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Cynthia O. Townsend - One of the best experts on this subject based on the ideXlab platform.
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Pain & AGING SECTION Original Research Article Longitudinal Treatment Outcomes for Geriatric Patients with Chronic Non-Cancer Pain at an Interdisciplinary Pain Rehabilitation Program
2016Co-Authors: Kathleen M Darchuk, Barbara K. Bruce, Cynthia O. Townsend, W. Michael Hooten, Jeffrey D. Rome, Harry S TrumanAbstract:Objective. This study examined depression, Pain catastrophizing, psychosocial functioning, and physical and emotional health attributes for geriatric patients admitted to an interdisciplinary Pain reha- bilitation center compared with middle and younger age groups. Design. Quasi-experimental time series. Setting. Interdisciplinary Pain Rehabilitation center at a tertiary referral medical center. Patients. In total, 411 patients with chronic non- cancer Pain completed the Pain Rehabilitation program from October 2004 to April 2006. Patients were divided into three groups based on age: older (ages 60+ ;n = 78); middle-age (ages 40-59; n = 230) and younger (ages 18-39; n = 141). Intervention. A 3-week outpatient interdisciplinary Pain Rehabilitation program based on a cognitive- behavioral model that incorporates opioid with- drawal. Outcome Measures. The Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Ques- tionnaire (SF-36), Pain Catastrophizing Scale (PCS), and Center for Epidemiological Studies- Depression Scale (CES-D) were administered at admission, discharge, and 6 months following treatment. The frequency of patients using opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines at each assessment point were compared. Results. Older patients reported reduced depres- sion, catastrophizing, Pain severity, and Pain inter- ference (P < 0.001) at discharge and 6 months follow-up. Older patients also reported increased perceived control, and physical and social function- ing at discharge and follow-up (P < 0.001). Improve- ment in older patients was comparable in magnitude to that of middle-age patients on all variables, whereas younger patients exhibited greater improvement on four variables. Significant reduc- tions in analgesic use were observed in all groups. Conclusion. Interdisciplinary Pain Rehabilitation incorporating opioid withdrawal can improve long- term psychological, social and physical functioning for geriatric chronic Pain patients.
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Bariatric Surgery Patients’ Response to a Chronic Pain Rehabilitation Program
Obesity Surgery, 2015Co-Authors: Anilga Tabibian, Karen B. Grothe, Manpreet S. Mundi, Todd A. Kellogg, Matthew M. Clark, Cynthia O. TownsendAbstract:Background Chronic Pain (CP) is a prevalent and disabling diagnosis in obese individuals, but how bariatric surgery patients respond to chronic Pain Rehabilitation treatment programs has not previously been described.
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Clinical outcomes of multidisciplinary Pain Rehabilitation among african american compared with caucasian patients with chronic Pain.
Pain Medicine, 2012Co-Authors: W. Michael Hooten, Cynthia O. Townsend, Miranda Knight-brown, Heidi J. LauresAbstract:Objectives. The primary aim of this study was to determine if the immediate outcomes of multidisciplinary Pain Rehabilitation were different for African Americans compared with Caucasians. Design. A retrospective repeated measures design was used, and all analyses were adjusted for marital and employment status, years of education, and Pain duration. Setting. Multidisciplinary Pain Rehabilitation center. Subjects. Each African American (N = 40) consecutively admitted to a multidisciplinary Pain Rehabilitation program was matched with three Caucasians (N = 120) on age, sex, and treatment dates. Intervention. A 3-week outpatient multidisciplinary Pain Rehabilitation program. Outcome Measures. The Multidimensional Pain Inventory, Short Form-36 Health Status Questionnaire, Center for Epidemiologic Studies-Depression scale, and Pain Catastrophizing Scale were administered at admission and dismissal. Results. At baseline, African Americans had greater Pain severity (P
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longitudinal treatment outcomes for geriatric patients with chronic non cancer Pain at an interdisciplinary Pain Rehabilitation program
Pain Medicine, 2010Co-Authors: Kathleen M Darchuk, Cynthia O. Townsend, Barbara K. Bruce, Jeffrey D. Rome, Michael W HootenAbstract:Objective. This study examined depression, Pain catastrophizing, psychosocial functioning, and physical and emotional health attributes for geriatric patients admitted to an interdisciplinary Pain Rehabilitation center compared with middle and younger age groups. Design. Quasi-experimental time series. Setting. Interdisciplinary Pain Rehabilitation center at a tertiary referral medical center. Patients. In total, 411 patients with chronic non-cancer Pain completed the Pain Rehabilitation program from October 2004 to April 2006. Patients were divided into three groups based on age: older (ages 60+; n = 78); middle-age (ages 40–59; n = 230) and younger (ages 18–39; n = 141). Intervention. A 3-week outpatient interdisciplinary Pain Rehabilitation program based on a cognitive-behavioral model that incorporates opioid withdrawal. Outcome Measures. The Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Questionnaire (SF-36), Pain Catastrophizing Scale (PCS), and Center for Epidemiological Studies-Depression Scale (CES-D) were administered at admission, discharge, and 6 months following treatment. The frequency of patients using opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines at each assessment point were compared. Results. Older patients reported reduced depression, catastrophizing, Pain severity, and Pain interference ( P < 0.001) at discharge and 6 months follow-up. Older patients also reported increased perceived control, and physical and social functioning at discharge and follow-up ( P < 0.001). Improvement in older patients was comparable in magnitude to that of middle-age patients on all variables, whereas younger patients exhibited greater improvement on four variables. Significant reductions in analgesic use were observed in all groups. Conclusion. Interdisciplinary Pain Rehabilitation incorporating opioid withdrawal can improve long-term psychological, social and physical functioning for geriatric chronic Pain patients.
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Sex differences in characteristics of smokers with chronic Pain undergoing multidisciplinary Pain Rehabilitation
Pain Medicine, 2009Co-Authors: W. Michael Hooten, Barbara K. Bruce, Cynthia O. Townsend, Yu Shi, David O. WarnerAbstract:Objective. The primary aim of this study was to determine the influence of sex and the interactions between sex and smoking status on the immediate treatment outcomes of patients undergoing multidisciplinary Pain treatment. Design. A retrospective, repeated measures design. Setting. Multidisciplinary Pain Rehabilitation center at a tertiary referral medical center. Patients. The cohort (N = 1,241) included 928 women and 313 men of whom 313 were current smokers, 294 were former smokers and 634 were never smokers consecutively admitted from September 2003 through February 2007. Interventions. A 3-week outpatient multidisciplinary Pain Rehabilitation program. Outcome Measures. The Multidimensional Pain Inventory, Short Form-36 Health Status Questionnaire, Center for Epidemiologic Studies-Depression scale, Pain Anxiety Symptom Scale, and Pain Catastrophizing Scale were administered at admission and dismissal. Results. Women experienced significantly greater improvement in depressive symptoms compared with men ( P = 0.023). Smokers experienced significantly greater improvements in depression ( P = 0.039), Pain catastrophizing ( P = 0.010), and anxiety ( P = 0.037) compared with former and never smokers. No significant interaction effects between treatment by sex by smoking status were observed. A significant sex by smoking status interaction was observed for daily morphine equivalent dose (mg/d) where male smokers consumed greater quantities of opioids compared with female smokers at program admission ( P < 0.001). Conclusions. The effects of smoking status on the immediate treatment outcomes of multidisciplinary Pain treatment are not modified by sex. However, women experienced significantly greater improvement in depression than men and male smokers consumed significantly greater quantities of opioids compared with female smokers at admission.
Barbara K. Bruce - One of the best experts on this subject based on the ideXlab platform.
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Development of an Interdisciplinary Pediatric Pain Rehabilitation Program: The First 1000 Consecutive Patients
Mayo Clinic Proceedings: Innovations Quality & Outcomes, 2017Co-Authors: Barbara K. Bruce, Karen E. Weiss, Chelsea M. Ale, Tracy E. Harrison, Philip R. FischerAbstract:Abstract Objective To describe the development of a clinically and financially successful interdisciplinary pediatric Pain Rehabilitation program at a large tertiary academic medical center and present demographic and clinical information on the first 1000 patients. Patients and Methods All patients who were consecutively admitted to this program between October 1, 2008, and March 31, 2015 were included in this review. The patients ranged in age from 9 to 24 years. The program is a 3-week, hospital-based outpatient treatment program that requires substantial parental involvement. At admission and discharge, patients completed the Center for Epidemiologic Studies of Depression Scale for Children, the Functional Disability Inventory, and the Pain Catastrophizing Scale for Children. Opioid use was also assessed. Results At admission, patients reported substantial Pain-associated disability and depressive symptoms; they had elevated Pain catastrophizing scores, and 16% were taking opioids. Primary sites/types of Pain included head, abdomen, and generalized. Functional disability scores decreased significantly, from 27 to 9 after the program ( P P Conclusion Participation in a multidisciplinary pediatric Pain Rehabilitation program can be successful, with significant decreases in disability, depression symptoms, and Pain catastrophizing, as well as discontinuation of opioid use.
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Pain & AGING SECTION Original Research Article Longitudinal Treatment Outcomes for Geriatric Patients with Chronic Non-Cancer Pain at an Interdisciplinary Pain Rehabilitation Program
2016Co-Authors: Kathleen M Darchuk, Barbara K. Bruce, Cynthia O. Townsend, W. Michael Hooten, Jeffrey D. Rome, Harry S TrumanAbstract:Objective. This study examined depression, Pain catastrophizing, psychosocial functioning, and physical and emotional health attributes for geriatric patients admitted to an interdisciplinary Pain reha- bilitation center compared with middle and younger age groups. Design. Quasi-experimental time series. Setting. Interdisciplinary Pain Rehabilitation center at a tertiary referral medical center. Patients. In total, 411 patients with chronic non- cancer Pain completed the Pain Rehabilitation program from October 2004 to April 2006. Patients were divided into three groups based on age: older (ages 60+ ;n = 78); middle-age (ages 40-59; n = 230) and younger (ages 18-39; n = 141). Intervention. A 3-week outpatient interdisciplinary Pain Rehabilitation program based on a cognitive- behavioral model that incorporates opioid with- drawal. Outcome Measures. The Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Ques- tionnaire (SF-36), Pain Catastrophizing Scale (PCS), and Center for Epidemiological Studies- Depression Scale (CES-D) were administered at admission, discharge, and 6 months following treatment. The frequency of patients using opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines at each assessment point were compared. Results. Older patients reported reduced depres- sion, catastrophizing, Pain severity, and Pain inter- ference (P < 0.001) at discharge and 6 months follow-up. Older patients also reported increased perceived control, and physical and social function- ing at discharge and follow-up (P < 0.001). Improve- ment in older patients was comparable in magnitude to that of middle-age patients on all variables, whereas younger patients exhibited greater improvement on four variables. Significant reduc- tions in analgesic use were observed in all groups. Conclusion. Interdisciplinary Pain Rehabilitation incorporating opioid withdrawal can improve long- term psychological, social and physical functioning for geriatric chronic Pain patients.
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longitudinal treatment outcomes for geriatric patients with chronic non cancer Pain at an interdisciplinary Pain Rehabilitation program
Pain Medicine, 2010Co-Authors: Kathleen M Darchuk, Cynthia O. Townsend, Barbara K. Bruce, Jeffrey D. Rome, Michael W HootenAbstract:Objective. This study examined depression, Pain catastrophizing, psychosocial functioning, and physical and emotional health attributes for geriatric patients admitted to an interdisciplinary Pain Rehabilitation center compared with middle and younger age groups. Design. Quasi-experimental time series. Setting. Interdisciplinary Pain Rehabilitation center at a tertiary referral medical center. Patients. In total, 411 patients with chronic non-cancer Pain completed the Pain Rehabilitation program from October 2004 to April 2006. Patients were divided into three groups based on age: older (ages 60+; n = 78); middle-age (ages 40–59; n = 230) and younger (ages 18–39; n = 141). Intervention. A 3-week outpatient interdisciplinary Pain Rehabilitation program based on a cognitive-behavioral model that incorporates opioid withdrawal. Outcome Measures. The Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Questionnaire (SF-36), Pain Catastrophizing Scale (PCS), and Center for Epidemiological Studies-Depression Scale (CES-D) were administered at admission, discharge, and 6 months following treatment. The frequency of patients using opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines at each assessment point were compared. Results. Older patients reported reduced depression, catastrophizing, Pain severity, and Pain interference ( P < 0.001) at discharge and 6 months follow-up. Older patients also reported increased perceived control, and physical and social functioning at discharge and follow-up ( P < 0.001). Improvement in older patients was comparable in magnitude to that of middle-age patients on all variables, whereas younger patients exhibited greater improvement on four variables. Significant reductions in analgesic use were observed in all groups. Conclusion. Interdisciplinary Pain Rehabilitation incorporating opioid withdrawal can improve long-term psychological, social and physical functioning for geriatric chronic Pain patients.
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Sex differences in characteristics of smokers with chronic Pain undergoing multidisciplinary Pain Rehabilitation
Pain Medicine, 2009Co-Authors: W. Michael Hooten, Barbara K. Bruce, Cynthia O. Townsend, Yu Shi, David O. WarnerAbstract:Objective. The primary aim of this study was to determine the influence of sex and the interactions between sex and smoking status on the immediate treatment outcomes of patients undergoing multidisciplinary Pain treatment. Design. A retrospective, repeated measures design. Setting. Multidisciplinary Pain Rehabilitation center at a tertiary referral medical center. Patients. The cohort (N = 1,241) included 928 women and 313 men of whom 313 were current smokers, 294 were former smokers and 634 were never smokers consecutively admitted from September 2003 through February 2007. Interventions. A 3-week outpatient multidisciplinary Pain Rehabilitation program. Outcome Measures. The Multidimensional Pain Inventory, Short Form-36 Health Status Questionnaire, Center for Epidemiologic Studies-Depression scale, Pain Anxiety Symptom Scale, and Pain Catastrophizing Scale were administered at admission and dismissal. Results. Women experienced significantly greater improvement in depressive symptoms compared with men ( P = 0.023). Smokers experienced significantly greater improvements in depression ( P = 0.039), Pain catastrophizing ( P = 0.010), and anxiety ( P = 0.037) compared with former and never smokers. No significant interaction effects between treatment by sex by smoking status were observed. A significant sex by smoking status interaction was observed for daily morphine equivalent dose (mg/d) where male smokers consumed greater quantities of opioids compared with female smokers at program admission ( P < 0.001). Conclusions. The effects of smoking status on the immediate treatment outcomes of multidisciplinary Pain treatment are not modified by sex. However, women experienced significantly greater improvement in depression than men and male smokers consumed significantly greater quantities of opioids compared with female smokers at admission.
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Effects of Smoking Status on Immediate Treatment Outcomes of Multidisciplinary Pain Rehabilitation
Pain Medicine, 2009Co-Authors: W. Michael Hooten, Jennifer L Kerkvliet, Barbara K. Bruce, Cynthia O. Townsend, John E. Schmidt, Christi A. Patten, David O. WarnerAbstract:Objective. The primary aim of this study was to determine the effects of smoking on treatment outcomes following multidisciplinary Pain Rehabilitation. A secondary aim was to assess the tobacco use characteristics of smokers with chronic Pain. Design. A prospective, nonrandomized, repeated measures design. Setting. Multidisciplinary Pain Rehabilitation center at a tertiary referral medical center. Patients. All patients ( N = 193) consecutively admitted from August 2005 through February 2006. Interventions. A 3-week outpatient multidisciplinary Pain Rehabilitation program. Outcome Measures. The Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Questionnaire (SF-36), Center for Epidemiologic Studies-Depression scale (CES-D), Pain Anxiety Symptom Scale (PASS-20) and Pain Catastrophizing Scale (PCS) were administered at admission and dismissal. Results. The study involved 49 (83% women) smokers and 144 (83% women) nonsmokers. The mean number of cigarettes smoked daily was 17.5 (SD 11.1) and the mean duration of smoking was 21.5 years (SD 12.1). After adjusting for demographic differences, repeated measures of analysis of covariance showed a main effect of smoking status for MPI affective distress ( P = 0.008), CES-D ( P = 0.001) and PCS ( P = 0.011). An interaction of smoking status and time was found for the PASS-20 ( P = 0.028), MPI affective distress ( P = 0.033), MPI life control ( P = 0.003) and SF-36 role-emotional ( P = 0.004) subscale. While the majority of smokers were ready to consider smoking abstinence, 43% declined a brief smoking cessation intervention. Conclusions. In this series of patients undergoing multidisciplinary treatment for chronic Pain, immediate treatment effects for a variety of outcome measures were similar or significantly better in smokers compared with nonsmokers.
Tonny Elmose Andersen - One of the best experts on this subject based on the ideXlab platform.
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Chronic Pain patients with possible co-morbid post- traumatic stress disorder admitted to multidisciplinary Pain Rehabilitation*a 1-year cohort study
European Journal of Psychotraumatology, 2014Co-Authors: Tonny Elmose Andersen, Louann Christensen Andersen, Per Grunwald AndersenAbstract:Background : Although post-traumatic stress disorder (PTSD) is a common co-morbidity in chronic Pain, little is known about the association between PTSD and Pain in the context of chronic Pain Rehabilitation. Objective : The aim of the present study was two-fold: (1) to investigate the association of a possible PTSD diagnosis with symptoms of Pain, physical and mental functioning, as well as the use of opioids, and (2) to compare the outcome of multidisciplinary chronic Pain Rehabilitation for patients with a possible PTSD diagnosis at admission with patients without PTSD at admission. Method : A consecutively referred cohort of 194 patients completed a baseline questionnaire at admission covering post-traumatic stress, Pain symptoms, physical and mental functioning, as well as self-reported sleep quality and cognitive difficulties. Medication use was calculated from their medical records. A total of 95 were admitted to further multidisciplinary treatment and included in the outcome study. Results : A high prevalence of possible PTSD was found (26.3%). Patients with possible co-morbid PTSD experienced significantly poorer general and mental health, poorer sleep quality, and more cognitive problems as well as inferior social functioning compared to patients without PTSD. Possible co-morbid PTSD did not result in higher use of opioids or sedatives. Surprisingly, possible co-morbid PTSD at admission was not associated with lower levels of symptom reduction from pre- to post-treatment. Conclusions : Possible co-morbid PTSD in chronic Pain is a major problem associated with significantly poorer functioning on several domains. Nevertheless, our results indicate that Pain-related symptoms could be treated with success despite possible co-morbid PTSD. However, since PTSD was only measured at admission it is not known whether Rehabilitation actually reduced PTSD. Keywords: Post-traumatic stress; chronic Pain; Rehabilitation; distress; physical functioning; opioids (Published: 8 August 2014) Citation: European Journal of Psychotraumatology 2014, 5 : 23235 - http://dx.doi.org/10.3402/ejpt.v5.23235
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chronic Pain patients with possible co morbid post traumatic stress disorder admitted to multidisciplinary Pain Rehabilitation a 1 year cohort study
European Journal of Psychotraumatology, 2014Co-Authors: Tonny Elmose Andersen, Louann Christensen Andersen, Per Grunwald AndersenAbstract:Background : Although post-traumatic stress disorder (PTSD) is a common co-morbidity in chronic Pain, little is known about the association between PTSD and Pain in the context of chronic Pain Rehabilitation. Objective : The aim of the present study was two-fold: (1) to investigate the association of a possible PTSD diagnosis with symptoms of Pain, physical and mental functioning, as well as the use of opioids, and (2) to compare the outcome of multidisciplinary chronic Pain Rehabilitation for patients with a possible PTSD diagnosis at admission with patients without PTSD at admission. Method : A consecutively referred cohort of 194 patients completed a baseline questionnaire at admission covering post-traumatic stress, Pain symptoms, physical and mental functioning, as well as self-reported sleep quality and cognitive difficulties. Medication use was calculated from their medical records. A total of 95 were admitted to further multidisciplinary treatment and included in the outcome study. Results : A high prevalence of possible PTSD was found (26.3%). Patients with possible co-morbid PTSD experienced significantly poorer general and mental health, poorer sleep quality, and more cognitive problems as well as inferior social functioning compared to patients without PTSD. Possible co-morbid PTSD did not result in higher use of opioids or sedatives. Surprisingly, possible co-morbid PTSD at admission was not associated with lower levels of symptom reduction from pre- to post-treatment. Conclusions : Possible co-morbid PTSD in chronic Pain is a major problem associated with significantly poorer functioning on several domains. Nevertheless, our results indicate that Pain-related symptoms could be treated with success despite possible co-morbid PTSD. However, since PTSD was only measured at admission it is not known whether Rehabilitation actually reduced PTSD. Keywords: Post-traumatic stress; chronic Pain; Rehabilitation; distress; physical functioning; opioids (Published: 8 August 2014) Citation: European Journal of Psychotraumatology 2014, 5 : 23235 - http://dx.doi.org/10.3402/ejpt.v5.23235
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the traumatised chronic Pain patient prevalence of posttraumatic stress disorder ptsd and Pain sensitisation in two scandinavian samples referred for Pain Rehabilitation
Scandinavian Journal of Pain, 2012Co-Authors: Tonny Elmose Andersen, Per Grunwald Andersen, Merja Vakkala, Ask ElklitAbstract:Abstract Introduction Correctly identifying chronic Pain patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a chronic Pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with Pain sensitisation, elevated levels of Pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in chronic Pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in chronic Pain patients referred consecutively for multidisciplinary Pain Rehabilitation. Aim The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in chronic Pain patients referred consecutively to multidisciplinary Pain Rehabilitation. We wanted to investigate whether specific Pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods Data were collected from two Scandinavian multidisciplinary Pain centres (Denmark and Finland). All patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 patients were assessed, of which 304 (DK, N = 220, female n = 144; FIN, N = 84, female n = 44) were admitted and consented to participate. All patients had to be diagnosed with a non-malign chronic Pain condition lasting for at least 6 months (median = 6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or Pain. Results A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular Pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion The study emphasised the importance of screening all chronic Pain patients for PTSD at admission for Pain Rehabilitation, using up to date diagnostic tools. Implications Untreated PTSD may exacerbate or maintain the Pain condition and negatively affect outcome of Pain Rehabilitation.
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The traumatised chronic Pain patient—Prevalence of posttraumatic stress disorder - PTSD and Pain sensitisation in two Scandinavian samples referred for Pain Rehabilitation
Scandinavian Journal of Pain, 2012Co-Authors: Tonny Elmose Andersen, Per Grunwald Andersen, Merja Vakkala, Ask ElklitAbstract:Abstract Introduction Correctly identifying chronic Pain patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a chronic Pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with Pain sensitisation, elevated levels of Pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in chronic Pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in chronic Pain patients referred consecutively for multidisciplinary Pain Rehabilitation. Aim The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in chronic Pain patients referred consecutively to multidisciplinary Pain Rehabilitation. We wanted to investigate whether specific Pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods Data were collected from two Scandinavian multidisciplinary Pain centres (Denmark and Finland). All patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 patients were assessed, of which 304 (DK, N =220, female n =144; FIN, N =84, female n =44) were admitted and consented to participate. All patients had to be diagnosed with a non-malign chronic Pain condition lasting for at least 6 months (median=6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or Pain. Results A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular Pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion The study emphasised the importance of screening all chronic Pain patients for PTSD at admission for Pain Rehabilitation, using up to date diagnostic tools. Implications Untreated PTSD may exacerbate or maintain the Pain condition and negatively affect outcome of Pain Rehabilitation.
Ask Elklit - One of the best experts on this subject based on the ideXlab platform.
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the traumatised chronic Pain patient prevalence of posttraumatic stress disorder ptsd and Pain sensitisation in two scandinavian samples referred for Pain Rehabilitation
Scandinavian Journal of Pain, 2012Co-Authors: Tonny Elmose Andersen, Per Grunwald Andersen, Merja Vakkala, Ask ElklitAbstract:Abstract Introduction Correctly identifying chronic Pain patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a chronic Pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with Pain sensitisation, elevated levels of Pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in chronic Pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in chronic Pain patients referred consecutively for multidisciplinary Pain Rehabilitation. Aim The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in chronic Pain patients referred consecutively to multidisciplinary Pain Rehabilitation. We wanted to investigate whether specific Pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods Data were collected from two Scandinavian multidisciplinary Pain centres (Denmark and Finland). All patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 patients were assessed, of which 304 (DK, N = 220, female n = 144; FIN, N = 84, female n = 44) were admitted and consented to participate. All patients had to be diagnosed with a non-malign chronic Pain condition lasting for at least 6 months (median = 6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or Pain. Results A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular Pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion The study emphasised the importance of screening all chronic Pain patients for PTSD at admission for Pain Rehabilitation, using up to date diagnostic tools. Implications Untreated PTSD may exacerbate or maintain the Pain condition and negatively affect outcome of Pain Rehabilitation.
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The traumatised chronic Pain patient—Prevalence of posttraumatic stress disorder - PTSD and Pain sensitisation in two Scandinavian samples referred for Pain Rehabilitation
Scandinavian Journal of Pain, 2012Co-Authors: Tonny Elmose Andersen, Per Grunwald Andersen, Merja Vakkala, Ask ElklitAbstract:Abstract Introduction Correctly identifying chronic Pain patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a chronic Pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with Pain sensitisation, elevated levels of Pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in chronic Pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in chronic Pain patients referred consecutively for multidisciplinary Pain Rehabilitation. Aim The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in chronic Pain patients referred consecutively to multidisciplinary Pain Rehabilitation. We wanted to investigate whether specific Pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods Data were collected from two Scandinavian multidisciplinary Pain centres (Denmark and Finland). All patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 patients were assessed, of which 304 (DK, N =220, female n =144; FIN, N =84, female n =44) were admitted and consented to participate. All patients had to be diagnosed with a non-malign chronic Pain condition lasting for at least 6 months (median=6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or Pain. Results A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular Pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion The study emphasised the importance of screening all chronic Pain patients for PTSD at admission for Pain Rehabilitation, using up to date diagnostic tools. Implications Untreated PTSD may exacerbate or maintain the Pain condition and negatively affect outcome of Pain Rehabilitation.
Jeffrey D. Rome - One of the best experts on this subject based on the ideXlab platform.
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Pain & AGING SECTION Original Research Article Longitudinal Treatment Outcomes for Geriatric Patients with Chronic Non-Cancer Pain at an Interdisciplinary Pain Rehabilitation Program
2016Co-Authors: Kathleen M Darchuk, Barbara K. Bruce, Cynthia O. Townsend, W. Michael Hooten, Jeffrey D. Rome, Harry S TrumanAbstract:Objective. This study examined depression, Pain catastrophizing, psychosocial functioning, and physical and emotional health attributes for geriatric patients admitted to an interdisciplinary Pain reha- bilitation center compared with middle and younger age groups. Design. Quasi-experimental time series. Setting. Interdisciplinary Pain Rehabilitation center at a tertiary referral medical center. Patients. In total, 411 patients with chronic non- cancer Pain completed the Pain Rehabilitation program from October 2004 to April 2006. Patients were divided into three groups based on age: older (ages 60+ ;n = 78); middle-age (ages 40-59; n = 230) and younger (ages 18-39; n = 141). Intervention. A 3-week outpatient interdisciplinary Pain Rehabilitation program based on a cognitive- behavioral model that incorporates opioid with- drawal. Outcome Measures. The Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Ques- tionnaire (SF-36), Pain Catastrophizing Scale (PCS), and Center for Epidemiological Studies- Depression Scale (CES-D) were administered at admission, discharge, and 6 months following treatment. The frequency of patients using opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines at each assessment point were compared. Results. Older patients reported reduced depres- sion, catastrophizing, Pain severity, and Pain inter- ference (P < 0.001) at discharge and 6 months follow-up. Older patients also reported increased perceived control, and physical and social function- ing at discharge and follow-up (P < 0.001). Improve- ment in older patients was comparable in magnitude to that of middle-age patients on all variables, whereas younger patients exhibited greater improvement on four variables. Significant reduc- tions in analgesic use were observed in all groups. Conclusion. Interdisciplinary Pain Rehabilitation incorporating opioid withdrawal can improve long- term psychological, social and physical functioning for geriatric chronic Pain patients.
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longitudinal treatment outcomes for geriatric patients with chronic non cancer Pain at an interdisciplinary Pain Rehabilitation program
Pain Medicine, 2010Co-Authors: Kathleen M Darchuk, Cynthia O. Townsend, Barbara K. Bruce, Jeffrey D. Rome, Michael W HootenAbstract:Objective. This study examined depression, Pain catastrophizing, psychosocial functioning, and physical and emotional health attributes for geriatric patients admitted to an interdisciplinary Pain Rehabilitation center compared with middle and younger age groups. Design. Quasi-experimental time series. Setting. Interdisciplinary Pain Rehabilitation center at a tertiary referral medical center. Patients. In total, 411 patients with chronic non-cancer Pain completed the Pain Rehabilitation program from October 2004 to April 2006. Patients were divided into three groups based on age: older (ages 60+; n = 78); middle-age (ages 40–59; n = 230) and younger (ages 18–39; n = 141). Intervention. A 3-week outpatient interdisciplinary Pain Rehabilitation program based on a cognitive-behavioral model that incorporates opioid withdrawal. Outcome Measures. The Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Questionnaire (SF-36), Pain Catastrophizing Scale (PCS), and Center for Epidemiological Studies-Depression Scale (CES-D) were administered at admission, discharge, and 6 months following treatment. The frequency of patients using opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines at each assessment point were compared. Results. Older patients reported reduced depression, catastrophizing, Pain severity, and Pain interference ( P < 0.001) at discharge and 6 months follow-up. Older patients also reported increased perceived control, and physical and social functioning at discharge and follow-up ( P < 0.001). Improvement in older patients was comparable in magnitude to that of middle-age patients on all variables, whereas younger patients exhibited greater improvement on four variables. Significant reductions in analgesic use were observed in all groups. Conclusion. Interdisciplinary Pain Rehabilitation incorporating opioid withdrawal can improve long-term psychological, social and physical functioning for geriatric chronic Pain patients.
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Reduction in medication costs for patients with chronic nonmalignant Pain completing a Pain Rehabilitation program: A prospective analysis of admission, discharge, and 6-month follow-up medication costs
Pain Medicine, 2009Co-Authors: Julie L. Cunningham, Jennifer L Kerkvliet, Jeffrey D. Rome, Cynthia O. TownsendAbstract:Objective. Chronic nonmalignant Pain (CNMP) is both a prevalent and a costly health problem in our society. Pain Rehabilitation programs have been shown to provide cost-effective treatment. A treatment goal for some Rehabilitation programs is reduction in the use of Pain-related medication. Medication costs savings from Pain Rehabilitation programs have not been analyzed in previous studies. Design. This prospective cohort study of 186 patients with CNMP addresses the costs of medications at admission to a 3-week outpatient Pain Rehabilitation program, at discharge, and at 6-month follow-up. Medication use was determined through a detailed pharmacist interview with patients at admission and discharge. Patients were sent questionnaires 6 months after program completion, which obtained current medication information. Results. Statistically significant medication cost savings were seen for program completers at discharge and at 6-month follow-up (P
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a longitudinal study of the efficacy of a comprehensive Pain Rehabilitation program with opioid withdrawal comparison of treatment outcomes based on opioid use status at admission
Pain, 2008Co-Authors: Cynthia O. Townsend, Michael W Hooten, Jennifer L Kerkvliet, Barbara K. Bruce, Jeffrey D. Rome, Connie A. Luedtke, J. HodgsonAbstract:Abstract Use of opioids for chronic non-cancer Pain is controversial and the efficacy of comprehensive Pain Rehabilitation programs (CPRPs) that incorporate opioid withdrawal requires further investigation. We test the hypothesis that patients with chronic Pain and longstanding opioid use who undergo opioid withdrawal in the course of rehabilitative treatment will experience significant and sustained improvement in Pain and functioning similar to patients who were not taking opioids. A longitudinal design study compared 373 consecutive patients admitted to the Mayo Clinic Pain Rehabilitation Center at admission, discharge and six-month posttreatment by opioid status at admission. Measures of Pain severity, depression, psychosocial functioning, health status, and Pain catastrophizing were used to assess between- and within-group differences. Treatment involved a 3-week interdisciplinary Pain Rehabilitation program focused on functional restoration. Over one-half of patients (57.1%) were taking opioids daily at admission. The majority of patients (91%) completed Rehabilitation and 70% of patients who completed the program returned questionnaires six months posttreatment. On admission, patients taking low- and high-dose opioids reported significantly greater Pain severity ( P = .001) and depression ( P = . 001) than the non-opioid group. Significant improvement was found on all outcome variables following treatment ( P P Conclusion: Patients with longstanding CPRP on chronic opioid therapy, who choose to participate in interdisciplinary Rehabilitation that incorporates opioid withdrawal, can experience significant and sustained improvement in Pain severity and functioning.
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Chronic Pain Rehabilitation in chronic headache disorders
Current Neurology and Neuroscience Reports, 2008Co-Authors: Barbara K. Bruce, Cynthia O. Townsend, W. Michael Hooten, Jeffrey D. Rome, Justin S. Moon, Jerry W. SwansonAbstract:This article reviews the treatment goals and efficacy of comprehensive Pain Rehabilitation programs for the treatment of chronic headache. Substantial data demonstrate improved outcomes from rehabilitative treatment for chronic noncancer Pain. We present a discussion of the most relevant recent publications on Pain Rehabilitation in chronic headache disorders. This article describes Pain Rehabilitation, reviews outcome data for chronic Pain patients treated in this setting, and describes the unique applicability of this treatment approach for patients with chronic headache. Particular attention is directed to the rationale for and the results of the withdrawal, in a Pain Rehabilitation setting, of opioids and simple analgesics, ergots, and triptans that contribute to medication overuse headaches. Additionally, a case example is reviewed that illustrates the structure and function of a Pain Rehabilitation program in the treatment of a patient with intractable headache.
