ABSTRACT
The purpose of this article is to provide a data-driven exploration of an interdisciplinary pain rehabilitation program (PRP) as a viable option for addressing the dual crises of chronic pain and opioid use. Psychologists are crucial providers in the PRP, in both intervention and leadership roles. There is well-established literature supporting pain rehabilitation as an effective treatment for chronic pain and functioning, but there are few studies examining the effects of pain rehabilitation on opioid misuse risk. We evaluated data from 60 patients with diverse chronic pain conditions who completed an interdisciplinary PRP to evaluate changes in pain, functioning (self-report and objective physical measure), psychological symptoms, and health-related quality of life. To evaluate the effect of pain rehabilitation on opioid-related risks, we examined opioid use and opioid misuse behaviors (measured by the Current Opioid Misuse Measure; COMM) pre- and posttreatment. Results demonstrated statistically significant improvements in all outcomes, with medium effect sizes for pain severity and large effect sizes for functioning, psychological symptoms, and emotional quality of life. Fifty-eight percent of patients were on opioid medications at entry compared with 15% at discharge. Among patients who entered on opioids, mean COMM scores were significantly reduced from above the cutoff for misuse risk (M = 13.57) to below the cutoff (M = 5.86). Overall, this study provided strong support for pain rehabilitation as an effective treatment for chronic pain and related suffering, while also providing a prevention-based opportunity for reducing opioid-related risk. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Subject(s)
Chronic Pain/rehabilitation , Opioid-Related Disorders/prevention & control , Adolescent , Adult , Aged , Analgesics, Opioid/adverse effects , Female , Humans , Male , Middle Aged , Quality of Life , Young AdultABSTRACT
BACKGROUND: Long-term medical and psychological follow-up after weight loss surgery is associated with improved patient outcomes. Weight regain after weight loss surgery is a common concern that has behavioral and psychological components; however, most patients do not attend behavioral medicine (BMED) follow-up appointments post-surgery. Innovative treatment models are needed to improve access to BMED to optimize long-term outcomes. OBJECTIVES: This study aimed to examine the feasibility and acceptability of an integrated BMED service within a bariatric surgery clinic. SETTING: University medical center, outpatient clinic. METHODS: Patients (n = 198) in a post-bariatric surgery clinic were screened for psychosocial/behavioral concerns and offered a same-day BMED consult, when appropriate. Patients rated their satisfaction with the consult and their confidence in being able to carry out the plan created during the consult. RESULTS: The top 3 concerns identified during screenings were emotional eating, body image, and cravings. The top 3 concerns addressed during consults were emotional eating, mood, and cravings. The mean length of consult was 26.1 minutes. The mean severity of problems addressed was 7 of 10. Patients' confidence ratings had a mean of 9.4 of 10 (1 = low, 10 = high) and satisfaction ratings had a mean of 9.8 of 10. CONCLUSIONS: In this clinic, the integration of a BMED service provided 40% of patients with behavioral intervention for psychosocial/behavioral concerns during routine surgery follow-up appointments. Patients indicated high satisfaction with consults and reported high confidence in being able to carry out the plan created during the consult.
Subject(s)
Bariatric Surgery/psychology , Behavioral Medicine/methods , Body Image/psychology , Obesity, Morbid/psychology , Obesity, Morbid/surgery , Patient Acceptance of Health Care/statistics & numerical data , Academic Medical Centers , Adult , Ambulatory Care/organization & administration , Bariatric Surgery/methods , Behavioral Medicine/statistics & numerical data , Body Mass Index , Delivery of Health Care, Integrated/organization & administration , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Obesity, Morbid/diagnosis , Outpatients/statistics & numerical data , Patient Safety , Pilot Projects , Postoperative Care/methods , Psychology , Risk Assessment , Weight LossABSTRACT
OBJECTIVES: The current study utilized mHealth technologies that were objective (e.g., sleep actigraphy and pulse oximetry) and time-sensitive (e.g., ecological momentary assessments [EMAs]) to characterize sleep in youth with sickle cell disease (SCD) and investigate the relationships between sleep variables and pain. It also investigated the influence of age on sleep and the sleep-pain relationship. METHODS: Eighty-eight youth with SCD (aged 8-17 years) were recruited from three regional pediatric SCD clinics. Youth completed twice daily EMAs for up to 4 weeks to assess nighttime subjective sleep quality and daily pain. They also wore a sleep actigraph for 2 weeks to assess sleep duration, sleep efficiency, and sleep latency, and a wrist-worn pulse oximeter for two nights to assess whether they had sleep apnea. Multilevel models were calculated predicting daily SCD pain using the sleep variables, age, and the interaction between age and the sleep variables. RESULTS: None of the sleep variables were related to one another. Poor subjective sleep quality during the night was related to high pain severity the next day, and high pain was related to poor subjective sleep quality that night. Older age was associated with poorer subjective sleep quality, shorter duration of nighttime sleep, and high sleep latency. Also, findings indicated that as age increased, the strength of the relationship between poor continuous subjective sleep quality and high pain severity increased. CONCLUSIONS: Future research is needed to examine possible mechanisms connecting subjective sleep quality to high pain.