Primary Care of Patients With Chronic Pain

Schneiderhan, Jill; Clauw, Daniel J.; Schwenk, Thomas L.

doi:10.1001/jama.2017.5787

Cited by 78 publications

(49 citation statements)

References 11 publications

(17 reference statements)

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“…Our data are consistent with previous studies carried out in smaller mixed disease cohorts, and supports the conclusion that pain is a common complaint in patients with FSHD1, similar to or possibly worse than in other neuromuscular conditions, even though a direct comparative study was not conducted . Furthermore, pain is reported in a higher percentage in our cohort that would be expected in the general population, where is ranges from 10% to 55% . The frequency and intensity of pain reported in our population are similar to what has been reported previously in osteoarthritis or rheumatoid arthritis .…”

Section: Discussionsupporting

confidence: 92%

“…5,14 Furthermore, pain is reported in a higher percentage in our cohort that would be expected in the general population, where is ranges from 10% to 55%. 22,23 The frequency and intensity of pain reported in our population are similar to what has been reported previously in osteoarthritis or rheumatoid arthritis. 24,25 Chronic pain is a substantial problem in FSHD1 and needs to be tackled in a holistic way with exercise/physiotherapy, psychosocial intervention and tailored pharmacological treatment.…”

Section: Discussionmentioning

confidence: 99%

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Chronic pain has a strong impact on quality of life in facioscapulohumeral muscular dystrophy

et al. 2017

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IntroductionEarlier small case series and clinical observations reported on chronic pain playing an important role in facioscapulohumeral dystrophy (FSHD). The aim of this study was to determine the characteristics and impact of pain on quality of life (QoL) in patients with FSHD.MethodsWe analyzed patient reported outcome measures collected through the U.K. FSHD Patient Registry.ResultsOf 398 patients, 88.6% reported pain at the time of study. The most frequent locations were shoulders and lower back. A total of 203 participants reported chronic pain, 30.4% of them as severe. The overall disease impact on QoL was significantly higher in patients with early onset and long disease duration. Chronic pain had a negative impact on all Individualised Neuromuscular Quality of Life Questionnaire domains and overall disease score.DiscussionOur study shows that pain in FSHD type 1 (FSHD1) is frequent and strongly impacts on QoL, similar to other chronic, painful disorders. Management of pain should be considered when treating FSHD1 patients. Muscle Nerve 57: 380–387, 2018

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Chronic pain has a strong impact on quality of life in facioscapulohumeral muscular dystrophy

et al. 2017

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“…Chronic pain is a major reason why patients seek primary care, and our current approach to pain management has resulted in unintended consequences, contributing to the current opioid crisis. 103 Safe and natural methods for pain management need to be explored, and we are just beginning to learn the potential of nutritional therapy. This finding suggests further work needs to be conducted on dietary interventions for pain.…”

Section: Discussion Of Key Findingsmentioning

confidence: 99%

A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal

Cucuzzella

Tondt

Dockter

et al. 2017

JMH

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Background: Metabolic syndrome has become a significant problem, with the American Diabetes Association estimating the cost of diabetes and pre-diabetes in the United States alone to be $322 billion per year. Numerous clinical trials have demonstrated the efficacy of low-carbohydrate diets in reversing metabolic syndrome and its associated disorders.Aim: This study was designed to examine how voluntary adherents to a low-carbohydrate diet rate its effectiveness and sustainability using an online survey.Setting and methods: The 57-question survey was administered online and shared internationally via social media and ‘low-carb’ communities. Where appropriate, chi-squared tests and paired t-tests were used to analyse the responses.Results: There were 1580 respondents. The majority of respondents had consumed less than 100 g of carbohydrates per day for over a year, typically for reasons of weight loss or disease management. There was a reported decrease in waist circumference and weight with a simultaneous decrease in hunger and increase in energy level. Of those who provided laboratory values, the majority saw improvements in their HbA1c, blood glucose measurements, and lipid panel results. There was a reduction in usage of various medications, and 25% reported medication cost savings, with average monthly savings of $288 for those respondents. In particular, the usage of pain relievers and anti-inflammatories dropped with a simultaneous decreased rating of pain and increase in mobility.Conclusion: We conclude that low-carbohydrate diets are a sustainable method of metabolic syndrome reversal in a community setting.

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“…10–15 Pain is a leading reason patients seek medical care and primary care clinicians (PCCs) are often the first points of contact. 16, 17 Pain management and safe opioid prescribing education for civilian pre-licensure students and PCCs is not universally required, but is required for MHS clinicians. 18–21 …”

Section: Introductionmentioning

confidence: 99%

Army and Navy ECHO Pain Telementoring Improves Clinician Opioid Prescribing for Military Patients: an Observational Cohort Study

et al. 2018

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BackgroundOpioid overdose deaths occur in civilian and military populations and are the leading cause of accidental death in the USA.ObjectiveTo determine whether ECHO Pain telementoring regarding best practices in pain management and safe opioid prescribing yielded significant declines in opioid prescribing.DesignA 4-year observational cohort study at military medical treatment facilities worldwide.ParticipantsPatients included 54.6% females and 46.4% males whose primary care clinicians (PCCs) opted to participate in ECHO Pain; the comparison group included 39.9% females and 60.1% males whose PCCs opted not to participate in ECHO Pain.InterventionPCCs attended 2-h weekly Chronic Pain and Opioid Management TeleECHO Clinic (ECHO Pain), which included pain and addiction didactics, case-based learning, and evidence-based recommendations. ECHO Pain sessions were offered 46 weeks per year. Attendance ranged from 1 to 3 sessions (47.7%), 4–19 (32.1%, or > 20 (20.2%).Main MeasuresThis study assessed whether clinician participation in Army and Navy Chronic Pain and Opioid Management TeleECHO Clinic (ECHO Pain) resulted in decreased prescription rates of opioid analgesics and co-prescribing of opioids and benzodiazepines. Measures included opioid prescriptions, morphine milligram equivalents (MME), and days of opioid and benzodiazepine co-prescribing per patient per year.Key ResultsPCCs participating in ECHO Pain had greater percent declines than the comparison group in (a) annual opioid prescriptions per patient (− 23% vs. − 9%, P < 0.001), (b) average MME prescribed per patient/year (−28% vs. −7%, p < .02), (c) days of co-prescribed opioid and benzodiazepine per opioid user per year (−53% vs. −1%, p < .001), and (d) the number of opioid users (−20.2% vs. −8%, p < .001). Propensity scoring transformation–adjusted results were consistent with the opioid prescribing and MME results.ConclusionsPatients treated by PCCs who opted to participate in ECHO Pain had greater declines in opioid-related prescriptions than patients whose PCCs opted not to participate.Electronic supplementary materialThe online version of this article (10.1007/s11606-018-4710-5) contains supplementary material, which is available to authorized users.

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Primary Care of Patients With Chronic Pain

Cited by 78 publications

References 11 publications

Chronic pain has a strong impact on quality of life in facioscapulohumeral muscular dystrophy

Chronic pain has a strong impact on quality of life in facioscapulohumeral muscular dystrophy

A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal

Army and Navy ECHO Pain Telementoring Improves Clinician Opioid Prescribing for Military Patients: an Observational Cohort Study

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