A Systematic Review of the Prospective Relationship between Child Maltreatment and Chronic Pain.

OBJECTIVE: The present systematic review aimed to evaluate the association between childhood maltreatment and chronic pain, with specific attention to the temporal nature of the relationship and putative moderators, including, the nature (type), timing of occurrence, and magnitude of maltreatment; whether physical harm or injury occurred; and whether post-traumatic stress disorder (PTSD) subsequently developed. METHOD: We included studies that measured the prospective relationship between child maltreatment and pain. Medline, EMBASE, PsycINFO, and CINAHL were searched electronically up to 28 July 2019. We used accepted methodological procedures common to prognosis studies and preregistered our review (PROSPERO record ID 142169) as per Cochrane review recommendations. RESULTS: Nine studies (17,340 participants) were included in the present review. Baseline participant age ranged from 2 years to more than 65 years. Follow-up intervals ranged from one year to 16 years. Of the nine studies included, three were deemed to have a high risk of bias. With the exception of one meta-analysis of three studies, results were combined using narrative synthesis. Results showed low to very low quality and conflicting evidence across the various types of maltreatment, with the higher quality studies pointing to the absence of direct (non-moderated and non-mediated) associations between maltreatment and pain. PTSD was revealed to be a potential mediator and/or moderator. Evidence was not found for other proposed moderators. CONCLUSIONS: Overall, there is an absence of evidence from high quality studies of an association between maltreatment and pain. Our results are limited by the small number of studies reporting the relationship between child maltreatment and pain using a prospective design. High quality studies, including prospective cohort studies and those that assess and report on the moderators described above, are needed to advance the literature.

A Systematic Review of the Prospective Relationship Between Bullying Victimization and Pain.

OBJECTIVE: This systematic review synthesized evidence about the relationship between childhood bullying victimization and chronic pain, with a focus on the temporal nature of the relationship and moderating factors, such as the type and intensity of victimization. METHOD: We included prospective cohort studies that examined the relationship between childhood bullying victimization and pain measured at least three months later. We conducted electronic searches of Medline, EMBASE, PsycINFO, and CINAHL up to June 30, 2019. Standard methodological procedures consistent with Cochrane reviews of prognosis studies were used (PROSPERO record ID 133146). RESULTS: We included four longitudinal studies (6275 participants) in this review. The mean age of participants at baseline ranged from 10 to 14 years and the follow-up periods ranged from 6 months to 12 years. Two of the four studies were judged as having high risk of bias. Meta-analysis of results from four studies revealed increased risk of pain among victimized compared to non-victimized youth (adjusted OR [95% CI] = 1.45 [1.06-1.97], but the effect size was small and not clinically important. Only one study examined the inverse association (ie, from pain to victimization), and there was not enough evidence to conduct a meaningful analysis of the proposed moderators. CONCLUSIONS: Study findings were limited by few prospective studies. Meta-analytic findings suggested that victimization may incur some risk for later pain, although the evidence was judged to be very low quality. High-quality studies that measure and report the nuances of bullying victimization are needed to test the proposed moderator models.

Influencing Pain Inferences Using Random Numerical Anchoring: Randomized Controlled Trial.

BACKGROUND: Numerical anchoring occurs when exposure to a numeric quantity influences a person's subsequent judgment involving other quantities. This could be applicable to the evaluation of pain, where exposure to an unrelated number before the evaluation of pain could influence pain ratings. OBJECTIVE: This study aimed to determine whether exposure to a random numeric anchor influences subsequent pain intensity ratings of a hypothetical patient. METHODS: In this study, 385 participants read a vignette describing a patient with chronic pain before being randomly assigned to one of four groups. Groups 1 and 2 spun an 11-wedge number wheel (0-10), which was, unbeknown to the participants, programmed to stop on a high number (8) or a low number (2), respectively. Group 3 spun a similar letter wheel (A-K), which was programmed to stop on either the letter C or I (control 1). Group 4 did not spin a wheel (control 2). Participants were then asked to rate the patient's pain intensity using a 0 to 10 numeric rating scale. RESULTS: The high-number group rated the patient's pain (median 8, IQR 2) significantly higher than the letter wheel control (median 7, IQR 2; P=.02) and the low-number group (median 6, IQR 2; P<.001). The low-number group rated the pain significantly lower than controls 1 and 2 (median 7, IQR 2; both P=.045). CONCLUSIONS: Pain ratings were influenced by prior exposure to a random number with no relevant information about the patient's pain, indicating anchoring had occurred. However, contrary to the traditional definition of anchoring where anchoring occurs even when participants are unaware of the anchor's influence, in this study, the anchoring effect was seen only in participants who believed that the anchor had influenced them. This suggests that anchoring effects could potentially occur among health care providers tasked with evaluating a patient's pain and should be evaluated further.

Effects of medical scribes on physician productivity in a Canadian emergency department: a pilot study.

BACKGROUND: Emergency department efficiency is a priority across Canada. In the United States, scribes may increase the number of patients seen per hour per physician; however, Canadian data are lacking. We sought to implement scribes in a Canadian emergency department with the hypothesis that scribes would increase the number of patients seen per hour per physician. METHODS: We conducted a 4-month quality improvement pilot study in a community emergency department in Ottawa, Ontario. Data collection began January 2015 after scribe training. Physicians received shifts with and without a scribe for a period of 4 months. Across the study, the mean number of patients seen per hour was determined for each physician during shifts with and without a scribe. We compared mean (± standard deviation [SD]) number of patients seen per hour based on presence or absence of a scribe by 2-tailed paired-samples t test. RESULTS: Eleven scribes participated and ranged in age from 18 to 23 years. Twenty-two full- or part-time emergency physicians were followed. We documented 463 physician-hours without use of a scribe and 693.75 physician-hours with use of a scribe. Across all 22 physicians, 18 (81.8%) saw more patients per hour with use of a scribe. Overall, the number of patients seen per hour per physician was significantly greater (+12.9%) during shifts with a scribe (mean [± SD] 2.81 [± 0.78]) than during shifts without a scribe (mean [± SD] 2.49 [± 0.60]; p = 0.006). INTERPRETATION: In this pilot study, the use of scribes resulted in an increased number of patients seen per hour per physician. Because this was a small study at a single centre, further research on the effects of scribes in Canada is warranted.