des parcours de soin et de l’accompagnement des patients douloureux débute par une démarche évaluative singulière, permettant l’appréciation globale de la condition du patient. Défini par plusieurs paramètres anatomiques, biomécaniques et neurophysiologiques, la posture constitue ainsi un indicateur précis de santé. La posturologie permet d’appréhender l’étude du contrôle postural, en proposant des tests fonctionnels cliniques, statiques ou dynamiques. Associées au pronostic de bonne récupération fonctionnelle et de participation sociale, l’identification puis l’évaluation des troubles de la posture permettraient d’apporter de nouveaux marqueurs cliniques de la prise en charge du patient douloureux. Une investigation clinique précise permet une stratégie thérapeutique au plus proche de l’étiologie des troubles posturaux et de la douleur. Dans ce contexte, le dépistage des troubles posturaux en consultation douleur apporte des perspectives dans la gestion des patients souffrant de douleur chronique, en complément de la prise en charge médicale.

Research Progress in Multimodal Pain Assessment

Article

Jan 2024

珊李

Accessing care within team-based models of primary care for the management of chronic low back pain in Ontario, Canada: a qualitative study of patient experiences

Article

Jul 2024
DISABIL REHABIL

Purpose: To understand experiences accessing care within team-based primary care models among adults with chronic low back pain (LBP). Materials & methods: We conducted an interpretive description qualitative study and collected data using one-to-one semi-structured interviews. Participants were recruited from publicly funded, team-based primary care models in Ontario, Canada. Results: We completed interviews with 16 adults with chronic LBP (9 women; median age of 66). Participants expressed a desire to access care from team-based models of primary care in hopes of alleviating pain and its impacts on daily life. Due to no direct out-of-pocket costs, co-location of healthcare providers, and the use of technology and virtual care, participants described an ease of accessing interprofessional care within team-based primary care models. Finally, participants described experiences with and expectations for timely access to care, being heard and understood by healthcare providers, and receiving coordinated care by an interprofessional team. Conclusions: Adults living with chronic LBP described overall positive experiences and specific expectations when accessing care within team-based models of primary care, whereby they experienced an ease of accessing interprofessional care with the hope of alleviating pain and its impacts. Results may be transferable to other chronic pain conditions and health system contexts.

Exploring the association between dietary Inflammatory Index and chronic pain in US adults using NHANES 1999–2004

Article

Full-text available

Apr 2024

Chronic pain, a substantial public health issue, may be influenced by dietary patterns through systemic inflammation. This cross-sectional study explored the association between Dietary Inflammatory Index (DII) and chronic pain among 2581 American adults from NHANES data. The DII, ranging from − 4.98 to 4.69, reflects the inflammatory potential of the diet, with higher scores indicating greater pro-inflammatory capacity. Our findings showed no significant association between the continuous DII score and chronic pain prevalence. However, a nonlinear relationship emerged. When the DII was categorized, a significant association between higher DII scores (DII ≥ 2.5) and chronic pain prevalence was observed. The analysis uncovered a U-shaped pattern, with an inflection point at a DII score of − 0.9, indicating an association between both low and high levels of dietary inflammation are associated with higher pain prevalence. This nuanced interaction between dietary inflammation and chronic pain indicates the possibility of incorporating dietary modification into pain management strategies and underscores the need for further research into the long-term effects of diet on chronic pain.

Cracking the Chronic Pain code: A scoping review of Artificial Intelligence in Chronic Pain research

Article

Mar 2024
ARTIF INTELL MED

Pain relief and associated factors: a cross-sectional observational web-based study in a Quebec cohort of persons living with chronic pain

Article

Full-text available

Mar 2024

Objectives Randomized clinical trials are used to evaluate the efficacy of various pain treatments individually, while a limited number of observational studies have portrayed the overall relief experienced by persons living with chronic pain. This study aimed to describe pain relief in real-world clinical settings and to identify associated factors. Methods This exploratory web-based cross-sectional study used data from 1,419 persons recruited in the community. Overall pain relief brought by treatments used by participants was assessed using a 0%–100% scale (10-unit increments). Results A total of 18.2% of participants reported minimal pain relief (0%–20%), 60.0% moderate to substantial pain relief (30%–60%), and 21.8% extensive pain relief (70%–100%). Multivariable multinomial regression analysis revealed factors significantly associated with greater pain relief, including reporting a stressful event as circumstances surrounding the onset of pain, living with pain for ≥10 years, milder pain intensity, less catastrophic thinking, use of prescribed pain medications, use of nonpharmacological pain treatments, access to a trusted healthcare professional, higher general health scores, and polypharmacy. Factors associated with lower pain relief included surgery as circumstances surrounding pain onset, use of over-the-counter pain medications, and severe psychological distress. Discussion In this community sample of persons living with chronic pain, 8 out of 10 persons reported experiencing at least moderate relief with their treatment. The analysis has enabled us to explore potential modifiable factors as opportunities for improving the well-being of persons living with chronic pain.

Multidisciplinary management of persistent pain in primary care-A systematic review

Article

Jan 2024
EUR J PAIN

Background and Objective A multidisciplinary approach is the gold standard in the management of persistent pain and is current practice in tertiary pain clinics. However, such approaches seem to be a rarity in primary care, although pain is the most common reason for visiting a primary care physician. A comprehensive systematic review was conducted to explore whether studies on multidisciplinary management programs for persistent pain exist in primary care. Databases and Data Treatment PubMed, Ovid MEDLINE, Scopus, CINAHL, and PsychINFO were searched from inception to October 2022, and supplementary research was conducted in June 2023. Screening, data extraction, and quality assessment were independently carried out by two researchers. The inclusion criteria were (1) adult patients (age >18 years); (2) non‐cancer pain, persisting over 3 months; (3) multidisciplinary intervention (treatment included ≥3 heathcare professionals); (4) intervention conducted in a primary care setting; and (5) reports published in English. Results Of the 1250 initially identified studies, 17 were selected for final analysis. Only studies reporting empirical data were included (cohort, case–control, randomized controlled trial, and observational). The study settings and intervention characteristics showed great heterogeneity. The primary care practices also varied across different countries and cultures. Overall, the quality of the studies was rather low and sample sizes were relatively small. Conclusions The review revealed that studies about such treatment interventions for persistent pain patients are scarce. The existing studies were heterogeneous in terms of intervention characteristics, population, outcome variables, and study methodology. Future studies are urgently needed. Significance Persistent pain is a growing challenge to the health care system, and most patients are treated in primary care. The biopsychosocial concept is the basis for the multidisciplinary management of pain. The review revealed that studies about treatment interventions for persistent pain patients are scarce. Existing studies were heterogeneous in terms of intervention characteristics, population, outcome variables, and study methodology. There is an urgent need for further studies on systematic multidisciplinary treatment protocols for managing persistent pain in primary care.

Pharmacologic Characterization of LTGO-33, a Selective Small Molecule Inhibitor of the Voltage-Gated Sodium Channel NaV1.8 with a Unique Mechanism of Action

Article

Full-text available

Jan 2024
MOL PHARMACOL

Discovery and development of new molecules directed against validated pain targets is required to advance the treatment of pain disorders. Voltage-gated sodium channels (NaVs) are responsible for action potential initiation and transmission of pain signals. NaV1.8 is specifically expressed in peripheral nociceptors and has been genetically and pharmacologically validated as a human pain target. Selective inhibition of NaV1.8 can ameliorate pain while minimizing effects on other NaV isoforms essential for cardiac, respiratory, and central nervous system physiology. Here we present the pharmacology, interaction site, and mechanism of action of LTGO-33, a novel NaV1.8 small molecule inhibitor. LTGO-33 inhibited NaV1.8 in the nM potency range and exhibited over 600-fold selectivity against human NaV1.1-NaV1.7 and NaV1.9. Unlike prior reported NaV1.8 inhibitors that preferentially interacted with an inactivated state via the pore region, LTGO-33 was state-independent with similar potencies against closed and inactivated channels. LTGO-33 displayed species specificity for primate NaV1.8 over dog and rodent NaV1.8 and inhibited action potential firing in human dorsal root ganglia neurons. Using chimeras combined with mutagenesis, the extracellular cleft of the second voltage-sensing domain was identified as the key site required for channel inhibition. Biophysical mechanism of action studies demonstrated that LTGO-33 inhibition was relieved by membrane depolarization, suggesting the molecule stabilized the deactivated state to prevent channel opening. LTGO-33 equally inhibited wild-type and multiple NaV1.8 variants associated with human pain disorders. These collective results illustrate LTGO-33 inhibition via both a novel interaction site and mechanism of action previously undescribed in NaV1.8 small molecule pharmacologic space. Significance Statement NaV1.8 sodium channels primarily expressed in peripheral pain-sensing neurons represent a validated target for the development of novel analgesics. Here we present the selective small molecule NaV1.8 inhibitor LTGO-33 that interdicts a distinct site in a voltage-sensor domain to inhibit channel opening. These results inform the development of new analgesics for pain disorders.

Pain and Disablement

Chapter

Mar 2020

Variations in population health status: Results from a United Kingdom national questionnaire survey

Article

Full-text available

Mar 1998

To measure the health of a representative sample of the population of the United Kingdom by using the EuroQoL EQ-5D questionnaire. Stratified random sample representative of the general population aged 18 and over and living in the community. United Kingdom. 3395 people resident in the United Kingdom. Average values for mobility, self care, usual activities, pain or discomfort, and anxiety or depression. One in three respondents reported problems with pain or discomfort. There were differences in the perception of health according to the respondent's age, social class, education, housing tenure, economic position, and smoking behaviour. The EQ-5D questionnaire is a practical way of measuring the health of a population and of detecting differences in subgroups of the population.

Use of primary health services in sparsely populated country districts by patients with musculoskeletal symptoms: consultations with a physician

Article

Full-text available

May 1993

To examine the extent to which people consult health centre doctors about various musculoskeletal symptoms and to identify those groups of patients who are responsible for the main workload in primary health care caused by musculoskeletal complaints. A cross sectional investigation based on case records of people who visited health centre physicians. The population of six Finnish health centre districts (93,000 inhabitants, 64 physicians' posts in primary care centres). 6526 patients (7634 visits) who consulted a physician at any of six health centres during a two week period, of which 1380 consulted for musculoskeletal symptoms. The reasons for the visits were abstracted from the case records and were analysed by cross tabulation. The rate of people visiting for musculoskeletal symptoms during a two week period was on average 15 per 1000 inhabitants. It was highest in men aged 45-54 years (25/1000) and in women aged 55-64 years (26/1000); the rate fell to the average in men over 54 and women over 64 years. Patients with musculoskeletal symptoms accounted for 21% of all patients and 27% of those over 15 years of age. Low back pain was the most common reason for consultation in men aged 25-54 years, while for women aged 35-74 years, the most common reason was neck and shoulder pain. Over one quarter of adults visiting a health centre doctor do so because of musculoskeletal disorders. This fact must be considered when developing health care services and organising basic education and further in-service training for doctors.

Chronic Pain in a Geographically Defined General Population

Article

Sep 1993

Objective: To establish basic epidemiological data on chronic pain (duration >3 months) in a defined population. Relationships between age, gender, and social class were tested. Design: A survey of pain symptoms, including location, intensity, duration, and functional capacity, was conducted by means of a mail questionnaire. Setting: General populations in two Swedish primary health care districts. Medical care was provided in a state health system. Subjects: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1,806). The response rate was 90%. Outcome Measures: Descriptive epidemiologic data in relation to objectives of the study. Results: Without sex differences, 55% (95% confidence interval, 53-58%) of the population had perceived persistent pain for 3 months and 49% for 6 months. Among individuals with chronic pain, 90% localized their pain to the musculoskeletal system to a variable extent. Women experienced more multiple localizations of pain and had pain in the neck, shoulder, arm, and thigh to a greater extent than men. Prevalence of pain increased by age up to 50-59 years for both genders and then slowly decreased. The neck-shoulder area was the most common site of pain (30.2%), followed by the lower back (23.2%). Even in the youngest age groups more than one of four reported chronic pain. Blue-collar workers and employers (including farmers) reported chronic pain to a greater extent than other groups. In 13% of the population, manifest pain problems were associated with reduced functional capacity. Conclusion: Chronic pain symptoms are common but unevenly distributed in a general population. The results may influence planning and consultation in primary health care as well as warranting selective prevention activities.

The prevalence of pain in a general population. The results of a postal survey in a county of Sweden

Article

May 1989
PAIN

In a postal survey, we asked 1009 randomly chosen individuals, age 18–84, about their pain problems. The pain prevalence depended on what types of questions were asked. Any pain or discomfort, including even a problem of short duration, was reported by 66% of those questioned. Forty percent reported ‘obvious pain’ (pain which affected them ‘to quite a high degree’ or more and was ‘like being stiff after exercise’ or worse) lasting more than 6 months. Pain problems of more than 6 months duration were reported far more often than short-lasting problems. Continuous or nearly continuous pain problems were reported as frequently as problems recurring regularly or irregularly. Pains in the neck, shoulders, arms, lower back and legs were most frequent. The prevalence of ‘obvious pain’ in these localizations was 15–20%. Pain was reported most frequently in the age group 45–64, where the prevalence of ‘obvious pain’ was 50% among males as well as females. Over 65 years of age the prevalence was less.

Prevalence of Anaemia in the General Population

Article

Dec 1961

G S KILPATRICK

New trends in photobiology The possible role of ionic species in selective biodistribution of photochemotherapeutic agents toward neoplastic tissue

Article

Dec 1990
J PHOTOCH PHOTOBIO B

Photochemotherapeutic agents are photosensitizers that are selectively retained by neo-plastic tissue. When tumor tissue containing these drugs is irradiated with visible electromagnetic radiation, the photosensitizing reaction may lead to tumor eradication, termed photodynamic therapy. Exogenous photosensitizers commonly used in clinical trials are mainly porphyrin derivatives. Phthalocyanines are currently being investigated as “second generation” photochemotherapeutic agents. The mechanism by which these photosensitizers are selectively retained in neoplastic tissue is unclear. This review examines the role of tissue and cellular pH as a factor in selective biodistribution. The pH values of normal and tumor tissue are summarized and the ionic species distribution diagram of porphyrins is presented. A two-fold mechanism of selective biodistribution is advanced, one involving normal tissue vs. tumor tissue selectivity, the other involving intracellular vs. intercellular distribution of sensitizer ionic species.

Survey of Pain in the United States: The Nuprin Pain Report

Article

Jan 1986

Richard A. Sternbach

colon; In August and September 1985, a nationwide telephone survey was made of 1,254 persons aged 18 and older, representing a cross-section of the adult population in the continental United States. This survey provided quantitative data on the prevalence and severity of different kinds of pain, the demographic characteristics of those with pain, the impact of pain on work and other activities, the relationship between pain and measures of stress and health locus of control, the use of medical and other professionals in pain treatment, and the effectiveness of various treatments for pain relief. This is the first nationwide survey of an unselected sample of the U.S. census and provides extensive data documenting the need for additional research on pain and its control and for improved education of the public and health professions. (C) Lippincott-Raven Publishers.

Whither General Practice ?

Article

F. Gray

Epidemiologic comparison of pain complains

Article

Mar 1988

A survey concerning common pain conditions and psychological distress was carried out among a probability sample of the adult enrollees of a large health maintenance organization in Seattle. The prevalence of pain in the prior six months was 41% for back pain; 26% for headache; 17% for abdominal pain; 12% for chest pain; and 12% for facial pain. Headache, abdominal and facial pain were less prevalent among older persons and more prevalent among females. We examined the temporal dimensions of these pain conditions, as well as intensity, treatment seeking, and activity limitation. The pain conditions were typically long standing, recurrent, of mild to moderate intensity, and usually did not limit activities. However, depending on the pain condition, 9-40% reported one or more days in the prior six months when they were unable to carry out their usual activities due to the pain problem. On average, persons with a pain condition had higher levels of anxiety, depression, and non-pain somatic symptoms as measured by the scales of the Symptom Checklist (SCL); poorer self-rating of health status; and more family stress compared to persons without a pain condition. Of these alternative measures of distress, the SCL somatization scale had the strongest independent association with pain. The increments in measures of anxiety, depression, and family stress with the presence of pain were greatest among persons with higher levels of non-pain somatic symptoms.

Undetected fibrositis in primary care practice

Article

Nov 1987
J FAM PRACTICE

The prevalence of symptoms related to fibrositis was investigated for patients seen in a primary care setting. Of 692 adult patients evaluated, 33 (4.6 percent) had symptoms of unexplained, chronic, diffuse muscular pain. Only three patients had been diagnosed as having fibrositis by their physician. Eighteen of 31 patients had symptoms sufficiently severe to interfere with their ability to perform their job or household chores. The percentages of these patients who met the fibrositis criteria ranged from 17 to 55 percent. These results suggest that unexplained, diffuse muscular aching is a common problem, that it is rarely diagnosed, and that the use of several criteria to define fibrositis excludes many patients with the typical primary symptoms.

Pain in General Practice: Pain as a Cause of Patient-Doctor Contact

Article

Jun 1986

In 1983 26 general practitioners in a Danish provincial town made a week's survey of pain as the main cause of patient-doctor contact during the day time. The population served was 45 000-50 000 persons of all ages. Coexistent pain which was not the cause of actual contact was not recorded. Out of 2 886 contacts of all causes 641 were due to pain (22% or 222/1 000 contacts). Percentages for acute and chronic pain were 61 and 39 respectively. The commonest causes of pain were musculo-skeletal (50%), visceral including cardio-vascular (20%), infectious (15%), and headaches (8%). The overall female: male ratio was 1.5: 1, but with considerable variation within the different pain categories. The ratios for acute and chronic pain were 1.4: 1 and 1.8: 1 respectively. About one hundred contacts were recorded as "problem cases" whose predominant complaints were low back pain, headaches, and visceral pain. Pain--especially chronic pain with a non-malignant cause--is a major problem in general practice. Essentially, pain is a primary health care problem and research in this field should be encouraged.

The prevalence of pain complaints in a general population

Article

Apr 1984

The authors argue that the study of the complaint of pain falls within the purview of epidemiological study. An analytic survey of 500 randomly selected households on the roster of a group family practice clinic was undertaken. The purpose was to determine the self-reported prevalence rates of any pain complaint and to determine the distribution of pain rates according to selected demographic and socioeconomic variables. Sixteen percent of the individuals sampled from a family practice (H.S.O.) had experienced pain within the 2 weeks preceding the survey. The prevalence rate of those with persistent pain was approximately twice that of those with temporary pain. More women than men reported temporary and persistent pain. The age specific morbidity rate for persistent pain increased with age. The back, lower extremities, and head and face were the most frequently identified sites of pain in both subgroups. Persons with persistent pain used health services, both community physicians and hospital care, more frequently than did those with temporary pain. No significant differences between the two groups were reported for physical, social or emotional function although the persistent pain group characterized their general health status more poorly.

Physician Office Visits for Low Back Pain: Frequency, Clinical Evaluation, and Treatment Patterns From a U.S. National Survey

Article

Feb 1995

This study is an analysis of national survey data from 5 sample years. The authors characterized the frequency of office visits for low back pain, the content of ambulatory care, and how these vary by physician specialty. Few recent data are available regarding ambulatory care for low back pain or how case mix and patient management vary by physician specialty. Data from the National Ambulatory Medical Care Survey were grouped into three time periods (1980-81, 1985, 1989-90). Frequency of visits for low back pain, referral status, tests, and treatments were tabulated by physician specialty. There were almost 15 million office visits for "mechanical" low back pain in 1990, ranking this problem fifth as a reason for all physician visits. Low back pain accounted for 2.8 percent of office visits in all three time periods. Nonspecific diagnostic labels were most common, and 56 percent of visits were to primary care physicians. Specialty variations were observed in caseload, diagnostic mix, and management. Back pain remains a major reason for all physician office visits. This study describes visit, referral, and management patterns among specialties providing the most care.

Chronic pain in a geographically defined general population: Studies of differences in age, gender, social class, and pain localization

Article

Sep 1993

To establish basic epidemiological data on chronic pain (duration > 3 months) in a defined population. Relationships between age, gender, and social class were tested. A survey of pain symptoms, including location, intensity, duration, and functional capacity, was conducted by means of a mail questionnaire. General populations in two Swedish primary health care districts. Medical care was provided in a state health system. A random sample (from the population register) of 15% of the population aged 25-74 (n = 1,806). The response rate was 90%. Descriptive epidemiologic data in relation to objectives of the study. Without sex differences, 55% (95% confidence interval, 53-58%) of the population had perceived persistent pain for 3 months and 49% for 6 months. Among individuals with chronic pain, 90% localized their pain to the musculoskeletal system to a variable extent. Women experienced more multiple localizations of pain and had pain in the neck, shoulder, arm, and thigh to a greater extent than men. Prevalence of pain increased by age up to 50-59 years for both genders and then slowly decreased. The neck-shoulder area was the most common site of pain (30.2%), followed by the lower back (23.2%). Even in the youngest age groups more than one of four reported chronic pain. Blue-collar workers and employers (including farmers) reported chronic pain to a greater extent than other groups. In 13% of the population, manifest pain problems were associated with reduced functional capacity. Chronic pain symptoms are common but unevenly distributed in a general population. The results may influence planning and consultation in primary health care as well as warranting selective prevention activities.

Comparative Antihypertensive Effects of Losartan 50 mg and Losartan 50 mg Titrated to 100 mg in Patients with Essential Hypertension

Article

Jan 1997

The antihypertensive activity of losartan potassium (losartan, Cozaar), an angiotensin II receptor antagonist, was evaluated in a parallel 12-week, double-blind, placebo-controlled trial in hypertensive patients with mild-to-moderate hypertension. After a 4-week, single-blind, placebo lead-in period, which included monitoring of baseline variables, 366 patients with a group mean sitting diastolic blood pressure of 101 +/- 5 (s.d.) mmHg were assigned randomly to one of three treatment groups: placebo, losartan 50 mg, or losartan 50 mg with the option to titrate to 100 mg after the first 6 weeks if the target sitting diastolic blood pressure (< 90 mmHg) was not reached. To assess the potential blood pressure response associated with the act of titration, patients in the placebo and losartan 50 mg treatment groups with a sitting diastolic blood pressure of > or = 90 mmHg at week 6 were mock titrated (changed to a new tablet containing the same study medication and dose). Sitting diastolic blood pressure was also evaluated at the end of the trial during a 1-week off-drug period to assess for rebound hypertension. At week 6, patients in the active-drug-treatment arms experienced significantly greater peak (6 h post-dose) and trough (24 h post-dose) reduction in systolic and diastolic sitting blood pressures compared with placebo (p < or = 0.01). Based on trough blood pressures at week 12, active drug (both arms) was more effective than placebo in lowering sitting diastolic blood pressure, with a very small additional benefit associated with increasing the dose of losartan to 100 mg in patients who did not reach the target blood pressure after the first 6 weeks on losartan 50 mg. There was no evidence of rebound hypertension during 1 week after withdrawal of losartan. The correlation between baseline plasma renin activity and reduction in peak and trough blood pressure at week 12, although statistically significant, was generally poor in the active treatment groups. In this trial, losartan was efficacious and well tolerated, and was similar to placebo with regard to adverse-experience profile. Adverse experiences that could reasonably be related to excessive lowering of blood pressure were not common and there was no evidence of rebound hypertension.

Treatment situation of hypertensive patients in Finnish primary health care

Article

Jan 1997
Blood Pres Suppl

To highlight the present situation in hypertension control in Finnish primary healthcare. All health centre doctors from 30 primary health centres were asked to record every consulting patient, pick up hypertensives and evaluate their blood pressure (BP) level, drug treatment, side effects and symptoms related to drug treatment, and compliance during 2 weeks in May 1995. In all, 337 doctors from the 30 health centres participated in the study. They recorded altogether 4405 hypertensive patients, of which 1209 men (83%) and 2311 women (87%) had drug treatment for hypertension. Of all the drug-treated hypertensive men and women, 33% and 37%, respectively were obese (BMI > or = 30.0 kg/m2). Altogether, 13% of the drug-treated hypertensive men and 10% of women were in good control when BP < 140/90 mmHg was used as the criterion. These proportions doubled when BP < 160/90 mmHg and tripled when BP < 160/95 mmHg were applied as criteria. The proportion of drug-treated hypertensives under poor control is still high in Finland. Only a quarter of treated hypertensive patients are in good control when the criterion BP < 160/90 mmHg is applied.

Persistent Pain and Well-Being: A World Health Organization Study in Primary Care

Article

Aug 1998

There is little information on the extent of persistent pain across cultures. Even though pain is a common reason for seeking health care, information on the frequency and impacts of persistent pain among primary care patients is inadequate. To assess the prevalence and impact of persistent pain among primary care patients. Survey data were collected from representative samples of primary care patients as part of the World Health Organization Collaborative Study of Psychological Problems in General Health Care, conducted in 15 centers in Asia, Africa, Europe, and the Americas. Consecutive primary care attendees between the age of majority (typically 18 years) and 65 years were screened (n = 25 916) and stratified random samples interviewed (n = 5438). Persistent pain, defined as pain present most of the time for a period of 6 months or more during the prior year, and psychological illness were assessed by the Composite International Diagnostic Interview. Disability was assessed by the Groningen Social Disability Schedule and by activity-limitation days in the prior month. Across all 15 centers, 22% of primary care patients reported persistent pain, but there was wide variation in prevalence rates across centers (range, 5.5%-33.0%). Relative to patients without persistent pain, pain sufferers were more likely to have an anxiety or depressive disorder (adjusted odds ratio [OR], 4.14; 95% confidence interval [CI], 3.52-4.86), to experience significant activity limitations (adjusted OR, 1.63; 95% CI, 1.41 -1.89), and to have unfavorable health perceptions (adjusted OR, 1.26; 95% CI, 1.07-1.49). The relationship between psychological disorder and persistent pain was observed in every center, while the relationship between disability and persistent pain was inconsistent across centers. Persistent pain was a commonly reported health problem among primary care patients and was consistently associated with psychological illness across centers. Large variation in frequency and the inconsistent relationship between persistent pain and disability across centers suggests caution in drawing conclusions about the role of culture in shaping responses to persistent pain when comparisons are based on patient samples drawn from a limited number of health care settings in each culture.

NHP ± Koetun terveydentilan mittari terveydenhuollon arviointitutkimuksiin (in Finnish, with an English summary: NHP ± a method for measuring health-related quality of life in health services evaluation)

Jan 1992
229-235

P Koivukangas
J Koivukangas
A Ohinmaa
È S-L Kivela
P Krause

Koivukangas P, Koivukangas J, Ohinmaa A, Kivela È S-L, Krause P. NHP ± Koetun terveydentilan mittari terveydenhuollon arviointitutkimuksiin (in Finnish, with an English summary: NHP ± a method for measuring health-related quality of life in health services evaluation), Sos la Èa Èket aikak 1992;29:229±235.

Demography and organisation of the health system

Jan 1992
103-107

Ma Èkela

Ma Èkela È M. Demography and organisation of the health system. In: Lawrence M, Pritchard P, editors. General practitioners education, UK and Nordic perspectives, London, UK: Springer-Verlag, 1992. pp. 103±107.

The frequency of presentation of pain. An analysis of 1000 consecutive consultations.

Jan 1990
11

Potter

Potter RG. The frequency of presentation of pain. An analysis of 1000 consecutive consultations. Pain Soc 1990;8:11±14.

Health and the use of health services in Finland, main ®ndings of the Finnish health care survey 1995/96 and changes from 1987. Jyva Èskyla È: National research and development centre for welfare and health and the Social insurance institution

Jan 1995

S Arinen
U Ha Èkkinen
T Klaukka
J Klavus
R Lehtonen
S Aro

Arinen S, Ha Èkkinen U, Klaukka T, Klavus J, Lehtonen R, Aro S. Health and the use of health services in Finland, main ®ndings of the Finnish health care survey 1995/96 and changes from 1987. Jyva Èskyla È: National research and development centre for welfare and health and the Social insurance institution, 1995. p. 1998.

International statistical classi®cation of diseases and related health problems

Jan 1992

WHO. International statistical classi®cation of diseases and related health problems, Vol. 1. Geneva, Switzerland: World Health Organisation, 1992.

Pain in general practice

Jan 1986
97-100

F Frùlund
C Frùlund

Frùlund F, Frùlund C. Pain in general practice. Scand J Prim Health Care 1986;4:97±100.

Pain in general practice.

Jan 1986
97

Frolund

The prevalence of pain in a general population.

Jan 1989
215

Brattberg

Persistent pain and well-being, a World Health Organization study in primary care.

Jan 1998
147

Gureje

NHP - Koetun terveydentilan mittari terveydenhuollon arviointitutkimuksiin (in Finnish, with an English summary: NHP - a method for measuring health-related quality of life in health services evaluation), Sos laaket aikak.

Jan 1992
229

Koivukangas

Pain as a reason to visit the doctor: A study in Finnish primary health care

Abstract

No full-text available

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