School-based intervention to improve the mental health of low-income, secondary school students in Santiago, Chile (YPSA): study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Depression is common and can have devastating effects on the life of adolescents. Psychological interventions are the first-line for treating or preventing depression among adolescents. This proposal aims to evaluate a school-based, universal psychological intervention to reduce depressive symptoms among student's aged 13-14 attending municipal state secondary schools in Santiago, Chile.</p> <p>Study design</p> <p>This is a cluster randomised controlled trial with schools as the main clusters. We compared this intervention with a control group in a study involving 22 schools, 66 classes and approximately 2,600 students. Students in the active schools attended 11 weekly and 3 booster sessions of an intervention based on cognitive-behavioural models. The control schools received their usual but enhanced counselling sessions currently included in their curriculum. Mean depression scores and indicators of levels of functioning were assessed at 3 and 12 months after the completion of the intervention in order to assess the effectiveness of the intervention. Direct and indirect costs were measured in both groups to assess the cost-effectiveness of this intervention.</p> <p>Discussion</p> <p>As far as we are aware this is the first cluster randomised controlled trial of a school intervention for depression among adolescents outside the Western world.</p> <p>Trial Registration</p> <p><a href="http://www.controlled-trials.com/ISRCTN19466209">ISRCTN19466209</a></p

Opioids for chronic pain: a knowledge assessment of nonpain specialty providers

Amy CS Pearson, Jason S Eldrige, Susan M Moeschler, W Michael Hooten Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA Introduction: Although the majority of opioids in the US are prescribed by nonpain specialists, these providers often report inadequate training in chronic pain management and opioid prescribing. The extent of health care providers&#39; knowledge of opioid prescribing for chronic pain has not been well established. The purpose of this study was to assess knowledge about the use of opioids for chronic pain among health care providers seeking pain-focused continuing medical education. Materials and methods: The study participants (n=131) were recruited at a pain-focused continuing medical education conference for nonpain specialists. Upon commencement of the conference, the KnowPain-50 survey was completed. The survey comprised 50 questions, and 18 questions were related to opioid management. The focus of each opioid question was further categorized as either medicolegal (n=7) or clinical (n=11). Results: The majority of study participants were male physicians with a mean age of 51.8 years. The proportion of correct responses to the 50-item survey was 72%. The proportion of correct responses to the 32 nonopioid questions was 74%, and the proportion of correct responses to the 18 opioid questions was 69% (P&lt;0.001). Similarly, the proportion of correct responses to the seven medicolegal opioid questions was 74%, and the proportion of correct responses to the eleven clinical opioid questions was 67% (P&lt;0.001). Conclusion: Health care providers demonstrated gaps in knowledge about the use of opioids for chronic pain. Lower scores on clinically based opioid questions may indicate an opportunity to provide focused educational content about this area of practice. This information could be helpful in designing future educational modules for nonpain providers. Keywords: chronic pain, opioids, prescription, continuing medical educatio

Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey

Amy CS Pearson,1 Rajat N Moman,2 Susan M Moeschler,3 Jason S Eldrige,3 W Michael Hooten3 1Department of Anesthesiology &amp; Perioperative Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, 2Mayo Clinic School of Medicine, 3Department of Anesthesiology &amp; Perioperative Medicine, Mayo College of Medicine, Rochester, MN, USA Introduction: Many providers report lack of confidence in managing patients with chronic pain. Thus, the primary aim of this study was to investigate the associations of provider confidence in managing chronic pain with their practice behaviors and demographics.Materials and methods: The primary outcome measure was the results of the Opioid Therapy Provider Survey, which was administered to clinicians attending a pain-focused continuing medical education conference. Nonparametric correlations were assessed using Spearman&rsquo;s rho.Results: Of the respondents, 55.0% were women, 92.8% were white, and 56.5% were physicians. Primary care providers accounted for 56.5% of the total respondents. The majority of respondents (60.8%) did not feel confident managing patients with chronic pain. Provider confidence in managing chronic pain was positively correlated with 1) following an opioid therapy protocol (P=0.001), 2) the perceived ability to identify patients at risk for opioid misuse (P=0.006), and&nbsp;3) using a consistent practice-based approach to improve their comfort level with prescribing opioids (P&lt;0.001). Provider confidence was negatively correlated with the perception that treating pain patients was a &ldquo;problem in my practice&rdquo; (P=0.005).Conclusion: In this study, the majority of providers did not feel confident managing chronic pain. However, provider confidence was associated with a protocolized and consistent practice-based approach toward managing opioids and the perceived ability to identify patients at risk for opioid misuse. Future studies should investigate whether provider confidence is associated with measurable competence in managing chronic pain and explore approaches to enhance appropriate levels of confidence in caring for patients with chronic pain. Keywords: chronic pain, opioids, confidence, continuing medical educatio

Pain severity is associated with muscle strength and peak oxygen uptake in adults with fibromyalgia

W Michael Hooten,1,2 Jolene M Smith,3 Jason S Eldrige,1 David A Olsen,3 W David Mauck,1 Susan M Moeschler11Department of Anesthesiology, 2Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, 3Mayo School of Graduate Medical Education, Rochester, MN, USABackground: The associations between pain, lower extremity strength, and aerobic conditioning have not been widely investigated in adults with fibromyalgia (FM). The principle objective of this study was to investigate the relationship between pain severity and knee strength in patients seeking treatment for FM. A secondary objective was to investigate the relationship between pain scores and aerobic conditioning.Methods: Three measures of knee strength (isokinetic extensor, isokinetic flexor, isometric extensor) were quantified in the dominant leg of 69 adults with FM using a dynamometer at speeds of 60 degrees per second (60&deg;/s) and 180&deg;/s. Peak oxygen uptake (VO2) was assessed using a cycle ergometer, and pain was assessed using the pain severity subscale of the Multidimensional Pain Inventory.Results: In univariable linear regression analyses using pain severity as the dependent variable, lesser values of isokinetic knee extensor strength at 60&deg;/s (P=0.041) and 180&deg;/s (P=0.010), isokinetic knee flexor strength at 60&deg;/s (P=0.028) and 180&deg;/s (P=0.003), and peak VO2 uptake (P=0.031) were predictive of greater pain severity scores. In multiple variable linear regression models adjusted for age, sex, body mass index, and opioid use, the following associations retained statistical significance; isokinetic knee extensor strength at 60&deg;/s (P=0.020) and 180&deg;/s (P=0.003), isokinetic knee flexor strength at 60&deg;/s (P=0.015) and 180&deg;/s (P=0.001), and peak VO2 uptake (P=0.014). However, no significant associations were found between pain severity and isometric knee extensor strength.Conclusion: The main findings from this study were that lesser values of isokinetic knee strength and peak VO2 uptake were predictive of greater pain severity scores. These results build on the findings of previous investigations, but ongoing research is needed to further characterize the effects of strength and peak VO2 uptake on the pathophysiology of FM.Keywords: fibromyalgia, knee extensor strength, knee flexor strength, isokinetic, peak oxygen uptak

Outcomes of C1&ndash;2 joint injections

Christopher M Aiudi,1 W Michael Hooten,2 Rebecca A Sanders,2 James C Watson,2 Susan M Moeschler,2 Halena M Gazelka,2 Bryan C Hoelzer,2 Jason S Eldrige,2 Wenchun Qu,3 Tim J Lamer2 1Mayo Clinic School of Medicine, 2Division of Pain Medicine, Department of Anesthesia and Perioperative Medicine, Mayo Clinic, 3Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA Objective: Intra-articular injections of the C1&ndash;2 joint are an effective therapeutic option for pain generated from degenerative and inflammatory conditions affecting the joint. Limited information exists about the adverse events (AEs) associated with these injections. The primary aim of this study is to describe the frequency and type of AEs associated with C1&ndash;2 joint injections. The secondary aim is to identify clinical factors associated with the occurrence of AEs of C1&ndash;2 joint injections. Design/methods: A retrospective chart review was conducted on all C1&ndash;2 joint injections performed at the Mayo Pain Medicine Clinic in Rochester, MN, from January 1, 2005 through July 31, 2015. AE data were extracted from procedural and post-procedural clinical notes. Analysis was conducted to determine correlations between any AE and demographic and clinical characteristics. Using univariate and multivariate logistic regression analyses, associations were determined. Results: From January 1, 2005 to July 31, 2015, 135 C1&ndash;2 injections were performed on 72 patients. Overall, at least 1 AE was reported in 18.5% of the injections. The most common AEs were post-procedural increase in pain and procedural vascular contrast uptake. There was a significant association between AE occurrence and greater pre-procedural maximum pain score. Conclusions: AEs from C1&ndash;2 joint injections occurred commonly, but there were no persistent or serious AEs associated with these injections. The data also demonstrate that patients with higher pre-procedural maximum pain scores are more likely to experience an AE. Keywords: C1&ndash;2 joint, facet, injection, adverse even