Chronic pain: an update on burden, best practices, and new advances

Cohen, Steven P.; Vase, Lene; Hooten, W. Michael

doi:10.1016/s0140-6736(21)00393-7

Cited by 1,220 publications

(963 citation statements)

References 114 publications

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“…As a group of NCDs, established MSK health conditions are the leading cause of disability worldwide, representing 17% of the global years lived with disability (YLDs) in 2019, with the rate of MSK-attributed YLDs per 100,000 population increasing by 23% since 1990 [ 5 ]. MSK conditions are the highest contributors to the global need for rehabilitation services across lifecourse [ 10 ] and a major contributor to the burden of chronic pain [ 11 ]. Low back pain remains the single leading cause of disability worldwide since 1990 and the leading cause in most countries, irrespective of economic development [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

Briggs

Jordan²,

Kopansky-Giles

et al. 2021

glob health res policy

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Background Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response. Methods An in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1–4 of the logic model. Results Thirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action (category 4) were also derived. Conclusion KIs strongly supported the creation of an adaptable global strategy to catalyse and steward country-level health systems strengthening responses for MSK health. The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health. Contextual considerations about MSK health and accelerators for action should be considered in reform activities.

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Section: Introductionmentioning

confidence: 99%

The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

Briggs

Jordan²,

Kopansky-Giles

et al. 2021

glob health res policy

View full text Add to dashboard Cite

show abstract

“…25 Serial Global Burden of Disease (GBD) studies have identified the need for health systems to respond to the burden of MSK conditions, supported by calls in many other publications that MSK conditions should be assigned a greater level of priority in national and global health systems strengthening efforts. 16 26 This is further exemplified by 2000-2010 Bone and Joint Decade, 27 the Lancet Series on low back pain 28 , the Lancet Series on chronic pain, 29 and planned Lancet Commission on osteoarthritis. 30 The Lancet Global Health Commission argued that formulation of national policy to prioritise prevention and management of NCDs is essential for health systems strengthening.…”

mentioning

confidence: 99%

Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health

et al. 2021

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IntroductionDespite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strategic response to guide global and national-level action on MSK health.MethodsDesign: mixed-methods, three-phase design.Phase 1: qualitative study with international key informants (KIs), including patient representatives and people with lived experience. KIs characterised the contemporary landscape for MSK health and priorities for a global strategic response.Phase 2: scoping review of national health policies to identify contemporary MSK policy trends and foci.Phase 3: informed by phases 1–2, was a global eDelphi where multisectoral panellists rated and iterated a framework of priorities and detailed components/actions.ResultsPhase 1: 31 KIs representing 25 organisations were sampled from 20 countries (40% low and middle income (LMIC)). Inductively derived themes were used to construct a logic model to underpin latter phases, consisting of five guiding principles, eight strategic priority areas and seven accelerators for action.Phase 2: of the 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. Eight overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model.Phase 3: 674 panellists from 72 countries (46% LMICs) participated in round 1 and 439 (65%) in round 2 of the eDelphi. Fifty-nine components were retained with 10 (17%) identified as essential for health systems. 97.6% and 94.8% agreed or strongly agreed the framework was valuable and credible, respectively, for health systems strengthening.ConclusionAn empirically derived framework, co-designed and strongly supported by multisectoral stakeholders, can now be used as a blueprint for global and country-level responses to improve MSK health and prioritise system strengthening initiatives.

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“…A variety of things can lead to epilepsy and chronic pain, which may include traumatic brain injury, very high fever, stroke, and infectious diseases, etc. (Wilson et al, 2017;Thijs et al, 2019;Cohen et al, 2021;Offringa et al, 2021) Parasitic infection of the brain are also common causes of epilepsy and usually be controlled with medication, but it causes seizures at a later time (Monk et al, 2021). As a result, although it may not be applicable for the patients with neurological diseases that pathology fully developed, our present results at least indicated that the early period administration of TMP on neurological diseases modeling progression might be of great importance for controlling psychiatric comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Inconsistent Time-Dependent Effects of Tetramethylpyrazine on Primary Neurological Disorders and Psychiatric Comorbidities

et al. 2021

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The aim of this study was to investigate the time dependent effects of tetramethylpyrazine (TMP, main activity compound of Ligusticum chuanxiong Hort) on two neurological disorders and their neuropsychiatric comorbidities. 6 Hz corneal rapid kindling was used to induce epileptogenesis and the inflammatory pain was induced by intra-articular Complete Freund’s adjuvant (CFA) injection. The mechanical pain thresholds were measured using von Frey hair (D4, D11, D18, D25 after CFA first injection), and the vertical rearings of the mice was observed. To test the neuropsychiatric comorbidities, anxiety-like behaviors of mice were examined by open field and elevated plus maze tests. Two behavioral despair models, tail suspension test and forced swimming test were also used to evaluate the depressive like behaviors. The results showed that TMP administered from the initial day (D1-D35 in kindling model, D0-D14 and D0-D28 in CFA model) of modeling retarded both the developments of 6 Hz corneal rapid kindling epileptogenesis and the CFA induced inflammatory pain. In comparison, late periods administration of TMP (D21-D35 in kindling and D14-D28 in CFA model) showed no effect on the epileptogenesis and the generalized seizures (GS) of kindling, but alleviated maintenance of CFA induced inflammatory pain. Furthermore, we also found all TMP treatments from the initial day of modeling alleviated the co-morbid depressive and anxiety-like behaviors in both models; however, late periods treatments did not, either in kindling or the CFA induced inflammatory pain. BDNF/ERK signaling impairment was also tested by western blot, and the results showed that TMP administered from the initial day of modeling increased the hippocampal BDNF/ERK expression, whereas late period administration showed no effects. Overall, our findings reveal the inconsistent time dependent effects of Tetramethylpyrazine on neurological disorders and their relative neuropsychiatric comorbidities, and provide novel insight into the early application of TMP that might enhance hippocampal BDNF/ERK signaling to alleviate neuropsychiatric comorbidities in neurological diseases.

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Chronic pain: an update on burden, best practices, and new advances

Cited by 1,220 publications

References 114 publications

The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health

Inconsistent Time-Dependent Effects of Tetramethylpyrazine on Primary Neurological Disorders and Psychiatric Comorbidities

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