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What influences chronic pain management?: A best-worst scaling experiment with final year medical students and general practitioners
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.ORCID iD: 0000-0002-2883-5603
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.ORCID iD: 0000-0002-6658-7874
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
2019 (English)In: British Journal of Pain, ISSN 2049-4637, Vol. 13, no 4, p. 214-225Article in journal (Refereed) Published
Abstract [en]

Background: Chronic pain education is an essential determinant for optimal chronic pain management. Given that attitudes and preferences are involved in making treatment decisions, identifying which factors are most influential to final year medical students’ and general practitioners’ (GPs) chronic pain management choices is of importance. This study investigates Swedish and Australian students’ preferences with respect to a chronic pain condition, using a best–worst scaling (BWS) experiment, which is designed to rank alternatives.

Methods: BWS, a stated-preference method grounded in random utility theory, was used to explore the importance of factors influencing chronic pain management.

Results: All three cohorts considered the patients’ pain description and previous treatment experience as the most important factors in making treatment decisions, whereas their demographics and voices or facial expressions while describing their pain were considered least important. Factors such as social support, patient preferences and treatment adherence were, however, disregarded by all cohorts in favour of pain assessment factors such as pain ratings, description and history. Swedish medical students and GPs show very high correlation in their choices, although the GPs consider their professional experience as more important compared to the students.

Conclusion: This study suggests that the relative importance of treatment factors is cemented early and thus underline the critical importance of improving pain curricula during undergraduate medical education.

Place, publisher, year, edition, pages
2019. Vol. 13, no 4, p. 214-225
Keywords [en]
Pain management, pain education, best-worst scaling, medical students, general practitioners
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-165668DOI: 10.1177/2049463719832331ISI: 000489776800003PubMedID: 31656627Scopus ID: 2-s2.0-85062322455OAI: oai:DiVA.org:umu-165668DiVA, id: diva2:1375778
Funder
Swedish Research Council, 12158Available from: 2019-12-06 Created: 2019-12-06 Last updated: 2023-03-24Bibliographically approved
In thesis
1. Chronic pain: from the study of student attitudes and preferences to the in vitro investigation of a novel treatment strategy
Open this publication in new window or tab >>Chronic pain: from the study of student attitudes and preferences to the in vitro investigation of a novel treatment strategy
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic pain will affect one in five adults during their lifetime, and it exerts a heavy burden on society with major physiological, psychological, social, and economic impacts. The current chronic pain curriculum taught to medical students in most settings is fragmented, inconsistent and inadequate and a vast majority of general practitioners considered their undergraduate training in chronic pain incomplete. Attitudes and beliefs amongst health care personnel are important and have shown to have impact on clinical management. There is currently a knowledge gap that needs to be addressed in this matter. In this thesis, through an online survey, the attitudes and beliefs of medical students in Sweden and Australia were surveyed. Additionally, we explored which factors influence chronic pain management amongst medical students in Sweden and Australia and Swedish general practitioners. We found that Swedish final year students have a more positive attitude towards chronic pain patients compared to Australian students. Both student cohorts perceived chronic pain management education in need of improvement. Furthermore, we found that the relative importance of factors that influence treatment decisions are formed early during undergraduate training, which further underlines the importance of improving pain curricula during undergraduate medical education in order to give the emerging workforce appropriate tools to manage chronic pain.

Management of chronic pain urgently requires novel, well-tolerated pharmacological treatment strategies. Palmitoylethanolamide (PEA) is a potential candidate for managing chronic pain. Its analgesic and anti-inflammatory effects have been observed in a range of experimental animal models and clinical trials. However, questions remain as to how PEA exerts its effects and how levels of PEA and its congeners are changed in states of pain and inflammatory disorders in humans. Treatment with PEA decreases cyclooxygenase 2 (COX-2) activity in animal models, but we found that PEA did not have direct effects upon the kinetic properties of COX-2 in a cell free system. However, COX-2 derived eicosanoid levels were reduced by PEA in lipopolysaccharide and interferon-g-stimulated RAW 264.7 cells. With respect to changes in PEA levels in a chronic inflammatory disorder, we investigated PEA levels, in addition to its synthesizing and hydrolysing enzymes in biopsies from patients with oral lichen planus (OLP). We found that the ratio of prostaglandins to PEA was increased in the OLP biopsy samples. Furthermore, PTGS2 mRNA levels (coding for COX-2) were increased in OLP-patients compared to controls relative to NAPEPLD mRNA levels (coding for a key enzyme in the synthesis of PEA). These results suggest that there is a relative deficit of PEA in OLP, raising the possibility that PEA might be useful for the treatment of this disorder.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2020. p. 96
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2085
Keywords
HC-PAIRS, best-worst scaling, palmitoylethanolamine, N-acylthanolamines, oral lichen planus, prostaglandins, chronic pain, prolonged pain, chronic pain education, chronic pain management, medical students, attitudes
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:umu:diva-173854 (URN)978-91-7855-268-9 (ISBN)978-91-7855-267-2 (ISBN)
Public defence
2020-09-11, Triple Helix, Samverkanshuset, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2020-08-21 Created: 2020-08-03 Last updated: 2020-08-10Bibliographically approved

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Rankin, LindaFowler, Christopher JohnStålnacke, Britt-Marie

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