Kevin E. Vowles

Deprivation is an established risk factor for the presence of chronic pain. Less is known about the relation between deprivation and the impact of chronic pain on functioning. The aim of the present study was to evaluate differences in functioning across people with chronic pain based on deprivation and evaluate if the risk of clinically significant disruption increases proportionally with greater deprivation. These issues were examined in a cross-sectional analysis of 491 treatment-seeking individuals with chronic pain. Participants completed measures of pain interference, social functioning, depression, anxiety, physical function, sleep disturbance, cognitive functioning, fatigue intensity and pain intensity. Deprivation was quantified using the Northern Ireland Multiple Deprivation Measure, which rank orders all postcodes in the province across seven domains. Three deprivation categories were derived (low, middle and high), which were used to evaluate sample differences in pain-related functioning. Significant between-group differences were indicated across all measures with the lowest deprivation group reporting higher functioning in relation to the other two groups across most measures. The only exceptions were for depression and anxiety which increased significantly across each level of deprivation. A similar pattern was found when examining clinically significant scores, particularly for social functioning, depression and anxiety. Deprivation is more than a risk factor for chronic pain. Deprivation is a risk factor for more distressing, disabling and disruptive chronic pain. These findings indicate that redirection of clinical efforts is warranted to allow interventions to more adequately address the complexities of those seeking treatment.

Objectives Changes in health regulations in many developed countries have expanded prescribing privileges from medical doctors to other health professionals, notably nurses and pharmacists working in hospital and general practice settings. While some of these prescribers operate in a supervised capacity, increasingly there are those who operate as autonomous prescribers. This development will likely increase capacity for addressing common health challenges in the future. In the present systematic review we evaluated the evidence of independent pharmacist prescribing (IPP) in the treatment of metabolic targets associated with chronic non-communicable diseases (cNCDs), which are common, costly and often diminish quality of life. Methods Published evidence evaluating the effects of IPP on cNCDs was reviewed. English language studies evaluating IPP for adults with these conditions and published since 2000 were included. Two reviewers independently evaluated papers for inclusion, IPP effectiveness and risk of bias. Results A total of 11 studies were included, which examined IPP for three metabolic targets related to cNCDs—namely, blood glucose, blood pressure and cholesterol. Seven randomised controlled trials (RCTs) provided robust support for IPP in the treatment of hypertension compared with usual prescriber care. For diabetes there was modest support for glycaemic control including one RCT and two non-randomised evaluations. For hypercholesterolaemia, there were two RCTs, both of which were not specifically targeted at cholesterol reduction and yielded unclear results. Conclusion Given that hypertension is one of the major risk factors for morbidity and mortality, expansion of care for this condition to include IPPs embedded in both hospital and community settings has marked potential for public health benefit. Although available evidence supports the feasibility of IPP for glycaemic control, more adequate evaluations are needed to determine safety and efficacy. Finally, IPP for hypercholesterolaemia likely requires additional investigation, including studies specifically targeting change in cholesterol.

Background: Chronic pain and post‐traumatic stress disorder (PTSD) are frequently comorbid and are associated with more significant pain‐related disruption than chronic pain alone. It is not clear if these disruptions are due to traumatic experience or specific symptoms related to PTSD. Methods: This issue was evaluated in a large sample ( N = 1367) of individuals with chronic pain presenting for treatment at an interdisciplinary pain rehabilitation service. As a secondary objective, the comorbidity of chronic pain and PTSD in Northern Ireland (NI) was also examined given high regional prevalence rates. Participants completed a PTSD screening measure, along with measures of pain interference, social functioning, pain anxiety, pain self‐efficacy, pain intensity and depression. Results: Screening indicated that 46.4% had never experienced a traumatic event, 22.5% had experienced a traumatic event but screened negative for PTSD and 31.1% screened positive for PTSD. Following identification of covariates, a Multivariate Analysis of Covariance examined differences in dependent measures by PTSD category, which yielded a similar pattern of results across measures. The group that screened positive for PTSD reported worse functioning and more disruptions in comparison to the other two PTSD groups, with the latter groups not differing on any measure. Conclusions: These analyses indicate that poorer functioning was not associated with trauma exposure alone; rather, it was experienced in association with PTSD symptoms. Further, comorbidity rates of PTSD and chronic pain in this NI dwelling sample were at the high end of the range in relation to previous work and exceeded past year regional prevalence estimates. Significance: PTSD assessment in those with chronic pain may be best served by evaluating the impact of these experiences on function, rather than focusing on the traumatic experiences in isolation. Further, there is scope to develop integrated chronic pain and PTSD treatments.

Background: Pain is the leading cause of disability and reduced quality of life worldwide. Despite the increasing burden for patients and healthcare systems, pain research remains underfunded and under focused. Having stakeholders identify and prioritize areas that need urgent attention in the field will help focus funding topics, reduce ‘research waste’, improve the effectiveness of pain research and therapy and promote the uptake of research evidence. In this study, the European Pain Federation (EFIC) developed a Pain Research Strategy for Europe.Methods: The study used multiple methods, including literature searches, multidisciplinary expert debate, a survey and a final consensus meeting. The cross‐sectional survey was conducted among 628 European pain researchers, clinicians, educators and industry professionals to obtain the rating and hierarchy of pain research priorities.The final consensus meeting involved a multidisciplinary expert panel including people with lived experience from 23 countries. The survey results guided discussions where top priorities were agreed.Results: Content analysis identified nine survey themes, of which five emerged as top priorities: (i) understand the pathophysiology of pain; (ii) understand and address comorbidities; (iii) critically assess current therapies; (iv) develop new treatments; and (v) explore the biopsychosocial impacts of pain. Physical, psychological and social approaches were prioritized at the same level as pharmacological treatments. The top priorities were endorsed by a multidisciplinary expert panel. The panel emphasized the importance of also clearly communicating the concepts of prediction, prevention self‐management and personalized pain management in the final strategy.Conclusions: The content of the final top research priorities' list reflects a holistic approach to pain management. The equal importance given to physical, psychological and social aspects alongside pharmacological treatments highlights the importance of a comprehensive biopsychosocial‐orientated research strategy. The expert panel's endorsement of five top priorities, coupled with an emphasis on communicating the concepts of prediction, prevention, self‐management and personalized pain management, provides a clear direction for future basic, translational and clinical research.Significance: EFIC has developed a Pain Research Strategy for Europe that identifies pain research areas deserving the most focus and financial support. Implementation and wide dissemination of this Strategy is vital to increase the conduct of urgent pain projects, pain research funding and the implementation of research findings into practice, to ultimately decrease the personal, societal and financial burden of pain.

Background/Objectives: Prescription opioid use before adulthood is typically effective for acute pain control and is also associated with adverse short- and long-term consequences. Methods: This study examined pediatric opioid prescribing trends over time across different age groups (early childhood, school age, adolescence, young adult) and sociodemographic subgroups (sex, ethnicity, race, language, payer type) from 2005 to 2016. Results: Utilizing 42,020 first outpatient opioid prescriptions for youth aged 0–21 years from a large US children’s hospital, this research found notable trends and disparities. Prescription rates increased by 35% from 2005–2007 to 2008–2010, then decreased by 14% from 2008–2010 to 2011–2013, and decreased again by 22% from 2011–2013 to 2014–2016. Chi-squared tests indicated significant changes in prescription rates across all sociodemographic subgroups, though only age group, ethnicity, and payer type (i.e., the party responsible for payment for hospital services) had changes with non-negligible effect sizes (Cramer’s V). Specifically, age group showed small to medium effects (V = 0.16), while ethnicity and payer demonstrated small effects (V = 0.10 each). This study highlights variations in opioid prescribing trends, particularly among different age groups, ethnicities, and payer statuses up to 2016. Conclusions: These findings reveal differing trends in pediatric opioid prescribing during the peak of the opioid epidemic, highlighting the importance of considering age and sociodemographic variables for understanding prescribing patterns fully and raising potential concerns about inequities in pain management. Future studies should explore similar trends from 2016 onward.

Background: Chronic pain is common and associated with disruptions in quality of life (QoL) and psychosocial functioning. These issues are particularly pronounced in veterans, although data in this regard primarily come from the United States Veterans Affairs System, meaning less is known regarding veterans of other countries and regions. The present study evaluated veterans living in Northern Ireland (NI), a region with historic high rates of both chronic pain and psychosocial difficulties associated with the decades-long period of civil and military conflict preceding the 1999 armistice (the Good Friday Agreement). Unique to the Northern Ireland military operation was the initiation of Home Service battalions comprised of local recruits, a role with increased risk due to the conflict’s nature and the fact that they were serving as a military and security presence in their home region. Methods: A cross-sectional assessment of veterans living in Northern Ireland ( N = 722) provided details of service type (Home Service vs other service), current health conditions (including chronic pain), and current psychosocial functioning (including physical and mental health QoL, anxiety, depression, and post-traumatic stress disorder [PTSD] symptoms). Results: Findings indicated that those with chronic pain had worse QoL, anxiety, depression, and PTSD. Those with chronic pain were also more likely to have served in the Home Services, be unemployed, and be receiving disability payment. Contrary to hypotheses, there was no interaction between chronic pain and service type. Conclusions: These results extend previous work with veterans to the unique circumstances of a post-conflict military that engaged in operations within its own country and underscore the need for coordinated, efficacious interventions for co-morbid chronic pain and anxiety, depression, and PTSD.

Objectives: The COVID-19 pandemic has had substantial impacts for both people using pain services and healthcare professionals delivering them. While the effects on service users have been studied, less is known about the effects for service providers. This study aimed to assess the impact of the pandemic on providers and the evolving role of telemedicine in treatment.Design & Methods: An electronic survey was distributed to the professional membership of the European Pain Federation (EFIC). The survey evaluated impact and adjustment to the COVID-19 pandemic separately across two pandemic years (March 2020-February 2021 and March 2021 to February 2022) and assessed worry about COVID-19, disruption and adjustment of pain services, and use of telehealth services. The change between the first and second pandemic years and the degree to which telehealth services were adopted was evaluated.Results: From 149 respondents, 131 (88%) participants provided sufficient data to be included in the analysis. Both providers worry about the pandemic and service disruption decreased significantly from the first to the second year of the pandemic. Prior to the pandemic, only 30% of providers offered telehealth appointments but this increased to 64% and 83%, respectively, in the first and second years of the pandemic.Conclusions: Although provider worry and disruption to delivery of pain services decreased during the second year of COVID-19 pandemic, waiting times for appointments continued to lengthen. The pandemic has hastened the adoption of telemedicine in pain services and plans to continue telehealth services seem common.