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The implementation of recent Centers for Disease Control and Prevention recommendations to move away from opioids and toward nonpharmacological therapies for the treatment of chronic pain could involve a difficult transition period for patients and practitioners. The focus of treatment should shift from eliminating pain completely to minimizing the impact of pain on quality of life. Many patients with chronic pain take opioids either because opioids were previously prescribed as a first-line treatment for chronic pain, on the basis of old standards of care, or because opioids were initially prescribed for acute pain. Patients currently taking opioids will need a tapering period during which they transition their pain management to interdisciplinary care and nonpharmacological treatments. To provide useful treatment options, physical therapists need to have a good understanding of the neuroscientific mechanisms of chronic pain, biopsychosocial components of chronic pain management, issues related to opioid use, and pain management strategies used by other health care professionals. Armed with knowledge and good communication skills, physical therapists can work within an interdisciplinary team to adapt care to each patient's needs and abilities. This perspective article provides guidance for physical therapists to effectively treat patients with chronic pain during the opioid tapering process. A framework has been created to help health care providers structure their reasoning as they collaborate to develop a unique approach for each patient., The implementation of recent Centers for Disease Control and Prevention (CDC) recommendations to move away from opioids and toward nonpharmacological therapies for the treatment of chronic pain could involve a [...]

Few studies examine how comorbid pain locations and bothersomeness impact adults with lumbar spinal stenosis (LSS). We describe the associations of the number of comorbid pain sites and cumulative bothersomeness of those sites with pain impact. This cross-sectional study uses baseline data from a cohort of adults aged ≥50 seeking non-surgical care for LSS at two spine clinics. Comorbid pain locations are summed from a self-reported checklist of 9 locations (range 0-9), and bothersomeness at each site is rated between 0-2 (range 0-18, higher indicates greater bothersomeness). Our dependent variable was a pain impact score (range 8-50), which is the sum of 8 items on the interference and function scales of the PROMIS-29 and back pain intensity rating. We use descriptive statistics and linear regression adjusted for confounders for analysis. As of September 2023, 449 participants completed the baseline data collection; 407 complete cases were analyzed. 62% were female, 37% had pain for >5 years, and 21% used opioids in the last month. The mean number of comorbid pain locations was 4.3 (SD 2.2), the mean bothersomeness was 5.9 (SD 3.2), and the mean impact was 27.7 (SD 9.0). For every additional pain site, the pain impact score increases 0.93 points (95% CI= 0.49-1.36) and pain bothersomeness increases 0.90 points (95% CI= 0.60-1.19). Comorbid pain locations and bothersomeness may be important to consider when creating a care plan to reduce pain impact in adults with LSS. Funded by the National Institutes of Health (T90 AT008544, R01 AG069891, P30AR072572).

Data describing longitudinal pain outcomes is limited, particularly among patients experiencing chronic medical and psychiatric conditions. This study analyzed longitudinal patient-reported pain intensity and interference within six disease-specific subgroups (arthritis, major depressive disorder, generalized anxiety disorder, comorbid depression and anxiety, migraine, and type 2 diabetes) as well as a healthy (free from chronic illness) comparator group from the Project Baseline Health Study, a community-based observational cohort study with data collected from 2017-2023. Cross-sectional distributions were created for pain intensity and interference scores taken at enrollment. Longitudinal correlations were calculated between pain scores and psychosocial measures collected concurrently every six months. In the analysis population (N = 2009 of 2505 total PBHS participants), each of the six disease-specific subgroups displayed higher average pain intensity and interference scores than the healthy comparator group. While 25% of healthy participants reported no pain intensity at enrollment and 37% reported no pain interference, these proportions were lower for all disease cohorts (Arthritis: 9%, 15%; Depression: 16%, 24%; Anxiety: 15%; 21%; Depression-Anxiety: 10%, 16%; Migraine: 12%; 22%; T2D: 15%, 23% - respectively). Within all subgroups, Satisfaction With Life (SWL) was the most negatively correlated with pain scores while the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were the most positively correlated. By examining pain distributions and correlations in a community-based population, this study offers novel insights into how patients with chronic illnesses experience pain.

The transition from acute to chronic low back pain (LBP) in community settings is not well understood. The purpose of this study was to assess the feasibility of recruitment and estimate the transition and continuation of chronic LBP. We also explored characteristics associated with this transition to chronic LBP. We enrolled n=131 participants, of which n=118 (90%) completed 3-month outcomes and n=111 (85%) completed 6-month outcomes. Acute LBP was defined by a duration of <4 weeks and a 30-day LBP-free period before the current acute episode. Chronic LBP was defined as pain most or every day over the past 3 months. The transition from acute to chronic LBP at 3 months was 32.2% (38/118), and at 6 months, 80.6% (25/31) of participants who transitioned at 3 months continued to have chronic LBP at 6 months. Participants with more frequent acute LBP and at an intensity of 30/100 were more likely to transition to chronic LBP (Risk Ratio (RR)=3.13, 95% Confidence Interval (CI) 1.84, 5.30) and continue to have chronic LBP at 6-months (RR=3.10, 95% CI 1.48, 6.08). Higher risk on the STarT Back Screening Tool was associated with the transition to chronic LBP at 3 months (RR=1.73, 95% CI 1.28, 2.35) and continuation of chronic LBP at 6 months (RR=1.26, 95% CI 1.10, 1.45). The recruitment of acute LBP was feasible in a community setting. Acute LBP is a common condition in the community and frequently transitions to chronic LBP, suggesting the potential for substantial burden in the community.