<p dir="ltr">Opioid-related risk assessment is a key component of safe and effective pain care. Prior opioid misuse is a known predictor of opioid-related risk, but its predictive quality depends on the specific behavior – some behaviors confer high risk (red flag), whereas others confer medium (yellow flag) or low risk (green flag). Race and gender disparities in opioid prescribing are well documented, but little is known about how patient race and gender interact with prior opioid misuse to impact physicians’ risk assessments. One hundred physicians were presented 12 virtual patients (videos and text vignettes) with chronic pain who varied by race (Black, White), gender (female, male), and prior opioid nonadherence (red, yellow, green flag). Physicians made assessment decisions about patients’ risk for future opioid-related adverse events, abuse/misuse, diversion, and opioid use disorder (OUD). Linear mixed effects models examined the independent and interactive effects of patient race, gender, and prior opioid misuse on physicians’ risk assessments. Results indicated that severity of prior opioid nonadherence significantly impacted physicians’ risk assessments for future opioid-related adverse events, prescription misuse/abuse, diversion, and OUD. However, these effects differed based on patient gender. Men with yellow flag behaviors were rated at higher risk for adverse events, abuse/misuse, and OUD relative to women with yellow flag behaviors. Conversely, among patients with red flag behaviors, women were rated at higher risk for adverse events, abuse/misuse, and OUD relative to men. Patient race did not impact physicians’ risk assessments. These findings inform efforts to enhance equity and outcomes in chronic pain care.</p>

No / Chronic pain is currently under-diagnosed and under-treated, partly because doctors' training in pain management is often inadequate. This situation looks certain to become worse with the rapidly increasing elderly population unless there is a wider adoption of best pain management practice. This paper reviews current knowledge of the development of chronic pain and the multidisciplinary team approach to pain therapy. The individual topics covered include nociceptive and neuropathic pain, peripheral sensitization, central sensitization, the definition and diagnosis of chronic pain, the biopsychosocial model of pain and the multidisciplinary approach to pain management. This last section includes an example of the implementation of a multidisciplinary approach in Belgium and describes the various benefits it offers; for example, the early multidimensional diagnosis of chronic pain and rapid initiation of evidence-based therapy based on an individual treatment plan. The patient also receives continuity of care, while pain relief is accompanied by improvements in physical functioning, quality of life and emotional stress. Other benefits include decreases in catastrophizing, self-reported patient disability, and depression. Improved training in pain management is clearly needed, starting with the undergraduate medical curriculum, and this review is intended to encourage further study by those who manage patients with chronic pain.

No / The objective of this article was to evaluate the effectiveness of pharmacist-led medication review in chronic pain management. Six electronic databases (Medline, Embase, PsycInfo, CINHAL, CENTRAL, International Pharmaceutical Abstracts) reference lists of retrieved articles and relevant websites were searched for randomized controlled trials published in the English language involving adults with chronic pain. Studies were included if one of the intervention arms had received pharmacist-led medication review independently or as part of a multidisciplinary intervention. Risk of bias was assessed for all the included studies. The search strategy yielded 583 unique articles including 5 randomized controlled trials. Compared with control, meta-analysis showed that participants in the intervention group had: a 0.8-point reduction in pain intensity on a 0 to 10 numerical rating scale at 3 months [95% confidence interval (CI), -1.28 to -0.36] and a 0.7-point reduction (95% CI, -1.19 to -0.20) at 6 months; a 4.84 point (95% CI, -7.38 to -2.29) and -3.82 point (95% CI, -6.49 to -1.14) improvement in physical functioning on a 0- to 68-point function subscale of Western Ontario and McMaster Universities Osteoarthritis Index at 3 and 6 months, respectively; and a significant improvement in patient satisfaction equivalent to a "small to moderate effect." Pharmacist-led medication review reduces pain intensity and improves physical functioning and patient satisfaction. However, the clinical significance of these findings remain uncertain due to small effect size and nature of reported data within clinical trials that limits recommendation of wider clinical role of pharmacist in chronic pain management.

Bakgrund: Långvarig smärta är ett komplext sjukdomstillstånd som kräver särskilda rehabiliteringsåtgärder. Ofta tillämpas ett interdisciplinärt arbetssätt vid smärtrehabilitering. Teamarbete är en viktig aspekt av det interdisciplinära arbetet. Det finns fortfarande ett begränsat antal studier som undersöker fysioterapeutens upplevelser av interdisciplinärt teamarbete. En studie som undersöker fysioterapeuters perspektiv kan bidra till ökad förståelse och kunskap inom området.   Syfte: Att undersöka fysioterapeuters upplevelser av teamarbete inom interdisciplinär rehabilitering vid långvarig smärta.  Metod: En kvalitativ studiedesign baserad på fem semistrukturerade intervjuer med fysioterapeuter som arbetat mellan ett och tolv år inom smärtrehabilitering bearbetades med kvalitativ innehållsanalys.  Resultat: Den kvalitativa innehållsanalysen resulterade i fyra kategorier och 15 underkategorier. De fyra huvudkategorierna som identifierades var följande: vikten av kommunikation vid teamarbete, organisatoriska förutsättningar som bidrar till gott samarbete, samspel en viktig grund för teamarbete och professionella och sociala färdigheter som påverkar teamarbete.  Konklusion: Resultatet från studien överensstämmer med tidigare forskning inom närliggande områden. Framgångsfaktorer vid kliniskt teamarbete kan vara utarbetade strukturer för kommunikation som reflektion och att sitta i närheten av varandra inom teamet. Olika synsätt och förändringar i teamets sammansättning kan försvåra teamarbete. För att främja ett effektivt teamarbete krävs det att individen kan samspela med andra professioner samt besitter både professionella och sociala färdigheter. / Background: Chronic pain is a complex condition that requires special attendance. Interdisciplinary care is a frequently used method in chronic pain rehabilitation. Teamwork is an important part of interdisciplinary care. Previous research considering physiotherapists' experiences in chronic pain rehabilitation is of limited extent. Hence, a study examining this topic could be of value. Purpose: The study's purpose was to explore physiotherapists' teamwork experiences in interdisciplinary rehabilitation of chronic pain.   Method: A qualitative design with semi-structured interviews was employed. Five physiotherapists that have been working in chronic pain rehabilitation between one to twelve years were recruited using convenient sampling. Qualitative content analysis was conducted to analyze the data.   Results: Four main categories and 15 subcategories were identified. The main categories described the importance of communication in teamwork, organizational structures and factors that influence teamwork, interplay between individuals in the team and how professional and social skills impact teamwork.   Conclusion: The findings in this study have previously been confirmed in studies conducted in related research areas. Well-designed structures for communication such as reflection and also having workspace close to each other within the team are suggestions for creating good teamwork. Different viewpoints among team members could be a barrier for effective teamwork as well as changes in the team constellation. An efficient teamwork is promoted when the individuals in the team are possessing both professional and social skills.

Ta min smärta på allvar; Att leva med långvarig smärta ur ett köns-och genusperspektiv  En litteraturstudie Bakgrund: Cirka 20–30% av världens befolkning lever med långvarig smärta. Könstillhörighet och genusaspekter, som tidigare studier har visat, påverkar människors välbefinnande och erfarenheter av smärta inom vården och samhället. Därför är det viktigt att undersöka vilken betydelse genus har vid långvarig smärta.  Syfte: Syftet med litteraturstudien är att beskriva vuxna patienters erfarenheter av att leva med långvarig smärta sett ur ett köns- och genusperspektiv.  Metod: Litteraturstudien inspirererades av Fribergs modell. Artikelsökning i databaserna Cinahl och Pubmed har gett resultat på nio empiriskt kvalitativa studier. Majoriteten av de sökningar som gjorts är fritextssökningar för att inkludera en större mängd artiklar. De utvalda studierna kvalitetsgranskades och graderades. Resultat: Analysen resulterade i tre kategorier; svårigheter i vardagen, smärtbehandling och bemötande inom sjukvården, med nio tillhörande underkategorier. Resultatet visade att den sensoriska upplevelsen av långvarig smärta inte skiljer sig mellan män och kvinnor. Däremot fanns skillnader kring erfarenheter i kontakt med sjukvården samt existerande samhällsnormer som påverkar hur patienten hanterar smärtsyndromet beroende på könsidentitet.   Konklusion: Samhällsnormerna ger påverkan på hur människor med långvarig smärta hanterade vardagen utifrån könsidentiteten och skapar svårigheter i det sociala livet.   Nyckelord: Genus, Kvinnor, Långvarig smärta, Män och Erfarenheter. / Abstract Take my pain seriously; Living with chronic pain from a sex- and gender perspectiveA literature review Background: Chronic pain affects around 20-30% of the world’s population and peoples’ lives long term. Peoples’ well-being has much to do with their contact and treatment in health care. Gender is, as earlier studies have shown, one of the variables that heavily contributes to how a person is perceived, by themselves and by society. It is therefore important to examine how aspects of gender impact those suffering from chronic pain.  Aim: The aim of this literature study was to describe adult patients’ experiences of living with chronic pain from a sex- and gender perspective.   Methods: The literature study was inspired by Friberg’s model. Article searches in the databases PubMed and Cinahl yielded nine qualitative studies. Majority of searches are free-text searches to include a wider amount of articles. The selected studies were quality reviewed and graded.  Results: The analysis resulted in three categories; Difficulties in daily life, pain management and treatment from the healthcare system, composed of nine subcategories. Results showed that the sensory sensation of long-term pain does not differ between men and women. There were differences regarding experiences in contact with healthcare and social norms that affect how the patient handles the pain syndrome relating to their gender identity. Conclusion: Societal norms affect how patients handle living with chronic pain based on their gender identity. Both male and female patients experience difficulties in their social life related to chronic pain. Keywords: Chronic pain, Experiences, Gender, Men &amp; Women

Yes / Chronic non-malignant pain is a global condition with a complex biopsychosocial impact on the sufferers. Relaxation skills are commonly included as part of a pain management programme, which is currently the recommended evidence-based intervention for this group of patients. However, there is little evidence behind the choice of relaxation method implemented, or their effectiveness. The aim of this study was to investigate the effectiveness of relaxation skills in the management of chronic non-malignant pain, related to pain intensity and health-related quality of life. A systematic literature review was conducted using MEDLINE, CINAHL, AMED, PEDro and PsycARTICLES. The Cochrane, DARE and Trip databases were also accessed, and searches were carried out using the terms (relaxation OR relaxation therapy OR relaxation training) AND (pain OR chronic pain). Following critical appraisal, ten studies met the inclusion criteria. Three studies reported a decrease in pain intensity as a result of the relaxation intervention, whilst only one study reported an improvement in health-related quality of life. Progressive muscle relaxation was the most commonly implemented method throughout, although its method of delivery differed between studies. There is little evidence for the use of relaxation as a stand-alone intervention for pain intensity and health-related quality of life for patients with musculoskeletal chronic non-malignant pain. More research is needed to determine its effectiveness.

People expenencmg chronic pain encounter increases m needs and endure the consequences of failure to satisfy needs. In much of the management of people with chronic pain, chronic pain is considered an abstract phenomenon with little attention given to the human experience. Numerous literature focus on a mechanistic reductionistic approach in management of chronic pain. Most literature is written by medical practitioners, nurses and psychologists from a health-care oriented methodology, whereas minimal research literature was contributed from a pastoral care and counselling perspective. This dissertation explores the needs and feelings of people with chronic pain to identify their needs at the various developmental stages of their pain experience, and within their relevant ecosystems, in order to develop a pastoral response. / Practical Theology / M. Th. (Practical Theology)

People expenencmg chronic pain encounter increases m needs and endure the consequences of failure to satisfy needs. In much of the management of people with chronic pain, chronic pain is considered an abstract phenomenon with little attention given to the human experience. Numerous literature focus on a mechanistic reductionistic approach in management of chronic pain. Most literature is written by medical practitioners, nurses and psychologists from a health-care oriented methodology, whereas minimal research literature was contributed from a pastoral care and counselling perspective. This dissertation explores the needs and feelings of people with chronic pain to identify their needs at the various developmental stages of their pain experience, and within their relevant ecosystems, in order to develop a pastoral response. / Philosophy, Practical and Systematic Theology / M. Th. (Practical Theology)

No description available.

Chronic pain sufferers are frequently misunderstood and stigmatised. The aim of this investigation was to provide a description of the lifewor1d of people with chronic low back pain, using the phenomenological method. Themes which emerged were that the persistent nature of chronic pain makes it particularly difficult to endure, arousing a profound fear of the future. It causes a disruption in the relationship between the person and the body, in which the person is forced to function within the constraints of pain. Sufferers are unable to fulfil social roles as expected and are forced to revise their goals and activities. The distress of their experience is mediated by the ability to make sense of their condition, finding meaning in the pain itself. The study highlights the value of the phenomenological method in health psychology. Recommendations are made which may be of benefit to people with chronic pain and their families. / Psychology / M. Sc. (Psychology)