ORCID Profile
0000-0001-7163-0390
Current Organisations
The University of Newcastle
,
Hunter New England Local Health District
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Publisher: Elsevier BV
Date: 12-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 1997
DOI: 10.1097/00004311-199703520-00006
Abstract: The presence of neuropathic pain in the postoperative period may be associated with unnecessary suffering, particularly if the diagnosis is not made and treatment modalities chosen are ineffective. It is likely that inadequate management of acute pain may set the scene for progression to a chronic pain state. The underlying neurobiological mechanisms whereby short-term stimuli may lead to long-term plasticity and structural changes in the nociceptive pathways are now being unraveled. The possibility arises that acute, intensive intervention may avoid or significantly reduce the development of these changes and subsequent chronic pain. Early diagnosis and treatment becomes a priority. There is a need for further research in this area to determine whether or not such theoretical potential can be turned to therapeutic advantage.
Publisher: Oxford University Press (OUP)
Date: 06-01-2016
DOI: 10.1093/PM/PNV048
Abstract: To compare the outcomes of a new group assessment format with conventional in idual assessment. A randomized controlled trial. An Australian tertiary hospital multidisciplinary pain service. Adults referred with chronic non-cancer pain. Following attendance at an education and orientation group, 211 participants were randomized to either a group assessment format (focused on supported self-assessment) or in idual assessment. Follow-up occurred 3 months post-assessment and prior to subsequent pain service intervention. Outcome measures were pain intensity, pain interference, self-efficacy, psychological distress, health care utilization beyond the pain service, waiting time, participant satisfaction, and implementation of self-management strategies. Seventy-two participants undertook group assessment and 90 were assessed in idually. Follow-up data were collected on 57 group and 72 in idual assessment participants. Results revealed no significant differences between the two assessment formats in outcome with the exception of wait-times. Median wait-time to the first offer of assessment was 47 days for the group format and 144 days for in idual. Group assessment provides a viable alternative to conventional in idual assessment. The group assessment reduced wait-times while delivering otherwise comparable outcomes.
Publisher: Wiley
Date: 04-1996
DOI: 10.1111/J.1445-2197.1996.TB01165.X
Abstract: Laparoscopic surgery has been widely embraced, often without adequate data concerning the range and incidence of complications. In the present series, our experience of complications requiring Intensive Care Unit (ICU) admission following laparoscopic surgery is described. The records of patients requiring ICU admission at John Hunter Hospital (JHH) following laparoscopic surgery over a 39 month period were retrospectively reviewed by an independent multidisciplinary panel. Twenty-three ICU admissions were identified. Twenty-one followed general surgical laparoscopic procedures and two followed gynaecological laparoscopies. Ten cases were operated on initially at JHH and 13 were transferred from other hospitals. During the study period, 2444 laparoscopic surgical cases were performed at JHH 725 general surgical procedures (1.37% admitted to ICU) and 1719 gynaecological procedures (no ICU admissions). Twelve cases suffered surgical complications (including five gastrointestinal tract perforations and three biliary tract injuries) and 11 cases were admitted for non-surgical problems. In 75% of surgical complications there was delay in diagnosis of more than 24 h. The duration of ICU stay for surgical complications (16.4 days) was significantly longer than for the non-surgical group (3.9 days). There was a greater likelihood of ICU admission following general surgical rather than gynaecological laparoscopy. Fifty-two per cent of the admissions were for surgical complications. Surgical complications are characterized by delay in diagnosis and longer ICU admission periods. Strategies to prevent some of these complications are discussed.
Publisher: Ubiquity Press, Ltd.
Date: 22-10-2020
DOI: 10.5334/IJIC.5426
Publisher: Wiley
Date: 12-04-2021
DOI: 10.5694/MJA2.51025
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.JPAIN.2022.07.008
Abstract: Over the last decade, the content, delivery and media of pain education have been adjusted in line with scientific discovery in pain and educational sciences, and in line with consumer perspectives. This paper describes a decade-long process of exploring consumer perspectives on pain science education concepts to inform clinician-derived educational updates (undertaken by the authors). Data were collected as part of a quality audit via a series of online surveys in which consent (non-specific) was obtained from consumers for their data to be used in published research. Consumers who presented for care for a persistent pain condition and were treated with a pain science education informed approach were invited to provide anonymous feedback about their current health status and pain journey experience 6, 12 or 18 months after initial assessment. Two-hundred eighteen consumers reported improvement in health status at follow-up. Results of the surveys from 3 cohorts of consumers that reported improvement were used to generate iterative versions of 'Key Learning Statements'. Early iteration of these Key Learning Statements was used to inform the development of Target Concepts and associated community-targeted pain education resources for use in public health and health professional workforce capacity building initiatives. PERSPECTIVE: This paper reflects an explicit interest in the insights of people who have been challenged by persistent pain and then recovered, to improve pain care. Identifying pain science concepts that consumers valued learning provided valuable information to inform resources for clinical interactions and community-targeted pain education c aigns.
Publisher: Wiley
Date: 12-1998
Publisher: SAGE Publications
Date: 06-04-2012
Abstract: This article reviews both traditional and emerging aspects of pain medicine within the context of a “whole-person,” lifestyle-based approach. This is consistent with contemporary systems theory formulations of chronic disease in general. A traditional approach sees ongoing pain as a fixed biological disorder and much of its management as the task of medically palliating or learning to cope. Within this framework, chronic pain has been conceptualized by some authors as a disease in its own right based on underlying alterations in nervous system processing. This explains the stronger correlation of chronic pain with neural sensitization than with structural change in bodily tissues. However, recent research findings are expanding current views of causation and management, and there is now a growing recognition that pain-related nervous system changes are potentially reversible. The so-called paradox of plasticity proposes that the same property of changeability in the nervous system that allows chronic pain to develop can also lead to its resolution. Nutrition and personal story are key aspects of an emerging whole-person approach and can be combined with traditional biomedical and cognitive behavioral interventions to enhance therapeutic gains. An interesting hypothesis deriving from recent research is that multiple unhelpful aspects of lifestyle contribute to systemic metaflammation, which in turn spills over to sensitize the nervous system and facilitate pain-related transmission. Therefore, addressing lifestyle factors therapeutically has the potential to desensitize the nervous system and reduce pain.
Publisher: SAGE Publications
Date: 06-2001
DOI: 10.1177/0310057X0102900304
Abstract: Following a standardized general anaesthetic for total abdominal hysterectomy, patients received either patient controlled analgesia (PCA) with morphine 1 mg/ml (group M, n=33) or morphine 1 mg/ml plus ketamine 2 mg/ml (group K, n=37) for 48 hours in a randomized, double-blind fashion. In 43 women the area of allodynia around the scar was mapped as a measure of the degree of central sensitization. A significant reduction in the area of allodynia was found in those receiving ketamine with morphine (42 cm 2 [interquartile range (IQR) 57] compared with 57 cm 2 [IQR 82] z=–2.0, P=0.04) in those receiving morphine alone. There were no significant differences between the two groups with respect to age, or weight, or between the subgroups within which the area of allodynia was measured with respect to length of incision. No significant differences were found between the groups with respect to pain scores, total or hourly drug consumption, patient satisfaction, nausea scores or antiemetic use. Patients in group K were more likely to require PCA for a shorter period than those in group M (median 40 hours, IQR 26 versus 48 hours IQR 7). Ten patients in group K were withdrawn because of side-effects (dysphoria n=4, nausea n=2, pruritus n=4) compared with one in group M (nausea n=1)(P=0.006). The potential usefulness of ketamine after hysterectomy was offset by a high incidence of adverse effects and a lack of opioid-sparing effects, such that combined intravenous ketamine and morphine PCA as used in this study cannot be recommended for routine care.
Publisher: Oxford University Press (OUP)
Date: 2011
DOI: 10.1111/J.1526-4637.2010.01016.X
Abstract: Two Australian public hospital multidisciplinary pain centers (MPCs) situated on opposite sides of the country. Restructuring our services to become patient-centred and patient-driven by enabling entry to our MPCs through an education portal, inclusive of both knowledge and self-management skills, and to then be free to select particular treatment options on the basis of evidence of known efficacy (risk/benefit). Group-based education to inform our patients of the current state of uncertainty that exists in Pain Medicine, both in regard to diagnostic and therapeutic practices. Using an interprofessional team approach, we aimed to present practical and evidence-based advice on techniques of pain self-management and existing traditional medical options. Early, resource efficient, group intervention provides many patients with sufficient information to make informed decisions and enables them to partner us in engaging a whole person approach to their care. We have implemented routine comprehensive audits of clinical services to better inform the planning and provision of health care across health services. System plasticity is as important to the process of integrated health care as it is to our understanding of the complexity of the lived experience of pain. Better-informed consumers partnered with responsive health professionals drive the proposed paradigm shift in service delivery. The changes better align the needs of consumers with the ability of health care providers to meet them, thus achieving the twin goals of patient empowerment and system efficiency.
Publisher: Elsevier BV
Date: 11-2002
Publisher: Oxford University Press (OUP)
Date: 12-2011
DOI: 10.1111/J.1526-4637.2011.01267.X
Abstract: The study was set in an Australian tertiary public hospital multidisciplinary pain center. The objectives of the study were to describe the conceptual shift undertaken by a multidisciplinary team in moving from a traditional approach to an emerging paradigm in pain medicine and to describe the practical application of a whole-person model of care and report outcomes over the period 2003-2010. The study design was descriptive, including a brief review of current evidence base, consideration of models of service delivery, and analysis of the impact of applying a new, whole-person model of care for persistent pain. Since 2004, a series of changes led to significant health system redesign. The process involved development of a broader, whole-person understanding of the in idual with pain and a more integrated approach to service delivery across the spectrum from community to tertiary care. Broad trends in the period 2003-2010 included a modest reduction in referral rate, marked reduction in waiting times, more efficient staff utilization, inversion of the ratio of new assessments to review appointments, increased telephone contact with primary care, increased use of personalized pain management plans, reduced procedural interventions and increased attendance at and clinically significant gains from shorter and more flexible group programs. Changes to conceptual framework inevitably influence the practicalities of service delivery. The application of a whole-person model for persistent pain brought improved engagement with the in idual in pain and more efficient delivery of care at a systems level.
Publisher: MDPI AG
Date: 08-11-2021
DOI: 10.3390/JCM10215203
Abstract: Nutrition plays an important role in pain management. Healthy eating patterns are associated with reduced systemic inflammation, as well as lower risk and severity of chronic non-cancer pain and associated comorbidities. The role of nutrition in chronic non-cancer pain management is an emerging field with increasing interest from clinicians and patients. Evidence from a number of recent systematic reviews shows that optimising diet quality and incorporating foods containing anti-inflammatory nutrients such as fruits, vegetables, long chain and monounsaturated fats, antioxidants, and fibre leads to reduction in pain severity and interference. This review describes the current state of the art and highlights why nutrition is critical within a person-centred approach to pain management. Recommendations are made to guide clinicians and highlight areas for future research.
Publisher: Wiley
Date: 07-10-2019
DOI: 10.1111/JHN.12601
Abstract: This systematic review aimed to evaluate the impact of nutrition interventions on participant reported pain severity and intensity in populations with chronic pain. Eight databases were systematically searched for studies that included adult populations with a chronic pain condition, a nutrition intervention and a measure of pain. Where possible, data were pooled using meta-analysis. Seventy-one studies were included, with 23 being eligible for meta-analysis. Studies were categorised into four groups: (i) altered overall diet with 12 of 16 studies finding a significant reduction in participant reported pain (ii) altered specific nutrients with two of five studies reporting a significant reduction in participant reported pain (iii) supplement-based interventions with 11 of 46 studies showing a significant reduction in pain and (iv) fasting therapy with one of four studies reporting a significant reduction in pain. The meta-analysis found that, overall, nutrition interventions had a significant effect on pain reduction with studies testing an altered overall diet or just one nutrient having the greatest effect. This review highlights the importance and effectiveness of nutrition interventions for people who experience chronic pain.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2019
DOI: 10.1097/PR9.0000000000000780
Abstract: To describe implementation and report preliminary outcomes of a resource-efficient, standardized group pathway for chronic noncancer pain. Descriptive cross-sectional study of a group-based pain management pathway in comparison with an Australasian benchmarking data set. An Australian tertiary multidisciplinary pain service. Patients with chronic noncancer pain actively participating in the group pathway in 2016. Referred patients were prioritized to a short-duration group–based standardized pain management pathway linking education, assessment, and treatment groups. Measures of pain, mood, self-efficacy, and catastrophizing and reduction in daily opioid use were collated from the Australasian data set. In 2016, 928 patients were actively engaged with the pain service. More patients were prioritized to receive treatment in a group format in comparison with other Australasian services (68.4% vs 22%). A greater percentage of patients attended their first clinical contact within 3 months of referral (81.4%) compared with the Australasian average (68.6%). Comparable improvements in average pain intensity, pain interference, depression, anxiety, stress, pain catastrophizing, and self-efficacy were observed. There was significantly greater reduction in opioid use, including for those taking more than 40 mg of oral morphine equivalent daily dose. Implementation of a sequence of short-duration groups as the default clinical pathway resulted in shorter waiting times and noninferior outcomes in key areas for patients completing the program, compared with Australasian averages. Given the resource efficiencies of the group process, this finding has implications for service design.
Publisher: Royal College of General Practitioners
Date: 04-04-2018
DOI: 10.3399/BJGPOPEN18X101609
Abstract: GPs are central to opioid strategy in chronic non-cancer pain (CNCP). Lack of treatment alternatives and providers are common reasons cited for not deprescribing opioids. There are limited data about availability of multidisciplinary healthcare providers (MHCPs), such as psychologists, physiotherapists, or dietitians, who can provide broader treatments. To explore availability of MHCPs, and the association with GP opioid deprescribing and transition to therapeutic alternatives for CNCP. Cross-sectional survey of all practising GPs ( N = 1480) in one mixed urban and regional Australian primary health network. A self-report mailed questionnaire assessed the availability of MHCPs and management of their most recent patient on long-term opioids for CNCP. Six hundred and eighty-one (46%) valid responses were received. Most GPs (71%) had access to a pain specialist and MHCPs within 50 km. GPs’ previous referral for specialist support was significantly associated with access to a greater number of MHCPs ( P = 0.001). Employment of a nurse increased the rate ratio of available MHCPs by 12.5% (incidence rate ratio [IRR] 1.125, 95% confidence interval [CI] = 1.001 to 1.264). Only one-third (32%) of GPs reported willingness to deprescribe and shift to broader CNCP treatments. Availability of MHCPs was not significantly associated with deprescribing decisions. Lack of geographical access to known MHCPs does not appear to be a major barrier to opioid deprescribing and shifting toward non-pharmacological treatments for CNCP. Considerable opportunity remains to encourage GPs' decision to deprescribe, with employment of a practice nurse appearing to play a role.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1999
DOI: 10.1097/00003072-199906000-00001
Abstract: Nuclear medicine techniques were used to show that the peripheral lymphatics are under autonomic control in much the same way as the blood vessels that supply the same anatomic region. Three patients with complex regional pain syndrome type 1 (reflex sympathetic dystrophy) involving a lower extremity were evaluated using three-phase bone scintigraphy and peripheral lymphoscintigraphy. Each patient was treated with ipsilateral chemical lumbar sympathectomy, and lymphoscintigraphy was repeated within several days of the procedure. All three patients had evidence of decreased flow (compared with the contralateral extremity) to normal flow after ipsilateral sympathectomy. Bone scintigraphy, before and after sympathectomy, was difficult to interpret because of the effects of altered weight bearing. Two patients who had unilateral peripheral edema showed marked improvement after sympathectomy and increased lymphatic flow. Peripheral lymphatic function is controlled by the autonomic nervous system. In reflex sympathetic dystrophy, peripheral edema may be caused by an increased sympathetic stimulus to the lymphatics. Further study of this phenomenon may show that nuclear medicine studies, such as bone scintigraphy and lymphoscintigraphy, can be used to distinguish patients who will benefit from sympathectomy from those who will not, thereby obviating invasive testing and unnecessary invasive treatment.
Publisher: Public Library of Science (PLoS)
Date: 08-11-2012
Publisher: AMPCo
Date: 22-04-2021
DOI: 10.5694/MJA2.51031
Publisher: Oxford University Press (OUP)
Date: 02-03-2021
DOI: 10.1093/TBM/IBAB007
Abstract: Guidelines for chronic noncancer pain prioritize behavioral treatments. In clinical practice transition from opioids to behavioral treatments is often not endorsed by patients or providers. Feasible interventions to support opioid tapering are needed, particularly in primary care. The objectives of this paper is to review the feasibility of behavioral interventions to support opioid tapering. Electronic databases (MEDLINE, Embase, PsycINFO, and CINAHL) were searched from inception to June 2019 to identify original studies reporting feasibility (consent rates completion rates patient-reported acceptability integration into clinical practice and adverse events) of opioid tapering and transition to behavioral treatments for adults experiencing chronic noncancer pain. Google scholar and contents tables of key journals were also searched. Two authors independently extracted data and assessed methodological quality using The Quality Assessment Tool for Quantitative Studies. Eleven publications met inclusion criteria, of which three were conducted in primary care. Consent rates ranged from 27% to 98% and completion rates from 6.6% to 100%. Four studies rated at least one component of patient acceptability: helpfulness from 50%–81% satisfaction 71%–94%, and “recommend to others” 74%–91%. Three studies reported provider perspectives and two studies reported adverse events. Quality assessment indicated all 11 studies were moderate or weak, primarily due to selection bias and lack of assessor blinding. There was also considerable heterogeneity in study design. The limited available data suggest that attempts to translate opioid tapering interventions into practice are likely to encounter substantial feasibility challenges. One possible way to ameliorate this challenge may be a clear policy context, which facilitates and support opioid reduction.
Publisher: Informa UK Limited
Date: 2019
DOI: 10.2147/JPR.S168785
Publisher: MDPI AG
Date: 16-01-2019
DOI: 10.3390/NU11010181
Abstract: The aim of this study was to examine the effect of a six-week 2 × 2 design on pain scores, quality of life, and dietary intake in patients attending an Australian tertiary pain clinic. The two intervention components were (1) personalized dietary consultations or waitlist control, and (2) active or placebo dietary supplement (fruit juice). Sixty participants were randomized into one of four groups at baseline (68% female, mean age 49 ± 15 years) with 42 completing the study (70% retention). All groups had statistically significant improvements in three of five pain outcomes. The personalized dietary consultation groups had clinically important improvements in three of five pain outcomes compared to the waitlist control groups. All groups had a statistically significant improvement in six of eight quality-of-life categories post intervention. All groups increased percentage energy from nutrient-dense foods (+5.2 ± 1.4%, p 0.001) with a significant group-by-time effect for percentage energy from total fat (p = 0.024), with the personalized dietary consultations plus placebo fruit juice reporting the largest reduction (−5.7 ± 2.3%). This study indicates that dietitian-delivered dietary intervention can improve pain scores, quality of life, and dietary intake of people experiencing chronic pain. Future research should evaluate efficacy in a full-powered randomized control trial.
Publisher: Oxford University Press (OUP)
Date: 14-08-2017
DOI: 10.1093/PM/PNW201
Abstract: Chronic pain is experienced by one in five Australians and is estimated to be the nation's third most costly health problem. In 2013, a chronic pain treatment outcomes registry was established, with the goals of evaluating treatment of chronic pain in multidisciplinary centers, establishing a benchmarking system to drive quality improvement and providing answers to important questions regarding types of treatment ("dose," intensity, and response) and which treatment is appropriate for different patients. This paper describes the development and the first-phase implementation of the registry. A minimum data set of primarily patient-rated measures was developed for use within pain management services. Governance structures and protocols for data collection were established, and software and resources created, to support pain management services. Data collection commenced in 21 centers in Australia and is being implemented in over 20 others across Australia and New Zealand within the first two years. Feedback in the initial phase has already resulted in improvements to the software and reports, as well as minor changes to the data set. Centers have submitted high-quality data describing the demographic and clinical characteristics of patients referred to specialist pain services. The electronic Persistent Pain Outcomes Collaboration has been established for Australasia and is strongly supported by specialist societies and consumer groups. The next phase will increase the proportion of follow-up data in order to realize the registry's goals of evaluation, benchmarking, and research to improve outcomes and services for patients experiencing persistent pain.
Publisher: Wiley
Date: 06-1991
DOI: 10.1111/J.1365-2044.1991.TB11710.X
Abstract: We have shown previously that high concentrations of IL-8 associated with anti-IL-8 autoantibodies (anti-IL-8:IL-8 complexes) are present in lung fluids from patients with the acute respiratory distress syndrome (ARDS), and correlate both with the development and outcome of ARDS. We also detected deposition of these complexes in lung tissues from patients with ARDS but not in control tissues. Moreover, we determined that IgG receptors (FcgammaRs) mediate activity of anti-IL-8:IL-8 complexes. In the current study, we generated anti-KC (KC = chemokine (CXC motif) ligand 1 (CXCL1)) autoantibody:KC immune complexes (KC-functional IL-8) in lungs of mice to develop a mouse model of autoimmune complex-induced lung inflammation. Both wild-type (WT) and gamma-chain-deficient mice that lack receptors for immune complexes (FcgammaRs) were studied. First, the mice were immunized with KC to induce anti-KC autoantibodies. Then, KC was administered intratracheally to generate anti-KC:KC complexes in the lung. Presence of anti-KC:KC complexes was associated with development of severe pulmonary inflammation that was, however, dramatically suppressed in gamma-chain-deficient mice. Second, because sepsis is considered the major risk factor for development of ARDS, we evaluated LPS-treated WT as well as gamma-chain-deficient mice for the presence of anti-KC:KC complexes and pulmonary inflammatory responses. We detected complexes between anti-KC autoantibodies and KC in lung lavages and tissues of mice treated with LPS. Moreover, gamma-chain-deficient mice that lack receptors for immune complexes were protected from LPS-induced pulmonary inflammation. Our results suggest that immune complexes containing autoantibodies contribute to development of lung inflammation in LPS-treated mice.
Publisher: SAGE Publications
Date: 11-07-2012
Abstract: Chronic pain has a significant economic and social impact on the community. The most common medical treatments for it include paracetamol, anti-inflammatory agents, and opioid analgesics. However, many of these medications cause side effects, and their long-term effectiveness is questionable. The traditional alternative to the biomedical approach is cognitive behavioral therapy. However, this has also been shown in recent studies to have only modest benefit. It is becoming clear that the effective management of chronic pain requires a more holistic, systems-based approach, hence the emerging interest in the relationship between pain and lifestyle. The authors aim to review the literature regarding the relationship between comprehensive lifestyle changes, markers of systemic inflammation, and the perception of chronic pain. An extensive search of bibliographic databases, including MEDLINE, PubMed, Web of Science, and Cochrane Library databases was made. A total of 2197 articles were identified using the search strategy. Only 44 articles were retrieved for critical appraisal, of which only 2 studies met the prespecified primary inclusion criteria and were included in the final review. These data provided some evidence that a single lifestyle factor (sleep restriction or disturbance) can produce elevated levels of interleukin-6, which is associated with higher pain intensity ratings. However, this review has highlighted a paucity of research based around the relationship between lifestyle, metaflammation, and chronic pain. There is a clear need for well-designed trials examining comprehensive lifestyle interventions and their effect on both pain intensity and markers of metaflammation.
Publisher: Oxford University Press (OUP)
Date: 13-03-2017
DOI: 10.1093/PM/PNX018
Abstract: Advocacy and commercially funded education successfully reduced barriers to the provision of long-term opioid analgesia. The subsequent escalation of opioid prescribing for chronic noncancer pain has seen increasing harms without improved pain outcomes. This was a one-group pretest-posttest design study. A multidisciplinary team developed a chronic pain educational package for general practitioner trainees emphasizing limitations, risk-mitigation, and deprescribing of opioids with transition to active self-care. This educational intervention incorporated prereadings, a resource kit, and a 90-minute interactional video case-based workshop incorporated into an education day. Evaluation was via pre- and postintervention (two months) questionnaires. Differences in management of two clinical vignettes were tested using McNemar's test. Of 58 eligible trainees, 47 (response rate = 81.0%) completed both questionnaires (36 of whom attended the workshop). In a primary analysis including these 47 trainees, therapeutic intentions of tapering opioid maintenance for pain (in a paper-based clinical vignette) increased from 37 (80.4%) pre-intervention to 44 (95.7%) postintervention (P = 0.039). In a sensitivity analysis including only trainees attending the workshop, 80.0% pre-intervention and 97.1% postintervention tapered opioids (P = 0.070). Anticipated initiation of any opioids for a chronic osteoarthritic knee pain clinical vignette reduced from 35 (74.5%) to 24 (51.1% P = 0.012) in the primary analysis and from 80.0% to 41.7% in the sensitivity analysis (P = 0.001). Necessary improvements in pain management and opioid harm avoidance are predicated on primary care education being of demonstrable efficacy. This brief educational intervention improved hypothetical management approaches two months subsequently. Further research measuring objective changes in physician behavior, especially opioid prescribing, is indicated.
Publisher: The Royal Australian College of General Practitioners
Date: 10-2019
Publisher: AMPCo
Date: 12-2020
DOI: 10.5694/MJA2.50881
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-11-2016
DOI: 10.1097/J.PAIN.0000000000000755
Abstract: We aimed to evaluate the effect of pain education on opioid prescribing by early-career general practitioners. A brief training workshop was delivered to general practice registrars of a single regional training provider. The workshop significantly reduced “hypothetical” opioid prescribing (in response to paper-based vignettes) in an earlier evaluation. The effect of the training on “actual” prescribing was evaluated using a nonequivalent control group design nested within the Registrar Clinical Encounters in Training (ReCEnT) cohort study: 4 other regional training providers were controls. In ReCEnT, registrars record detailed data (including prescribing) during 60 consecutive consultations, on 3 occasions. Analysis was at the level of in idual problem managed, with the primary outcome factor being prescription of an opioid analgesic and the secondary outcome being opioid initiation. Between 2010 and 2015, 168,528 problems were recorded by 849 registrars. Of these, 71% were recorded by registrars in the nontraining group. Eighty-two percentages were before training. Opioid analgesics were prescribed in 4382 (2.5%, 95% confidence interval [CI]: 2.40-2.63) problems, with 1665 of these (0.97%, 95% CI: 0.91-1.04) representing a new prescription. There was no relationship between the training and total prescribing after training (interaction odds ratio: 1.01 95% CI: 0.75-1.35 P value 0.96). There was some evidence of a reduction in initial opioid prescriptions in the training group (interaction odds ratio: 0.74 95% CI: 0.48-1.16 P value 0.19). This brief training package failed to increase overall opioid cessation. The inconsistency of these actual prescribing results with “hypothetical” prescribing behavior suggests that reducing opioid prescribing in chronic noncancer pain requires more than changing knowledge and attitudes.
Publisher: SAGE Publications
Date: 06-2004
DOI: 10.1177/0310057X0403200305
Abstract: We hypothesized that perioperative ketamine administration would modify acute central sensitization following utation and hence reduce the incidence and severity of persistent post- utation pain (both phantom limb and stump pain). In a randomized, controlled trial, 45 patients undergoing above- or below-knee utation received ketamine 0.5 mg.kg –1 or placebo as a pre-induction bolus followed by an intravenous infusion of ketamine 0.15 mg.kg –1 .h –1 or normal saline for 72 hours postoperatively. Both groups received standardized general anaesthesia followed by patient-controlled intravenous morphine. The surface area of allodynia over the stump was mapped at days 3 and 6. Post utation pain was assessed at days 3 and 6 and at 6 months postoperatively. We found no significant difference between groups in the surface area of stump allodynia or in morphine consumption. There was an unexplained, but significant, increase in the incidence of stump pain in the ketamine group at day 3. At six-month review, the incidence of phantom pain was 47% in the ketamine group and 71% in the control group. This did not reach statistical significance (P=0.28) as the power of the study was based on the search for a large treatment effect. The incidence of stump pain at six months was 47% in the ketamine group and 35% in the control group (P=0.72). There were no significant between-group differences in pain severity throughout the study period. Ketamine at the dose administered did not significantly reduce acute central sensitization or the incidence and severity of post- utation pain.
Publisher: Wiley
Date: 04-2017
DOI: 10.1111/IMJ.13394
Publisher: Informa UK Limited
Date: 09-2016
DOI: 10.2147/JPR.S115814
Publisher: MDPI AG
Date: 14-06-2017
Publisher: SAGE Publications
Date: 20-09-2023
Publisher: SAGE Publications
Date: 04-1998
DOI: 10.1177/0310057X9802600206
Abstract: A prospective survey of one thousand and sixty-two patients receiving epidural analgesia in surgical wards was undertaken over a two-year period. The duration of infusion ranged from one to fourteen days, with a mode of three days. There were 1131 episodes where a local anaesthetic and opioid mixture was used and 160 where opioids were used alone. Local anaesthetic was not used without opioids. 23% of catheters were removed prematurely because of catheter related problems including accidental dislodgement (13%) and skin site inflammation (5.3%). No epidural abscess or haematoma was identified. In 14% of the total number of episodes there was either no demonstrable block or complications occurred requiring a change of solution: 30% of this group were salvaged following intervention by the Acute Pain Service (APS). The incidence of respiratory depression was 0.24%. There was no case of delayed respiratory depression. Epidural analgesia can be used safely in surgical wards provided that regular review of the patients is undertaken. It must be anticipated however, that up to 20% of patients will not receive adequate analgesia for the first 48 hours postoperatively. The failure rate could be halved if accidental dislodgement of epidural catheters could be eliminated.
Publisher: SAGE Publications
Date: 04-1998
DOI: 10.1177/0310057X9802600203
Abstract: The use of subcutaneous tunnelling to prevent movement of epidural catheters was examined in a prospective controlled trial. There were 113 patients in the standard group and 100 in the tunnelled group. The groups were similar with respect to age, sex and weight. There were 176 thoracic catheters, and 37 lumbar catheters. Mean duration of catheterization in the tunnelled group was 3.5±1.3 days and in the standard group, 3.1±1.5 days. In total, 60 catheters moved significantly from their initial position: 17 (28%) moved inwards and 43 (72%) moved outwards. 159 catheters were still functioning at the time of their removal, 76 standard and 83 tunnelled. This represents 67 and 83% of the two groups respectively. Subcutaneous tunnelling was shown to prevent clinically significant inwards (P=0.043) and outwards (P=0.0005) movement of epidural catheters and is more likely to result in a functional epidural blockade at the time of catheter removal (P=0.0084).
Publisher: Therapeutic Guidelines Limited
Date: 06-2018
Publisher: Elsevier
Date: 2017
No related grants have been discovered for Chris Hayes.