Search

Objective The Graded Chronic Pain Scale (GCPS) is frequently used in pain research and treatment to classify mild, bothersome, and high impact chronic pain. This study's objective was to validate the revised version of the GCPS (GCPS-R) in a US Veterans Affairs (VA) healthcare sample to support its use in this high-risk population. Methods Data were collected from Veterans (n = 794) via self-report (GCPS-R and relevant health questionnaires) and electronic health record extraction (demographics and opioid prescriptions). Logistic regression, adjusting for age and gender, was used to test for differences in health indicators by pain grade. Adjusted odds ratio (AOR) with 95% confidence intervals (CIs) were reported with CIs not including an AOR of 1 indicating that the difference exceeded chance. Results In this population, the prevalence of chronic pain (pain present most or every day, prior 3 months) was 49.3%: 7.1% with mild chronic pain (mild pain intensity and lower interference with activities); 23.3% bothersome chronic pain (moderate to severe pain intensity with lower interference); and 21.1% high impact chronic pain (higher interference). Results of this study mirrored findings in the non-VA validation study; differences between bothersome and high impact were consistent for activity limitations and present but not fully consistent for psychological variables. Those with bothersome chronic pain or high impact chronic pain were more likely to receive long-term opioid therapy compared to those with no/mild chronic pain. Conclusions Findings highlight categorical differences captured with the GCPS-R, and convergent validity supports use of the GCPS-R in US Veterans. [ABSTRACT FROM AUTHOR]

A randomized, controlled trial was conducted to determine if a primary care-based, care-management intervention for multiple conditions would improve medical outcomes and depression scores among patients with major depression and poorly controlled diabetes, coronary heart disease or both. Compared to usual care, an intervention guideline-based, patient-centered management of depression and chronic disease under the supervision of nurses was found to significantly improve the control of medical disease and depression.

The main objective was to compare usual primary care for depression with two intervention programs namely, telephone care management and telephone care management plus telephone psychotherapy. Three-group randomized controlled trial with allocation concealment and blinded outcome assessment were conducted between November 2000 and May 2002.

Giving antidepressants or psychotherapy to patients with arthritis who are also depressed can benefit them in more ways than one, according to a study of 1,001 patients. Not only did the treatment lessen their depression, it also reduced their pain and improved their overall functioning and quality of life. Depression can have the same impact on disability as heart disease and other chronic diseases.

Usual medical care often fails to meet the needs of chronically ill patients, even in managed, integrated delivery systems. The medical literature suggests strategies to improve outcomes in these patients. Effective interventions tend to fall into one of five areas: the use of evidence-based, planned care; reorganization of practice systems and provider roles; improved patient self-management support; increased access to expertise; and greater availability of clinical information. The challenge is to organize these components into an integrated system of chronic illness care. Whether this can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care remains unanswered.

Objectives. The purposes of this study were to (1) characterize the social disability associated with the common psychiatric illnesses of primary care patients in terms of role dysfunction (self-care, family role, social role, occupational role) and (2) establish whether severity of psychiatric illness and disability level show synchrony of change. Methods. A two-stage sample design was employed. In the first state, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness by their physicians and with the General Health Questionnaire. A stratified random sample (n = 285) with differing probabilities was selected for a second-stage interview. Patients with psychiatric symptons were reinterviewed 1 and 3.5 years later (n = 143). Results. (1) Disability Level among patients was increased (moderately for depression, mildly for anxiety and was associated with severity of psychiatric illness. (2) Most disability was found in occupational and social roles. (3) Change in severity of psychiatric illness was concordant wit change in level of disability and was largely invariant across diagnosis (depression, anxiety, mixed anxiety/depression). At follow-up, disability among improved patients had returned to normal levels. Conclusions. Psychiatric illness in primary care patients is associated with mild to moderate disability, and severity of psychiatric illness and disiability show synchrony of change. (Am J Public Health. 1993;83:385-390), Psychiatric illnesses such as depression and anxiety can cause mild to moderate social disability in some patients treated by primary care physicians. The degree of loss of functioning in social roles may increase with the severity of disease. A study examined the level of disability among patients of primary care physicians with psychiatric illnesses over a three-and-a-half-year period. The level of disability had increased moderately for the patients suffering from depression and mildly for those suffering from anxiety. An increase in disability was associated with an increase in the severity of illness. The level of disability depended on the severity of psychiatric symptoms. Patients whose illnesses improved returned to a normal level of functioning. The patients' occupational and social roles were more affected by disability than their family roles or personal care.

Background Multisite chronic pain (MSCP) is associated with increased chronic pain impact, but methods for identifying MSCP for epidemiological research have not been evaluated. Objective We assessed the validity of identifying MSCP using electronic health care data compared with survey questionnaires. Methods Stratified random samples of adults served by Kaiser Permanente Northwest and Washington (N = 2,059) were drawn for a survey, oversampling persons with frequent use of health care for pain. MSCP and single-site chronic pain were identified by two methods, with electronic health care data and with self-report of common chronic pain conditions by survey questionnaire. Analyses were weighted to adjust for stratified sampling. Results MSCP was somewhat less common when ascertained by electronic health records (14.7% weighted prevalence) than by survey questionnaire (25.9% weighted prevalence). Agreement of the two MSCP classifications was low (kappa agreement statistic of 0.21). Ascertainment of MSCP with electronic health records was 30.9% sensitive, 91.0% specific, and had a positive predictive value of 54.5% relative to MSCP identified by self-report as the standard. After adjusting for age and gender, patients with MSCP identified by either electronic health records or self-report showed higher levels of pain-related disability, pain severity, depressive symptoms, and long-term opioid use than persons with single-site chronic pain identified by the same method. Conclusions Identification of MSCP with electronic health care data was insufficiently accurate to be used as a surrogate or screener for MSCP identified by self-report, but both methods identified persons with heightened chronic pain impact. [ABSTRACT FROM AUTHOR]

Objective Chronic musculoskeletal pain (CMSP) disorders are among the most prevalent and disabling conditions worldwide. It would be advantageous to have common outcome measures when comparing results across different CMSP research studies. Methods The Veterans Health Administration appointed a work group to recommend core outcome measures for assessing pain intensity and interference as well as important secondary domains in clinical research. The work group used three streams of data to inform their recommendations: 1) literature synthesis augmented by three recently completed trials; 2) review and comparison of measures recommended by other expert groups; 3) two Delphi surveys of work group members. Results The single-item numerical rating scale and seven-item Brief Pain Inventory interference scale emerged as the recommended measures for assessing pain intensity and interference, respectively. The secondary domains ranked most important included physical functioning and depression, followed by sleep, anxiety, and patient-reported global impression of change (PGIC). For these domains, the work group recommended the Patient-Reported Outcome Information System four-item physical function and sleep scales, the Patient Health Questionnaire two-item depression scale, the Generalized Anxiety Disorder two-item anxiety scale, and the single-item PGIC. Finally, a single-item National Health Interview Survey item was favored for defining chronic pain. Conclusions Two scales comprising eight items are recommended as core outcome measures for pain intensity and interference in all studies of chronic musculoskeletal pain, and brief scales comprising 13 additional items can be added when possible to assess important secondary domains. [ABSTRACT FROM AUTHOR]

Objective We aimed to determine if opioid risk reduction initiatives including dose reduction and risk mitigation strategies for chronic noncancer pain patients receiving chronic opioid therapy (COT) had a differential impact on average daily opioid doses of COT patients at higher risk for opioid-related adverse outcomes compared with lower-risk patients. Design Interrupted time series. Setting Group Health Cooperative (GH), a health care delivery system and insurance within Washington State, between 2006 and 2014. Population GH enrollees on COT defined as receiving a supply of 70 or more days of opioids within 90 days using electronic pharmacy data for filled prescriptions. Methods We compared the average daily morphine equivalent doses (MED) of COT patients with and without each of the following higher-risk characteristics: mental disorders, substance use disorders, sedative use, and male gender. Results In all four pairwise comparisons, the higher-risk subgroup had a higher average daily MED than the lower-risk subgroup across the study period. Adjusted for covariates, modest differences in the annual rate of reduction in average daily MED were noted between higher- and lower-risk subgroups in three pairwise comparisons: those with mental disorders vs without (–8.2 mg/y vs –5.2 mg/y, P  = 0.005), with sedative use vs without (–9.2 mg/y vs –5.8 mg/y, P  = 0.004); mg), in men vs women (–8.8 mg/y vs –5.9 mg/y, P  = 0.01). Conclusion Using clinical policy initiatives in a health care system, dose reductions were achieved among COT patients at higher risk for opioid-related adverse outcomes that were at least as large as those among lower-risk patients. [ABSTRACT FROM AUTHOR]

This article considers methodology for developing an education-only control group and proposes a simple approach to designing rigorous and well-accepted control groups. This approach is demonstrated in a large randomized trial. The Lifestyles trial (n = 367) compared three group interventions: (a) cognitive-behavioral treatment (CBT) for osteoarthritis pain, (b) CBT for osteoarthritis pain and insomnia, and (c) education-only control (EOC). EOC emulated the interventions excluding hypothesized treatment components and controlling for nonspecific treatment effects. Results showed this approach resulted in a control group that was highly credible and acceptable to patients. This approach can be an effective and practical guide for developing high-quality control groups in trials of behavioral interventions. [ABSTRACT FROM AUTHOR]

Background. Chronic opioid therapy (COT) guidelines recommend developing a COT care plan at the initiation of COT. Objective. Assess the timeliness of care planning upon initiation of COT. Design. Observational cohort study in a setting incentivizing and tracking documentation of COT care plans in electronic health records (EHRs). Participants. Study participants (N=896) were aged 45 years or older, had initiated an episode of opioid use within the prior 6 months, and reported regular use of prescription analgesics when screened for a baseline interview about 3 months after an index opioid prescription Measures. A timely care plan was defined by an EHR documented care plan prior to or within 4 months after the index opioid prescription. Results. Among COT initiators, 30% had a timely COT care plan documented in the EHR within 4 months following index prescription, while 51% had a documented COT care plan within 12 months following index prescription. Among those interviewed at 1 year follow-up (N=735), 252 (34.2%) reported opioid use on 7 or more days in the prior 2 weeks. Less than half (45.6%) of the 252 individuals who sustained regular opioid use at 1 year had predicted at baseline that it was somewhat, very, or extremely likely they would be using opioids regularly in 1 year. Conclusions. Patients initiating COT were unlikely to have timely COT care plans. Many who sustained regular opioid use at 1 year had not anticipated using opioids long term. [ABSTRACT FROM AUTHOR]

Pain appears to be a common consequence of psychological illness across cultures. Researchers collected data on pain, psychological illness and disability in 5,438 primary care patients from 15 centers in Asia, Africa, Europe and the Americas. Overall, 22% of the patients reported persistent pain, but the percentages ranged from 5% to 33% depending on the country. Those with pain were more likely to have anxiety and depressive disorders. Persistent pain was consistently linked to psychological illness in all cultures, but not to disability.