Assessment of the Influence of Demographic and Professional Characteristics on Health Care Providers' Pain Management Decisions Using Virtual Humans

Disparities in health care associated with patients’ gender, race, and age are well documented. Previous studies using virtual human (VH) technology have demonstrated that provider characteristics may play an important role in pain management decisions. However, these studies have largely emphasized group differences. The aims of this study were to examine dentists’ and physicians’ use of VH characteristics when making clinical judgments (i.e., cue use) and to identify provider characteristics associated with the magnitude of the impact of these cues (β-weights). Providers (N=152; 76 physicians, 76 dentists) viewed video vignettes of VH patients varying in gender (male/female), race (white/black), and age (younger/older). Participants rated VH patients’ pain intensity and unpleasantness and then rated their own likelihood of administering non-opioid and opioid analgesics. Compared to physicians, dentists had significantly lower β-weights associated with VH age cues for all ratings (p0.69). These effects varied by provider race and gender. For pain intensity, professional differences were present only among non-white providers. White providers had greater β-weights than non-white providers for pain unpleasantness but only among men. Provider differences regarding the use of VH age cues in non-opioid analgesic administration were present among all providers except non-white males. These findings highlight the interaction of patient and provider factors in driving clinical decision making. Although profession was related to use of VH age cues in pain-related clinical judgments, this relationship was modified by providers’ personal characteristics. Additional research is needed to understand what aspects of professional training or practice may account for differences between physicians and dentists and what forms of continuing education may help to mitigate the disparities

Chronic Pelvic Pain and Sexual Dysfunction Among Females and Males Receiving Treatment for Opioid Use Disorder

Introduction: Chronic pain brings complexity to opioid use disorder (OUD). Psychosocial and neurobiological risks for Chronic Pelvic Pain (CPP) and OUD overlap. The primary objective of this exploratory study is to compare sex-specific prevalence of CPP and sexual dysfunction between individuals receiving buprenorphine for OUD and a comparison group receiving treatment for other chronic medical conditions (CMC). Methods: Participants from an OUD treatment (n = 154) and primary care clinic (n = 109) completed a survey between July 2019 and February 2020 assessing reproductive and sexual health. Sex-stratified CPP and pain interference measures were adapted from the Brief Pain Inventory for females, and for males, the Brief Male Sexual Function Inventory and NIH Chronic Prostatitis Symptom Index. The Male and Female Sexual Function Index assessed sexual dysfunction. Prevalence of CPP and sexual dysfunction between groups were compared using Pearson χ2 and Fisher's Exact tests. Results: Participants were 54.4% female and 75.0% Black with almost half having a psychiatric diagnosis. Among OUD females, the highest pain severity reported was for menstrual-related pain, and for OUD males, testicular pain. CPP most interfered with mood in OUD females vs. sleep and enjoyment of life in OUD males. There were no differences in prevalence for global sexual dysfunction with 91.6% of females and 84.2% of males screening positive across groups. Discussion/Implications: CPP and sexual dysfunction are important components of wellness and may play a role in OUD recovery trajectories. The value of addressing CPP and sexual dysfunction in tailored comprehensive, sex-informed OUD treatment approaches should be further investigated.</p

Chronic Pelvic Pain and Sexual Dysfunction Among Females and Males Receiving Treatment for Opioid Use Disorder

Introduction: Chronic pain brings complexity to opioid use disorder (OUD). Psychosocial and neurobiological risks for Chronic Pelvic Pain (CPP) and OUD overlap. The primary objective of this exploratory study is to compare sex-specific prevalence of CPP and sexual dysfunction between individuals receiving buprenorphine for OUD and a comparison group receiving treatment for other chronic medical conditions (CMC). Methods: Participants from an OUD treatment (n = 154) and primary care clinic (n = 109) completed a survey between July 2019 and February 2020 assessing reproductive and sexual health. Sex-stratified CPP and pain interference measures were adapted from the Brief Pain Inventory for females, and for males, the Brief Male Sexual Function Inventory and NIH Chronic Prostatitis Symptom Index. The Male and Female Sexual Function Index assessed sexual dysfunction. Prevalence of CPP and sexual dysfunction between groups were compared using Pearson χ2 and Fisher's Exact tests. Results: Participants were 54.4% female and 75.0% Black with almost half having a psychiatric diagnosis. Among OUD females, the highest pain severity reported was for menstrual-related pain, and for OUD males, testicular pain. CPP most interfered with mood in OUD females vs. sleep and enjoyment of life in OUD males. There were no differences in prevalence for global sexual dysfunction with 91.6% of females and 84.2% of males screening positive across groups. Discussion/Implications: CPP and sexual dysfunction are important components of wellness and may play a role in OUD recovery trajectories. The value of addressing CPP and sexual dysfunction in tailored comprehensive, sex-informed OUD treatment approaches should be further investigated.</p

The Influence of Health Care Professional Characteristics on Pain Management Decisions

Objective Evidence suggests that patient characteristics such as sex, race, and age influence the pain management decisions of health care providers. Although this signifies that patient demographics may be important determinants of health care decisions, pain-related care also may be impacted by the personal characteristics of the health care practitioner. However, the extent to which health care provider characteristics affect pain management decisions is unclear, underscoring the need for further research in this area. Methods A total of 154 health care providers (77 physicians, 77 dentists) viewed video vignettes of virtual human (VH) patients varying in sex, race, and age. Practitioners provided computerized ratings of VH patients’ pain intensity and unpleasantness, and also reported their willingness to prescribe non-opioid and opioid analgesics for each patient. Practitioner sex, race, age, and duration of professional experience were included as predictors to determine their impact on pain management decisions. Results When assessing and treating pain, practitioner sex, race, age, and duration of experience were all significantly associated with pain management decisions. Further, the role of these characteristics differed across VH patient sex, race, and age. Conclusions These findings suggest that pain assessment and treatment decisions may be impacted by the health care providers’ demographic characteristics, effects which may contribute to pain management disparities. Future research is warranted to determine whether findings replicate in other health care disciplines and medical conditions, and identify other practitioner characteristics (e.g., culture) that may affect pain management decisions

Association of cerebellar and pre-motor cortex gray matter density with subjective intoxication and subjective response following acute alcohol intake

Abstract Acute alcohol intake produces subjective intoxication (SI) and response (SR; e.g., valanced stimulation and sedation), which has important implications for alcohol-related risk. Individuals who experience less SI may be more likely to engage in risky behaviors while drinking. Gray matter morphometry in brain regions underlying cognitive and affective processes may help to inform individual differences in subjective intoxication and response. The subjective effects of alcohol vary between limbs of the blood alcohol concentration (BAC) curve (i.e., whether BAC is rising or falling; acute tolerance). We examined the relationship between gray matter density (GMD) and SI/SR as a function of BAC limb. Healthy social drinkers (N = 89; 55 women) completed an alcohol challenge paradigm (target BAC = 0.08 g/dL) and structural magnetic resonance imaging (MRI). Participants completed measures of SR and SI on ascending and descending BAC limbs. Association between GMD and SI/SR on each limb were assessed using whole-brain, voxel-wise general linear models. GMD estimates were extracted from significant clusters. Differences in association of GMD and SI/SR between limbs were assessed using hierarchical regression. Significant associations of SI with GMD on the ascending limb were observed in the cerebellum. A significant association between SR and GMD on the descending limb were observed in the pre-motor cortex (BA6) and cerebellum. We identified common and unique associations among cerebellum and pre-central gyrus structures with SI and SR between BAC limbs. Functional imaging studies may further clarify unique dimensions of subjective alcohol effects linked to the observed structural associations

A virtual reality platform for the measurement of drinking topography

BackgroundThe assessment of alcohol consumption during a drinking bout, known as drinking topography, may help improve understanding of biopsychosocial mechanisms underlying alcohol consumption. However, past studies have been limited by effort-intensive, time-consuming, and error-prone processes involved in collecting, organizing, and standardizing drinking topography data. Recent technologies allowing integrated data collection and greater environmental control, such as virtual reality (VR), could resolve these problems.MethodsIn this pilot project, we assessed alcohol consumption topography of participants in a VR drinking environment with a programmable virtual confederate (i.e., bar goer) during two testing sessions. In one, the confederate drank quickly (30-60 s sip interval). In the other, the confederate drank slowly (60-120 s sip interval). Participants\u27 hands and beverage were represented in VR. Between sips, beverages were placed on a Bluetooth-enabled scale, allowing real-time updates of drink weight. Participant experience was assessed after each testing visit. Multilevel modeling was used to characterize the effect of confederation condition on sip interval and sip volume. Descriptive analyses were used for participant experience data.ResultsResults showed significant, moderate-to-strong between-visit correlations for topographic measures (r = 0.50 to r = 0.84) and indicate participants found the experience to be comfortable and acceptable. Multilevel models indicated participants had greater sip volumes and lower sip intervals when the confederate drank quickly.ConclusionsFuture studies should take advantage of the considerable translational value of this technology to improve understanding of risk associated with individual drinking bouts and develop novel interventions for reducing hazardous drinking

Beliefs About Perioperative Opioid and Alcohol Use among Elective Surgical Patients Who Report Unhealthy Drinking: A Qualitative Study.

ObjectivesElective surgical patients with unhealthy alcohol use have unique pain management needs and addiction risk factors that are relevant to surgical preparation and recovery. This descriptive qualitative study sought to better understand patients' beliefs and behaviors related to opioid use, alcohol use, and pain management in the perioperative context.DesignWe conducted individual semi-structured interviews between July 2017 and March 2018.SettingA large Midwestern academic health system.SubjectsParticipants were elective surgical patients meeting unhealthy alcohol use criteria, recruited from the health system's preoperative anesthesia clinic.MethodSemistructured interview guides explored beliefs and behaviors relating to alcohol and opioid use, health status, and surgical care. Interview recordings were transcribed and coded for thematic analysis.ResultsAmong 20 elective surgical patients (25% female), we identified three key themes regarding alcohol use, opioid use, and their co-use before and after surgery. First, desires and intentions to use opioids for postoperative pain management varied widely, even before opioids were prescribed. Second, some participants described alcohol as a preferred pain management strategy. Third, participants held a range of beliefs about the risks and benefits of alcohol and opioid co-use.ConclusionsAppropriate assessment of beliefs and intentions regarding opioid and alcohol use could help identify patients most vulnerable to new opioid problems and unhealthy alcohol use in the context of perioperative surgical pain. These findings have important implications for perioperative pain management