APS Press Room
News Highlights from The Journal of Pain • January 2005
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
GLENVIEW, Ill, Jan. 30, 2005 -- The following news highlights summarize selected articles in the current (January 2005) issue of The Journal of Pain (Vol.6, No. 1), the peer-reviewed scientific journal of the American Pain Society (APS). Based in Glenview, Ill., APS is a multidisciplinary educational and scientific organization dedicated to serving people in pain.
The opinions and ideas expressed in articles appearing in The Journal of Pain do not necessarily reflect those of the editor and publisher or of the American Pain Society.
ETHICAL CHALLENGES IN THE MANAGEMENT OF CHRONIC NON-MALIGNANT PAIN; NEGOTIATING THROUGH THE CLOUD OF DOUBT
Mark Sullivan, MD, PhD and Betty Farrell, RN, PhD, University of Washington and City of Hope Medical Center
Through the Decade of Pain Control and Research and other public awareness initiatives, untreated chronic pain is now being recognized as a major public health problem in the US, and the primary area of concern has been cancer and pain management at the end of life. Recently, however, the focus has expanded to chronic non-cancer pain and more liberal use of opioid pain medications. Sullivan and Farrell contend that confusion exists regarding the goals for this treatment and its proper place in chronic pain treatment protocols.
Cancer pain management is focused on maximizing patient comfort, but comfort alone is not an adequate treatment goal for chronic non-malignant pain. Unlike cancer pain, non-malignant chronic pain isn’t proportional to disease severity. According to the authors, the lack of proportionality fosters concerns about malingering, exaggeration and psychogenic pain among care providers, especially primary care physicians. In particular, physician doubts about patients’ self-reported unrelieved chronic pain has brought about concerns regarding possible addiction that unfortunately influence clinical decision making. The essential question, say the authors, isn’t whether chronic non-cancer pain is real or proportional to objectively measured disease severity, but how should pain be managed to optimize the patients overall quality of life?
The authors recommend that physicians should accept all patient pain reports as valid but negotiate goals early in treatment and use opioids only if they improve the patient’s overall health-related quality of life. Further, all patients with chronic non-malignant pain should be assessed for psychiatric disorders and referred for treatment, if necessary.
In a commentary article, Sridhar V. Vasudevan, Center for Pain and Work Rehabilitation, St. Nicholas Hospital, Sheboygan Wis., supports the conclusions of Sullivan and Farrell about treating chronic non-malignant pain. He strongly agreed with their recommendation to negotiate care plans with pain patients and said pain clinicians can learn from what has been published on chronic headaches and “analgesia rebound headache.” He noted that for certain non-malignant pain patients, discontinuing opioids can eliminate pain. However, he urged that long-term shared goals be set with patients, emphasizing shared decision making to achieve long-term benefits.
EFFICACY AND SAFETY OF OXYMORPHONE EXTENDED-RELEASE IN CHRONIC LOW BACK PAIN: RESULTS OF A RANDOMIZED, DOUBLE-BLIND, PLACEBO AND ACTIVE-CONTROLLED PHASE III STUDY
Martin E. Hale, MD, Chris Dvergsten and Joseph Gimbel Gold Coast Research, LLC, Weston, FL.
In this trial, 213 patients with chronic low back pain were studied to evaluate the comparative analgesic efficacy and safety of oxymorphone extended-release with placebo and oxycodone controlled-release formulation. The data showed that oxymorphone and oxycodone were superior to placebo and generally safe and effective for treating low back pain. Oxymorphone, however, showed equal analgesic benefit to oxycodone at half the per-milligram daily dose with comparable safety.
FORGIVENESS AND CHRONIC LOW BACK PAIN: A PRELIMINARY STUDY EXAMINING THE RELATIONSHIP OF FORGIVENESS TO PAIN, ANGER AND PSYCHOLOGICAL DISTRESS
James W. Carson, PhD., Francis J. Keefe, PhD et al, Duke University Medical Center Department of Psychiatry
This study examines the relationship of the ability to forgive and severity of chronic pain. The authors studied 61 patients with chronic low back pain and found that patients varied considerably in their scores on forgiveness-related variables. Patients who had higher forgiveness scores reported lower levels of pain, anger and psychological distress. Further, the authors concluded that patients who reported an inability to forgive others for perceived offenses may have higher levels of pain and related psychological distress.
DOES PERSONALITY AT COLLEGE ENTRY PREDICT NUMBER OF REPORTED PAIN CONDITIONS AT MID-LIFE?
Katherine Applegate, PhD, Francis Keefe, PhD., et al, Duke University Medical Center Department of Psychiatry
Duke researchers sought to evaluate whether personality traits identified upon college admission can be predictive of the frequency of reported pain conditions later in life. This is the first study to examine how personality assessed in younger adults relates to the number of chronic pain conditions reported 30 years later. Some 2300 students admitted to the University of North Carolina in 1965-66 were given the Minnesota Multiphasic Personality Inventory (MMPI). It was found that among students with elevated MMPI scales for hypochondriasis, hysteria and paranoia there was a small but significant relationship with reports of chronic pain conditions at 30-year follow-up.