<p>Multidisciplinary pain management program for patients with chronic musculoskeletal pain in Japan: a cohort study</p>

Abstract

IntroductionMultidisciplinary pain management is a useful method for treating chronic musculoskeletal pain. Currently, few facilities in Japan offer multidisciplinary pain treatment, especially in the inpatient setting. We implemented a multidisciplinary pain management program based on International Association for the Study of Pain recommendations. This study described our initial efforts in implementing the program, and reported 3- and 6-month follow-up results.Materials and methodsOur pain management team included orthopedic surgeons, psychiatrists, nurses, physical therapists, clinical psychologists, pharmacists, and nutritionists. The 3-week inpatient pain management program comprised exercise therapy, psychotherapy, and patient education. We evaluated patients using the Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), Pain Disability-Assessment Scale (PDAS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), EuroQol Five Dimensions (EQ-5D), and physical examinations (flexibility, muscle endurance, walking ability, and physical fitness). Statistical analyses were performed using paired t-tests and Wilcoxon matched-pairs signed-rank sum tests with Bonferroni correction after the Friedman test.ResultsData for 23 patients were analyzed before and immediately after the program. Statistically significant improvements were seen in BPI, PCS, PDAS, HADS, PSEQ, EQ-5D, flexibility, muscle endurance, walking ability, and physical fitness. Eight patients were also assessed 3 and 6 months after the program. PCS (rumination and helplessness) scores and flexibility showed significant improvement at 3 and 6 months. Significant improvement was seen in PDAS and HADS (anxiety) scores and muscle endurance at 6 months, and in PSEQ scores immediately and at 3 and 6 months.ConclusionOur inpatient pain management program can improve patients’ physical function and ability to cope with chronic musculoskeletal pain, which supports improved quality of life. Our program is currently being expanded to better assist patients with chronic musculoskeletal pain.

Pharmacist‐led intervention on chronic pain management: A systematic review and meta‐analysis

“…Participants in these studies had reported chronic pain originating from the musculoskeletal systems (knee, spine, joint, back), neurological system (headache and migraine) and unspecified chronic pain. Pain measurement tools used in these studies were the Chronic Pain Grade Scale (CPGS), 18,28 Numeric Pain Rating Scale (NPRS), 15,26 Western Ontario and McMaster Universities osteoarthritis index (WOMAC), 16,17 Brief Pain Inventory (BPI), [23][24][25] pharmacotherapeutic pain inventory, 20 and the Pain, Enjoyment of Life and General Activity score (PEG). 27 3.2 | Quality of studies…”

“…Most of the studies were judged to be of average quality. Two of the studies were judged to have a serious risk of bias, 21,26 five moderate, [22][23][24][25]27 and only one low risk of bias. 28 The studies were judged to have a serious risk of bias due to participant selection and confounding (Table S2).…”

“…We also identified five studies where pharmacists were involved in the multidisciplinary or interdisciplinary team for the management of pain. 16,21,[23][24][25] Pharmacists reviewed patient medications, 16 performed opiate stewardship, where they screened and evaluated the use of opioids to support its judicious use, 21,23,24 and provided patient education. 25 These approaches led to improvements in pain score, 16 pain disability index, 24 symptoms of anxiety and depression, [23][24][25] selfefficacy, 25 pain severity and interference, as well as reduced need for morphine use 21,23 (Table 4).…”

“…Six studies reported pain intensity scores. [23][24][25][26][27][28] Pharmacist intervention or 27,28 Similarly, among five of the reported studies, [23][24][25][26][27] physical functioning was improved in four studies [23][24][25][26] while no impact was observed in the study by Vogler et al in 2017. 27 Pharmacists conducted opiate stewardship and optimized the dose of morphine, with dose reduction in two studies 21,23 and dose increment in a study by Chelminski et al in 2005.…”

Efficacy of Intra Articular Botulinum Toxin Injection in Sickle Cell Patients’ Joints

“…The goal of therapy for patients with chronic pain is to improve functional capability while decreasing the level of pain. 4,5 Health professionals are reluctant to prescribe opioids due to stigma with addiction and side effects. 6 There is widespread fear of drug dependency when the painful crisis is managed with opioids.…”