MULTITASKER AND FAMILY provider. Always attentive, do-it-all parent. Handyperson, cook and family vacation planner. Busy, active spouse who still finds time for fun. People tend to take healthy loved ones and all they contribute for granted – until chronic pain throws a wrench into what once was a comfortable household.
Chronic pain disrupts the balance of give and take among spouses, parents and children. Drastic shifts in a family member’s ability to function, financial burdens from reduced income and rising medical costs, and the ever-present awareness of suffering can’t help but take a toll at home. Breezy conversations of the past can become emotionally loaded minefields.
Young children may blame themselves when parents seem angry or impatient. Kids can feel neglected when their mom or dad can’t attend school activities or sporting events and they may resent the loss of attention. Kids sometimes have to take on additional chores or unaccustomed caregivingroles.
A unique pain program is helping complex surgical patients wean off opioids safely and effectively, while offering alternative ways to cope with their pain and improve how they function.
A study following 251 surgical patients at risk of developing chronic pain or persistent opioid use at Toronto General Hospital (TG), University Health Network (UHN) found that almost half of patients who did not take opioids before surgery were able to wean off opioids, and one in four of those who did take opioids before surgery were able to wean completely.
Prescription opioids play an important role in addressing certain kinds of pain — they are the best pharmacological option available for acute pain and widely used for cancer-related pain.
Two pathways in the brain converging at the amygdala regulate the anxiety and depression that often accompanies chronic pain, suggests research in male rats published in JNeurosci. One of these pathways may represent a top-down mechanism that controls negative emotion under stress.
Using optogenetic stimulation, Zhizhong Pan and colleagues identify two opposing neural pathways — one that carries pain signals from the parabrachial nucleus to the central nucleus of amygdala (PBN-CeA) and another from the basolateral amygdala to CeA (BLA-CeA) — that integrate negative and positive emotion.
A Kaiser Permanente study of nearly 2,500 patients who used high doses of opioids for at least six months showed that reducing their opioid use did not lower their satisfaction with care. The study, “Satisfaction With Care After Reducing Opioids for Chronic Pain,” was published today in The American Journal of Managed Care.
“Physicians are often concerned they will receive lower satisfaction scores if they reduce opioids for patients who are accustomed to high opioid doses to manage chronic pain,” said the study’s lead author, Adam L. Sharp, MD, MS, of Kaiser Permanente Southern California Department of Research & Evaluation. “This study showed that following current recommendations and reducing opioids for chronic pain did not result in lower satisfaction scores.”
Opioid use has been a major health concern in the U.S. Opioid use increased in the United States by 300 percent from 1997 to 2010, and overdose deaths increased 200 percent from 2000 to 2014. An in-depth analysis of U.S. data released by the Centers for Disease Control and Prevention in March showed that drug overdoses killed 63,632 Americans in 2016 and nearly two-thirds of those deaths involved a prescription or illicit opioid.
The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) at ACL issued a request for information about people with disabilities and opioid use disorder, which yielded comments from 50 respondents, including consumers, community and national organizations, research teams, and federal partners.
Key findings from this effort are helpful to NIDILRR as it considers developing new funding opportunities related to the opioid crisis. These responses provided information about what is known and what are the most pressing research questions for the disability and rehabilitation research fiends. A common thread among respondents was that there are many important unanswered research questions at the nexus of chronic pain, opioid misuse, and people with disabilities.
By teaching patients better strategies for coping with chronic pain, cognitive behavioral therapy (CBT) is a valuable treatment alternative for the millions of Americans taking opioids for noncancer pain, according to an article in the Journal of Psychiatric Practice. The journal is published by Wolters Kluwer.
“Cognitive behavioral therapy is a useful and empirically based method of treatment for pain disorders that can decrease reliance on the excessive use of opiates,” write Drs. Muhammad Hassan Majeed of Natchaug Hospital, Mansfield Center, Conn., and Donna M. Sudak of Drexel University College of Medicine, Philadelphia. They discuss evidence supporting the use of CBT to avoid or reduce the use of opioids for chronic pain.
Because ongoing pain is a significant problem that affects 39 to 85 percent of people living with HIV, everyone with the infection should be assessed for chronic pain, recommend guidelines released by the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) and published in the journal Clinical Infectious Diseases. Those who screen positive should be offered a variety of options for managing pain, starting with non-drug treatment such as cognitive behavioral therapy, yoga and physical therapy, suggest the first comprehensive guidelines on HIV and chronic pain.
“Because HIV clinicians typically are not experts in pain management, they should work closely with others, such as pain specialists, psychiatrists and physical therapists to help alleviate their patients’ pain,” said Douglas Bruce, MD, MA, MS, lead author of the guidelines, chief of medicine at Cornell Scott-Hill Health Center, and associate clinical professor of medicine at Yale University, New Haven, Conn. “These comprehensive guidelines provide the tools and resources HIV specialists need to treat these often-complex patients, many of whom struggle with depression, substance use disorders, and have other health conditions such as diabetes.”
Cognitive Behavioral Therapy (CBT) is the most frequently used psychological intervention for people with chronic pain, and new approaches for improving CBT outcomes may be found in the psychological flexibility model and Acceptance and Commitment therapy (ACT), according to research reported in The Journal of Pain.
Acceptance and Commitment Therapy (ACT) is based on the psychological flexibility model, which includes a therapeutic process known as “self-as-context” (SAC). Contextual self refers to a sense of self that is not based on self-evaluations. It is similar to being an observer of one’s own psychological experiences. Researchers in the United Kingdom writing in The Journal of Pain examined whether ACT influences SAC and if changes in measures of SAC are associated with treatment outcomes.
Deep brain stimulation (DBS) of the ventral striatum/anterior limb of the internal capsule is safe and feasible in addressing the affective component of pain in patients with post-stroke pain syndrome.
Cleveland Clinic investigators reported findings from the first prospective, randomized, controlled trial of DBS for neuropathic pain in a presentation at the 2017 annual scientific meeting of the American Association of Neurological Surgeons. The study was also published in the May 2017 issue of Annals of Neurology.
“We showed that active versus sham DBS of the ventral striatum/anterior limb of the internal capsule produced significant improvements in multiple outcome measures associated with the affective sphere of chronic pain,” says lead investigator Andre Machado, MD, PhD, Chairman of Cleveland Clinic’s Neurological Institute. “This trial represents a paradigm shift in chronic pain management in that it targeted neurostimulation to brain structures related to the affective, rather than sensory, sphere of chronic pain.”
Poorer and less-educated older Americans are more like to suffer from chronic pain than those with greater wealth and more education, but the disparity between the two groups is much greater than previously thought, climbing as high as 370 percent in some categories, according to new research by a University at Buffalo medical sociologist.
The results, based on 12 years of data from more than 19,000 subjects aged 51 and over, excluding those diagnosed or treated for cancer, provide several kinds of bad news about chronic pain in the United States, according to Hanna Grol-Prokopczyk, an assistant professor of sociology at UB and the paper’s author, published in this month’s issue of the journal Pain.
Chronic pain levels are also rising by period and not just by age, meaning people who were in their 60s in 2010 reported more pain than people who were in their 60s in 1998. “There are a lot of pressures right now to reduce opioid prescription,” says Grol-Prokopczyk. “In part, this study should be a reminder that many people are legitimately suffering from pain. Health care providers shouldn’t assume that someone who shows up in their office complaining of pain is just trying to get an opioid prescription. “We have to remember that pain is a legitimate and widespread problem,” she says.