Treatment Efficacy, Clinical Utility, and Cost-Effectiveness of Multidisciplinary Biopsychosocial Rehabilitation Treatments for Persistent Low Back Pain: A Systematic Review

Study Design: Systematic review. Objectives: To review the current literature on the treatment efficacy, clinical utility, and cost-effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) for patients suffering from persistent (nonspecific) lower back pain (LBP) in relation to pain intensity, disability, health-related quality of life, and work ability/sick leave. Methods: We carried out a systematic search of Web of Science, Cochrane Library, PubMed Central, EMBASE, and PsycINFO for English- and German-language literature published between January 2010 and July 2017. Study selection consisted of exclusion and inclusion phases. After screening for duplication, studies were excluded on the basis of criteria covering study design, number of participants, language of publication, and provision of information about the intervention. All the remaining articles dealing with the efficacy, utility, or cost-effectiveness of intensive (more than 25 hours per week) MBR encompassing at least 3 health domains and cognitive behavioral therapy–based psychological education were included. Results: The search retrieved 1199 publications of which 1116 were duplicates or met the exclusion criteria. Seventy of the remaining 83 articles did not meet the inclusion criteria; thus 13 studies were reviewed. All studies reporting changes in pain intensity or disability over 12 months after MBR reported moderate effect sizes and/or p-values for both outcomes. The effects on health-related quality of life were mixed, but MBR substantially reduced costs. Overall MBR produced an enduring improvement in work ability despite controversy and variable results. Conclusions: MBR is an effective treatment for nonspecific LBP, but there is room for improvement in cost-effectiveness and impact on sick leave, where the evidence was less compelling

Safety concerns with the Centers for Disease Control opioid calculator

Jeffrey Fudin,1–4 Mena Raouf,2 Erica L Wegrzyn,2–4 Michael E Schatman5,61Scientific and Clinical Affairs, Remitigate, LLC, Delmar, NY, USA; 2Stratton VA Medical Center, Albany, NY, USA; 3Western New England University College of Pharmacy, Springfield, MA, USA; 4Albany College of Pharmacy & Health Sciences, Albany, NY, USA; 5Research and Network Development, Boston Pain Care, Waltham, MA, USA; 6Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USAMorphine milligram equivalence (MME) and other comparable acronyms have been employed in federal pain guidelines and used by policy makers to limit opioid prescribing.1–5 On March 18, 2016, the Centers for Disease Control (CDC) released its Guideline for Prescribing Opioids for Chronic Pain.1 The guidelines provided 12 recommendations for “primary care clinicians prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care”. One of the CDC recommendations states that clinicians “should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day”.

Mediterranean Pain Forum 2024 - Building a Bridge for Better Pain Management Education

Giuliano Lo Bianco,1 Sean Li,2 Miles Day,3 Michael E Schatman4,5 1Anesthesiology and Pain Department, Fondazione Istituto ”G. Giglio”, Cefalù, Palermo, Italy; 2National Spine and Pain Centers, Shrewsbury, NJ, USA; 3Pain Research, The Pain Center at Grace Clinic, Department of Anesthesiology, Texas Tech University HSC, Lubbock, TX, USA; 4Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 5Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USACorrespondence: Michael E Schatman, Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA, Tel +1 425-647-4880, Email [email protected]

Can we not work together to help family practitioners become more effective pain managers?

Jeffrey Fudin,1,2,3 Timothy J Atkinson,4 Mena Raouf,4 Michael E Schatman51Stratton VA Medical Center, Albany, NY, USA; 2Albany College of Pharmacy and Health Sciences, Albany, NY, USA; 3Scientific and Clinical Affairs, Remitigate LLC, Delmar, NY, USA; 4VA Tennessee Valley Healthcare System, Murfreesboro, Nashville, TN, USA; 5US Pain Foundation, Bellevue, WA, USASnyder et al recently published a review in American Family Physician titled, “Treating Painful Diabetic Peripheral Neuropathy: An Update”, which provided an overview of pharmacologic treatment options for providers; however, some of the recommendations made by the authors were concerning.1 Recommendations that caught our attention included statements around pregabalin adjustment for renal impairment, using selective serotonin reuptake inhibitors (SSRIs) in the treatment of diabetic peripheral neuropathy (DPN), classification of tramadol, tapentadol, and oxycodone in DPN

10 kHz spinal cord stimulation: a retrospective analysis of real-world data from a community-based, interdisciplinary pain facility [Corrigendum]

DiBenedetto DJ, Wawrzyniak KM, Schatman ME, Kulich RJ, Finkelman M. J Pain Res. 2018;11:2929–2941.   On page 2931, Figure 1 was incorrect. The correct figure is included below:   Read the original articl

Defining Personas of People Living with Chronic Pain: An Ethnographic Research Study

Melissa Cullens,1 Cyan James,1 Meran Liu,1 Amaresh Vydyanathan,2– 4 Naum Shaparin,3– 5 Michael Schatman,6,7 Jacob Hascalovici2,3,5,8 1Clearing Relief Labs Inc., New York City, NY, USA; 2Relief Medical Group P.A, New York City, NY, USA; 3Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA; 4Multidisciplinary Pain Program, Montefiore Medical Center, Bronx, NY, USA; 5The Arthur S. Abramson Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Bronx, NY, USA; 6Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York City, NY, USA; 7Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York City, NY, USA; 8Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USACorrespondence: Jacob Hascalovici, Relief Medical Group P.A, 169 Madison Ave, Suite 2412, New York City, New York City, 10016, USA, Email [email protected]: Pain is the leading reason for which people seek medical care in the United States, and chronic pain (CP) affects approximately 50 million people in the US Pain perception is deeply personal, is highly correlated with behavioral and emotional disorders, and is greatly influenced by physiological and environmental factors. The patient-provider relationship can have profound implications for clinical outcomes within the context of treating CP. However, limited access to pain specialists, the complex nature of many CP-causing conditions, the absence of instruments for objective pain measurement, and the need to foster a trust-based patient-provider relationship throughout treatment pose unique challenges.Objective: To support a more optimal CP care delivery system that leverages a healthy therapeutic patient-provider relationship, we systematically gathered deeper knowledge of the behaviors, interpersonal dynamics, home environment, values, and mindsets of people who experience CP.Methods: We employed ethnographic research methods to collect and analyze data on views, habits, strategies, attitudes, and life circumstances of a range of participants living with CP. We aggregated, analyzed, and summarized participant data to identify trends and similarities.Results: Our findings suggest that patients can be broadly categorized into five predominant pain typologies, or “personas”, which are characterized by respective symptom durations, care management preferences, values, communication styles, and behaviors.Conclusion: Identifying CP personas may enhance the ability to personalize CP care and help foster more robust therapeutic relationships, which may lead to greater trust, improved patient satisfaction, and better clinical outcomes.Keywords: chronic pain, personas, biopsychosocial, doctor–patient relationshi

Does a research group increase impact on the scientific community or general public discussion? Alternative metric-based evaluation

Manuela De Gregori,1-3,* Valeria Scotti,4,* Annalisa De Silvestri,4 Moreno Curti,4 Guido Fanelli,2,5,6 Massimo Allegri,2,5,6 Michael E Schatman,2,7 1Pain Therapy Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 2Study In Multidisciplinary PAin Research Group, Parma, Italy; 3Young Against Pain Group, Parma, Italy; 4Center for Scientific Documentation and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 5Anesthesia, Critical Care, and Pain Medicine, Department of Surgical Sciences, University of Parma, Italy; 6Anesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliero, Universitaria di Parma, Parma, Italy; 7US Pain Foundation, Bellevue, WA, USA *These authors contributed equally to this work. Abstract: In this study, we investigated the impact of scientific publications of the Italian SIMPAR (Study In Multidisciplinary PAin Research) group by using altmetrics, defined as nontraditional metrics constituting an alternative to more traditional citation-impact metrics, such as impact factor and H-index. By correlating traditional and alternative metrics, we attempted to verify whether publications by the SIMPAR group collectively had more impact than those performed by its individual members, either in solo publications or in publications coauthored by non-SIMPAR group investigators (which for the purpose of this study we will refer to as “individual publications”). For all the 12 members of the group analyzed (pain therapists, biologists, and pharmacologists), we created Open Researcher and Contributor ID and Impact Story accounts, and synchronized these data. Manually, we calculated the level metrics for each article by dividing the data obtained from the research community by those obtained from the public community. We analyzed 759 articles, 18 of which were published by the SIMPAR group. Altmetrics demonstrated that SIMPAR group publications were more likely to be saved (77.8% vs 45.9%), discussed (61.1% vs 1.1%, P<0.0001), and publicly viewed (11.1% vs 1.3%, P=0.05) than individual publications. These results support the importance of multidisciplinary research groups in the impact of scientific literature; the interaction and synergy among the research participants allowed the obtainment of high impact-literature in the field of personalized pain medicine. Finally, our findings demonstrate the potential of altmetrics in estimating the value of the research products of a group. Keywords: altmetrics, SIMPAR group, pain-research impac

Cannabis and intractable chronic pain: an explorative retrospective analysis of Italian cohort of 614 patients

Guido Fanelli,1,2 Giuliano De Carolis,3 Claudio Leonardi,4 Adele Longobardi,5,6 Ennio Sarli,7,8 Massimo Allegri,1,2 Michael E Schatman9 1Anesthesia, Critical Care and Pain Medicine Unit, Division of Surgical Sciences, Department of Medicine and Surgery, University of Parma, 2Anesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliero Universitaria Parma, Parma, 3Pain Therapy Service, Azienda Ospedaliero Universitaria Pisana, Pisa, 4Department of Drug Addiction Diseases, Local Public Health of Rome, Rome, 5Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 6Young Against the Pain (YAP) Group, Parma, 7Progetti Live Surgery, 8PinHub Group, Florence, Italy; 9Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA Background: Despite growing interest in the therapeutic use of cannabis to manage chronic pain, only limited data that address these issues are available. In recent years, a number of nations have introduced specific laws to allow patients to use cannabis preparations to treat a variety of medical conditions. In 2015, the Italian government authorized the use of cannabis to treat several diseases, including chronic pain generally, spasticity in multiple sclerosis, cachexia and anorexia among AIDS and cancer patients, glaucoma, Tourette syndrome, and certain types of epilepsy. We present the first snapshot of the Italian experience with cannabis use for chronic pain over the initial year of its use.Methods: This is a retrospective case series analysis of all chronic pain patients treated with oral or vaporized cannabis in six hubs during the initial year following the approval of the new Italian law (December 2015 to November 2016). We evaluated routes of administration, types of cannabis products utilized, dosing, and effectiveness and safety of the treatment.Results: As only one of the six centers has extensively used cannabinoids for intractable chronic pain (614 patients of 659), only the population from Azienda Ospedaliero Universitaria Pisana (Pisa) was considered. Cannabis tea was the primary mode of delivery, and in almost all cases, it was used in association with all the other pain treatments. Initial and follow-up cannabinoid concentrations were found to vary considerably. At initial follow-up, 76.2% of patients continued the treatment, and <15% stopped the treatment due to side effects (none of which were severe).Conclusion: We present the first analysis of Italian clinical practice of the use of cannabinoids for a large variety of chronic pain syndromes. From this initial snapshot, we determined that the treatment seems to be effective and safe, although more data and subsequent trials are needed to better investigate its ideal clinical indication. Keywords: cannabis, cannabinoids, chronic pain, safety, cannabidio

Mobile Health App (AGRIPPA) to Prevent Relapse After Successful Interdisciplinary Treatment for Patients With Chronic Pain: Protocol for a Randomized Controlled Trial

BACKGROUND: To facilitate adherence to adaptive pain management behaviors after interdisciplinary multimodal pain treatment, we developed a mobile health app (AGRIPPA app) that contains two behavior regulation strategies. OBJECTIVE: The aims of this project are (1) to test the effectiveness of the AGRIPPA app on pain disability; (2) to determine the cost-effectiveness; and (3) to explore the levels of engagement and usability of app users. METHODS: We will perform a multicenter randomized controlled trial with two parallel groups. Within the 12-month inclusion period, we plan to recruit 158 adult patients with chronic pain during the initial stage of their interdisciplinary treatment program in one of the 6 participating centers. Participants will be randomly assigned to the standard treatment condition or to the enhanced treatment condition in which they will receive the AGRIPPA app. Patients will be monitored from the start of the treatment program until 12 months posttreatment. In our primary analysis, we will evaluate the difference over time of pain-related disability between the two conditions. Other outcome measures will include health-related quality of life, illness perceptions, pain self-efficacy, app system usage data, productivity loss, and health care expenses. RESULTS: The study was approved by the local Medical Research Ethics Committee in October 2019. As of March 20, 2020, we have recruited 88 patients. CONCLUSIONS: This study will be the first step in systematically evaluating the effectiveness and efficiency of the AGRIPPA app. After 3 years of development and feasibility testing, this formal evaluation will help determine to what extent the app will influence the maintenance of treatment gains over time. The outcomes of this trial will guide future decisions regarding uptake in clinical practice. TRIAL REGISTRATION: Netherlands Trial Register NL8076; https://www.trialregister.nl/trial/8076. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/18632