Emotional Pain and Acute Nociception

This study examined differences and similarities in responses to acute nociception in adults with a significant history of emotional pain relative to matched controls with a significant past positive life experience and a sample of chronic pain patients. Using 28 volunteers who responded to advertisements (n = 14, emotional pain group; n = 14, positive life experience group), and 14 chronic pain patients from a prior study, this investigation utilized measures of pain threshold and tolerance during a laboratory finger pressure pain induction experiment. Each participant experienced two levels of pressure pain (i.e., high and low) and two levels of induced fear (i.e., high and low). Mixed between-within subject ANOVAs revealed a significant main effect of weight for pain threshold and tolerance, suggesting the importance of stimulus intensity. Exploratory analyses suggested an interaction between weight and group membership for pain tolerance. Findings indicate that individuals who are self-selected to talk about emotional pain possibly may have a higher pain tolerance for more intense pain stimulation as compared to participants reporting positive life events and chronic pain

Predicting Opioid Prescribing Behaviors: Influence of an Expert Opioid-Risk Evaluation

Opioid analgesics have been shown to be effective for short-term pain reduction; however, chronic opioid therapy does not improve functioning, and may lead to problems with dependence and abuse. Physicians report having difficulty discerning substance abuse or drug diversion, which can lead to over- or under- prescribing, poor pain management, and may contribute to the growing number of opioid-related overdose deaths. The primary aim of this study was to determine if a psychological opioid risk evaluation influenced opioid prescribing in physicians at the West Virginia University (WVU) Family Medicine Clinic. For this retrospective study, participants were 151 (89 female) adult patients being considered for long-term opioid therapy. Patients participated in a psychological opioid risk evaluation, which included several questionnaires and a clinical interview. This evaluation resulted in an opioid risk level (i.e., low, low-moderate, moderate, moderate-high, high) being assigned to each patient representing clinical judgment about their potential risk for misusing or abusing opioid medication. An electronic medical record review was conducted on each patient, abstracting information about if an opioid was prescribed, in addition to several other factors, which later were included in logistic regression analyses. Patients prescribed an opioid were more likely to be married or with a long term partner and have a higher level of education. Patients not prescribed an opioid were more likely to report a higher pain rating at the time of the evaluation, a history of abuse or substance abuse, or have higher total scores for questionnaires measuring pain catastrophizing, misuse or diversion behaviors, and depression symptoms. Risk status and substance abuse history significantly predicted opioid prescribing, with a decrease in risk status resulting in an increase in opioid prescribing, and those with a history of substance abuse being less likely to be prescribed an opioid; however, substance abuse did not significantly improve the overall model and was removed. Additionally, demographic variables (i.e., age, sex, ethnicity/race) were not significant predictors of prescribing as found in other studies. These findings suggest that providing physicians with additional information about their patient\u27s opioid abuse potential aids in prescribing decisions and may reduce prescribing bias based on demographic factors. Risk status may allow physicians to integrate evidence-based factors into their decision-making process in a simplified manner, and possibly improve patient care. Future work should continue to address physicians\u27 prescribing perspective, accuracy of evaluations, effect on patient care, and cost analyses for the healthcare system

Pain Experiences and Their Relation to Opioid Misuse Risk and Emotion Dysregulation

Pain is a complex, multidimensional experience but often is measured as a unidimensional experience. This study aimed to separately assess the sensory and affective components of pain and identify their relations to important pain-related outcomes, particularly in terms of opioid misuse risk and emotion dysregulation among patients with chronic pain receiving treatment in Appalachia. Two hundred and twelve patients presenting to a multidisciplinary pain center completed the Difficulties in Emotion Regulation Scale (DERS-18), Screener and Opioid Assessment for Patients with Pain—Revised (SOAPP-R), and short-form McGill Pain Questionnaire (SF-MPQ). The sensory experience of pain was unrelated to emotion dysregulation (r = 0.06, p = 0.57) and weakly related to opioid misuse risk (r = 0.182, p \u3c 0.05). In contrast, the affective experience of pain was moderately related to emotion dysregulation (r = 0.217, p \u3c 0.05) and strongly related to opioid misuse risk (r = 0.37, p \u3c 0.01). In addition, emotion dysregulation predicted variance in opioid misuse risk above and beyond the affective and sensory experiences of pain ((b = 0.693, p \u3c 0.001). The results suggest patients with a strong affective experience versus sensory experience of pain and challenges with emotion regulation may require a more comprehensive intervention to address these underlying components in order to reduce their risk of misusing opioid medications

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

Equipping Health Professions Educators to Better Address Medical Misinformation

As part of a cooperative agreement with the US Centers for Disease Control and Prevention (Federal Award Identification Number [FAIN]: NU50CK000586), the Association of American Medical Colleges (AAMC) began a strategic initiative in 2022 both to increase confidence in COVID-19 vaccines and to address medical misinformation and mistrust through education in health professions contexts. Specifically, the AAMC solicited proposals for integrating competency-based, interprofessional strategies to mitigate health misinformation into new or existing curricula. Five Health Professions Education Curricular Innovations subgrantees received support from the AAMC in 2022 and reflected on the implementation of their ideas in a series of meetings over several months. Subgrantees included the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Florida International University Herbert Wertheim College of Medicine, the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, the Maine Medical Center/Tufts University School of Medicine, and the University of Chicago Pritzker School of Medicine. This paper comprises insights from each of the teams and overarching observations regarding the challenges and opportunities involved with leveraging health professions education to address medical misinformation and improve patient health

Pain Experiences and Their Relation to Opioid Misuse Risk and Emotion Dysregulation

Pain is a complex, multidimensional experience but often is measured as a unidimensional experience. This study aimed to separately assess the sensory and affective components of pain and identify their relations to important pain-related outcomes, particularly in terms of opioid misuse risk and emotion dysregulation among patients with chronic pain receiving treatment in Appalachia. Two hundred and twelve patients presenting to a multidisciplinary pain center completed the Difficulties in Emotion Regulation Scale (DERS-18), Screener and Opioid Assessment for Patients with Pain—Revised (SOAPP-R), and short-form McGill Pain Questionnaire (SF-MPQ). The sensory experience of pain was unrelated to emotion dysregulation (r = 0.06, p=0.57) and weakly related to opioid misuse risk (r = 0.182, p<0.05). In contrast, the affective experience of pain was moderately related to emotion dysregulation (r = 0.217, p<0.05) and strongly related to opioid misuse risk (r = 0.37, p<0.01). In addition, emotion dysregulation predicted variance in opioid misuse risk above and beyond the affective and sensory experiences of pain ((b = 0.693, p<0.001). The results suggest patients with a strong affective experience versus sensory experience of pain and challenges with emotion regulation may require a more comprehensive intervention to address these underlying components in order to reduce their risk of misusing opioid medications

Use of Checklists Teaches Communication Skills Utilized by Specialties

Abstract Objectives: The purpose of the current study was to implement the use of communication checklists and determine whether medical students were able to attend to and distinguish differences in communication skills between various physician specialties. Methods: As part of a newly-revised medical education curriculum, all first-year medical students at a mid-Atlantic medical school were required to complete a communication skills checklist while observing 10 clinical encounters performed by attending physicians. The checklists were collected and analyzed for trends found within the reporting. Results: Even novice learners distinguished complex medical communication skills when structured observation checklists were used as a teaching tool. Significant differences were noted in demonstrations of targeted communication skills when analyzed by physician specialty and gender. Conclusions: Structured observation checklists can be used as an instructional tool for exposing medical students to advanced physician-patient communication skills, providing students with guidance on what skills to observe and identify, and highlighting the differences in implementation of these skills across specialties. Practice implications: This study provides implications for faculty development as well as medical communication curriculum. Communication checklists can assist in providing structured observations and normative feedback for learners and faculty desiring to improve their physician-patient communication skills