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  1. Article ; Online: An Examination of Day-to-Day and Intraindividual Pain Variability in Low Back Pain.

    Wesolowicz, Danielle M / Bishop, Mark D / Robinson, Michael E

    Pain medicine (Malden, Mass.)

    2021  Volume 22, Issue 10, Page(s) 2263–2275

    Abstract: Objective: This study aimed to capture day-to-day changes in pain intensity in individuals with low back pain (LBP), which may be indicative of patients' ability to modulate their pain levels. A secondary aim was to explore the presence of latent ... ...

    Abstract Objective: This study aimed to capture day-to-day changes in pain intensity in individuals with low back pain (LBP), which may be indicative of patients' ability to modulate their pain levels. A secondary aim was to explore the presence of latent subgroups characterized by pain level, intraindividual pain variability, and change in pain over a 14-day period.
    Subjects: Participants were 54 adults with self-reported LBP recruited from outpatient physical therapy clinics and the community.
    Methods: Over the course of 14 days, participants completed daily measures of pain intensity, catastrophizing, pain self-efficacy, and negative affect. Change in pain intensity as well as total amount of intraindividual pain variability were also calculated.
    Results: Daily increases in maladaptive coping and affective responses (i.e., higher catastrophizing, higher negative affect, lower pain self-efficacy) were associated with increases in pain intensity. A hierarchical cluster analysis revealed three subgroups: 1) moderate pain intensity, moderate pain variability, increase in pain over time; 2) low pain intensity, low pain variability, no change in pain over time; and 3) moderate pain intensity, high pain variability, decrease in pain over time. Cluster 2 demonstrated more adaptive coping and affective responses at baseline and during the 14-day period, and clusters 1 and 3 did not differ in their coping or affective responses.
    Conclusions: These findings provide support that day-to-day changes in pain, coping, and affective responses are meaningful and provide additional evidence of pain variability as a potential phenotypic characteristic.
    MeSH term(s) Adaptation, Psychological ; Adult ; Catastrophization ; Humans ; Low Back Pain ; Pain Measurement ; Self Report
    Language English
    Publishing date 2021-04-05
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2015903-1
    ISSN 1526-4637 ; 1526-2375
    ISSN (online) 1526-4637
    ISSN 1526-2375
    DOI 10.1093/pm/pnab119
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  2. Article ; Online: Pain Care at Home to Amplify Function: Protocol Article.

    Black, Anne C / Edmond, Sara N / Frank, Joseph W / Abelleira, Audrey / Snow, Jennifer L / Wesolowicz, Danielle M / Becker, William C

    Substance use & addiction journal

    2024  , Page(s) 29767342241236032

    Abstract: Guidelines recommend strategies to optimize opioid medication safety, including frequent reassessment of the benefits and harms of long-term opioid therapy. Prescribers, who are predominantly primary care providers (PCPs), may lack the training or ... ...

    Abstract Guidelines recommend strategies to optimize opioid medication safety, including frequent reassessment of the benefits and harms of long-term opioid therapy. Prescribers, who are predominantly primary care providers (PCPs), may lack the training or resources to implement these guideline-concordant practices. Two interventions have been designed to assist PCPs and tested within the Veterans Health Administration (VHA). Telemedicine Collaborative Management (TCM) provides primarily medication management support via care manager-prescriber teams. Cooperative Pain Education and Self-Management (COPES) promotes self-management strategies for chronic pain via cognitive behavior therapy techniques. Each intervention has been shown to improve prescribing and/or patient outcomes. The added value of combining these interventions is untested. With funding and central coordination by the Integrative Management of Chronic Pain and Opioid Use Disorder for Whole Recovery (IMPOWR) Network of the National Institutes of Health Helping to End Addiction Long-term (HEAL) Initiative, we will conduct a multisite patient-level randomized hybrid II effectiveness-implementation trial within VHA to compare TCM to TCM + COPES on the primary composite outcome of pain interference and opioid safety, secondary outcomes of alcohol use, anxiety, depression, and sleep, and other consensus IMPOWR Network measures. Implementation facilitation strategies informed by interviews with healthcare providers will target site-specific needs. The impact of these strategies on TCM implementation will be assessed via established formative and summative evaluation techniques. Economic analyses will evaluate intervention cost-effectiveness.
    Language English
    Publishing date 2024-03-12
    Publishing country United States
    Document type Journal Article
    ISSN 2976-7350
    ISSN (online) 2976-7350
    DOI 10.1177/29767342241236032
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  3. Article ; Online: Increasing buprenorphine access for patients with chronic pain: a quality improvement initiative.

    Wesolowicz, Danielle M / Spelman, Juliette F / Edmond, Sara N / Schwartz, Amy R / Kravetz, Jeffrey D / Edens, Ellen L / Becker, William C

    Pain medicine (Malden, Mass.)

    2023  Volume 25, Issue 3, Page(s) 226–230

    Abstract: Objective: Buprenorphine is effective for chronic pain and safer than full-agonist opioids; however, limited education about and support for buprenorphine can result in under-prescribing in primary care and reduced access in specialty pain clinics. The ... ...

    Abstract Objective: Buprenorphine is effective for chronic pain and safer than full-agonist opioids; however, limited education about and support for buprenorphine can result in under-prescribing in primary care and reduced access in specialty pain clinics. The purpose of this quality improvement initiative was to optimize and evaluate procedures for transferring patients stable on buprenorphine for chronic pain from a specialty pain clinic back to primary care.
    Setting: Eight primary care clinics within a Veterans Health Administration health care system.
    Methods: A standard operating procedure for facilitated transfer of prescribing was developed after a needs assessment and was introduced during an educational session with primary care providers, and providers completed a survey assessing attitudes about buprenorphine prescribing. Success of the initiative was measured through the number of patients transferred back to primary care over the course of 18 months.
    Results: Survey results indicated that primary care providers with previous experience prescribing buprenorphine were more likely to view buprenorphine prescribing for pain as within the scope of their practice and to endorse feeling comfortable managing a buprenorphine regimen. Providers identified systemic and educational barriers to prescribing, and they identified ongoing support from specialty pain care and primary care as a facilitator of prescribing. Metrics suggested that the standard operating procedure was generally successful in transferring and retaining eligible patients in primary care.
    Conclusion: This quality improvement initiative suggests that a facilitated transfer procedure can be useful in increasing buprenorphine prescribing for pain in primary care. Future efforts to increase primary care provider comfort and address systemic barriers to buprenorphine prescribing are needed.
    MeSH term(s) Humans ; Chronic Pain/drug therapy ; Buprenorphine/therapeutic use ; Quality Improvement ; Analgesics, Opioid/therapeutic use ; Educational Status
    Chemical Substances Buprenorphine (40D3SCR4GZ) ; Analgesics, Opioid
    Language English
    Publishing date 2023-10-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2015903-1
    ISSN 1526-4637 ; 1526-2375
    ISSN (online) 1526-4637
    ISSN 1526-2375
    DOI 10.1093/pm/pnad140
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 6119: Show issues Location:
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  4. Article ; Online: Qualitative Analysis of Patient Perspectives of Buprenorphine After Transitioning From Long-Term, Full-Agonist Opioid Therapy Among Veterans With Chronic Pain.

    Edmond, Sara N / Wesolowicz, Danielle M / Snow, Jennifer L / Currie, Sophia / Jankelovits, Amanda / Chhabra, Manik S / Becker, William C

    The journal of pain

    2023  Volume 25, Issue 1, Page(s) 132–141

    Abstract: Guidelines recommend consideration of modification, tapering, or discontinuation of long-term, full-agonist opioid therapy when harms outweigh benefits; one alternative to tapering or discontinuing full-agonist opioids for the management of chronic pain ... ...

    Abstract Guidelines recommend consideration of modification, tapering, or discontinuation of long-term, full-agonist opioid therapy when harms outweigh benefits; one alternative to tapering or discontinuing full-agonist opioids for the management of chronic pain is switching to the partial agonist buprenorphine. As the use of buprenorphine for pain expands, understanding the patient experience during and after the transition to buprenorphine is critical. We conducted 45- to 60-minute semistructured qualitative interviews with 19 patients to understand the experiences of patients with chronic pain actively maintained on buprenorphine after previously receiving full-agonist, long-term opioid therapy. Patients were recruited from 2 medical centers via provider referral. Through thematic analysis, 5 overall themes were identified, including satisfaction with buprenorphine, the importance of preconceptions about buprenorphine, experiences with transitions, patient-provider communication, and potential contributions to racial disparities in pain care. While we heard a range of experiences, most patients were satisfied with buprenorphine, reporting either equivalent pain control to their previous regimens or reporting less analgesia but improved functioning due to a reduction in side effects (eg, mental clarity). Patients also emphasized the importance of a nonjudgmental, patient-centered approach, including education about the risks and benefits of buprenorphine. The few Black patients interviewed all reported limited access to pain care, which is consistent with the well-documented existence of racial disparities in access to pain treatment. As buprenorphine is used more frequently for pain management, provider education focused on pain treatment disparities, patient-centered approaches informed by motivational interviewing, and increasing acceptance of buprenorphine as an option for pain are needed. PERSPECTIVE: Qualitative analyses of patient experiences transitioning from full-agonist opioids to buprenorphine for chronic pain revealed general satisfaction. Patients reflected on functioning, tradeoffs between analgesia and side effects, patient-centered care, and access to treatment, highlighting how future research should focus on outcomes valued by patients.
    MeSH term(s) Humans ; Analgesics, Opioid ; Buprenorphine/therapeutic use ; Chronic Pain/drug therapy ; Chronic Pain/chemically induced ; Veterans ; Opiate Substitution Treatment ; Opioid-Related Disorders/drug therapy
    Chemical Substances Analgesics, Opioid ; Buprenorphine (40D3SCR4GZ)
    Language English
    Publishing date 2023-08-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2018789-0
    ISSN 1528-8447 ; 1526-5900
    ISSN (online) 1528-8447
    ISSN 1526-5900
    DOI 10.1016/j.jpain.2023.07.027
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5237: Show issues Location:
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  5. Article ; Online: Opioid tapering support using a web-based app: Development and protocol for a pilot randomized controlled trial.

    Edmond, Sara N / Wesolowicz, Danielle M / Moore, Brent A / Ibarra, Jennifer / Chhabra, Manik / Fraenkel, Liana / Becker, William C

    Contemporary clinical trials

    2022  Volume 119, Page(s) 106857

    Abstract: Background: Given limited efficacy and potential harms of long-term opioid therapy, it is patient-centered and guideline-concordant to offer patients the opportunity to engage in a supportive, patient-centered tapering program. The goal of this study ... ...

    Abstract Background: Given limited efficacy and potential harms of long-term opioid therapy, it is patient-centered and guideline-concordant to offer patients the opportunity to engage in a supportive, patient-centered tapering program. The goal of this study was to develop and pilot an interactive web-based program designed to support patients willing to consider an opioid taper; this manuscript describes the development and the protocol for a pilot randomized trial of Summit.
    Methods: We used intervention mapping to develop the Summit program; during the development period we engaged multiple stakeholder groups and conducted usability testing to refine the interactive, theory-informed, multi-component mobile website program which includes education, video testimonials, self-management skills, and access to a peer specialist. We will evaluate the Summit program in a two-arm, 9 month randomized-controlled trial where 64 individuals will be assigned either to the Summit program or to a control group (pain tracking app). As a pilot trial, the primary outcomes are feasibility and acceptability; we will also measure patient-reported outcomes related to pain, quality of life, and opioid use.
    Implications: We developed an interactive program; results of the pilot trial are pending. If shown to be effective, Summit would be useful both in augmenting care for patients who are engaged in a taper with primary care.
    MeSH term(s) Analgesics, Opioid ; Humans ; Internet ; Mobile Applications ; Pain ; Pilot Projects ; Quality of Life ; Randomized Controlled Trials as Topic
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2022-07-18
    Publishing country United States
    Document type Clinical Trial Protocol ; Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2182176-8
    ISSN 1559-2030 ; 1551-7144
    ISSN (online) 1559-2030
    ISSN 1551-7144
    DOI 10.1016/j.cct.2022.106857
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    Zs.A 1581: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  6. Article ; Online: Video-telecare collaborative pain management during COVID-19: a single-arm feasibility study.

    Rogers, Daniel G / Frank, Joseph W / Wesolowicz, Danielle M / Nolan, Charlotte / Schroeder, Allison / Falker, Caroline / Abelleira, Audrey / Moore, Brent A / Becker, William C / Edmond, Sara N

    BMC primary care

    2023  Volume 24, Issue 1, Page(s) 134

    Abstract: Background: Chronic pain is among the most common conditions presenting to primary care and guideline-based care faces several challenges. A novel pain management program, Video-Telecare Collaborative Pain Management (VCPM), was established to support ... ...

    Abstract Background: Chronic pain is among the most common conditions presenting to primary care and guideline-based care faces several challenges. A novel pain management program, Video-Telecare Collaborative Pain Management (VCPM), was established to support primary care providers and meet new challenges to care presented by the COVID-19 pandemic.
    Methods: The present single-arm feasibility study aimed to evaluate the feasibility and acceptability of VCPM and its components among U.S. veterans on long-term opioid therapy for chronic pain at ≥ 50 mg morphine equivalent daily dose (MEDD). VCPM consists of evidence-based interventions, including opioid reassessment and tapering, rotation to buprenorphine and monitoring, and encouraging behavioral pain and opioid-use disorder self-management.
    Results: Of the 133 patients outreached for VPCM, 44 completed an initial intake (33%) and 19 attended multiple VCPM appointments (14%). Patients were generally satisfied with VCPM, virtual modalities, and provider interactions. Nearly all patients who attended multiple appointments maintained a buprenorphine switch or tapered opioids (16/19; 84%), and buprenorphine switches were generally reported as acceptable by patients. Patients completing an initial intake with VCPM had reduced morphine equivalent daily dose after three months (means = 109 mg MEDD vs 78 mg), with greater reductions among those who attended multiple appointments compared to intake only (Δ
    Conclusion: Pre-defined feasibility and acceptability targets for VCPM and its components were broadly met, and preliminary data are encouraging. Novel strategies to improve enrollment and engagement and future directions are discussed.
    MeSH term(s) Humans ; Pain Management ; Analgesics, Opioid/therapeutic use ; COVID-19 ; Chronic Pain/drug therapy ; Feasibility Studies ; Pandemics ; Morphine ; Buprenorphine/therapeutic use
    Chemical Substances Analgesics, Opioid ; Morphine (76I7G6D29C) ; Buprenorphine (40D3SCR4GZ)
    Language English
    Publishing date 2023-06-29
    Publishing country England
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ISSN 2731-4553
    ISSN (online) 2731-4553
    DOI 10.1186/s12875-023-02052-2
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  7. Article: The roles of gender and profession on gender role expectations of pain in health care professionals.

    Wesolowicz, Danielle M / Clark, Jaylyn F / Boissoneault, Jeff / Robinson, Michael E

    Journal of pain research

    2018  Volume 11, Page(s) 1121–1128

    Abstract: Introduction: Gender-related stereotypes of pain may account for some assessment and treatment disparities among patients. Among health care providers, demographic factors including gender and profession may influence the use of gender cues in pain ... ...

    Abstract Introduction: Gender-related stereotypes of pain may account for some assessment and treatment disparities among patients. Among health care providers, demographic factors including gender and profession may influence the use of gender cues in pain management decision-making. The Gender Role Expectations of Pain Questionnaire was developed to assess gender-related stereotypic attributions of pain regarding sensitivity, endurance, and willingness to report pain, and has not yet been used in a sample of health care providers. The purpose of this study was to examine the presence of gender role expectation of pain among health care providers. It was hypothesized that health care providers of both genders would endorse gender stereotypic views of pain and physicians would be more likely than dentists to endorse these views.
    Methods: One-hundred and sixty-nine providers (89 dentists, 80 physicians; 40% women) were recruited as part of a larger study examining providers' use of demographic cues in making pain management decisions. Participants completed the Gender Role Expectations of Pain Questionnaire to assess the participant's views of gender differences in pain sensitivity, pain endurance, and willingness to report pain.
    Results: Results of repeated measures analysis of variance revealed that health care providers of both genders endorsed stereotypic views of pain regarding willingness to report pain (
    Conclusion: These findings affirm the presence of some gender-related stereotypic views among health care providers and suggest the presence of a view among health care providers that men are underreporting their pain in comparison to women. Future work can refine the effects of social learning history and other psychosocial factors that contribute to gender and provider differences in pain management decisions.
    Language English
    Publishing date 2018-06-15
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2495284-9
    ISSN 1178-7090
    ISSN 1178-7090
    DOI 10.2147/JPR.S162123
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