{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:05:31Z","timestamp":1753877131892,"version":"3.41.2"},"reference-count":68,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T00:00:00Z","timestamp":1706140800000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Pain flares have a substantive impact on the quality of life and well-being of patients with cancer. We identified longitudinal trajectories (clusters) of cancer pain flares in ambulatory patients and sociodemographic and clinical predictors of these trajectories.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In a prospective cohort study using ecological momentary assessment (mEMA), we collected patient-reported daily pain flare ratings data over 5\u2009months and identified predictors and correlates using validated measures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The mean age of the sample (N\u2009=\u2009270) was 60.9\u2009years (SD\u2009=\u200911.2), 64.8% were female, and 32.6% self-identified as African American. Four pain flare clusters were identified. The \u201chigh-occurrence\u201d cluster (23% of patients) experienced 5.5 (SD = 5.47) daily flares, whereas low-moderate clusters (77%) reported 2.4 (SD = 2.74) daily flares (P\u2009&amp;lt;\u2009.000). Those in the high-occurrence cluster reported higher pain scores (P\u2009=\u2009.000), increased pain-related interference (P\u2009=\u2009.000), depressive symptoms (P\u2009=\u2009.023), lower quality of life (P\u2009=\u2009.001), and reduced pain self-efficacy (P\u2009=\u2009.006). Notably, 67.2% of those prescribed opioids as needed (PRN only) were in the high-occurrence pain flare cluster, compared with 27.9% with PRN and around-the-clock opioid prescriptions (P\u2009=\u2009.024). Individual predictors of high-occurrence pain flares were income below $30\u200a000, unemployment, being African American, lower education level, Medicaid insurance, current opioid misuse (COMM), baseline inpatient hospital stay duration, and PRN-only opioid regimen. In the multiple predictor model, lower education level, unemployment, COMM score, extended inpatient duration, and PRN-only opioid regimen remained significant.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In ambulatory patients with cancer, high occurrence of pain flares may be mitigated by attention to opioid prescription factors and addressing social determinants of health needs of underserved patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jncics\/pkae003","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T08:39:49Z","timestamp":1706171989000},"source":"Crossref","is-referenced-by-count":0,"title":["Trajectories and predictors of high-occurrence pain flares in ambulatory cancer patients on opioids"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5866-8279","authenticated-orcid":false,"given":"Salimah H","family":"Meghani","sequence":"first","affiliation":[{"name":"Department of Biobehavioral Health Sciences; NewCourtland Center for Transitions and Health, University of Pennsylvania , Philadelphia, PA, USA"},{"name":"Abramson Cancer Center, University of Pennsylvania , Philadelphia, PA, USA"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Quinn","sequence":"additional","affiliation":[{"name":"Department of Biobehavioral Health Sciences; NewCourtland Center for Transitions and Health, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Biobehavioral Health Sciences; NewCourtland Center for Transitions and Health, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesse","family":"Chittams","sequence":"additional","affiliation":[{"name":"Department of Biobehavioral Health Sciences; NewCourtland Center for Transitions and Health, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neha","family":"Vapiwala","sequence":"additional","affiliation":[{"name":"Abramson Cancer Center, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Naylor","sequence":"additional","affiliation":[{"name":"Department of Biobehavioral Health Sciences; NewCourtland Center for Transitions and Health, University of Pennsylvania , Philadelphia, PA, USA"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6793-6474","authenticated-orcid":false,"given":"Martin","family":"Cheatle","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George J","family":"Knafl","sequence":"additional","affiliation":[{"name":"School of Nursing, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"issue":"3","key":"2024022110311806000_pkae003-B1","doi-asserted-by":"crossref","DOI":"10.3390\/cancers15030591","article-title":"Update on prevalence of pain in patients with cancer 2022: a systematic literature review and meta-analysis","volume":"15","author":"Snijders","year":"2023","journal-title":"Cancers (Basel)"},{"issue":"6","key":"2024022110311806000_pkae003-B2","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1016\/j.jpainsymman.2015.12.340","article-title":"Update on prevalence of pain in patients with cancer: systematic review and meta-analysis","volume":"51","author":"van den Beuken-van Everdingen","year":"2016","journal-title":"J Pain Symptom Manage"},{"issue":"6","key":"2024022110311806000_pkae003-B3","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/j.jpainsymman.2015.12.329","article-title":"From \u201cbreakthrough\u201d to \u201cepisodic\u201d cancer pain? 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