APS Press Room
News Highlights from The Journal of Pain • May 2008
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
A Better Way to Predict Aberrant Drug Behavior in Pain Patients
GLENVIEW, IL, May 29, 2008—Though opioid pain medications are effective for treating chronic pain, many physicians are reluctant to prescribe them fearing potential for addiction and abuse. Harvard researchers may have an answer to this problem with a new screening tool, published in The Journal of Pain, to predict which pain patients are most likely to exhibit aberrant medication-related behavior.
The estimated prevalence of addiction to any substance in pain patients is about 10 percent, yet most physicians who prescribe potent pain drugs have little training in addiction or confronting aberrant drug behavior. Even though substance abuse is evident in chronic pain patients, potential addiction risk does not outweigh the benefit of effective pain management. Optimal use of opioids, therefore, requires physicians to evaluate potential drug-abuse risks in their patients. But how?
Researchers at the Pain Management Center at Harvard's Brigham and Women's Hospital sought to improve deficiencies in screening questionnaires used to identify which chronic pain patients could be at risk for abusing their pain medication. The purpose of the study was to develop and validate a new, revised version of the standard questionnaire (Screener and Opioid Assessment for Patients with Pain), but with enhancements to include patient self reports with provider observations and toxicology results.
Fifty-five chronic pain patients were randomly selected to complete the new screening survey from a group of 283 that had completed the standard questionnaire. The researchers determined the revised survey elicited information critical for determining which chronic pain patients may have problems with long-term opioid therapy. From an initial pool of 142 items, the final questionnaire was reduced to 24. They probed for problems with mood, temperament, feelings of impatience and frustration. Several items were related to attitudes about pain medication.
The authors concluded the revised screening tool is an improvement on the original questionnaire in identifying drug abuse risk potential among chronic pain patients. It was found to be more reliable and less susceptible to deception.
Source: Validation of the Revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R); Stephen F. Butler, Katherine Fernandez, Christine Benoit, Simon H. Budman and Robert Jamison; Brigham and Women's Hospital and Harvard Medical School, Boston, MA
Fibromyalgia Pain Linked with Central Nervous System Disorder
Fibromyalgia is a chronic pain condition that causes widespread pain and tenderness throughout the body. A University of Michigan study, published in The Journal of Pain, shows that fibromyalgia is associated with central nervous system abnormalities evidenced by patients' elevated sensitivity to auditory and pressure sensations.
The Michigan researchers studied 31 subjects to determine if there is a global central nervous system problem underlying sensory processing in fibromyalgia patients. They noted that few studies have employed different stimuli in consistent ways and levels of intensity to measure pain sensitivities in this patient group. In this study, fibromyalgia patients and normal subjects were exposed to random auditory and pressure stimuli.
Consistent with prior research, the fibromyalgia subjects in the study showed greater sensitivity to auditory tones and reported higher sensitivity to daily sounds. Further, significant associations were observed between the auditory and pressure responses and support the claim that such abnormalities maybe related to a common pathophysiological mechanism. They also noted that fibromyalgia subjects perceived auditory stimuli to be of the same intensity as felt by control subjects, even though their actual intensity levels were lower.
The authors concluded their findings show that fibromyalgia is associated with a central nervous deficit in sensory processing. Further research is needed to examine mechanisms governing these perceptual abnormalities.
Source: A Psychophysical Study of Auditory and pressure sensitivity in Patients with Fibromyalgia and Healthy Controls; Michael E. Geiseer, Jennifer M. Glass, Ljubinka D. Rajcevska, Daniel J. Clauw, David A. Williams, Paul R. Kileny, and Richard H. Gracely; University of Michigan, Ann Arbor
Does Partner Support Moderate Depression in Low Back Pain Patients?
It is well documented that chronic low back pain has a negative effect on relationships. Also, the quality of relationships may influence the pain experience. In this Journal of Pain article, the authors looked at the role of psychosocial variables as mediators of pain.
Several previous studies have reported the benefit of social support in chronic pain. However, no studies have examined potential mediators of the association between pain and relationship satisfaction in patients with chronic low back pain. Fifty-four subjects in southeastern Ontario with chronic low back pain were studied. They completed several survey instruments, such as the Multidimensional Pain Inventory, Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale and the Dyadic Adjustment Scale. Mediation analyses were conducted for each psychosocial variable to determine their roles as mediators in the association between pain and relationship satisfaction.
The study's findings suggest that chronic low back pain may promote increased perceived negative responses by a partner, which in turn may be associated with decreased relationship satisfaction. Likewise, the authors noted that depression linked with chronic low back pain is associated with decreased relationship satisfaction. The authors recommend that addressing the style of interactions and communication between couples may lessen the dissatisfaction with intimate relationships among chronic pain patients.
Source: The Mediating Role of Depression and Negative Partner Reponses in Chronic Low back Pain and Relationship Satisfaction; Samantha E. Waxman, Dean A. Tripp and Ricardo Flamenbaum; Queen's University, Kingston, Ontario
Study Assesses Pain and School Achievement
Little is known about the role of pain as an influence on a child's ability to perform in school. Some studies have shown that children with chronic pain have more absences, on average about 1 to 3 days a month. But few researchers have looked beyond absence rates to evaluate school functioning in children with pain conditions.
The researchers tested three hypotheses for their study of 220 Boston-area students ages 12-17:
1) Higher school absences rates will be associated with other indicators of school impairment, including poor academic performance, lower perceived academic performance and teacher-reported school adjustment
2) Greater school impairment will be associated with older age and greater pain intensity
3) Multiple reports of school impairment will be positively inter-correlated.
The authors used school attendance records, descriptions of accommodations for students with chronic pain, and teacher ratings of academic competence to assess student performance.
They reported that many of the adolescents with chronic pain missed significant time from school, showed a decline in academic performance, and perceived their pain to be an impediment to success. They determined that variables of school impairment are inter-correlated in that impairment in one domain is associated with similar patterns in other domains of school functioning. For example, frequent absences pose a risk for low academic achievement and subsequent long-term social disability.
One other finding from the study is pain intensity and duration were unrelated to school functioning in these subjects.
Source: School Impairment in Adolescents with Chronic Pain; Deirdre E. Logan, Laura E. Simons, Michelle J. Stein and Laura Chastain; Children's Hospital, Boston and Harvard Medical School