This systematic review for a clinical practice guideline by the ACP summarizes evidence about the benefits and harms of nonpharmacologic therapies, including acupuncture, exercise, tai chi, yoga, m...

Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline

The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain.

Chronic pain: an update on burden, best practices, and new advances

The biopsychosocial model of pain dominates the scientific community's understanding of chronic pain. Indeed, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another. In this article, we review two categories of studies that evaluate the contributions of psychosocial factors to the experience of chronic pain. First, we consider general psychosocial variables including distress, trauma, and interpersonal factors. Additionally, we discuss pain-specific psychosocial variables including catastrophizing, expectations, and pain-related coping. Together, we present a diverse array of psychological, social, and contextual factors and highlight the need to consider their roles in the development, maintenance, and treatment of chronic pain conditions.

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Evaluating Psychosocial Contributions to Chronic Pain Outcomes

Cannabis has been used for medicinal purposes for thousands of years. The prohibition of cannabis in the middle of the 20th century has arrested cannabis research. In recent years there is a growing debate about the use of cannabis for medical purposes. The term 'medical cannabis' refers to physician-recommended use of the cannabis plant and its components, called cannabinoids, to treat disease or improve symptoms. Chronic pain is the most commonly cited reason for using medical cannabis. Cannabinoids act via cannabinoid receptors, but they also affect the activities of many other receptors, ion channels and enzymes. Preclinical studies in animals using both pharmacological and genetic approaches have increased our understanding of the mechanisms of cannabinoid-induced analgesia and provided therapeutical strategies for treating pain in humans. The mechanisms of the analgesic effect of cannabinoids include inhibition of the release of neurotransmitters and neuropeptides from presynaptic nerve endings, modulation of postsynaptic neuron excitability, activation of descending inhibitory pain pathways, and reduction of neural inflammation. Recent meta-analyses of clinical trials that have examined the use of medical cannabis in chronic pain present a moderate amount of evidence that cannabis/cannabinoids exhibit analgesic activity, especially in neuropathic pain. The main limitations of these studies are short treatment duration, small numbers of patients, heterogeneous patient populations, examination of different cannabinoids, different doses, the use of different efficacy endpoints, as well as modest observable effects. Adverse effects in the short-term medical use of cannabis are generally mild to moderate, well tolerated and transient. However, there are scant data regarding the long-term safety of medical cannabis use. Larger well-designed studies of longer duration are mandatory to determine the long-term efficacy and long-term safety of cannabis/cannabinoids and to provide definitive answers to physicians and patients regarding the risk and benefits of its use in the treatment of pain. In conclusion, the evidence from current research supports the use of medical cannabis in the treatment of chronic pain in adults. Careful follow-up and monitoring of patients using cannabis/cannabinoids are mandatory.

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Cannabinoids and Pain: New Insights From Old Molecules

Chronic pain is a significant and costly problem in the United States as well as throughout the industrialized world. Unfortunately, there have been concerns about the effectiveness of traditional medical interventions, suggesting the need for alternative chronic pain treatment strategies. However, the introduction of the biopsychosocial model of pain during the past decade stimulated the development of more therapeutically effective and cost-effective interdisciplinary chronic pain management programs. In the present article we briefly review the history of pain management, discuss the major components of a "true" interdisciplinary pain management program, focus on the evidence-based outcomes that have documented the effectiveness of such interdisciplinary pain management programs, and note the barriers that have blocked the wider use of such programs. Finally, we discuss future directions in interdisciplinary pain management.

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Interdisciplinary chronic pain management

As chronic pain contributes to tremendous personal and societal costs, efforts at identifying and understanding pain-related disability via the biopsychosocial model have become increasingly important in addressing pain-related health outcomes. This study attempted to compare the predictive ability of the Pain Disability Questionnaire against other established measures in terms of health and pain-related outcomes. The sample consisted of 254 adult chronic pain patients seeking treatment through an interdisciplinary chronic pain management clinic. Participants were administered a battery of assessments including the Pain Disability Questionnaire and other established measures of health and pain-related outcomes (e.g., NIH PROMIS measures) at baseline and post-treatment time points. Results demonstrated convergent validity between the Pain Disability Questionnaire and the other study measures. Hierarchical regression analyses revealed significant associations between pain-related disability as measured by the Pain Disability Questionnaire and a range of biopsychosocial outcomes. Pain Disability Questionnaire scores, as placed in categorical severity levels, demonstrated good discriminative abilities in terms of predicting health-related factors. These findings support the clinical use of the Pain Disability Questionnaire as an empirically supported predictor of health-related outcomes as compared with other established measures of pain and health outcomes.

Comparative Ability of the Pain Disability Questionnaire in Predicting Health Outcomes

Mo1582 PSYCHIATRIC DISEASE IS COMMON AFTER ADULT LIVER TRANSPLANTATION AND ASSOCIATED WITH SIGNIFICANT FINANCIAL BURDEN IN A LARGE U.S. NATIONAL COHORT

As the geriatric population continues to grow in the United States, explorations into understanding the role of mental health for this age group have become increasingly paramount. Many mental health problems within the geriatric population are experienced at a higher rate than adult normative samples, including certain psychiatric and neurocognitive disorders. Among these, one of the most highly prevalent psychiatric disorders experienced in older age is depression. As mental health can affect a range of different spheres including social relationships and medical outcomes, careful evaluation and treatment of psychiatric concerns and behavioral issues can help optimize factors and potentially improve quality of life. Also, recognition of the historical context of mental health concerns in the elderly is important in setting the stage for improved understanding of current mental health concerns in this population. This chapter will review a brief history of mental health with a focus on key aspects related to geriatric issues, explore some common mental health concerns experienced within elderly populations, and provide an overview of depression in the elderly. Also included is an overview of mental health treatment options and future directions for research.

Ben Lippe

Papers

Interdisciplinary chronic pain management

Comparative Ability of the Pain Disability Questionnaire in Predicting Health Outcomes

Mo1582 PSYCHIATRIC DISEASE IS COMMON AFTER ADULT LIVER TRANSPLANTATION AND ASSOCIATED WITH SIGNIFICANT FINANCIAL BURDEN IN A LARGE U.S. NATIONAL COHORT

Mental Health Disorders in Older Adult Populations