OBJECTIVE: This manuscript reviews peer-reviewed literature published from 2010-2012 relevant to the management of chronic pain in the primary care setting. DESIGN: Narrative review of peer-reviewed literature. METHODS: We searched MEDLINE, PubMed, and reference lists and queried expert contacts for English-language studies related to the management of chronic noncancer pain in adult patients in primary care settings.
Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing
BACKGROUND: Patients with chronic pain, depression, and substance use disorder (SUD) are often treated in primary care settings. An estimated 52% of patients have a diagnosis of chronic pain, 5% to 13% have depression, and 19% have SUD. These estimates are likely low when considering the fact that 50% of primary care patients with depression and 65% with SUD are undiagnosed or do not seek help. These three conditions have overlapping neurophysiological processes, which complicate the treatment outcomes of a primary physical illness.
BACKGROUND: The health of doctors who work in primary care is threatened by workforce and workload issues. There is a need to find and appraise ways in which to protect their mental health, including how to achieve the broader, positive outcome of well-being. Our primary outcome was to evaluate systematically the research evidence regarding the effectiveness of interventions designed to improve General Practitioner (GP) well-being across two continua; psychopathology (mental ill-health focus) and 'languishing to flourishing' (positive mental health focus).
Research has consistently demonstrated a link between the experience of adverse childhood experiences (ACEs) and adult health conditions, including mental and physical health problems. While a focus on the prevention or mitigation of adversity in childhood is an important direction of many programs, many individuals do not access support services until adulthood, when health problems may be fairly engrained. It is not clear which interventions have the strongest evidence base to support the many adults who present to services with a history of ACEs.
INTRODUCTION: Chronic non-cancer pain (CNCP) affects up to 50% of the world's population. It impacts negatively on quality of life; entailing high costs on our medical systems, and translates to economic burden due to work loss. Aetiology of CNCP is complex and multifactorial, embracing the somatosensory, cognitive and affective domains. Opioid analgesia and other invasive interventions are often inadequate for clinical management of CNCP. Recently, mindfulness-based stress reduction (MBSR) has become a popular therapy for various medical conditions, including CNCP.
PURPOSE: Positive effects have been reported after mindfulness-based interventions (MBIs) in diverse clinical and nonclinical populations. Primary care is a key health care setting for addressing common chronic conditions, and an effective MBI designed for this setting could benefit countless people worldwide. Meta-analyses of MBIs have become popular, but little is known about their efficacy in primary care. Our aim was to investigate the application and efficacy of MBIs that address primary care patients.
Acupuncture in Medicine: Journal of the British Medical Acupuncture Society
AIMS: To analyse the cost effectiveness of using the moxibustion technique to correct non-vertex presentation and to reduce the number of caesarean sections performed at term. METHOD: A deterministic model of decision analysis has been developed to analyse the cost of treatment in which heat is applied by moxibustion (the combustion of Artemisia vulgaris) at acupuncture point BL67 for pregnant women with non-vertex fetal position at 33-35?weeks' gestation. This approach was compared with conventional treatment recommendations based on the knee-chest posture technique.
BACKGROUND: The relationship between perinatal psychiatric disorders and the use of effective contraceptive methods among postpartum women served by primary care clinics has not been established. STUDY DESIGN: This was a prospective cohort study with 831 pregnant women recruited from 10 primary care clinics of the public sector in S„o Paulo followed up to 18 months after delivery. RESULTS: Among 701 postpartum women, 644 women (91.8%) had resumed sexual activity. Two hundred fifty-three women (39.2%) were classified as using a less effective contraception method (LECM).
OBJECTIVES: (1) To ascertain from patients what really matters to them on a personal level of such high importance that it should 'always happen' when they interact with healthcare professionals and staff groups. (2) To critically review existing criteria for selecting 'always events' (AEs) and generate a candidate list of AE examples based on the patient feedback data. DESIGN: Mixed methods study informed by participatory design principles. SUBJECTS AND SETTING: Convenience samples of patients with a long-term clinical condition in Scottish general practices.
INTRODUCTION: The home-based Otago Exercise Programme has been shown to increase sustained physical-activity levels in older people recruited through primary care, when supported by health professionals. The ProAct65+ trial is testing this programme using volunteer peer mentors to support behaviour change. This qualitative study explored how these peer mentors experienced their role. METHODS: Ten peer mentors from the ProAct65+ trial were interviewed. Semi-structured interviews were audio-recorded, transcribed verbatim and thematically analysed.