Abstract Objectives Chronic pain is associated with an increased prevalence of anxiety and depression. However, correlations between pain intensity and psychological distress are generally weak, suggesting a more complex relationship. Although evidence indicates a bidirectional association, the role of potential mediators warrants further study. The aim of this cross-sectional registry study was to explore mediators of the relationship between pain intensity and psychological distress, and vice versa, among individuals with chronic pain. Methods This cross-sectional cohort study included 6,497 adult chronic non-cancer pain patients from the Swedish Quality Registry for Pain Rehabilitation (SQRP) with Patient-Reported Outcome Measures (PROMs) data (2008–2016). Five potential mediators – catastrophizing, fear-avoidance, physical activity level, acceptance and insomnia – were examined in the bidirectional relationship between pain intensity and psychological distress using Partial Least Squares Structural Equation Modelling (PLS-SEM). Results The direct paths (i.e., correlations) between pain intensity and psychological distress in both directions became non-significant when controlling for the five mediators. Insomnia and catastrophizing emerged as the most important mediators, each with medium effect sizes, followed by acceptance, which showed a small effect size. Fear-avoidance demonstrated little to no influence. Physical activity showed no substantial mediating effect in any model. Conclusions This study supports the idea that the clinically observed association between pain intensity and psychological distress is more accurately explained by the influence of mediators, specifically catastrophizing, insomnia, and acceptance, rather than a direct effect between the two. These findings suggest that clinical assessments and interventions for patients with chronic pain should prioritize addressing catastrophizing, insomnia, and acceptance.
Abstract Objectives Clinical guidelines for patients with neuropathic pain (NeP) recommend setting achievable treatment goals relevant to their daily lives. We therefore evaluated the associations of the EuroQol 5-Dimensions 5-Levels (EQ-5D-5L) with reduced quality of life (QoL) in patients with chronic low back pain with NeP (CLBP-NeP) or chronic cervical pain with NeP (CCP-NeP) to help inform the setting of such treatment goals. Methods Secondary data were analyzed from two observational studies of patients with CLBP-NeP or CCP-NeP. The associations of each EQ-5D-5L dimension (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with reduced QoL (defined as the ratio of each dimension to the increase in disutility) of patients with CLBP-NeP or CCP-NeP by change in pain Numeric Rating Scale (NRS) were calculated. Results In patients with CLBP-NeP, mobility and pain/discomfort were associated with reduced QoL at lower pain levels, which was maintained at higher pain levels for mobility, but not for pain/discomfort. Anxiety/depression and self-care were associated with reduced QoL at higher pain levels. Usual activity was associated with reduced QoL across pain levels. In patients with CCP-NeP, an association of pain/discomfort with reduced QoL was observed across pain levels, increasing at higher pain levels. Usual activity was associated with reduced QoL at lower pain levels, with this association decreasing at higher levels. Self-care was associated with reduced QoL across pain levels, and mobility was more strongly associated at higher levels. Anxiety/depression was associated with reduced QoL across pain levels. Conclusions These results indicate that factors associated with reduced QoL in patients with CLBP-NeP or CCP-NeP may differ depending on pain level. Focusing on mobility at lower pain levels and on psychological aspects at higher levels in CLBP-NeP, and on usual activities and pain/discomfort in CCP-NeP, may help set more effective treatment goals. An individualized approach may also help to improve patients’ QoL of patients with NeP.
INTRODUCTION:Thoracic epidural analgesia (EDA) is recommended for multimodal perioperative pain management. However, increased pain and opioid consumption are frequently observed following EDA discontinuation. Risk factors for this transition phase remain poorly characterized after pancreatic surgery. AIM:The primary aim was to characterize analgesic strategies, including opioid consumption and use of non-opioid agents, following EDA discontinuation after pancreatic cancer surgery (days 0-2). The secondary aim was to determine predictors of increased opioid consumption on the day of EDA discontinuation (day 0). METHODS:In this retrospective cohort study, adult patients who underwent pancreatic cancer surgery between 01 June 2021 and 31 June 2023 at Sahlgrenska University Hospital, Gothenburg, Sweden, and received postoperative EDA were identified using institutional electronic health records. Total daily opioid consumption (oral morphine equivalent daily dose, OMEDD) and non-opioid pharmacological treatments were characterized. Factors associated with opioid consumption on day 0 were determined using multivariable linear regression. Variable importance analysis based on R2 decomposition (Lindeman-Merenda-Gold method) was performed. RESULTS:A total of 194 patients were included. Median OMEDD (IQR) was 98 (60-142) mg on day 0, 75 (60-105) mg on day 1, and 60 (45-90) mg on day 2. EDA duration, age, epidural infusion rates, and preoperative opioid use were independently associated with opioid consumption at EDA discontinuation. Preoperatively confirmed malignancy and EDA analgesic failure showed potential associations. The final model explained 20.8 % of the variance in opioid consumption (adjusted R2=0.208). CONCLUSIONS:The transition from EDA to oral analgesia after pancreatic surgery is accompanied by high opioid consumption. In this cohort, longer EDA treatment, younger age, higher epidural infusion rates, and preoperative opioid use were associated with increased opioid consumption at EDA discontinuation, suggesting that patients at risk of high opioid usage may be identified in advance and could benefit from tailored, multimodal opioid-sparing strategies.
BACKGROUND:Chronic back pain is a major cause of disability and a socioeconomic burden. Previous studies on back pain have suggested a moderately increased risk for cardiovascular mortality in elderly women, but evidence in elderly men is lacking. We investigated the association between continuous chronic back pain for more than a year and incident cardiovascular events in a cohort of elderly men. METHODS:The Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based cohort of elderly men (mean age, 71 years; n=1,024), was used to investigate the association between continuous back pain lasting more than one year and incident cardiovascular events (defined as a composite of coronary heart disease, cerebrovascular disease or cardiovascular mortality). RESULTS:During up to 20 years follow-up, 504 individuals developed a cardiovascular event. In Cox proportional-hazards models adjusted for a large number of established cardiovascular risk factors, socioeconomic factors, and lifestyle factors (age, systolic blood pressure, antihypertensive treatment, high- and low-density lipoprotein-cholesterol, triglycerides, lipid-lowering treatment, glomerular filtration rate, urinary albumin excretion, body mass index, diabetes, diabetes medication, insulin-sensitivity, C-reactive protein, educational level, smoking, physical activity) continuous chronic back pain was robustly associated with a more than 70 % increased risk for cardiovascular events (multivariable hazard ratio 1.71, 95 % confidence intervals 1.23-2.37, p<0.001). CONCLUSIONS:Continuous chronic back pain for more than a year is a risk factor for cardiovascular events in elderly men. Our findings confirm previous evidence, highlighting chronic pain as a clinically relevant and under-recognized risk factor for cardiovascular disease that warrants consideration in future clinical guidelines.
BACKGROUND:Although acute pain is one of the most common complaints in the emergency department (ED), it is often undertreated. Several interventions, such as the implementation of an acute pain protocol, have been evaluated in order to optimize pain management, with variable results. The aim of this study was to evaluate the long-term efficacy of a nurse-initiated pain-management protocol 10 years after implementation. METHODS:This was a prospective, observational study recruiting all consecutive adult patients with acute pain in the ED of a Level-1 trauma center during a period of 4 weeks. The primary outcome was the percentage of the composite endpoint 'pain awareness'. The secondary outcomes were patient satisfaction; administration of analgesics; NRS scores and waiting time until receiving analgesics. RESULTS:Three hundred and 23 patients were included in this study. The percentage of pain awareness was 69 %. In 41.5 % of patients, analgesics were administered and in 55.1 %, an NRS-score was documented. Regarding patient satisfaction, no significant correlation was observed between waiting time until receiving analgesics and satisfaction. DISCUSSION:The percentage of pain awareness was 69 % with an existing pain protocol in place. Overall, patient satisfaction was positive in the majority of the patients. Further research into the types of analgesics that are more likely to optimize the protocol is necessary.
