Diagnosing and Treating Chronic Pain: Are We Doing This Right?

Carnago, Lisa; O’Regan, Amy; Hughes, Jaime M

doi:10.1177/21501327211008055

Cited by 15 publications

(13 citation statements)

References 8 publications

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“…And so she said that opened a door up for her.' Patient perceptions of not being heard or believed and consequently feeling that they have ongoing untreated pain with results that were below their expectations are findings shared by other studies amongst non-Indigenous participants living with persistent pain (26,27). However, for Aboriginal and Torres Strait Islander patients this situation appears to be aggravated by the perception of persistent disregard of them as individuals.…”

Section: Discussionmentioning

confidence: 72%

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Communication and access to healthcare: Experiences of Aboriginal and Torres Strait Islander people managing pain in Queensland, Australia

et al. 2022

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BackgroundPain management requires a multidisciplinary approach and a collaborative relationship between patient-provider in which communication is crucial. This study examines the communication experiences of Aboriginal and Torres Strait Islander patients and Aboriginal and Torres Strait Islander Hospital Liaison Officers (ATSIHLOs), to improve understanding of how pain is managed in and through patient-health professional communication.MethodsThis qualitative study involved a purposive sample of patients attending three persistent pain clinics and ATSIHLOs working in two hospitals in Queensland, Australia. Focus groups and in-depth interviews explored the communication experiences of patients managing pain and ATSIHLOs supporting patients with pain. This study adopted a descriptive phenomenological methodology, as described by Colaizzi (1978). Relevant statements (patient and ATSIHLOs quotes) about the phenomenon were extracted from the transcripts to formulate meanings. The formulated meanings were subsequently sorted into thematic clusters and then integrated into themes. The themes were then incorporated into a concise description of the phenomenon of communication within pain management. Findings were validated by participants.ResultsA total of 21 Aboriginal and Torres Strait Islander participants were involved in this study. Exploration of the communication experiences of patients and ATSIHLOs revealed overlapping themes of important barriers to and enablers of communication that affected access to care while managing pain. Acknowledging historical and cultural factors were particularly important to build trust between patients and health professionals. Some patients reported feeling stigmatized for identifying as Aboriginal and Torres Strait Islander, while others were reluctant to disclose their background for fear of not having the same opportunity for treatment. Differences in the expression of pain and the difficulty to use standard pain measurement scales were identified. Communication was described as more than the content delivered, it is visual and emotional expressed through body language, voice intonation, language and the speed of the conversation.ConclusionCommunication can significantly affect access to pain management services. Aboriginal and Torres Strait Islander patients highlighted the burden of emotional pain caused by historical factors, negative stereotypes and the fear of discrimination. Pain management services and their health professionals need to acknowledge how these factors impact patients trust and care.

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Section: Discussionmentioning

confidence: 72%

“…Specialists outside pain medicine may feel it is not their area of expertise. The multidimensional nature of persistent pain and challenges in managing it in generalist health care settings are barriers to optimal pain care ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Communication and access to healthcare: Experiences of Aboriginal and Torres Strait Islander people managing pain in Queensland, Australia

et al. 2022

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“…In humans, the diagnosis of acute pain is often performed through self-report of symptoms and use of the visual analog scale and numeric rating scale ( Bendinger and Plunkett, 2016 ). Chronic pain diagnosis presents a greater challenge, requiring a multifaceted approach to quantify sensory, cognitive and psychological components, and even with specialized tools and a cooperative human patient it can be difficult to tease apart the complex syndromes and various associated comorbidities ( Bendinger and Plunkett, 2016 ; Carnago et al, 2021 ). These methods of diagnosing acute and chronic pain are often inaccurate or not possible in animals and in humans that are mentally incapacitated, preverbal neonates, or unable to precisely communicate their experience.…”

Section: Measuring Pain In Livestockmentioning

confidence: 99%

The Neuroimmune Interface and Chronic Pain Through the Lens of Production Animals

et al. 2022

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Communication between the central nervous system (CNS) and the immune system has gained much attention for its fundamental role in the development of chronic and pathological pain in humans and rodent models. Following peripheral nerve injury, neuroimmune signaling within the CNS plays an important role in the pathophysiological changes in pain sensitivity that lead to chronic pain. In production animals, routine husbandry procedures such as tail docking and castration, often involve some degree of inflammation and peripheral nerve injury and consequently may lead to chronic pain. Our understanding of chronic pain in animals is limited by the difficulty in measuring this pathological pain state. In light of this, we have reviewed the current understanding of chronic pain in production animals. We discuss our ability to measure pain and the implications this has on animal welfare and production outcomes. Further research into the neuroimmune interface in production animals will improve our fundamental understanding of chronic pain and better inform human clinical pain management and animal husbandry practices and interventions.

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“…Although diagnostic categories are a core tenet of clinical care and guide a reasonable range of treatment choices, individuals who share a common diagnosis are not the same, and some might respond more favorably to one treatment than to another. This is perhaps particularly true in the case of chronic pain [ 1 ]. In treating a patient, it is important to consider not only the underlying diagnosis (e.g., arthritis) and predominant presumed mechanism (e.g., neuropathic, inflammatory, nociplastic) but also demographic, social, and psychological factors, as these potentially modulate both the degree of pain [ 2 ] and how the patient responds to a proposed treatment.…”

Section: Introductionmentioning

confidence: 99%

Profiles of Risk and Resilience in Chronic Pain: Loneliness, Social Support, Mindfulness, and Optimism Coming out of the First Pandemic Year

et al. 2022

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Objective Individuals experience chronic pain differently, not only based on different clinical diagnosis, but also on differing degrees of influence by biopsychosocial pain modulators. We aimed to cluster chronic pain patients into distinct subgroups based on psychosocial characteristics and pain intensity, and subsequently examined group differences in pain-related interference approximately one year later. Methods In this observational, longitudinal study, patients with chronic pain (N = 94) completed validated assessments of psychosocial characteristics and pain intensity at the beginning of COVID-related social distancing (April-June, 2020). One year later (May-June, 2021), patients completed a follow-up survey with assessments of pain interference, loneliness, social support, mindfulness, and optimism. Results A cluster analysis, using psychosocial factors and pain intensity, empirically produced three patient groups: 1) PsychoSocial Predominant (PSP), characterized by high psychosocial distress and average pain intensity; 2) Pain Intensity Predominant (PIP), characterized by average psychosocial distress and high pain intensity; and 3) Less Elevated Symptoms (LES), characterized by low psychosocial distress and low pain intensity. At the 1-year follow-up, patients in the PSP and PIP clusters suffered greater pain interference compared to the LES cluster, while the PSP cluster also reported greater loneliness, and lower mindfulness and optimism. Conclusions An empiric psychosocial-based clustering of patients identified three distinct groups, which differed in pain interference. Patients with high psychosocial modulation of pain at the onset of social distancing (PSP cluster) suffered not only greater pain interference, but also greater loneliness and lower levels of mindfulness and optimism, suggesting some potential behavioral targets for this group in the future.

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Diagnosing and Treating Chronic Pain: Are We Doing This Right?

Cited by 15 publications

References 8 publications

Communication and access to healthcare: Experiences of Aboriginal and Torres Strait Islander people managing pain in Queensland, Australia

Communication and access to healthcare: Experiences of Aboriginal and Torres Strait Islander people managing pain in Queensland, Australia

The Neuroimmune Interface and Chronic Pain Through the Lens of Production Animals

Profiles of Risk and Resilience in Chronic Pain: Loneliness, Social Support, Mindfulness, and Optimism Coming out of the First Pandemic Year

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