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      Chronic Pain, Mood Disorders and Substance Use: Outcomes of Interdisciplinary Care in a Residential Psychiatric Hospital

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          Abstract

          Purpose

          The objective is to report outcomes of an interdisciplinary group-based residential chronic pain recovery program (CPRC), located in a private non-profit psychiatric hospital. The chronic pain program was aimed at treatment and engagement in self-care of both pain and co-occurring disorders in a residential facility that also offered treatment for specific psychiatric disorders.

          Patients and Methods

          A retrospective chart review was conducted that included a convenience sample of 131 patients admitted from March 2012 through August 2017 who completed treatment. An interdisciplinary team of professionals provided psycho-behavioral therapy, movement therapies and medication management. Patients completed a battery of psycho-social and demographic questionnaires on admission and before discharge of the program.

          Results

          Significant differences were noted in pain severity, pain interference, depression and anxiety (p<.01) between admission and discharge, and the Chronic Pain Coping Inventory demonstrated significant differences in guarding (p <.001), asking (p =.018), exercise (p <.001), relaxation (p <.001), and pacing (p=.024). Of patients using opioids on admission, at discharge, 37% had tapered and remained off all opioids, 43% were using buprenorphine for opioid use disorder, and 20% continued on analgesic opioids.

          Conclusion

          Treatment was associated with reductions in pain severity and interference, in anxiety and in depression as well as improvements in pain coping. Additionally, there was a reduction in reliance on opioids for pain relief.

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          Most cited references 29

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          Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art.

          The purpose of this article is to describe the current state-of-the-art regarding the co-occurrence of the anxiety disorders and chronic pain. First, we describe the core characteristics of chronic pain and its co-occurrence with the anxiety disorders. Second, we review data on the prevalence of co-occurrence. Third, we describe the mutual maintenance and shared vulnerability models, both of which have been offered to explain the co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain and may have applicability to various other anxiety disorders. Fourth, we provide an integrative review of available research addressing the postulates of these models specific to the mechanisms of anxiety sensitivity, selective attention to threat, and reduced threshold for alarm. We conclude with general recommendations for improving assessment and treatment of patients who present with an anxiety disorder accompanied by clinically significant pain. Given that most of the available evidence has come from studies of PTSD and chronic pain, we provide a detailed agenda for future investigation of the co-occurrence of chronic pain and other anxiety disorders.
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            Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis

            Background Chronic pain patients increasingly seek treatment through mindfulness meditation. Purpose This study aims to synthesize evidence on efficacy and safety of mindfulness meditation interventions for the treatment of chronic pain in adults. Method We conducted a systematic review on randomized controlled trials (RCTs) with meta-analyses using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the GRADE approach. Outcomes included pain, depression, quality of life, and analgesic use. Results Thirty-eight RCTs met inclusion criteria; seven reported on safety. We found low-quality evidence that mindfulness meditation is associated with a small decrease in pain compared with all types of controls in 30 RCTs. Statistically significant effects were also found for depression symptoms and quality of life. Conclusions While mindfulness meditation improves pain and depression symptoms and quality of life, additional well-designed, rigorous, and large-scale RCTs are needed to decisively provide estimates of the efficacy of mindfulness meditation for chronic pain. Electronic supplementary material The online version of this article (doi:10.1007/s12160-016-9844-2) contains supplementary material, which is available to authorized users.
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              A methodology for conducting retrospective chart review research in child and adolescent psychiatry.

              Retrospective research has become largely undervalued and underutilized in child and adolescent psychiatry with the increasing singular focus on randomized control trials, despite the wealth of clinically relevant data available in historical medical records. In this paper a systematic and scientific approach to chart review research methodology for psychiatry is described. Informed by available literature, a methodological stepwise approach for retrospective chart review was developed. A nine step method aimed at maximizing benefits and minimizing limitations is discussed. Retrospective chart review is an important methodology with distinct advantages and has the potential to provide psychiatry with valuable research opportunities. This method of study should not be lost in the field of psychiatry.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                24 June 2020
                2020
                : 13
                : 1515-1523
                Affiliations
                [1 ]Department of Psychiatry, Yale School of Medicine , New Haven, CT, USA
                [2 ]Department of Anesthesiology, Geisel School of Medicine at Dartmouth , Hanover, NH, USA
                [3 ]Silver Hill Hospital , New Canaan, CT, USA
                [4 ]Yale Child Study Center, Yale University School of Medicine, Yale University , New Haven, CT, USA
                Author notes
                Correspondence: Frank D Buono Tel + 1-203-9372309 *118Fax + 1-203-6040542 Email frank.buono@yale.edu
                Article
                250568
                10.2147/JPR.S250568
                7322115
                © 2020 Buono et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Tables: 3, References: 42, Pages: 9
                Categories
                Original Research

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