Person: Jamison, Robert
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Jamison
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Jamison, Robert
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Publication Influence of opioid-related side effects on disability, mood, and opioid misuse risk among patients with chronic pain in primary care(Wolters Kluwer, 2017) Jamison, Robert; Dorado, Kathleen; Mei, Anna; Edwards, Robert; Martel, Marc O.Abstract Background: There is increasing concern among primary care practitioners about the use of opioids for chronic pain, including their adverse effects, but little attention has been given to how reports of side effects from prescription medication can contribute to outcomes among patients with chronic pain. The aim of this study was to investigate the impact of frequently reported side effects on mood, disability, and opioid misuse in patients with chronic pain prescribed opioids within primary care. Methods: Two hundred (N = 200) patients with chronic pain taking opioids for pain were recruited into the study. All patients completed baseline measures and a monthly side effects checklist once a month for 6 months. Patients were divided evenly based on a median split of the number of endorsed side effects over 6 months. The subjects repeated the baseline measures at the end of the study period. Results: Over time, reports of medication side effects tended to decrease, but differences in frequency of reported side effects from baseline to follow-up (6-month time) were not significant, and the order of the frequency of the reported side effects remained similar. Patients who reported significant medication-related adverse effects reported significantly greater activity interference, negative affect, and catastrophizing compared with those with fewer side effects (P < 0.01). In addition, those patients with pain who reported more side effects showed significantly higher scores on opioid misuse risk (P < 0.001). Discussion: This study demonstrates the important role of monitoring medication-related side effects among patients with chronic pain who are prescribed opioid medication for pain within primary care.Publication Psychopathology predicts the outcome of medial branch blocks with corticosteroid for chronic axial low back or cervical pain: a prospective cohort study(Springer Science and Business Media LLC, 2009-02-16) Wasan, Ajay D.; Jamison, Robert; Pham, Loc; Tipirneni, Naveen; Nedeljkovic, Srdjan; Katz, JeffreyBackground: Comorbid psychopathology is an important predictor of poor outcome for many types of treatments for back or neck pain. But it is unknown if this applies to the results of medial branch blocks (MBBs) for chronic low back or neck pain, which involves injecting the medial branch of the dorsal ramus nerves that innervate the facet joints. The objective of this study was to determine whether high levels of psychopathology are predictive of pain relief after MBB injections in the lumbar or cervical spine. Methods: This was a prospective cohort study. Consecutive patients in a pain medicine practice undergoing MBBs of the lumbar or cervical facets with corticosteroids were recruited to participate. Subjects were selected for a MBB based on operationalized selection criteria and the procedure was performed in a standardized manner. Subjects completed the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression Scale (HADS) just prior to the procedure and at one-month follow up. Scores on the HADS classified the subjects into three groups based on psychiatric symptoms, which formed the primary predictor variable: Low, Moderate, or High levels of psychopathology. The primary outcome measure was the percent improvement in average daily pain rating one-month following an injection. Analysis of variance and chi-square were used to analyze the analgesia and functional rating differences between groups, and to perform a responder analysis. Results: Eighty six (86) subjects completed the study. The Low psychopathology group (n = 37) reported a mean of 23% improvement in pain at one-month while the High psychopathology group (n = 29) reported a mean worsening of -5.8% in pain (p < .001). Forty five percent (45%) of the Low group had at least 30% improvement in pain versus 10% in the High group (p < .001). Using an analysis of covariance, no baseline demographic, social, or medical variables were significant predictors of pain improvement, nor did they mitigate the effect of psychopathology on the outcome. Conclusion: Psychiatric comorbidity is associated with diminished pain relief after a MBB injection performed with steroid at one-month follow-up. These findings illustrate the importance of assessing comorbid psychopathology as part of a spine care evaluation.Publication Acute low back pain is marked by variability: An internet-based pilot study(Springer Science and Business Media LLC, 2011-10-05) Suri, Pradeep; Rainville, James; Fitzmaurice, Garrett; Katz, Jeffrey; Jamison, Robert; Martha, Julia; Hartigan, Carol; Limke, Janet; Jouve, Cristin; Hunter, DavidBackground: Pain variability in acute LBP has received limited study. The objectives of this pilot study were to characterize fluctuations in pain during acute LBP, to determine whether self-reported 'flares' of pain represent discrete periods of increased pain intensity, and to examine whether the frequency of flares was associated with back-related disability outcomes. Methods: We conducted a cohort study of acute LBP patients utilizing frequent serial assessments and Internet-based data collection. Adults with acute LBP (lasting ≤3 months) completed questionnaires at the time of seeking care, and at both 3-day and 1-week intervals, for 6 weeks. Back pain was measured using a numerical pain rating scale (NPRS), and disability was measured using the Oswestry Disability Index (ODI). A pain flare was defined as 'a period of increased pain lasting at least 2 hours, when your pain intensity is distinctly worse than it has been recently'. We used mixed-effects linear regression to model longitudinal changes in pain intensity, and multivariate linear regression to model associations between flare frequency and disability outcomes. Results: 42 of 47 participants (89%) reported pain flares, and the average number of discrete flare periods per patient was 3.5 over 6 weeks of follow-up. More than half of flares were less than 4 hours in duration, and about 75% of flares were less than one day in duration. A model with a quadratic trend for time best characterized improvements in pain. Pain decreased rapidly during the first 14 days after seeking care, and leveled off after about 28 days. Patients who reported a pain flare experienced an almost 3-point greater current NPRS than those not reporting a flare (mean difference [SD] 2.70 [0.11]; p < 0.0001). Higher flare frequency was independently associated with a higher final ODI score (ß [SE} 0.28 (0.08); p = 0.002). Conclusions: Acute LBP is characterized by variability. Patients with acute LBP report multiple distinct flares of pain, which correspond to discrete increases in pain intensity. A higher flare frequency is associated with worse disability outcomes.Publication Prevalence of chronic pain with neuropathic characteristics: a randomized telephone survey among medical center patients in Kuwait(Dove Medical Press, 2017) Zghoul, Nadia; Ross, Edgar; Edwards, Robert; Ahmed, Adel; Jamison, RobertBackground: Chronic pain with neuropathic characteristics is considered to be an international health problem. However, surveys on the actual incidence of neuropathic pain have not been conducted in many Middle East countries, including Kuwait. The aim of this study was to examine the incidence of pain and medical comorbidities among a random sample of patients treated at a large medical center in Kuwait. Methods: A list of 1,000 patients was created from the hospital medical record system, and a telephone survey was conducted on 759 patients who responded to the phone call, of which 67.2% (N=510) participated. Those who stated that they had pain every day for the past 3 months were invited to answer additional questions about their pain. Results: Fifty-six percentage of those surveyed (N=283) reported experiencing chronic pain. Total average age was 49.2 years (SD=14.5), 45.5% were female, and 70.5% were Kuwaiti nationals. Most (74.3%) reported having diabetes and one-third (32.2%) showed evidence of neuropathic pain characteristics (mean DN4=2.8, SD=1.7). Other comorbid medical conditions were prevalent (48.4% hypertension, 30.4% arthritis, 22.6% heart disease, and 20.4% asthma) with an average of 2.3 (SD=1.3) medical problems per person. Those with pain tended to be older, female, unemployed, and overweight (p<0.01). The pain was mostly located in the lower extremities and those with neuropathic pain tended to report a higher intensity of pain and a higher frequency of seeking treatment for their pain in a clinic or hospital (p<0.05). Most relied on over-the-counter medications for their pain (38.1%). Very few were taking prescription medication for their pain. Conclusion: This survey suggests that chronic pain is more prevalent in a medical population in Kuwait than previously anticipated. Health care services and behavioral interventions to improve lifestyle changes in Kuwait and other Arab countries are needed to positively impact pain and reduce other comorbidities.