Browsing by Subject "Pain management"
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Item A Systematic Approach to Developing Virtual Patient Vignettes for Pediatric Health Equity Research(Mary Ann Liebert, 2022-11-22) Mulchan, Siddika S.; Miller, Megan; Theriault, Christopher B.; Zempsky, William T.; Hirsh, Adam; Psychology, School of ScienceObjective: The aim of this study was to describe a systematic approach to developing virtual patient (VP) vignettes for health equity research in pediatric pain care. Methods: VPs were initially developed to depict the body posture and movements of actual children experiencing pain. Researchers and clinicians with expertise in pediatric pain worked closely with a professional animator to portray empirically supported pain expression in four, full-motion, virtual male characters of two races (i.e., White and Black). Through an iterative process, VPs were refined to (1) appear realistic in a clinical setting and (2) display archetypal pain behavior and expression during a 1-min video clip without sound. Text vignettes were developed with consultation from experts in pain care and presented alongside VPs to assess clinical decision-making. VP vignettes were piloted in a sample of pediatric providers (N=13). Results: Informed by the literature and expertise of stakeholders, several revisions were made to improve VPs' facial grimacing and realism before piloting. VPs appeared to accurately capture important aspects of pain expression and behavior common among pediatric patients with pain disorders. Additional refinements to the text vignettes were made based on provider feedback to improve clarity and clinical relevance. Conclusions: This article presents a working framework to facilitate a systematic approach to developing VP vignettes. This framework is a first step toward advancing health equity research by isolating psychosocial and interpersonal factors affecting provider behavior and decision-making. Future research is needed to validate the use of VP vignettes for assessing provider behavior contributing to health inequities for youth with pain disorders.Item Advances in Coccygectomy: A Comprehensive Review Evaluating Surgical Techniques for Coccygodynia(MDPI, 2025-02-19) Obeng-Gyasi, Barnabas; Brown, Ethan D. L.; Chinthala, Anoop Sai; Mao, Gordon; Neurological Surgery, School of MedicineBackground: Coccygodynia presents significant challenges in diagnosis and treatment. While coccygectomy has emerged as a crucial intervention for refractory cases, significant heterogeneity exists in surgical techniques. Traditional approaches are increasingly complemented by novel methods, necessitating a comprehensive review of current surgical options. Methods: A comprehensive literature review was conducted using Ovid MEDLINE, Cochrane Library and Embase databases from inception to present. Search terms included "coccygectomy", "coccydynia", "coccygodynia", "coccyx pain" and "tailbone pain". We analyzed peer-reviewed studies focusing on surgical techniques, outcomes and complications of coccygectomy. Studies were excluded if non-peer-reviewed, non-English without translation, or not directly addressing surgical management. Results: Traditional midline approaches, while common, demonstrate increased wound complications compared to paramedian techniques. Minimally invasive methods, including coccygeoplasty and endoscopic coccygectomy, show promising early outcomes with reduced recovery times. Both partial and complete resections provide significant pain relief, with complete resection potentially offering superior results in severe cases. Wound closure technique significantly impacts surgical success. Conclusions: Optimal outcomes in coccygectomy require individualized surgical approaches incorporating modern techniques like paramedian incision and advanced wound closure. Emerging minimally invasive procedures may further reduce complications and enhance recovery. Treatment success depends on careful patient selection and surgical technique optimization.Item Assessment, Quantification, and Management of Fracture Pain: from Animals to the Clinic(SpringerLink, 2020-10) McVeigh, Luke G.; Perugini, Anthony J.; Fehrenbacher, Jill C.; White, Fletcher A.; Kacena, Melissa A.; Orthopaedic Surgery, School of MedicinePurpose of review: Fractures are painful and disabling injuries that can occur due to trauma, especially when compounded with pathologic conditions, such as osteoporosis in older adults. It is well documented that acute pain management plays an integral role in the treatment of orthopedic patients. There is no current therapy available to completely control post-fracture pain that does not interfere with bone healing or have major adverse effects. In this review, we focus on recent advances in the understanding of pain behaviors post-fracture. Recent findings: We review animal models of bone fracture and the assays that have been developed to assess and quantify spontaneous and evoked pain behaviors, including the two most commonly used assays: dynamic weight bearing and von Frey testing to assess withdrawal from a cutaneous (hindpaw) stimulus. Additionally, we discuss the assessment and quantification of fracture pain in the clinical setting, including the use of numeric pain rating scales, satisfaction with pain relief, and other biopsychosocial factor measurements. We review how pain behaviors in animal models and clinical cases can change with the use of current pain management therapies. We conclude by discussing the use of pain behavioral analyses in assessing potential therapeutic treatment options for addressing acute and chronic fracture pain without compromising fracture healing. There currently is a lack of effective treatment options for fracture pain that reliably relieve pain without potentially interfering with bone healing. Continued development and verification of reliable measurements of fracture pain in both pre-clinical and clinical settings is an essential aspect of continued research into novel analgesic treatments for fracture pain.Item Bringing Virtual Reality to Mainstream Pediatric Care(Advocate Aurora Research Institute, 2024-07-16) Kuang, Wayne; Yang, Eric J.; Truong, Roland; Woo, Benjamin K. P.; Anesthesia, School of MedicineVirtual reality (VR) stands as an innovative technology transforming our interactions with the digital world. Its integration into health care has proven advantageous for both patients and health care providers across multiple levels and modalities. Given that VR is becoming increasingly accessible and prevalent, health care providers should explore incorporating the technology into their practices, particularly within the pediatric population, which is becoming progressively more accustomed to the technology. This topic synopsis provides a broad discussion of the current literature, exploring current and probable future applications of VR in pediatric patient care, particularly in improving the hospital experience, facilitating education during hospitalizations, providing an alternative to pharmacological therapy for pain management, and enhancing mental health care practices.Item Development and field testing of primary care screening tools for harms of long-term opioid therapy continuation and tapering to discontinuation: a study protocol(BMJ Publishing, 2021-10-07) Timko, Christine; Kroenke, Kurt; Nevedal, Andrea; Lor, Mai Chee; Oliva, Elizabeth; Drexler, Karen; Sandbrink, Friedhelm; Hoggatt, Katherine; Medicine, School of MedicineIntroduction: Despite calls for screening tools to help providers monitor long-term opioid therapy (LTOT) harms, and identify patients likely to experience harms of discontinuation, such screening tools do not yet exist. Current assessment tools are infeasible to use routinely in primary care and focus mainly on behaviours suggestive of opioid use disorder to the exclusion of other potential harms. This paper describes a study protocol to develop two screening tools that comprise one integrated instrument, Screen to Evaluate and Treat (SET). SET1 will indicate if LTOT may be harmful to continue (yes or no), and SET2 will indicate if tapering to discontinue opioids may be harmful to initiate (yes or no). Patients receiving LTOT who screen positive on the SET tools should receive subsequent additional assessment. SET will give providers methods that are feasible to implement routinely to facilitate more intensive and comprehensive monitoring of patients on LTOT and decision-making about discontinuation. Methods and analysis: We will develop the screening tools, SET1 and SET2, concurrently. Tool development will be done in stages: (1) comprehensive literature searches to yield an initial item pool for domains covered by each screening tool; (2) qualitative item analyses using interviews, expert review and cognitive interviewing, with subsequent item revision, to yield draft versions of each tool; and (3) field testing of the draft screening tools to assess internal consistency, test-retest reliability and convergent and discriminant validity. Ethics and dissemination: Ethical approval was obtained from the Institutional Review Boards of Stanford University and the University of California, San Francisco for the VA Palo Alto Health Care System, and the VA San Francisco Healthcare System, respectively. Findings will be disseminated through peer-reviewed manuscripts and presentations at research conferences.Item Effect of different Kinesio tape tensions on experimentally-induced thermal and muscle pain in healthy adults(PLOS, 2021-11-05) Naugle, Keith E.; Hackett, Jason; Aqeel, Dania; Naugle, Kelly M.; Kinesiology, School of Health and Human SciencesAthletes and rehabilitation specialists have used Kinesio tape (KT) to help alleviate pain symptoms. Currently, no clear mechanism exists as to why pain is relieved with the use of KT and whether the pain relieving effect is simply a placebo effect. Additionally, the most effective taping parameters (tension of tape) for pain reduction remain unknown. We used quantitative sensory testing to address these key gaps in the KT and pain literature. Using a repeated-measures laboratory design, we examined whether KT applied at different tensions reduces experimentally-induced pain compared to a no tape condition and KT with minimal tension. Heat pain thresholds (HPT's), pressure pain thresholds (PPT's), and pressure pain suprathreshold (PPS: 125% of PPT) tests were administered to the forearm prior to and during KT and no tape conditions. Tape was applied to the ventral forearm at 25% of max tension, 75% of max tension, and no tension (placebo). Repeated measures ANOVA's evaluated the pain outcomes between conditions and across time. KT had no significant effect on PPT's and HPT's (p's >0.05). The ANOVA on PPS revealed that KT applied at 25% of tension significantly reduced pain ratings from the pretest (M = 34.4, SE = 5.5) to post-test 1 (M = 30.3, SE = 4.7) and post-test 2 (M = 30.4, SE = 4.7). No other conditions significantly reduced suprathreshold pressure pain. However, pain ratings at posttest-1 during the no-tape condition (M = 36.4, SE = 5.3) were significantly greater than pain ratings during post-test 1 and post-test 2 of all three tape conditions. In conclusion, the current study revealed that KT applied at low tension is the optimal tension to reduce pressure-evoked muscle pain. Additionally, the results suggested that KT applied at low, high, or no tension may acutely prevent increased muscle sensitivity with repeated pressure stimulation.Item Emergency Department Utilization After Administration of Peripheral Nerve Blocks for Upper Extremity Surgery(Sage, 2022) Loewenstein, Scott N.; Bamba, Ravinder; Adkinson, Joshua M.; Surgery, School of MedicineBackground: The purpose of this study was to determine the impact of upper extremity peripheral nerve blocks on emergency department (ED) utilization after hand and upper extremity surgery. Methods: We reviewed all outpatient upper extremity surgeries performed in a single Midwestern state between January 2009 and June 2019 using the Indiana Network for Patient Care. These encounters were used to develop a database of patient demographics, comorbidities, concurrent procedures, and postoperative ED visit utilization data. We performed univariate, bivariate, and multivariate logistic regression analyses. Results: Among 108 451 outpatient surgical patients, 9079 (8.4%) received blocks. Within 1 week of surgery, a greater proportion of patients who received peripheral nerve blocks (1.4%) presented to the ED than patients who did not (0.9%) (P < .001). The greatest risk was in the first 2 postoperative days (relative risk, 1.78; P < .001). Pain was the principal reason for ED utilization in the block cohort (53.6%) compared with those who did not undergo a block (35.1%) (P < .001). When controlling for comorbidities and demographics, only peripheral nerve blocks (adjusted odds ratio [OR], 1.71; P = 0.007) and preprocedural opioid use (adjusted OR, 1.43; P = .020) conferred an independently increased risk of ED utilization within the first 2 postoperative days. Conclusions: Peripheral nerve blocks used for upper extremity surgery are associated with a higher risk of unplanned ED utilization, most likely related to rebound pain. Through proper patient education and pain management, we can minimize this unnecessary resource utilization.Item Evaluation of Individualized Pain Plans for Children With Sickle Cell Disease Admitted for Vaso-occlusive Crisis at Riley Hospital for Children(Allen Press, 2022) Arends, Alexandria M.; Perez, Anne; Wilder, Christina; Jacob, Seethal A.; Pediatrics, School of MedicineObjective: Vaso-occlusive crisis (VOC) is the most common problem reported by patients with sickle cell disease (SCD). The objective of this study was to evaluate the impact of individualized pain plans in pediatric patients with SCD admitted for VOC. Methods: This was a pre- and post-study of patients with SCD admitted to Riley Hospital for Children for VOC from July 1, 2019, through July 1, 2020. The primary outcome was length of inpatient stay for VOC. Secondary outcomes included final pain score, days on scheduled opioids, days on breakthrough opioids, and average morphine milligram equivalents (MME) used per day. Results: Nine patients were included. The mean age was 16 years (range, 10-20 years). Key clinical findings were decreases in median [IQR] for final pain scores (7 [4.5-9] vs 6 [2.5-8], p = 0.396) and number of days of breakthrough opioid use (5 [3-8] vs 4 [2.5-5.5], p = 0.233). Following implementation of an individualized pain plan, there was an increase in median average MME per day (65.94 [53.1-97.7] vs 82.85 [41-114.3], p = 0.844). Median length of stay and days on scheduled opioids remained the same. Conclusions: This study demonstrated that use of individualized pain plans in a small population of patients with SCD might result in decreased pain scores and decreased days on breakthrough opioids.Item Examining influential factors in providers' chronic pain treatment decisions: a comparison of physicians and medical students(BioMed Central, 2015-10-01) Hollingshead, Nicole A.; Meints, Samantha; Middleton, Stephanie K.; Free, Charnelle A.; Hirsch, Adam T.; Department of Psychology, School of ScienceBACKGROUND: Chronic pain treatment guidelines are unclear and conflicting, which contributes to inconsistent pain care. In order to improve pain care, it is important to understand the various factors that providers rely on to make treatment decisions. The purpose of this study was to examine factors that reportedly influence providers' chronic pain treatment decisions. A secondary aim was to examine differences across participant training level. METHODS: Eighty-five participants (35 medical students, 50 physicians) made treatment decisions for 16 computer-simulated patients with chronic pain. Participants then selected from provided lists the information they used and the information they would have used (had it been available) to make their chronic pain treatment decisions for the patient vignettes. RESULTS: Frequency analyses indicated that most participants reported using patients' pain histories (97.6 %) and pain description (95.3 %) when making treatment decisions, and they would have used information about patients' previous treatments (97.6 %) and average and current pain ratings (96.5 %) had this information been available. Compared to physicians, medical students endorsed more frequently that they would have used patients' employment and/or disability status (p < 0.05). A greater proportion of medical students wanted information on patients' use of illicit drugs and alcohol to make treatment decisions; while a greater proportion of physicians reported using personal experience to inform their decisions. DISCUSSION: This study found providers use patients' information and their own experiences and intuition to make chronic pain treatment decisions. Also, participants of different training levels report using different patient and personal factors to guide their treatment decisions. CONCLUSIONS: These results highlight the complexity of chronic pain care and suggest a need for more chronic pain education aimed at medical students and practicing providers.Item Implementing a pragmatic clinical trial to tailor opioids for chronic pain on behalf of the IGNITE ADOPT PGx investigators(Wiley, 2024) Skaar, Todd C.; Myers, Rachel A.; Fillingim, Roger B.; Callaghan, John T.; Cicali, Emily; Eadon, Michael T.; Elwood, Erica N.; Ginsburg, Geoffrey S.; Lynch, Sheryl; Nguyen, Khoa A.; Obeng, Aniwaa Owusu; Park, Haesuk; Pratt, Victoria M.; Rosenman, Marc; Sadeghpour, Azita; Shuman, Saskia; Singh, Rajbir; Tillman, Emma M.; Volpi, Simona; Wiisanen, Kristin; Winterstein, Almut G.; Horowitz, Carol R.; Voora, Deepak; Orlando, Lori; Chakraborty, Hrishikesh; Van Driest, Sara; Peterson, Josh F.; Cavallari, Larisa A.; Johnson, Julie A.; Dexter, Paul R.; IGNITE Pragmatic Trials Network; Medicine, School of MedicineChronic pain is a prevalent condition with enormous economic burden. Opioids such as tramadol, codeine, and hydrocodone are commonly used to treat chronic pain; these drugs are activated to more potent opioid receptor agonists by the hepatic CYP2D6 enzyme. Results from clinical studies and mechanistic understandings suggest that CYP2D6-guided therapy will improve pain control and reduce adverse drug events. However, CYP2D6 is rarely used in clinical practice due in part to the demand for additional clinical trial evidence. Thus, we designed the ADOPT-PGx (A Depression and Opioid Pragmatic Trial in Pharmacogenetics) chronic pain study, a multicenter, pragmatic, randomized controlled clinical trial, to assess the effect of CYP2D6 testing on pain management. The study enrolled 1048 participants who are taking or being considered for treatment with CYP2D6-impacted opioids for their chronic pain. Participants were randomized to receive immediate or delayed (by 6 months) genotyping of CYP2D6 with clinical decision support (CDS). CDS encouraged the providers to follow the CYP2D6-guided trial recommendations. The primary study outcome is the 3-month absolute change in the composite pain intensity score assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) measures. Follow-up will be completed in July 2024. Herein, we describe the design of this trial along with challenges encountered during enrollment.