Search

To examine feasibility and acceptability of providing stepped collaborative care case management targeting posttraumatic stress disorder (PTSD) and pain symptoms after major traumatic injury. Participants were major trauma survivors in Victoria, Australia, at risk of persistent pain or PTSD with high baseline symptoms. Participants were block-randomized, stratified by compensation-status, to the usual care (n = 15) or intervention (n = 17) group (46% of eligible patients). The intervention was adapted from existing stepped collaborative care interventions with input from interdisciplinary experts and people with lived experience in trauma and disability. The proactive case management intervention targeted PTSD and pain management for 6-months using motivational interviewing, cognitive behavioral therapy strategies, and collaborative care. Qualitative interviews explored intervention acceptability. Intervention participants received a median of 7 h case manager contact and reported that they valued the supportive and non-judgmental listening, and timely access to effective strategies, resources, and treatments post-injury from the case manager. Participants reported few disadvantages from participation, and positive impacts on symptoms and recovery outcomes consistent with the reduction in PTSD and pain symptoms measured at 1-, 3- and 6-months. Stepped collaborative care was low-cost, feasible, and acceptable to people at risk of PTSD or pain after major trauma. After hospitalization for injury, people can experience difficulty accessing timely support to manage posttraumatic stress, pain and other concerns. Stepped case management-based interventions that provide individualized support and collaborative care have reduced posttraumatic stress symptom severity for patients admitted to American trauma centers. We showed that this model of care could be adapted to target pain and mental health in the trauma system in Victoria, Australia. The intervention was low cost, acceptable and highly valued by most participants who perceived that it helped them use strategies to better manage post-traumatic symptoms, and to access clinicians and treatments relevant to their needs. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis is a major cause of pain and disability. Pain control is poor, with most patients remaining in moderate to severe pain. This may be because central causes of pain, a common contributor to knee pain, are not affected by current treatment strategies. Antidepressants, such as amitriptyline, have been used to treat chronic pain in other conditions. The aim of this randomised, double blind, controlled trial, is to determine whether low dose amitriptyline reduces pain in people with painful knee osteoarthritis over 3 months compared to benztropine, an active placebo.Methods/design: One hundred and sixty people with painful radiographic knee osteoarthritis will be recruited via clinicians, local and social media advertising. Participants will be randomly allocated in a 1:1 ratio to receive either low dose amitriptyline (25 mg) or active placebo (benztropine mesylate, 1 mg) for 3 months. The primary outcome is change from baseline in knee pain (WOMAC pain subscale) at 12 weeks. Secondary outcomes include change in function (total WOMAC) and the proportion of individuals achieving a substantial response (≥ 50% reduction in pain intensity, measured by Visual Analog Scale, VAS, from no pain to worst pain imaginable, 0-100 mm) and moderate response (≥ 30% reduction in pain intensity, measured by VAS) at 12 weeks. Intention to treat analyses will be performed. Subgroup analyses will be done.Discussion: This study will provide high level evidence regarding the effectiveness of low dose amitriptyline compared to benztropine in reducing pain and improving function in knee OA. This trial has the potential to provide an effective new therapeutic approach for pain management in knee osteoarthritis, with the potential of ready translation into clinical practice, as it is repurposing an old drug, which is familiar to clinicians and with a well described safety record.Trial Registration: Australian New Zealand Clinical Trials Registry prior to recruitment commencing ( ACTRN12615000301561 , March 31, 2015, amended 14 December 2018, February 2021). Additional amendment requested 18 July 2021. [ABSTRACT FROM AUTHOR]

Introduction: The perceived capacity to perform particular activities or skills (i.e. self-efficacy) is paramount in occupational therapy and is thought to be reinforced by actual functional capacity. This study examined whether changes in self-efficacy or confidence to lift weighted items influences changes in occupational performance and disability levels in patients attending a cognitive behavioural therapy pain management programme. Method: Clients attending an 8-week cognitive behavioural therapy pain management programme (N = 125) completed questionnaires before treatment, at discharge, and at 3-month and 6-month reviews, including measures of pain self-efficacy, disability and self-perceived performance and satisfaction using the Canadian occupational performance measure. Analyses examined disability and occupational performance over time, adjusting for baseline characteristics (age, sex, education), and sought to determine whether self-efficacy or lifting confidence influenced the outcomes. Results: The level of disability, lifting confidence, self-efficacy and occupational performance all improved over time; however, only occupational performance and lifting confidence maintained improvements up to the 6-month review. Self-efficacy had a greater impact on occupational performance than lifting confidence. [ABSTRACT FROM AUTHOR]

Lower rates of cancer screening among racial/ethnic minorities and low-income populations may contribute to disparate cancer outcomes.[1] Federal housing assistance programs may potentially influence cancer screening disparities but has received relatively little attention. These programs, which are administered through the U.S. Department of Housing and Urban Development (HUD) and include public housing and rental assistance (i.e., Housing Choice Vouchers), currently serve approximately 10 million individuals.[2] Similar to populations in the USA with the lowest cancer screening rates, HUD housing assistance recipients are nearly exclusively low-income and disproportionately non-white.[3] Federal housing assistance may affect cancer screening rates through several mechanisms. As housing authorities, developers, and health systems work to use housing as a platform for service coordination and health promotion, greater attention should be given to improving cancer screening in this vulnerable population. [Extracted from the article]

Objective. Chronic pain is experienced by one in five Australians and is estimated to be the nation's third most costly health problem. In 2013, a chronic pain treatment outcomes registry was established, with the goals of evaluating treatment of chronic pain in multidisciplinary centers, establishing a benchmarking system to drive quality improvement and providing answers to important questions regarding types of treatment ("dose," intensity, and response) and which treatment is appropriate for different patients. This paper describes the development and the first-phase implementation of the registry. Methods.A minimum data set of primarily patient-rated measures was developed for use within pain management services. Governance structures and protocols for data collection were established, and software and resources created, to support pain management services. Results. Data collection commenced in 21 centers in Australia and is being implemented in over 20 others across Australia and New Zealand within the first two years. Feedback in the initial phase has already resulted in improvements to the software and reports, as well as minor changes to the data set. Centers have submitted high-quality data describing the demographic and clinical characteristics of patients referred to specialist pain services. Conclusions. The electronic Persistent Pain Outcomes Collaboration has been established for Australasia and is strongly supported by specialist societies and consumer groups. The next phase will increase the proportion of follow-up data in order to realize the registry's goals of evaluation, benchmarking, and research to improve outcomes and services for patients experiencing persistent pain. [ABSTRACT FROM AUTHOR]

Background. Opioids are increasingly prescribed for chronic noncancer pain across the developed world. Clinical guidelines for management of these patients focus on over-use. However, research into other types of long-term medication indicates that many patients minimize drug use whenever possible. Objective. To identify the varying influences on patients' decisions about their use of prescribed opioids and explore whether concepts of resistance and minimization of intake apply to these patients. Design. A multiprofessional team performed a qualitative interview study using the constant-comparative method. Patient's decision making was explored in depth and with a thematic analysis utilizing a published "Model of medicine-taking." Setting and participants. A purposive sample of 20 participants drawn from two pain clinics in Melbourne, Australia. The sample was biased toward patients interested in nonmedication pain management options. Findings. Patients' needs to obtain relief from severe pain, maintain function, and minimize side effects could lead to under-use as well as over-use of prescribed opioids. In keeping with the published Model of medicine-taking, resistance to taking opioids was a common and important influence on behavior. In the face of severe chronic pain, many participants used a variety of strategies to evaluate, avoid, reduce, self-regulate, and replace opioids. Furthermore, participants perceived a resistance to opioids within the system and among some healthcare professionals. This sometimes adversely affected their adherence. Conclusions. Both patients and doctors exhibit aspects of resistance to the use of prescribed opioids for chronic noncancer pain, suggesting that this shared concern could be the basis of a productive therapeutic alliance to improve communication and shared decision making. Summary. Clinical guidelines for opioids use for chronic noncancer pain focus on over-use. Our qualitative interview study found that many patients resisted and minimized the use of opioids. Using a published "Model of medicine-taking," we identified various influences on patient decision making. Both patients and doctors had concerns about using opioids for chronic noncancer pain. These could be the basis of a productive therapeutic alliance to improve communication and shared decision making. [ABSTRACT FROM AUTHOR]

Objective and Design Individuals seeking treatment for chronic pain in multidisciplinary pain management services are typically already on high doses of pain medications. This cross-sectional cohort study of patients with long-term chronic pain examined profiles of polypharmacy and pain medication-related harm exposure. Setting Multidisciplinary pain management service. Subjects The cohort comprised 224 patients taking medications for their pain (1-9 medications; mean = 3.19) with an average pain duration of 10.33 years. Methods The Medication Quantification Scale III ( MQS-III) was used to examine potential harm exposure. We generated detriment scores for simple analgesics, adjunctive therapies (e.g., anticonvulsants), opioids, and benzodiazepines. Results The total MQS-III score was correlated with the total number of medications, but not with age. Almost 10% of patients took medications from all four categories, with most taking medications from two (37%) to three (35%) classes. Eighty percent of patients were taking opioids, accounting for 41% of total MQS scores. Five primary profiles of potential medication-related harms were identified: high harm from all medication categories (N = 12); above average harm from single category-simple analgesics (N = 76), adjunctive analgesics (N = 59), or opioids (N = 46); and above average opioid and benzodiazepine harm (N = 31). Conclusions While treatment with multiple medications for synergistic or adjunctive effects may assist in medical management of chronic pain, this approach generates increased potential harm exposure. We show that the majority of detriment comes from medications other than opioids and highlight the importance of profiling all pain medications contributing to polypharmacy in clinical pain studies. [ABSTRACT FROM AUTHOR]

The article talks about a prognostic study on psychiatric consequences of serious injury and psychiatric morbidity. Topics include the prevalence of mental disorders within 3 years after serious injury, risk factors for onset of disorders within 1 year of such injury, and psychiatric assessment and diagnosis using gold standard tools. Other topics include injury measures, pain scores, and early detection and treatment of later onset disorders due to persistent pain and physical disability.

Aims To investigate the progression of the illness and opioid journeys of people who are taking opioids for chronic non-cancer pain. Methods In-depth qualitative interviews were conducted with 20 people who were taking opioids for non-cancer pain. A purposive sample was drawn from patients attending two pain clinics in Melbourne, Australia. Transcripts were analyzed within case, as individual narratives, and across case, as a thematic analysis. Conceptual explanatory variables were developed. Results The experience of taking opioids for chronic non-cancer pain varies greatly between individuals and these diverse narratives-chaos, restitution, and quest narratives-raise questions about why and how some individuals find a way forward, while others remain in situations of chaotic and worsening ill health. We offer an explanation for this variability in terms of four key influences: support from individual health professionals and the health system; medical explanation or solutions; social support and social responsibilities; and the use of non-pharmaceutical interventions and self-help strategies. A unifying theme was the importance of maintaining hope. Conclusion The four key factors influencing the progress of people taking opioids for chronic non-cancer pain are rooted in the provisions made by society for caring for this patient group and involve relationships between patient and provider, between patients and their social world, and between different providers and their professional knowledge. In our patient sample, effective support involved the provision and maintenance of hope, and professionals who are knowledgeable about opioids and chronic pain, good communicators, and cognizant with their patients' social support and responsibilities. [ABSTRACT FROM AUTHOR]

Objective Patients with pain 3 years after injury are at risk of lifetime pain. It is not known if the predictors of chronic pain at 3 years are the same as those for earlier time points or whether other factors become important. Clarifying these factors will aid our understanding of the development of long-term pain and further inform the development of models for screening and early intervention for pain in the aftermath of injury. Design Patients admitted to two trauma centers underwent a comprehensive physical and psychological assessment of known and potential risk factors for chronic pain during their index admission. Three years after injury, these patients were assessed for the presence of chronic pain (score was ≥5 on an 11-point numerical rating scale during the last episode of pain, and present in the last month and at least two times in the past week) and pain-related disability. Logistic regression was used to identify independent risk factors for the presence of chronic pain and disability. Results Two hundred and twenty patients (75.9% of the original cohort) were assessed at 3 years. Of these, 146 (66.7%) reported some pain and 52 (23.7%) reported chronic pain. Factors (present at the time of injury) that predicted chronic pain were lower socioeconomic status, pain severity, and injury severity. The predictive power of these combined factors was modest. Conclusions Three years after serious injury, almost a quarter of patients report chronic pain, and more than a third report at least moderate pain-related disability. The predicative power of measures taken in the acute setting is not enough to support discharge screening alone as a method of triaging high-risk patients to early intervention. [ABSTRACT FROM AUTHOR]