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- Ahangari, Alebtekin
(författare)
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Prevalence of Chronic Pelvic Pain Among Women : An Updated Review
- 2014
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Ingår i: Pain Physician. - Paducah, KY 42001 USA : American Social Interventional Pain Physicians. - 1533-3159 .- 2150-1149. ; 17:2, s. E141-E147
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Forskningsöversikt (refereegranskat)abstract
- Background: Chronic pelvic pain (CPP), defined as a noncyclical pain lasting for more than 6 months can lead to lower physical performance and quality of life in women. CPP is a worldwide problem affecting women of all ages. However, health care professionals and researchers, due to its complex nature and the lack of knowledge surrounding the condition, frequently neglect CPP. Subsequently, basic data and knowledge regarding CPP remain incomplete. Objective: To update the review of the worldwide estimation of the CPP prevalence considering the World Health Organization systematic review by Latthe et al in 2006 as point of departure. Study Design: A systematic review of CPP prevalence studies. Method: Electronic search was performed to find related articles through PubMed between 2005 and 2012 based on the PRISMA statement (2009). Results: From 140 studies, only 7 studies were about CPP prevalence. Their study design consisted of 3 cross sectional studies, one population based mailing questionnaire study, one survey study (computer assisted telephone interview), one data analysis by questionnaire, and one prospective community based study. Limitations: Paucity of population based studies in addition to probability of existence of studies at the local level with limited access to worldwide databases, lack of consensus about definition of CPP among researchers and therapists, and non-inclusion of CPP related key words in databases such as PubMed. Conclusion: Based on these articles, prevalence in general ranged between 5.7% and 26.6%. There were many countries and regions without basic data in the field of CPP. This review shows the paucity of studies, especially multidisciplinary researches with multifactorial views on CPP. Multidisciplinary studies would provide more reliable data for estimating the prevalence of CPP and its psycho-socioeconomic burden, as well as finding its etiologies and characteristics. This would be the first step towards better treatment and care for women with CPP.
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| 2. |
- Hambraeus, Johan, et al.
(författare)
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Cost-effectiveness of Radiofrequency Denervation for Zygapophyseal Joint Pain
- 2021
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Ingår i: Pain Physician. - : NLM (Medline). - 1533-3159 .- 2150-1149. ; 24:8, s. E1205-E1218
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Chronic pain is a leading cause of disability. Radiofrequency denervation (RFD) is effective when performed according to guidelines for patients with correctly diagnosed zygapophyseal joint pain (ZJP). However, the cost-effectiveness of this method has not been fully explored.OBJECTIVE: The aim of this study was to analyze whether RFD is cost-effective for ZJP from a societal perspective.STUDY DESIGN: Cost effectiveness study based on an observational study.SETTING: An interventional pain management clinic in central Sweden.METHODS: Patients - This cost-effectiveness study was performed for all patients (n = 873) assessed between 2010 and 2016 at a specialized interventional pain clinic in Sweden. Those diagnosed with ZJP (n = 331, 37.9%) were treated with RFD and followed up for 1 year after the RFD. Using data collected from national registers, we determined the health care costs, medication costs, the patients' time and travel costs, and the patients' ability to work. The effects of RFD on quality-adjusted life years (QALY) and cost/QALY gained were calculated.RESULTS: On average, patients reported very low health-related quality of life (HRQoL; EQ-5D index: 0.212). After RFD, HRQoL increased significantly to 0.530 (P < 0.0001). Drug consumption and specialized health care consumption were reduced by 54% and 81%, respectively, and the cost/QALY gained from a societal perspective was 221,324 Swedish krona (USD ~26,008). The sensitivity analysis showed that the treatment was cost-effective in all scenarios evaluated, using the patients as their own controls. The cost/QALY gained from a health care perspective was 72,749 Swedish krona (USD ~8,548).LIMITATIONS: The results are based on data collected at one center. The results need to be compared with those from pain rehabilitation programs and should be confirmed using data from other centers.CONCLUSIONS: Patients referred for RFD in Sweden report extremely low HRQoL. HRQoL significantly increased following RFD in patients with ZJP. Medications and health care consumption decreased after RFD. RFD was cost-effective, and the sensitivity analysis yielded stable results in different scenarios. Therefore, RFD is a cost-effective treatment that meets the Swedish National Board of Health and Welfare criteria for a high priority treatment.TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT01835704) with Protocol ID SE-Dnr-2012-446-31M-1. https://clinicaltrials.gov/ct2/show/NCT01835704.
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| 3. |
- Nijs, Jo, et al.
(författare)
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Dysfunctional endogenous analgesia during exercise in patients with chronic pain : to exercise or not to exercise?
- 2012
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Ingår i: Pain Physician. - 1533-3159 .- 2150-1149. ; 15:3 Suppl, s. ES205-13
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Exercise is an effective treatment for various chronic pain disorders, including fibromyalgia, chronic neck pain, osteoarthritis, rheumatoid arthritis, and chronic low back pain. Although the clinical benefits of exercise therapy in these populations are well established (i.e. evidence based), it is currently unclear whether exercise has positive effects on the processes involved in chronic pain (e.g. central pain modulation).OBJECTIVES: Reviewing the available evidence addressing the effects of exercise on central pain modulation in patients with chronic pain.METHODS: Narrative review.RESULTS: Exercise activates endogenous analgesia in healthy individuals. The increased pain threshold following exercise is due to the release of endogenous opioids and activation of (supra)spinal nociceptive inhibitory mechanisms orchestrated by the brain. Exercise triggers the release of beta-endorphins from the pituitary (peripherally) and the hypothalamus (centrally), which in turn enables analgesic effects by activating μ-opioid receptors peripherally and centrally, respectively. The hypothalamus, through its projections on the periaqueductal grey, has the capacity to activate descending nociceptive inhibitory mechanisms. However, several groups have shown dysfunctioning of endogenous analgesia in response to exercise in patients with chronic pain. Muscle contractions activate generalized endogenous analgesia in healthy, pain-free humans and patients with either osteoarthritis or rheumatoid arthritis, but result in increased generalised pain sensitivity in fibromyalgia patients. In patients having local muscular pain (e.g. shoulder myalgia), exercising non-painful muscles activates generalized endogenous analgesia. However, exercising painful muscles does not change pain sensitivity either in the exercising muscle or at distant locations.LIMITATIONS: The reviewed studies examined acute effects of exercise rather than long-term effects of exercise therapy.CONCLUSIONS: A dysfunctional response of patients with chronic pain and aberrations in central pain modulation to exercise has been shown, indicating that exercise therapy should be individually tailored with emphasis on prevention of symptom flares. The paper discusses the translation of these findings to rehabilitation practice together with future research avenues.
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| 6. |
- Wadström, Miriam G, et al.
(författare)
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Pediatric Hip Disease Increases the Risk for Opioid Use in Adulthood : Long-term Burden of Pain and Depression
- 2022
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Ingår i: Pain Physician. - : AM SOC INTERVENTIONAL PAIN PHYSICIANS. - 1533-3159 .- 2150-1149. ; 25:7, s. E1153-E1160
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Legg-Calvé-Perthes disease (LCPD) and slipped capital femoral epiphysis (SCFE) can result in painful deformation of the hip joint with impaired range of motion and early development of secondary osteoarthritis. It has not been investigated whether having LCPD or SCFE is associated with increased use of pain or antidepressant drug prescriptions later in life.OBJECTIVE: With this study, we aimed to investigate if patients with a history of LCPD or SCFE have an increased risk of prescription analgesic or antidepressant drugs in adulthood compared with matched controls.STUDY DESIGN: The included patients were identified by the Swedish Patient Register and matched for age, gender, and residency with 10 control individuals not exposed to any of the mentioned pediatric hip diseases, by the Swedish National Population Register.SETTING: This was a nationwide, registry-based cohort study which included 1,292 patients diagnosed with LCPD at age 2-15 years and 1,613 patients diagnosed with SCFE at age 5-16 years and > 17 years from 2005 through 2011.METHODS: Prescription data of first-line analgesic drugs (acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids), or first-line antidepressant drugs (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants) were derived from the Swedish Prescribed Drugs Register. Conditional logistic regression models were fitted to estimate the relative risk for the prescription in exposed compared with unexposed individuals. Adjustment was performed for gender and birth year.RESULTS: In the group with an LCPD diagnosis, the adjusted odds ratio for analgesic prescriptions overall was 1.3 (95% CI, 1.2-1.5). For patients with an SCFE diagnosis, the adjusted odds ratio for analgesic prescriptions overall was 1.4 (95% CI, 1.3-1.6). Among patients with an LCPD diagnosis, the adjusted odds ratio for antidepressant prescriptions overall was 1.0 (95% CI, 0.8-1.2). For patients with an SCFE diagnosis, the adjusted odds ratio was 1.2 (95% CI, 1.1-1.4).LIMITATIONS: As with all register studies, there are known associated biases such as selection, detection, and observational bias as well as the uncertain quality of input data. Further, the Swedish Prescribed Drugs Register only includes drugs that were prescribed by a physician and dispensed at a pharmacy. This is also a factor that may lead to underestimating the use of acetaminophen and nonsteroidal anti-inflammatory drugs, as these drugs can be acquired "over the counter."CONCLUSION: During childhood, patients with LCPD or SCFE seem to suffer long-term pain and have an increased risk of requiring analgesic medication in adulthood, including opioids. It is important to assess the causes, type, and severity of pain to optimize pain management to counteract possible overuse in these patients. Seemingly, patients with LCPD do not have an increased risk for antidepressant drug therapy in adulthood whereas we did see an increased risk for that in patients with previous SCFE compared with the general population.
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| 7. |
- Wouter, V., et al.
(författare)
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The Predictive Value of Fear Avoidance Beliefs for Outcomes Following Surgery for Lumbar Degenerative Disease: A Systematic Review and Best Evidence Synthesis
- 2022
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Ingår i: Pain Physician. - 1533-3159 .- 2150-1149. ; 25:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Currently, evidence regarding fear avoidance beliefs as potential predictors for lumbar surgery outcomes seems insufficient and strong conclusions are not yet available. Objective: This systematic review aimed to evaluate the predictive value of preoperative fear avoidance beliefs for postoperative pain intensity, functional status, and health-related quality of life following surgery for lumbar degenerative disease. Study Design: Systematic review and best evidence synthesis. Methods: An extensive search was performed in PubMed/Medline, EMBASE, PsycINFO, CINAHL and the Cochrane library for articles published up until October 2021. Two independent reviewers performed the screening, data extraction, and quality assessment, with a third independent reviewer consulting to resolve any disagreement. Observational studies that included patients undergoing surgery for lumbar degenerative disease, as well as evaluated fear avoidance beliefs (i.e., pain-related fear, pain catastrophizing, pain anxiety) in relation to a surgical outcome measure (i.e., pain intensity, functional status and health-related quality of life) were included in the review. The CHARMS-and QUIPS-tools were used for data extraction and quality assessment, respectively. A best evidence synthesis was performed resulting in conclusions regarding strong, moderate, conflicting, and limited levels of evidence. Results: A total of 24 studies (n = 17,881) were included in this review. Following best evidence synthesis, 3 included studies reported no significant predictive value of preoperative pain-related fear for postoperative pain intensity resulting in moderate evidence for this relationship. Moderate evidence was also found indicating no significant predictive value of preoperative pain-related fear for postoperative functional status, as 6 out of 8 relevant studies reported this result. Only one study reported on the predictive value of preoperative pain catastrophizing for postoperative health -related quality of life, resulting in limited evidence for the absence of this predictive relationship. All other relationships were found to have conflicting evidence. Limitations: To evaluate surgical outcome, only patient-reported outcome measures as used by spine registries were included. Thus, our findings cannot be extrapolated to all surgery outcomes following lumbar degenerative disease and should only be interpreted in relation to postoperative pain intensity, functional status, or health-related quality of life. Conclusion: Best evidence synthesis showed moderate evidence indicating that preoperative pain-related fear is not a significant predictor for postoperative pain and function following surgery for lumbar degenerative disease. Additionally, limited evidence was found for a lack of predictive value of preoperative pain catastrophizing for postoperative health-related quality of life. As current evidence regarding the predictive value of preoperative fear avoidance beliefs following such a surgery is mixed, further research is required before more definitive conclusions can be made.
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