The Economic Costs of Pain in the United States

Gaskin, Darrell J.; Richard, Patrick

doi:10.1016/j.jpain.2012.03.009

Cited by 1,885 publications

(1,353 citation statements)

References 21 publications

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“…Here we present results from a secondary analysis of an open-label oral opioid trial that was designed to investigate differences in opioid analgesia between subgroups of patients with low and high levels of NA [1]. Prior work had suggested that CLBP patients with high levels of comorbid NA have diminished opioid analgesia compared with CLBP patients with low levels of NA [31,32], and the primary outcome analyses for this study replicated those findings.…”

Section: Introductionsupporting

confidence: 52%

“…As described in the prior publication [1], this was a $6-month prospective cohort study of oral opioid therapy, with a 1-week baseline, a 2-week run-in of placebo (for one week) and active drug (subjects could choose oxycodone or morphine for 1 week) in randomized order, a 3-week titration period, a 4-month maintenance phase, and a 1-month taper (ClinicalTrials.gov Identifier: NCT01502644). CLBP patients with a discogenic pain syndrome of at least 6 months' duration and an average Negative Affect and Pain Modulation daily pain intensity of >3/10 were recruited.…”

Section: Study Sample and Designmentioning

confidence: 99%

“…Subjects taking opioids prior to enrollment underwent a 2-week weaning period and then remained off opioids for at least 1 week prior to initiating treatment. In total, 34% of participants were on opioids prior to enrolling in this study, with no difference between the low and high NA groups [1]. The study was approved by the Institutional Review Board at Brigham and Women's Hospital, and all participants provided written and verbal informed consent.…”

Section: Study Sample and Designmentioning

confidence: 99%

“…In addition, subjects were evaluated for medication misuse with the Drug Misuse Index (DMI), which summarizes assessment of opioid misuse in 3 domains: patient self-report on the Current Opioid Misuse Measure [37], provider assessment of misuse on the Addiction Behaviors Checklist [38], and results of urine toxicology screening [39]. The DMI is converted to a categorical variable reflecting adherence to opioids; a positive finding of misuse on any of these three measures results in a positive DMI., If all three measures are negative for misuse, the DMI is negative [1,40]. In total, participants came to BWH for 13 inperson study visits over the course of the trial.…”

Section: Study Sample and Designmentioning

confidence: 99%

“…Persistent pain is a serious therapeutic challenge and a public health epidemic; it affects over 100 million Americans per year, is among the leading causes of reduced quality of life, and carries direct and indirect costs of over 600 billion dollars annually in the U.S. alone [1]. In addition, long-term administration of analgesic medications (such as opioids) involves a variety of risks [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

Edwards¹,

Dolman²,

Michna³

et al. 2016

Pain Med

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Objective. Opioids are frequently prescribed for chronic low back pain (CLBP), but there are broad individual differences in the benefits and risks of opioid therapy, including the development opioidinduced hyperalgesia. This study examined quantitative sensory testing (QST) data among a group of CLBP patients undergoing sustained oral opioid treatment. We investigated whether individual differences in psychological characteristics were related to opioid-induced changes in pain perception and pain modulation.Design. The six-month, open-label trial evaluated patients with low to high levels of negative affect (e.g., symptoms of distress, depression and anxiety); participants underwent QST at baseline (prior to initiating treatment) and during oral opioid treatment.Setting. A chronic pain management center.Patients. The 31 study participants had chronic discogenic back pain, with a pain intensity rating >3/10. Participants were divided into groups with high vs. low levels of Negative Affect (NA).Results. In the previously-published manuscript describing the clinical outcomes of the trial, high NA patients achieved only about half of the analgesic effect observed in the low NA group (Wasan AD, Michna E, Edwards RR, et al. Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. Anesthesiology 2015;123:86172). The QST findings reported here suggested that tolerance to experimental (cold pressor) pain and conditioned pain modulation tended to decrease in the high NA group over the course of opioid treatment, while temporal summation of mechanical pain declined in the low NA group.Conclusions. These results reveal that while the low NA group seemed to exhibit a generally adaptive, analgesic pattern of changes during opioid management, the high NA group showed a pattern more consistent with opioid-induced hyperalgesic

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Section: Introductionsupporting

confidence: 52%

Section: Study Sample and Designmentioning

confidence: 99%

Section: Study Sample and Designmentioning

confidence: 99%

Section: Study Sample and Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

Edwards¹,

Dolman²,

Michna³

et al. 2016

Pain Med

View full text Add to dashboard Cite

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Addressing Obstacles to Evidence-Informed Pain Care

2020

AMA Journal of Ethics

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Pain is a universal human experience and the most common reason patients seek health care. This article describes barriers to effective, high-quality, evidence-informed pain care. Based on the clinical literature and pain specialists' survey results, the AMA Pain Care Task Force suggests strategies that clinicians can use to offer good pain care to patients. The task force also canvasses key policy-level concerns that situate clinicians in micro-and macro-level complexities related to payers, workforce and training demands, legal and regulatory questions, research, stigma, and patients' beliefs and expectations. The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.

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Management of Persistent Pain in the Older Patient

Makris

Abrams

Gurland

et al. 2014

JAMA

267

201

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Importance Persistent pain is highly prevalent, costly, and frequently disabling in later life. Objective To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult. Evidence Acquisition Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults. Findings Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended–emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician. Conclusions and Relevance Treatment planning for persistent pain in later life requires a clear understanding of the patient's treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy.

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The Economic Costs of Pain in the United States

Cited by 1,885 publications

References 21 publications

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

Addressing Obstacles to Evidence-Informed Pain Care

Management of Persistent Pain in the Older Patient

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