Journal Article Annotations
2016, 2nd Quarter
Annotations by Elie Isenberg-Grzeda, MD and Sean Heffernan, MD
The finding: The authors studied a large sample and identified both risk factors (male, longer pain duration, higher anger levels, helplessness, greater pain magnification, being more depressed) and protective factors (relationship, having a medical cure for pain) for suicidal ideation.
Strengths and weaknesses: Major limitation is the use of self-administered survey rather than clinical evaluation.
Relevance: As not all of these factors are the same as suicide risks in pain-independent settings, this is a valuable read which can help clinical care, specifically safety assessment.
The finding: Mirtazapine use in patients with pain and concomitant depression resulted in a statistically significant reduction in score on the numerical rating scale for pain when compared to placebo over a 12-week period.
Strengths and weaknesses: As the gold standard in intervention studies, the RCT study design reflects methodological rigor and presumes that bias was kept at a minimum. The study’s main weakness was that it used the numerical rating scale pain score, which may not be the most relevant measure in pain studies. To their credit, they did reinforce their findings by using quality of life measures.
Relevance: Unlike TCAs, SNRIs, and antiepileptics, mirtazapine is not necessarily a “go to” pain medication, and this study may support its use in the treatment of pain, which would add yet another tool in the armamentarium of those treating chronic pain and depression.
The finding: This study examined the relationships between several common targets of CBT for chronic pain (pain catastrophizing and self-efficacy) and mindfulness-based stress reduction for pain (mindfulness and acceptance). The study found key associations between these variables at baseline. They also reported that for most of the targeted areas, both mindfulness and CBT were more effective than usual care, and neither had large or clinically significant differences.
Strengths and weaknesses: The major strength of this study is that it followed a diverse group of patients over the course of a year.
Relevance: This provides evidence of efficacy for using either of two common psychotherapeutic treatments for chronic low back pain.