Improvements from a small-group multidisciplinary pain self-management intervention for women living with pelvic pain maintained at 12 months.

BACKGROUND: A small-group multidisciplinary pain self-management program for women living with pelvic pain, with or without endometriosis, was developed to address identified unmet treatment needs. Following completion, over 80% of participants demonstrated clinically significant improvement across a number of domains. There was no clinically significant deterioration on any measure and benefits continued at three months follow-up. AIMS: This study examines patient-reported outcomes at 12 months following program completion to ascertain maintenance of these improvements. MATERIALS AND METHODS: Self-report measures assessed quality of life across the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials domains prior to, at completion and 12 months following participation. RESULTS: At 12 months follow-up, improvement was seen in mean group scores for all baseline measures for 57% of participants who returned valid 12-month follow-up data, with clinically significant improvement seen for within-subject scores for 50% of these participants for pain severity and also for pain-related activity interference. Improvements were also reported in key predictors of long-term outcomes, pain self-efficacy and catastrophic worry, with 92% reporting improvement in each of these two constructs. There were 83% of respondents who reported feeling both improvement in overall sense of wellbeing and improvement in their physical ability compared to before the program. CONCLUSIONS: Results suggest that a six-week multidisciplinary small-group intervention increases participants' abilities to self-manage pain and improves quality of life with lasting clinically significant improvements.

Implementing an osteoarthritis management program to deliver guideline-driven care for knee and hip osteoarthritis in a U.S. academic health system.

Objective: Assess implementation feasibility and outcomes for an Osteoarthritis Management Program (OAMP) at an academic center. Design: This open study assessed an OAMP designed to deliver care in 1-5 individual or group visits across ≤12 months. Eligibility included adults with knee or hip osteoarthritis with ≥1 visit from 7/1/2017-1/15/2021. A multidisciplinary care team provided: education on osteoarthritis, self-management, exercise, weight loss; pharmacologic management; assessments of mood, sleep, quality of life, and diet. Clinic utilization and growth are reported through 2022. Patient outcomes of body mass index (BMI), pain, and function were analyzed using multivariable general linear models. OAMP outcomes were feasibility and sustainability. Results: Most patients were locally referred by primary care. 953 patients attended 2531 visits (average visits 2.16, treatment duration 187.9 days). Most were female (72.6%), older (62.1), white (91.1%), and had medical insurance (95.4%). Obesity was prevalent (84.7% BMI ≥30, average BMI 40.9), mean Charlson Comorbidity Index was 1.89, and functional testing was below average. Longitudinal modeling revealed statistically but not clinically significant pain reduction (4.4-3.9 on 0-10 scale, p â€‹= â€‹0.002). BMI did not significantly change (p â€‹= â€‹0.87). Higher baseline pain and BMI correlated with greater reductions in each posttreatment. Uninsured patients had shorter treatment duration. Increasing clinic hours (4-24 â€‹h weekly) and serving 953 patients over four years demonstrated OAMP sustainability. Conclusions: OAMP implementation was feasible and sustainable. Patients with high baseline pain and BMI were more likely to improve. Noninsurance was a barrier. These results contribute to understanding OAMP outcomes in U.S. healthcare.

Estimation of cognitive impairment in chronic pain patients and characteristics of estimated mild cognitive impairment.

Background: Patients with chronic pain suffer from psychological effects such as anxiety due to the pain itself. Pain can not only impair activities of daily living (ADL) and quality of life (QOL), but also impair cognitive function. Therefore, in this study, we aimed to estimate the cognitive function of chronic pain patients using a deep neural network (DNN) model that has already been implemented in society. We investigated the characteristics of patients presumed to have mild cognitive impairment (MCI) and, at the same time, verified the relationship with the questionnaire commonly used in chronic pain research, which is administered by 43 university affiliated hospitals and medical institutions participating in the chronic pain research group of the Ministry of Health, Labor and Welfare in Japan (assessment batteries). Method: The study included 114 outpatients from a multidisciplinary pain clinic, and we estimated their Mini-Mental State Examination (MMSE) scores based on age and basic blood test data (23 items). Furthermore, we classified the estimated MMSE scores of chronic pain patients into two groups based on a cutoff score of 27, which indicates MCI, and compared the blood data and assessment batteries. Additionally, we used a control group of 252 healthy adults aged 45 years or older who visited a dementia prevention outpatient clinic for comparison with the MMSE scores of chronic pain patients. Result: The MMSE scores in chronic pain patients were below the cutoff for MCI. When classified into two groups based on the estimated MMSE score of 27 points, WBC, RBC, Hb, Hct, PLT, UA, BUN, creatinine, Triglyceride, and γ-GT were significantly higher in the blood data. In the MCI group, PDAS values were significantly lower. Furthermore, only in the non-MCI group, a significant correlation was found between the estimated MMSE value and BPI, PDAS, and Locomo. The estimated MMSE scores were significantly lower in chronic pain patients than in healthy adults (p = 0.04). Conclusion: Patients with chronic pain may exhibit cognitive impairment due to systemic metabolic disturbances. This suggests that chronic pain affects activities of daily living, resulting in systemic metabolic disorders.

Patient Presentations in a Community Pain Clinic after COVID-19 Infection or Vaccination: A Case-Series Approach.

OBJECTIVES: Early case report studies and anecdotes from patients, medical colleagues, and social media suggest that patients may present to chronic pain clinics with a number of complaints post COVID-19 infection or vaccination. The aim of this study is to systematically report on a consecutive series of chronic pain patients seen in a community-based pain clinic, who acquired symptoms after COVID-19 infection or vaccination. METHODS: This retrospective cross-sectional descriptive study identified all patients seen at the clinic over a 4-month period (January-April 2022) with persistent symptoms after COVID-19 infection, vaccination, or both. Information was collected on sex, gender, age, details of vaccination, new pains, or exacerbation of old pain plus the development of novel symptoms. RESULTS: The study identified 21 community dwellers (17 females and 4 males; F/M 4.25/1; age range 22-79 years; mean age 46.3 years), with symptoms attributed to COVID-19 infection or vaccination. Several patients suffered exacerbation of previous pains or developed novel pains, as well as high levels of anxiety and mood disorders. A review of the existing literature provides support for the spectrum of symptoms displayed by the study group. CONCLUSIONS: Information collected in this study will add to the body of COVID-19-related literature and assist particularly community practitioners in recognizing and managing these conditions.

Machines, journeys, prisons and yo-yos: Metaphors of pain, illness and medicine in consultations with chronic pain patients.

INTRODUCTION: This paper examines pain, illness and medicine metaphors as used in consultations between chronic pain patients and anaesthesiologists, physiotherapists and psychologists in a Belgian pain clinic. As metaphors frame and highlight aspects of understanding and experiences of life events, including illness, they can provide insight in how health professionals and patients construct illness, pain and medicine in interaction. MATERIALS AND METHOD: 16 intake consultations (collected in Belgium in April-May 2019) between 6 patients and 4 health professionals were qualitatively coded twice ATLAS. TI by a team of 3 coders, using an adjusted form of the Metaphor Identification Procedure. Each metaphor was labelled for source domain, target domain and speaker. RESULTS: A number of metaphors that have been previously documented in past research were frequent in our data too, such as journey and machine metaphors, although sometimes also used differently, like war metaphors. Our data set also contained many few-used and sometimes more novel metaphors, such as ILLNESS IS A YO-YO. Many metaphors highlight particular aspects of living with and talking about chronic pain, such as its duration and persistent presence, a lack of agency and feelings of powerlessness, and a dualistic perspective on body and mind. DISCUSSION AND CONCLUSION: The metaphors used by health professionals and patients give insight in the lived experience of having and treating chronic pain. In this way, they can contribute to our understanding of patients' experiences and challenges, how they recur in clinical communication, and how they are related to wider discourses on health, illness and pain.

Cincuenta años del Departamento de Medicina del Dolor y Paliativa del Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán¼ / Fifty anniversary of the department of pain and palliative medicine at the Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán¼

Resumen: Introducción: En México, la primera clínica especializada en el alivio del dolor fue fundada en 1972 por el Dr. Ramón De Lille Fuentes en el Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán¼ (INCMNSZ). Material y métodos: Se realizó una búsqueda histórica documental y entrevistas a quienes han colaborado con el Departamento de Medicina del Dolor y Paliativa del INCMNSZ desde su fundación. Resultados: Nuestra visión es ofrecer atención del dolor, cuidados paliativos y apoyo continuo. Para ello, documentamos nuestra historia y los logros del departamento. Conclusiones: A 50 años de su fundación, el Departamento de Medicina del Dolor y Paliativa del INCMNSZ es un foro de desarrollo científico y de formación de capital humano con un enfoque humanista.

Abstract: Introduction: In Mexico, the first clinic specializing in pain relief was founded in 1972 by Dr. Ramón De Lille Fuentes at the Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán¼ (INCMNSZ). Material and methods: A historical documentary search and interviews were carried out with those who have collaborated with the Department of Pain and Palliative Medicine of the INCMNSZ since its foundation. Results: Our vision is to offer pain management, palliative care, and ongoing support. To do this, we document the history and achievements of the department. Conclusions: 50 years after its foundation, the INCMNSZ Department of Pain and Palliative Medicine is a forum for scientific development and human capital training with a humanistic approach.

Implementation and Outcomes of an Advanced Nurse Practitioner Telephone Chest Pain Clinic Developed in Response to the COVID-19 Pandemic.

Introduction: During the COVID-19 pandemic, a virtual telephone advanced nurse practitioner (ANP) led chest pain clinic was set up because face-to-face clinic visits had ceased. Methods: This retrospective cohort analysis compared the ANP virtual chest pain clinic to the face-to-face nurse specialist-led clinic. Results: Autonomous nursing management was significantly higher in the virtual clinic, and significantly fewer patients were referred for functional testing. Coronary arterial disease (CAD) diagnosis did not differ. Conclusion: ANP autonomy and experience enabled continued chest pain assessment and CAD diagnosis via a virtual telephone clinic.

The Overuse of the Emergency Department at a Multidisciplinary Pain Clinic by Patients with Chronic Pain: A Cross-Sectional Study.

Introduction Pain represents up to 78% of emergency department (ED) appointments, and an average of 16% of patients that consume ED resources have chronic pain. ED overuse could be an indicator of poor pain management. We are not aware of any study that has ever been carried out to understand the incidence of patients followed up at a multidisciplinary pain clinic (MPC) who overuse the ED. We aim to characterize patients in our MPC who overuse the emergency department, comprehend our percentages, and develop effective methods to reduce these numbers in the near future. Materials and methods We reviewed the medical records of patients observed in our MPC in 2019, selected patients with more than six ED visits from 2019 to 2021, and registered their ED visit diagnosis and evolution. We followed up on these patients and characterized them according to demographic aspects, chronic pain diagnostics, comorbidities, chronic medication, number of chronic pain department appointments, and patients that underwent invasive pain treatment. Results In 2019, 1892 patients were evaluated at our MPC, and only 1% were classified as overusers of the ED. The average number of episodes per patient was 10 in 2019, seven in 2020, and four in 2021. 70% of episodes were due to pain, and 94% were discharged immediately. The majority were women, and 69% were under the age of 69. Seventy-three percent had psychiatric disorders, and 95% and 89% were medicated with opioid and antidepressant medication, respectively, prior to the ED evaluation. Chronic primary pain was the most common diagnosis (47%), followed by chronic secondary musculoskeletal pain (21%). In 2019, most of these patients had only one appointment at our MPC, and in 2021, 79% had no appointments at all. Conclusion Our findings emphasize the particularities of patients with chronic pain who are followed in an MPC and misuse the ED. We observe the predominance of middle-aged people, which raises concerns about the impact of chronic pain in the active population. Issues like the predominance of patients with a diagnosis of primary chronic pain, psychiatric disorders, and being polymedicated with antidepressants and opioids are also a concern. We also realized that a high percentage of patients who overuse EDs lost follow-up at MPC over the past three years, which may reinforce the idea that they were misguided in the treatment of their chronic pain. We recognized the need to improve teamwork with primary care in the follow-up of these patients as well as sensitize emergency service professionals to refer this patient rather than medicate acutely so that follow-up could be carried out in the appropriate places to reduce the percentage of ED overuse.

Long-term opioid therapy and mental health comorbidity in patients with chronic pain.

OBJECTIVES: Evidence suggests that patients with chronic pain and mental illness are more likely to receive long-term opioid therapy (LTOT) and at higher doses but are also at increased risk of experiencing opioid-related harm. This study investigates LTOT and its relationship to mental illness in the setting of a university-based outpatient pain clinic with liaison psychiatric care. METHODS: Retrospective analysis of patients with chronic pain admitted between 2011 and 2015. After a 1-year treatment period, patients with non-opioid treatment, guideline-recommended LTOT, and high-dose LTOT were compared, and multiple regression analysis was performed to identify predictors of higher opioid dosage. RESULTS: Of 769 patients, 46% received LTOT (opioids for >90 consecutive days), 13% at high dosage (>120 oral morphine milligram equivalents [MME] / day). Two thirds of all patients had mental illness. The prevalence of psychiatric diagnoses and prescription rate of psychotropic medication did not significantly differ between groups. Pain chronicity stages, use of antidepressants, and sex significantly predicted MME/day but explained only a minor part of the variance. The association with antidepressants can be attributed to the prescription of antidepressants for analgesic purposes rather than for treating depression. No association with any other type of psychiatric disorders was observed. CONCLUSION: This study shows that mental health comorbidity is highly prevalent but that the prescribed opioid dosage is independent of it in the clinical setting of this study. The concept of liaison psychiatric care might have essentially contributed to the "detachment" of opioid prescription and psychiatric conditions but cannot be isolated from other potentially contributing factors within this single-center observational study.

Virtual care exercise interventions in multidisciplinary chronic pain clinics: a qualitative study of perspectives of adults living with chronic pain.

PURPOSE: Chronic pain affects 1 in 4 Canadians and is a leading contributor of disability. Although virtual care has become more prevalent, it is unclear how adults living with chronic pain perceive virtual delivery of exercise interventions within multidisciplinary chronic pain clinics (MCPC). This study explores the perspectives of adults living with chronic pain regarding their perceived barriers and facilitators and recommendations when implementing virtual care exercise interventions within MCPCs. METHODS: We conducted an interpretive description qualitative study based on semi-structured interviews with adults (age ≥18 years) living with chronic pain from a MCPC in Toronto, Canada, between March 1 and April 30, 2021. RESULTS: We completed fifteen (N = 15) interviews of adults living with chronic pain. We identified eight themes that addressed the study objectives: 1) virtual care supplements in-person care, 2) virtual care improves accessibility, 3) impact of technology on participation, 4) navigating the home environment, 5) impact of pain on participation, 6) impact of supervision and feedback, 7) the need for tailored care, and 8) the need for preparation and additional support. CONCLUSION: Our results reveal that adults living with chronic pain view virtual care exercise interventions positively however, the implementation of these interventions must be carefully considered within MCPCs. Specifically, virtual care was considered an excellent adjunct to in-person care but should not replace it completely.Implications for RehabilitationChronic pain is a leading contributor of disability.Exercise interventions are recommended component of comprehensive pain management.Virtual delivery of exercise interventions are becoming more prevalent.Adults living with chronic pain view virtual care exercise interventions positively as they can supplement in-person care and improve access to this type of care.

Chronic Non-cancer Pain Management in a Tertiary Pain Clinic Network: a Retrospective Study.

INTRODUCTION: Chronic pain is a distressing condition that should be treated in specialized pain clinics. Pain clinics offer a holistic, evidence-based approach, including pharmacological, complementary, and invasive treatments. This study aimed to provide preliminary information regarding chronic pain treatments and identify reasons for accessing an important hub-spoke pain clinic network. METHODS: A retrospective multicenter cross-sectional study was carried out. A total of 1606 patients' records were included. Patients were selected from the 26 pain clinics of a single region in Italy. Univariate and multivariate logistic regression models were used. RESULTS: Multivariate models showed that the use of opioids were considered effective for severe or moderate pain [odds ratio (OR) 0.41; 95% 0.33-0.51], while the use of invasive treatments (OR 2.45; 95% 1.95-3.06) and the use of complementary therapy (OR 1.87; 95% 1.38-2.51) were associated with severe or moderate pain. Overall, age, sex, nonsteroidal anti-inflammatory drugs (NSAID) use, a combination of NSAIDs, complementary therapies, and a combination of opioids and invasive treatments did not seem to be significantly associated with the nature of pain. Multivariate models confirmed that clinical parameters such as the nature of pain, multi-diagnosis, more than one site of pain, treatments, and general practitioner, but not the severity of pain and use of invasive treatments, had an impact on the choice of a pain clinic. CONCLUSION: Opioids are useful in managing moderate or severe chronic pain. Multimodal approaches are used for the management of chronic pain. Moreover, it is not clear how patients are addressed to access different pain clinics (spoke versus hub) networks. More widespread adoption is needed for an interdisciplinary approach to managing chronic pain and adopting guideline recommendations, and rigorous research is required to provide more substantial evidence and support clinical practice.

The Pain Clinic for Older People.

OBJECTIVE: Multidisciplinary pain clinics have an established role in the management of persistent pain, but there is little evidence to support this approach in an older population. This study describes the characteristics and pain outcomes of patients attending a pain clinic designed exclusively for older people. METHODS: A retrospective audit was performed of outcomes of the Pain Clinic for Older People (PCOP) in 2015-2019. Response to treatment was determined by change in Brief Pain Inventory (BPI) scores at initial attendance and after a treatment program. Clinically meaningful improvement was defined by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) consensus criteria of ≥30% improvement in average pain and one-point improvement in pain interference. Results were compared with the national benchmark collated by the electronic Persistent Pain Outcomes Collaboration (ePPOC), which reports the combined results from 67 participating Australian and New Zealand pain services. RESULTS: Patients attending the PCOP had a mean age of 80.5 years and had high rates of frailty (84%), cognitive impairment (30%), and multimorbidity. Significant reductions in BPI average pain and BPI pain interference scores were achieved. Clinically meaningful improvement in BPI average pain was achieved in 63% of patients attending the PCOP who were 65-74 years of age and in 46% of patients who were ≥75 years of age, which met the national benchmark set by ePPOC of 40% for both age groups. Clinically meaningful improvement in BPI pain interference was achieved in 69% of those attending the PCOP who were 65-74 years of age and in 66% of those who were ≥75 years of age, comparable to the ePPOC benchmark of 71% and 65% for the respective age groups. CONCLUSION: PCOP clients achieved significant and meaningful improvements in their pain outcomes that satisfied the national benchmark. Advanced age, cognitive impairment, frailty and multimorbidity should not be regarded as barriers to benefit from a pain clinic specifically designed for older people.

Treating chronic pain: Current and future status of treatments and aftercare / 全日本鍼灸学会雑誌

The definition of pain by the International Association for the Study of Pain (IASP), as revised in 2020, states that it is "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage," suggesting that pain or similar unpleasant sensory experiences may arise even if the cause of such sensations cannot be clearly identified. Pain, on the other hand, has been classified chronologically as acute, subacute or chronic pain such as those directly caused by cancer and non-cancer diseases and by the mechanisms involved. These are divided into nociceptive, neuropathic, and nociplastic pain, the last one of which is a recent addition to the classification. WHO created an independent category dedicated to chronic pain in its latest version of the International Classification of Diseases (ICD-11) defining it as pain that continues or reiterates over a period of three months or longer. As prolonged pain causes both physical and mental damage resulting in degradation of quality of life, it has been stressed that such pain must be approached from both the physical and mental perspectives. For this reason, multi-faceted evaluation is useful in treating chronic pain. In Japan, there are a number of guidelines for the treatment of chronic pain that have been published by different scientific societies as well as by a study group of the MHLW's Chronic Pain Policy Project. These serve as guides for providing evidence-based treatments to affected patients. Chronic pain remains a major challenge since they not only lower the quality of life of affected patients but also cause considerable damage to Japanese society as a whole.

Access to pain medicines and follow-up consultation after radiofrequency ablation for trigeminal neuralgia during the COVID-19 pandemic.

Background: In the recent coronavirus disease 2019 (COVID-19) pandemic, follow-up of patients with trigeminal neuralgia post radio-frequency ablation (RFA) of the Gasserian ganglion was restricted because of closure of pain clinic services (PCSs) at our institution, travel restrictions, and fear of contracting COVID-19 infection by hospital visit. Periodic follow-ups are a must in this group of patients. Because the access to pain medications and consultations remained restricted, we tried identifying the factors predisposing to these difficulties in patients. Methods: We had contacted patients telephonically, who underwent RFA at our institution in the past 5 years as the PCS had not re-started to follow up with in-person consultation. Demographics, socio-economic factors, clinical factors, literacy status, distance to the health care system, and current health status were noted. Collected data were analyzed descriptively, and correlations were calculated between the predictors for difficulty in follow-up to access the medications and consultations. Results: Out of 121 patients who underwent RFA in the past 5 years, 73 were accessible on phone. Of these, 42.46% (31/73) patients had difficulty in accessing either medications or consultation. The literacy status of the patient was the strongest predictor (0.044) with a negative correlation (-1.216). Difficulty in accessing PCS was associated with a poor health status (p-0.032) and higher pain scores (0.066). Conclusion: Along with the clinical factors, we have to overlook other factors in predicting difficulty to access PCS in trigeminal neuralgia patients post the RFA status. Difficulty in access to pain medicines and/or consultations was associated with a poor health status and higher pain scores.

Feasibility of a brief mindfulness-based program for burnout in pain healthcare professionals.

Introduction: Stress inherent to health care, which is characterized by work overload and shortage of specialized staff, is associated with decreased quality of life and suboptimal patient care. Mindfulness-based programs have proved to be effective in reducing stress in healthcare providers. This study aims to assess the feasibility of an 8-week mindfulness program to reduce the burnout levels of the staff of a pain clinic in a tertiary public hospital. Materials and methods: A longitudinal study with a within subject pre/post-intervention design, consisting of daily face-to-face 10-min sessions and the creation of a virtual group using a social media platform. Variables measured: burnout, mindfulness, empathy, self-compassion, and demographic characteristics. Results: Program feasibility (i.e., reach, adherence, acceptability, and preliminary effectiveness) was evaluated in 10 participants (6 physicians, 2 nurse practitioners, 1 nursing assistant, and 1 administrative). The results revealed a high reach (i.e., participation rate of 90%), excellent adherence to the program (daily practice 95% of times), and very good acceptability of the group format and satisfaction with most treatment components. Regarding potential effectiveness, we report the results of the Wilcoxon signed-rank tests and its associated effect size (r). We observed improvements in mindfulness and all its subscales (-2.077 ≤ Z ≤ -2.703, 0.69 ≤ r ≤ 0.90, all p < 0.05) except for non-reactivity and all subcomponents of self-compassion (-2.501 ≤ Z ≤ -2.611, 0.83 ≤ r ≤ 0.87, all p < 0.05) but not on its global self-compassion score. Empathy and burnout did not change. In an exploratory manner, however, we found significant reductions in the burnout component of emotional exhaustion, but only in physicians (Z = -2.201, p = 0.028, r = 0.73). Discussion: We believe that the 8-week mindfulness-based program described in the present investigation might be a feasible and potentially effective method that can be easily implemented to reduce burnout and promote mindfulness in specialized pain clinics.

Anterior knee pain post-multiple surgeries for tibia fracture effectively managed with infrapatellar fat pad injection: a case report.

BACKGROUND: The anterior knee compartment is filled by the infrapatellar fat pad (IFP) and has been emphasized as a source of anterior knee pain (AKP). CASE PRESENTATION: A 51-year-old woman sustained a right tibial plateau and open diaphyseal fracture 2 years earlier. She remained with chronic AKP after undergoing bone fixations. Increased anterior portion of the IFP brightness and decreased adipose tissue gliding with flexion and extension compared to the unaffected side was shown on ultrasonography. An injection of 0.2% lidocaine between the patellar tendon and IFP, and into the IFP under ultrasound guidance, immediately relieved the pain. The pain kept recurring although injections were effective for a while; thus, surgery was scheduled. Scar tissue on the IFP surface was endoscopically excised and her pain dramatically reduced. CONCLUSION: This is the first report in which the detection of increased brightness on ultrasound of IFP and the injections into the IFP triggered an additional surgical intervention. Ultrasound evaluation and injection may be beneficial in pain clinic patients presenting with AKP and may provide an opportunity for diagnosis.

Feasibility, diagnostic performance and clinical value of an abbreviated echocardiography protocol in an out-patient cardiovascular setting: a pilot study.

BACKGROUND: There has been a growing demand for echocardiography services over the last 5 years, with this supply-demand mismatch exacerbated by the COVID-19 pandemic. Prior studies have suggested a high proportion of normal findings among echocardiograms requested for patients without known cardiovascular disease, particularly in low-risk cohorts. This pilot study investigates the role of an abbreviated echocardiography protocol in improving access to echocardiography services in a low-risk outpatient setting within the rapid access chest pain (RACP) clinic. METHOD: A retrospective review of electronic medical records and transthoracic echocardiography (TTE) studies for 212 patients from RACP clinic in 2019 (cohort A), prior to the introduction of the abbreviated echocardiography protocol, and 175 patients seen in the RACP clinic in 2021 (cohort B) was performed. The outcomes measured include the echocardiography referral burden from RACP clinic, waiting time for a TTE and echocardiography findings. RESULTS: 33% and 45% of patients seen in the RACP clinic in 2019 and 2021, respectively, were referred for a TTE. The most common indications include chest pain (50%), dyspnoea (19%) and palpitations (11%). Abnormal findings were identified in 36% of TTEs performed in cohort A and 13% in cohort B. The median echocardiogram study time was significantly shorter in cohort B (7 min vs 13 min, p < 0.00001), with a lower number of images acquired (43 vs. 62, p < 0.00001). The median waiting time for an echocardiography in cohort B was significantly shorter (median: 14 days vs. 42 days in 2019, p < 0.00001). No major pathologies were missed on a retrospective review of these images. CONCLUSION: Our study demonstrates that an abbreviated echocardiography protocol has potential to improve access to echocardiography services through increasing scheduling capacity, without compromising diagnostic performance in a low-risk outpatient population.

The Effect of Remote-Based Monitoring and Education Program on Cancer Pain Management in an Outpatient Pain Clinic.

BACKGROUND: Pain is one of the most feared consequences of cancer for patients and their families. Many barriers may hinder optimal pain management. AIM: Examine the effect of remote-based monitoring and education program on cancer pain management, patient-related barriers, and level of adherence to pain medication. METHODS: A sample of 134 patients was assigned to two groups; 68 in the intervention group and 66 in the control. The intervention group received three educational sessions by telephone. Both groups completed questionnaires at baseline and one month after the initial visit. RESULTS: Significant differences were found between the groups in the levels of pain right now (p = .030), pain at its least (p = .016), and in the percentage of achieved pain relief (p = .048). Moreover, the intervention group experienced lower levels of interference with their general activity (p = < .001), mood (p = .011), and normal work (p = .004) post-intervention. The Attitudinal Barriers differences were statistically significant in the total mean (p = < .001), and the subscales of physiological effects (p = < .001), fatalism (p = < .001), communication (p = < .001), harmful effects (p = < .001). Participants in the intervention group exhibited higher adherence levels (p = .001). CONCLUSIONS: Patients suffering from cancer-related pain can benefit from remote-based monitoring and education programs to improve pain management outcomes, overcome barriers, and increase adherence. Further research is needed to investigate the different available educational methods and long-term effects.

A history of depression in patients attending a chronic pain management clinic in South Africa: A retrospective chart review.

Background: Chronic pain and depression are closely related conditions, which commonly exist as comorbid disorders. Understanding the prevalence of depression in patients presenting with chronic pain is vital for effective pain management. Aim: Our study aimed to establish the prevalence of a history of depression in patients presenting with chronic pain to a chronic pain management clinic at a tertiary academic hospital and to describe the characteristics of patients with both conditions. Setting: Groote Schuur Hospital, Chronic Pain Management Clinic, Cape Town, South Africa. Method: A retrospective review of 665 medical charts of consecutive patients accessing the clinic over a 7-year period was conducted. Baseline, patient-centred data were collected. Results: Of the 665 charts, 623 were analysed. The median age of patients was 53 years. The prevalence of depression in patients presenting with chronic pain was 32%, three times higher than the national life-time prevalence in South Africa. The majority (77%) of patients with chronic pain and depression were female (p < 0.01). Overall, 51% of the patients assessed were unemployed with low levels of education. The majority of our study patients had received a tricyclic antidepressant at some time prior to presentation. Conclusion: The high prevalence of a history of depression in patients presenting with chronic pain in our study, emphasises the importance of looking for and understanding the interrelation of the physiological, psychiatric, psychological and socio-economic factors that are common to both depression and chronic pain. Pain relief alone is insufficient to ensure optimal rehabilitation of these patients and integrating the management of their depression should improve patient outcomes and overall well-being.

Decreasing waiting time for new patients at a community pain clinic.

Long waiting time to access pain medicine clinics poses a significant mental, physical, and socioeconomic burden on patients with chronic pain. This project aimed to develop interventions to reduce the waiting time for new referrals. We used the define, measure, analyze, improve, control (DMAIC) method. Clinic data were analyzed over a 6-month period. Pilot interventions were then implemented in one provider's clinic over a 3-month period. Outcome measures included the number of new patients seen, number of "no shows," and number of patients on the waitlist. Late cancellation and no shows were the main causes of the clinic lost time. Interventions to reduce unutilized clinic time were implemented, including making appointment reminder calls, identifying cancellations in advance, and adding slots on the provider's template to account for cancellations and no shows. These interventions resulted in a 16% decrease in no shows, a 60% increase in new patients seen, and a significant 47% reduction in the number of patients on the entire clinic waitlist. These findings suggest that simple procedures and changes in the clinic identified via a quality improvement process can significantly improve clinic time utilization.