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Mihlberg E, Arnbak BAM. Prognostic factors for long-term improvement in pain and disability among patients with persistent low back pain. Chiropr Man Therap 2024; 32:26. [PMID: 38918850 PMCID: PMC11202371 DOI: 10.1186/s12998-024-00546-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Prognostic research in low back pain (LBP) is essential for understanding and managing the condition. This study aimed to, (1) describe the proportions with mild-moderate and severe pain and disability at baseline, 1-year and 4-year follow-up, and (2) investigate prognostic factors for improvement in pain and disability over 4 years in a cohort of secondary care LBP patients. METHODS This was a secondary analysis of a cohort of patients with LBP aged 18-40 years recruited from a non-surgical outpatient spine clinic between March 2011 and October 2013 (n = 1037). Questionnaires were collected at baseline, 1-year, and 4-year follow-up. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ 0-100) and pain intensity using the Numeric Rating Scale (NRS 0-10). 'Mild-moderate pain' was defined as NRS < 7 and 'severe pain' as NRS ≥ 7. Likewise, 'mild-moderate disability' was defined as RMDQ < 58.3, and 'severe disability' was RMDQ ≥ 58.3. In the prognostic analysis, improvement in pain and disability over 4 years was defined as meeting both criteria: decrease of ≥ 2 on the NRS and of ≥ 20.8 on the RMDQ. Sixteen candidate prognostic factors were assessed by multivariate logistic regression. RESULTS Among patients with information available at all three time points (n = 241), 54%/48% had persistent mild-moderate pain/disability, while only 7%/15% had persistent severe pain/disability. Of patients included in the multivariate prognostic analysis regarding improvement over 4 years (n = 498), 32% had improved in pain and disability after 4 years. Positive associations were found for pain intensity (OR 1.34 [95%CI: 1.17-1.54]), disability (OR 1.01 [1.00-1.02]), and regular employment or studying (OR 1.67 [1.06-2.64]), and negative associations for episode duration (OR 0.99 [0.99-1.00]) and risk of persistent pain (OR 0.58 [0.38-0.88]). CONCLUSION Patients with persistent LBP in secondary care had mostly mild-moderate pain and disability consistently at all three time points, with few having consistently severe symptoms over 4 years. Moreover, approximately half of the included patients improved in pain and disability. We found that pain intensity, disability, episode duration, regular employment or studying, and risk of persistent pain predicted a long-term improvement. However, the limited availability of complete follow-up data may affect generalisability.
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Affiliation(s)
- Elin Mihlberg
- Center of Muscle and Joint health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, DK-5230, Denmark
| | - Bodil Al-Mashhadi Arnbak
- Center of Muscle and Joint health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, DK-5230, Denmark.
- Department of Radiology, Hospital Lillebaelt, Beriderbakken 4, Vejle, DK-7100, Denmark.
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Krypotos AM, Sjouwerman R, Teppers M, Vlaeyen JWS. Pavlovian-to-instrumental transfer in individuals with chronic pain. Behav Res Ther 2024; 176:104491. [PMID: 38452688 DOI: 10.1016/j.brat.2024.104491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 03/09/2024]
Abstract
Avoidance of pain has been argued to be key factor leading pain events to chronic disability. In this respect, research has focused on investigating the working mechanisms of avoidance's acquisition. Avoidance of painful stimuli has been traditionally studied using a combination of Pavlovian and Instrumental procedures. However, such approach seems to go against real-life scenarios where avoidance is commonly acquired more readily. Using a novel pain avoidance paradigm, we tested whether pain avoidance can be installed in absence of associations between a cue and pain omission, and whether such avoidance differs between pain patients and healthy controls. Participants first learned to avoid painful stimuli by pressing a grip bar. Then, they passively encountered pairings of one geometrical shape with pain and of another geometrical shape without pain. Lastly, participants encountered the geometrical shapes while being able to use the grip bar. Results showed that participants pressed the bar more vigorously when encountering the previously pain-related shape compared to the pain-unrelated shape. This effect did not seem to differ between pain patients and healthy control. Our study could inspire a new way in measuring avoidance in pain, possibly paving the way to better understanding how avoidance is installed in chronic pain.
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Affiliation(s)
- Angelos-Miltiadis Krypotos
- Research Group of Healthy Psychology, KU Leuven, Belgium; Department of Clinical Psychology, Utrecht University, Netherlands.
| | | | - Mathijs Teppers
- Ziekenhuis Oost-Limburg, Lanaken, Belgium; TRACE (Centre for Translational Psychological Research), Belgium
| | - Johan W S Vlaeyen
- Research Group of Healthy Psychology, KU Leuven, Belgium; Experimental Health Psychology, Maastricht University, Netherlands
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3
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Fonseca Das Neves J, Serra E, Kosinski T, Maréchal V, Rollin N, Richard O, Jehel L, Rusinek S. Catastrophizing and rumination mediate the link between functional disabilities and anxiety/depression in fibromyalgia. A double-mediation model. L'ENCEPHALE 2024; 50:162-169. [PMID: 37137739 DOI: 10.1016/j.encep.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 05/05/2023]
Abstract
Fibromyalgia can be considered to be a model of chronic pain resulting from dysregulation of pain processing. From a psychological point of view, it is possible to consider transdiagnostic processes that would participate in both the dysregulation of pain and associated emotions. OBJECTIVE The aim of this study was to test the links that exist between the tendency to Repetitive Negative Thinking (RNT) and the anxious-depressive manifestations in fibromyalgia. More specifically, we wanted to test a double mediation model where RNT would mediate the link between pain and depression/anxiety via catastrophizing. METHOD Eighty-two patients with fibromyalgia completed a series of questionnaires evaluating their level of depression, anxiety, disability related to pain, catastrophizing as well as various measures of Repetitive Thoughts. RESULTS The results showed strong correlations between RNT levels, pain, and anxious-depressive manifestations in this population. Moreover, the links between pain and depression/anxiety were mediated by catastrophizing and RNT in serial. CONCLUSION Results support the interest of studying RNT as a transdiagnostic process in fibromyalgia pain. Considering RNT in fibromyalgia allows a better understanding of tthe links that exist between pain and emotional disorders in this population and thus to better understand the psychopathological comorbidity of fibromyalgia.
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Affiliation(s)
| | - Eric Serra
- Centre d'étude et de traitement de la douleur, Centre hospitalier universitaire Amiens-Picardie, Amiens, France; Laboratoire PSITEC ULR 4072 , université de Lille, Lille, France
| | - Thierry Kosinski
- Laboratoire PSITEC ULR 4072 , université de Lille, Lille, France
| | - Virginie Maréchal
- Psychiatrie de Liaison, Centre hospitalier universitaire Amiens-Picardie, 80000 Amiens, France
| | - Noémie Rollin
- Laboratoire PSITEC ULR 4072 , université de Lille, Lille, France; Consultation douleur, Centre hospitalier de Soissons, Soissons, France
| | - Olivier Richard
- Centre d'étude et de traitement de la douleur, Centre hospitalier universitaire Amiens-Picardie, Amiens, France
| | - Louis Jehel
- Psychiatrie de Liaison, Centre hospitalier universitaire Amiens-Picardie, 80000 Amiens, France; Equipe MOODS-IPSOM, U1018, CESP/INSERM, 94807 Villejuif Cedex, France
| | - Stéphane Rusinek
- Laboratoire PSITEC ULR 4072 , université de Lille, Lille, France
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4
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Overmann L, Schleip R, Michalak J. Exploring fascial properties in patients with depression and chronic neck pain: An observational study. Acta Psychol (Amst) 2024; 244:104214. [PMID: 38461580 DOI: 10.1016/j.actpsy.2024.104214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Depressive disorder and chronic pain are prevalent conditions that often co-occur. The myofascial fascial continuum has been hypothesized to contribute to both conditions. However, limited research exists on the specific association between fascial properties and chronic pain and depression. OBJECTIVE This study aims to investigate the properties of the deep fascia of the M. trapezius and their relationship with depression, chronic neck pain, and cervical spine mobility. METHOD This study compared fascial properties between two groups: individuals with depression and chronic neck pain, and healthy individuals. Fascial thickness, elasticity, and stiffness were measured as primary outcomes using standardized techniques such as ultrasound imaging and compliance meter. Statistical analyses were conducted to identify potential differences and correlations in fascial properties between the two groups. RESULT Significant differences emerge in stiffness, tone, and fascia thickness in the deep fascia, alongside identified correlations between depression, chronic pain, and these variables. CONCLUSION The study highlights the impact of depression and chronic pain on fascial properties, emphasizing the need for further research in this domain to unravel the intricate connections and potential implications for treatment strategies.
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Affiliation(s)
- Lea Overmann
- Department of Psychology, University of Witten-Herdecke, Germany
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University Munich, Germany
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Ibrahim ME, El-Zoghby SM, Zaghloul NM, Shehata SA, Farghaly RM. Musculoskeletal pain among medical residents: role of workplace safety climate and sexual harassment. BMC Musculoskelet Disord 2024; 25:167. [PMID: 38388888 PMCID: PMC10882788 DOI: 10.1186/s12891-024-07272-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Workplace factors are important predictors of occurrence of musculoskeletal pain among different occupational populations. In healthcare, a psychologically unsafe work environment can negatively affect the emotional, physical and psychological well-being of physicians. This study aimed to examine the relationship between workplace violence, sexual harassment and musculoskeletal pain among Egyptian physicians in their years of residency. METHODS We distributed an online self-administered questionnaire to 101 residents working in various healthcare sectors in Egypt. It included sections on demographic data, working conditions, widespread pain index (WPI), pain interference short-form, workplace violence and harassment questionnaire, psychosocial safety climate questionnaire (PSC) and sexual harassment climate questionnaire. RESULTS All residents had at least one painful site on the WPI (range 1-11). The mean WPI was 3.5 ± 2.4, and 39.6% satisfied the criteria of having widespread pain by having at least 4 pain sites. Widespread pain index showed a weak statistically significant negative correlation with workplace PSC score (rho = - 0.272, p = 0.006), and a statistically significant weak positive correlation with the calculated total abuse index (rho = 0.305, p = 0.002). Workplace violence and abuse, as measured by a calculated abuse index was the only significant predictors of widespread pain among residents. CONCLUSION WPV was found to be a predictor of musculoskeletal pain among medical residents. Healthcare organizations need to address WPV by employing preventive strategies to minimize its hazardous effects and ensure a safe working environment for physicians.
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Affiliation(s)
- Maha E Ibrahim
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt.
| | - Safaa M El-Zoghby
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Nancy M Zaghloul
- Department of Forensic Medicine and Clinical Toxicology, Misr University for Science and Technology, Cairo, Egypt
| | - Shaimaa A Shehata
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Rasha M Farghaly
- Department of Community, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
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Swärdh E, Thorstensson CA, Khatri S, Kindblom K, Opava CH. Approaches to osteoarthritis: a qualitative study among physical therapists in Maharashtra, India. Physiother Theory Pract 2024; 40:327-337. [PMID: 36047816 DOI: 10.1080/09593985.2022.2118005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND OBJECTIVE Osteoarthritis (OA) is a major and growing problem in India. Better knowledge dissemination and implementation of evidence-based practice in Indian physical therapy require a better understanding of approaches to OA (i.e. perceptions of the condition and its management by Indian physical therapists (PTs)) which was the aim of our study. DESIGN AND METHOD We used qualitative content analysis to analyze semi-structured interviews with 19 PTs from Maharashtra state, purposefully selected to represent both sexes, different ages and different educational and professional backgrounds. FINDINGS We identified a main overarching theme of meaning, OA as a degenerative and irreversible condition with the four descriptive themes Assessment, Standardized treatment protocol, Leadership and Patient compliance as PTs' approaches to OA. The descriptive themes indicate that much focus seems to be on pain, physical impairments and biomechanics, with initial treatments being mainly passive. Communication appears to be mainly unidirectional with the PTs instructing the patients, who are expected to comply with PTs instructions. Clinical practice guidelines (CPGs) were not mentioned. CONCLUSIONS Our findings can inform the design of awareness campaigns on evidence-based OA management and increase the understanding of the educational needs of students and PTs in non-Western countries. It is important to recognize that CPGs are mainly based on studies carried out in Western countries and that there are context-specific barriers to implementation in other parts of the world that have large populations.
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Affiliation(s)
- Emma Swärdh
- Division of Physiotherapy, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Carina A Thorstensson
- Institute of Neuroscience and Physiology, Gothenburg University, Göteborg, Sweden
- Department of Research and Development, Halland County Council, Varberg, Sweden
| | - Subhash Khatri
- Dr. APJ Abdul Kalam College of Physiotherapy, Pravara Institute of Medical Sciences - DU, Rahata, Ahmednagar, Maharashtra, India
| | - Kristina Kindblom
- Division of Physiotherapy, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Dr. APJ Abdul Kalam College of Physiotherapy, Pravara Institute of Medical Sciences - DU, Rahata, Ahmednagar, Maharashtra, India
| | - Christina H Opava
- Division of Physiotherapy, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Dr. APJ Abdul Kalam College of Physiotherapy, Pravara Institute of Medical Sciences - DU, Rahata, Ahmednagar, Maharashtra, India
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Linton SJ, O'Sullivan PB, Zetterberg HE, Vlaeyen JWS. The "future" pain clinician: Competencies needed to provide psychologically informed care. Scand J Pain 2024; 24:sjpain-2024-0017. [PMID: 39119640 DOI: 10.1515/sjpain-2024-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/09/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND & OBJECTIVE Psychologically informed care has been proposed to improve treatment outcomes for chronic pain and aligns with a person-centered approach. Yet implementation lags behind, and studies suggest that a lack of competency leads to poor results. It is unclear what training clinicians require to deliver this care. We examine how we might improve psychologically informed care guided by the needs of the patient and in congruence with the scientific literature with a particular focus on how competencies might be upgraded and implementation enhanced. METHODS We selectively review the literature for psychologically informed care for pain. The patient's view on what is needed is contrasted with the competencies necessary to meet these needs and how treatment should be evaluated. RESULTS Patient needs and corresponding competencies are delineated. A number of multi-professional skills and competencies are required to provide psychologically informed care. Single-subject methodologies can determine whether the care has the desired effect for the individual patient and facilitate effectiveness. We argue that becoming a competent "pain clinician" requires a new approach to education that transcends current professional boundaries. CONCLUSIONS Providing person-centered care guided by the needs of the patient and in line with the scientific literature shows great potential but requires multiple competencies. We propose that training the pain clinician of the future should focus on psychologically informed care and the competencies required to meet the individual's needs. Single-subject methodology allows for continual evaluation of this care.
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Affiliation(s)
- Steven J Linton
- Center for Health and Medical Psychology, School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - Peter B O'Sullivan
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Hedvig E Zetterberg
- Center for Health and Medical Psychology, School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Johan W S Vlaeyen
- Experimental Health Psychology, Maastricht University, Maastricht, Netherlands and Health Psychology Research Group, KU Leuven, Leuven, Belgium
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Jaltare KP, Vanderijst L, Karos K, Torta DM. The impact of the social context on the development of secondary hyperalgesia: an experimental study. Pain 2023; 164:2711-2724. [PMID: 37433188 DOI: 10.1097/j.pain.0000000000002971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/28/2023] [Indexed: 07/13/2023]
Abstract
ABSTRACT Social support has been shown to reduce pain ratings and physiological responses to acute pain stimuli. Furthermore, this relationship is moderated by adult attachment styles. However, these effects have not been characterized in experimentally induced symptoms of chronic pain, such as secondary hyperalgesia (SH) which is characterized by an increased sensitivity of the skin surrounding an injury. We aimed to examine whether social support by handholding from a romantic partner can attenuate the development of experimentally induced SH. Thirty-seven women, along with their partners, participated in 2 experimental sessions 1 week apart. In both sessions, SH was induced using an electrical stimulation protocol. In the support condition, the partner was seated across from the participant holding the participant's hand during the electrical stimulation, whereas in the alone condition, the participant went through the stimulation alone. Heart rate variability was measured for both the participant as well as the partner before, during, and after the stimulation. We found that the width of the area of hyperalgesia was significantly smaller in the support condition. Attachment styles did not moderate this effect of social support on the area width. Increasing attachment avoidance was associated with both a smaller width of hyperalgesia and a smaller increase in the sensitivity on the stimulated arm. For the first time, we show that social support can attenuate the development of secondary hyperalgesia and that attachment avoidance may be associated with an attenuated development of secondary hyperalgesia.
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Affiliation(s)
- Ketan Prafull Jaltare
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Laetitia Vanderijst
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Kai Karos
- Section Experimental Health Psychology, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maaastricht, the Netherlands
- Department of Clinical Psychology, Faculty of Psychology, Open University of the Netherlands, Heerlen, the Netherlands
| | - Diana M Torta
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
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McGrath RL, Shephard S, Parnell T, Verdon S, Pope R. Recommended approaches to assessing and managing physiotherapy clients experiencing psychological distress: a systematic mapping review. Physiother Theory Pract 2023:1-31. [PMID: 38009858 DOI: 10.1080/09593985.2023.2284823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Some physiotherapists find assessing and managing clients experiencing psychological distress challenging and are uncertain regarding the boundaries of the profession's scope. OBJECTIVE To map the approaches recommended for physiotherapists in scholarly literature, with respect to the assessment and management of clients experiencing psychological distress. METHODS A systematic mapping review was conducted. CINAHL, APA PsycINFO, Embase, and Medline ALL databases were systematically searched for secondary and tertiary literature relevant to the research objective. Recommended approaches were extracted from each article and analyzed descriptively and thematically. RESULTS 3884 records were identified with 40 articles meeting the inclusion/exclusion criteria. Most recommendations related to identifying, assessing, and managing pain-related distress, with depression screening and referral also receiving some attention. Three approaches to detecting and assessing psychological distress were identified: 1) brief depression screen; 2) integrated suicide/nonsuicidal self-harm and depression screen; and 3) multidimensional screen and health-related distress assessment. Regarding the management of psychological distress the main approaches identified were: 1) education and reassurance; 2) cognitive-behavioral approaches; 3) mindfulness; and 4) case management. CONCLUSION While assessment and management of health-related distress by physiotherapists is commonly recommended, further guidance is needed to differentiate various forms of distress.
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Affiliation(s)
- Ryan L McGrath
- Department of Rural Health, University of Melbourne, Shepparton, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Australia
| | - Sophie Shephard
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Tracey Parnell
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Sarah Verdon
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Rodney Pope
- Department of Rural Health, University of Melbourne, Shepparton, Australia
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Sueki DG, Dunleavy K, Puentedura EJ, Heard L, Van der Heide P, Cheng MS. Differing Effects of Nociception and Pain Memory on Isometric Muscle Strength in Participants With and Without a History of Injury: A Quasi-Experimental Study. Am J Phys Med Rehabil 2023; 102:787-794. [PMID: 36753453 DOI: 10.1097/phm.0000000000002205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The goals of this study are to establish whether mechanical pressure pain, short-term memory recall of a painful stimulus, or long-term memory of a previous painful lower limb injury alters isometric muscle strength and whether there was a difference in responses between participants with and without a previous history of injury. DESIGN Fifty-nine pain-free participants (29 with previous injury and 30 without) participated in this study. Tibialis anterior isometric muscle strength was compared pre- and post-noxious mechanical stimulus with instructions to recall pain (short- and long-term). RESULTS Short- and long-term pain recall produced a significant reduction in muscle strength (short-term: F (1,57) = 160.472, P < 0.001; long-term: F (1,57) = 128.899, P < 0.001). A greater decrease was experienced with short- and long-term pain memory than exposure to mechanical pain (mechanical pain: -14.8% or -32.98 kg, 95% confidence interval [CI], -41.57 to -24.19; short-term: -24.1% or -52.70 kg, 95% CI = -60.98 to -44.34; long-term: -20.3% or -44.63 kg, 95% CI = -52.77 to -36.95). There was no significant difference in responses associated with an injury history. CONCLUSIONS Findings suggest that recalled pain memory can impact motor responses and calls attention to the role of past injury history in the rehabilitation process.
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Affiliation(s)
- Derrick G Sueki
- From the Department of Physical Therapy, Azusa Pacific University, Azusa, California (DGS); Department of Physical Therapy, University of Florida, Gainesville, Florida (KD); Department of Physical Therapy, Baylor University, Waco, Texas (EJP); Scripps Memorial Hospital, Encinitas, California (LH); Amigo Baby, Oxnard, California (PVH); and Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida (M-SC)
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Norman-Nott N, Hesam-Shariati N, Wilks CR, Schroeder J, Suh J, Briggs NE, McAuley JH, Quidé Y, Gustin SM. Internet-Delivered Dialectical Behavioral Therapy Skills Training for Chronic Pain: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e41890. [PMID: 37285187 DOI: 10.2196/41890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Emotion dysregulation is key to the development and maintenance of chronic pain, feeding into a cycle of worsening pain and disability. Dialectical behavioral therapy (DBT), an evidence-based treatment for complex transdiagnostic conditions presenting with high emotion dysregulation, may be beneficial to manage and mitigate the emotional and sensory aspects of chronic pain. Increasingly, DBT skills training as a key component of standard DBT is being delivered as a stand-alone intervention without concurrent therapy to help develop skills for effective emotion regulation. A previous repeated-measure single-case trial investigating a novel technologically driven DBT skills training, internet-delivered DBT skills training for chronic pain (iDBT-Pain), revealed promising findings to improve both emotion dysregulation and pain intensity. OBJECTIVE This randomized controlled trial aims to examine the efficacy of iDBT-Pain in comparison with treatment as usual to reduce emotion dysregulation (primary outcome) for individuals with chronic pain after 9 weeks and at the 21-week follow-up. The secondary outcomes include pain intensity, pain interference, anxiety symptoms, depressive symptoms, perceived stress, posttraumatic stress, harm avoidance, social cognition, sleep quality, life satisfaction, and well-being. The trial also examines the acceptability of the iDBT-Pain intervention for future development and testing. METHODS A total of 48 people with chronic pain will be randomly assigned to 1 of 2 conditions: treatment and treatment as usual. Participants in the treatment condition will receive iDBT-Pain, consisting of 6 live web-based group sessions led by a DBT skills trainer and supervised by a registered psychologist and the iDBT-Pain app. Participants in the treatment-as-usual condition will not receive iDBT-Pain but will still access their usual medication and health interventions. We predict that iDBT-Pain will improve the primary outcome of emotion dysregulation and the secondary outcomes of pain intensity, pain interference, anxiety symptoms, depressive symptoms, perceived stress, harm avoidance, social cognition, sleep quality, life satisfaction, and well-being. A linear mixed model with random effects of individuals will be conducted to investigate the differences between the baseline, 9-week (primary end point), and 21-week (follow-up) assessments as a function of experimental condition. RESULTS Recruitment started in February 2023, and the clinical trial started in March 2023. Data collection for the final assessment is planned to be completed by July 2024. CONCLUSIONS If our hypothesis is confirmed, our findings will contribute to the evidence for the efficacy and acceptability of a viable intervention that may be used by health care professionals for people with chronic pain. The results will add to the chronic pain literature to inform about the potential benefits of DBT skills training for chronic pain and will contribute evidence about technologically driven interventions. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12622000113752; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383208&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/41890.
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Affiliation(s)
- Nell Norman-Nott
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Negin Hesam-Shariati
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, Australia
| | - Chelsey R Wilks
- Department of Psychological Science, University of Missouri-St Louis, St. Louis, MO, United States
| | - Jessica Schroeder
- School of Computer Science and Engineering, University of Washington, Washington, WA, United States
| | - Jina Suh
- School of Computer Science and Engineering, University of Washington, Washington, WA, United States
- Microsoft Research, Redmond, WA, United States
| | - Nancy E Briggs
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Yann Quidé
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, Australia
| | - Sylvia M Gustin
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, Australia
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12
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Effectiveness of a Primary Care Multidisciplinary Treatment for Patients with Chronic Pain Compared with Treatment as Usual. J Clin Med 2023; 12:jcm12030885. [PMID: 36769533 PMCID: PMC9918146 DOI: 10.3390/jcm12030885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
To manage chronic pain, multidisciplinary interventions have been increasingly deployed, mostly in secondary or tertiary care settings. Evidence on the effectiveness of multidisciplinary intervention within primary care is scarce. This study examined the effectiveness of a primary care multidisciplinary treatment for chronic pain compared with treatment as usual (TAU). The intervention consisted of pain neuroscience education and treatment by a GP, psychologist, and physiotherapist. Both groups filled out patient-reported outcome measures at baseline, 6 months, and 12 months. The results indicated there were no statistically significant differences for the primary outcomes of pain intensity, number of pain sites, and health-related quality of life (HR-QoL). There was a statistically significant difference in the secondary outcome perceived health change in favor of the intervention group. None of the other differences were statistically significant. A post-hoc analysis showed that there were statistically significant effects on patients' illness perceptions in favor of the intervention group. Based on the results, the findings do not support effectiveness of a low intensity outpatient multidisciplinary primary care treatment to treat chronic pain compared with TAU. However, as a result of several study limitations, it is considered unwarranted to conclude that multidisciplinary treatment in primary care is not valuable at all.
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13
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Diotaiuti P, Corrado S, Mancone S, Cavicchiolo E, Chirico A, Siqueira TC, Andrade A. A psychometric evaluation of the Italian short version of the Fear of Pain Questionnaire-III: Psychometric properties, measurement invariance across gender, convergent, and discriminant validity. Front Psychol 2023; 13:1087055. [PMID: 36726497 PMCID: PMC9886064 DOI: 10.3389/fpsyg.2022.1087055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction The Fear of Pain Questionnaire-III (FPQ-III) is a self-assessment instrument developed specifically to measure fear based on various pain stimuli converging on three factors: severe pain, medical pain, and minor pain. It actually remains the most studied and internationally used tool even in its short versions. The aim of this work was to propose a new validation study oriented to confirm the good psychometric properties of a short model of the FPQ-III for the Italian context. Methods A large sample of participants was recruited (n = 1,064) and Exploratory Factor Analysis (EFA) as well as Confirmatory Factor Analysis (CFA) were performed. Measurement invariance of the FPQ-III across gender was also evaluated. In order to examine convergent validity, a further convenient sample (n = 292) was used and variables related to the individual's pain experience, locus of control and coping orientations were assessed. A final discriminant assessment using experimental manipulation through fear eliciting videos was performed. Results The three factors structure of the 13-item version of the questionnaire was confirmed (χ2 = 148.092, CFI = 0.971, TLI = 0.962, RMSEA = 0.046, RMSEA 90% CI = 0.037-0.056) as well as the measurement invariance across gender. Item internal reliability was satisfactory. The results provided evidence of the good predictive validity of the FPQ-III and the discriminant assessment demonstrated that the instrument is suitable in detecting changes in fear of pain induced by specific situational conditions. Discussion The scale in this short version is suitable for quickly and efficiently gathering information about the perceived intensity of such anticipatory fears that might affect even the healthy person dysfunctionally.
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Affiliation(s)
- Pierluigi Diotaiuti
- Department of Human Sciences, Society and Health, University of Cassino and Lazio, Cassino, Italy,*Correspondence: Pierluigi Diotaiuti,
| | - Stefano Corrado
- Department of Human Sciences, Society and Health, University of Cassino and Lazio, Cassino, Italy
| | - Stefania Mancone
- Department of Human Sciences, Society and Health, University of Cassino and Lazio, Cassino, Italy
| | - Elisa Cavicchiolo
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Andrea Chirico
- Department of Psychology of Development and Socialization Processes, Sapienza University of Rome, Rome, Italy
| | - Thais Cristina Siqueira
- Health and Sports Science Center, Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Alexandro Andrade
- Health and Sports Science Center, Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
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14
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Structural Model Based on Genetic Algorithm for Inhibiting Fatty Acid Amide Hydrolase. AI 2022. [DOI: 10.3390/ai3040052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The fatty acid amide hydrolase (FAAH) is an enzyme responsible for the degradation of anandamide, an endocannabinoid. Pharmacologically blocking this target can lead to anxiolytic effects; therefore, new inhibitors can improve therapy in this field. In order to speed up the process of drug discovery, various in silico methods can be used, such as molecular docking, quantitative structure–activity relationship models (QSAR), and artificial intelligence (AI) classification algorithms. Besides architecture, one important factor for an AI model with high accuracy is the dataset quality. This issue can be solved by a genetic algorithm that can select optimal features for the prediction. The objective of the current study is to use this feature selection method in order to identify the most relevant molecular descriptors that can be used as independent variables, thus improving the efficacy of AI algorithms that can predict FAAH inhibitors. The model that used features chosen by the genetic algorithm had better accuracy than the model that used all molecular descriptors generated by the CDK descriptor calculator 1.4.6 software. Hence, carefully selecting the input data used by AI classification algorithms by using a GA is a promising strategy in drug development.
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15
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Todd J, Austin H, Clarke P, Notebaert L. Chronic Pain, Insomnia and their Mutual Maintenance: A Call for Cognitive Bias Research. THE JOURNAL OF PAIN 2022; 23:1530-1542. [PMID: 35472519 DOI: 10.1016/j.jpain.2022.03.241] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/04/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
Chronic pain and insomnia are highly comorbid: Approximately 50% of those with chronic pain experience insomnia or clinically significant sleep disturbances, and 50% of those with insomnia experience chronic pain. Further, these conditions can be extremely disabling, particularly when they co-occur. There is increasing recognition of the need to tackle both chronic pain and insomnia together, as evidenced by growing empirical research in this area. Cognitive processing biases have been independently implicated in both chronic pain and in insomnia. Given their trans-diagnostic status, cognitive biases may therefore have a role in explaining the co-occurrence and mutual maintenance of these conditions. These biases also represent novel, potentially modifiable targets for treatment. However, the role of cognitive biases has not been adequately explored in comorbid chronic pain and insomnia. Here, we describe the state of cognitive bias research in chronic pain and insomnia, considering evidence for the roles of attentional bias, interpretation bias, expectancy bias, and memory bias. In reviewing the literature, it is apparent that similar cognitive biases operate in insomnia and chronic pain, with preliminary, albeit sparse, evidence of pain-related cognitive biases influencing sleep-related outcomes. On the basis of current findings and separate theoretical models, we present a novel, testable cognitive model of comorbid chronic pain and insomnia, to guide future research in this area. Key recommendations for the future of this relatively new field are provided. PERSPECTIVE: Chronic pain and insomnia are highly co-morbid, suggesting an overlap in causal mechanisms. Empirical research, although sparse, suggests that cognitive biases may play a role in their development and mutual maintenance. Our novel cognitive model generates research avenues of clinical importance for treating co-morbid chronic pain and insomnia.
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Affiliation(s)
- Jemma Todd
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia; School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia.
| | - Henry Austin
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia; Cardio Respiratory Sleep, Nedlands, Western Australia, Australia
| | - Patrick Clarke
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Lies Notebaert
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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16
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Mittinty MM, Santiago PHR, Jamieson L. Assessment of Pain-Related Fear in Indigenous Australian Populations Using the Fear of Pain Questionnaire-9 (FPQ-9). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6256. [PMID: 35627793 PMCID: PMC9141503 DOI: 10.3390/ijerph19106256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023]
Abstract
In this study, we examined the psychometric properties of the Fear of Pain Questionnaire (FPQ-9) in Indigenous Australian people. FPQ-9, a shorter version of the original Fear of Pain Questionnaire-III, was developed to support the demand for more concise scales with faster administration time in the clinical and research setting. The psychometric properties of FPQ-9 in Indigenous Australian participants (n = 735) were evaluated with network psychometrics, such as dimensionality, model fit, internal consistency and reliability, measurement invariance, and criterion validity. Our findings indicated that the original FPQ-9 three-factor structure had a poor fit and did not adequately capture pain-related fear in Indigenous Australian people. On removal of two cross-loading items, an adapted version Indigenous Australian Fear of Pain Questionnaire-7 (IA-FPQ-7) displayed good fit and construct validity and reliability for assessing fear of pain in a sample of Indigenous Australian people. The IA-FPQ-7 scale could be used to better understand the role and impact of fear of pain in Indigenous Australian people living with chronic pain. This could allow for more tailored and timely interventions for managing pain in Indigenous Australian communities.
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Affiliation(s)
- Manasi Murthy Mittinty
- Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2050, Australia
| | - Pedro H. R. Santiago
- Indigenous Oral Health Unit, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; (P.H.R.S.); (L.J.)
| | - Lisa Jamieson
- Indigenous Oral Health Unit, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; (P.H.R.S.); (L.J.)
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17
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Mittinty MM, Hedges J, Jamieson L. Building evidence to reduce inequities in management of pain for Indigenous Australian people. Scand J Pain 2022; 22:356-364. [PMID: 34898133 DOI: 10.1515/sjpain-2021-0173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Pain is a universal experience which each person encounters differently, guided by the psycho-socio-environmental context in which it occurs. Although more research is underway yet very little is known about pain from Indigenous Australian perspective. Therefore, this study aims to examine, experience of pain and coping, and utility of three measures: Brief Pain Inventory short form, McGill Pain Questionnaire and Numerical rating scale, from Indigenous South Australian people perspective. METHODS Thirteen in-person interviews were conducted which lasted around 90 min and were audio-recorded. The transcripts were coded and analysed thematically with NVivo. RESULTS Six key themes were identified; 1: Spiritual conceptualisation of pain; 2: Frequent experience of trauma and injury; 3: Influence of familial history of pain; 4: Acceptance of pain as normal; 5: Outlook on biomedical management of pain; 6: Preference for non-pharmacological management of pain. Also, the three measures did not fully capture pain from an Indigenous Australian perspective which is more deeply rooted in a bio-psycho-socio-spiritual context which is cardinal to conceptualization of health and wellbeing in Indigenous Australian communities. CONCLUSIONS Findings highlight some commonalities as well as unique differences between Indigenous experiences of pain as compared to non-Indigenous. Factors such as spiritual connection with pain, grief and loss, history of trauma and injury, fear of addiction to pain medication and exposure to pain from early childhood had important implications for how participants viewed pain.
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Affiliation(s)
- Manasi Murthy Mittinty
- Pain Management and Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Northern Clinical School, School of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Joanne Hedges
- Indigenous Oral Health, Australian Research Centre for Population Oral Health, Adelaide Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Lisa Jamieson
- Indigenous Oral Health, Australian Research Centre for Population Oral Health, Adelaide Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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18
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Niederer D, Engel T, Pfeifer AC, Arampatzis A, Beck H, Wippert PM, Schiltenwolf M, Mayer F. Which Functional Outcomes Can be Measured in Low Back Pain Trials and Therapies?: A Prospective 2-Year Factor-, Cluster-, and Reliability-Multicenter Analysis on 42 Variables in 1049 Individuals. Spine (Phila Pa 1976) 2021; 46:1495-1508. [PMID: 33731576 DOI: 10.1097/brs.0000000000004028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective 2-year factor-, cluster-, and reliability-multicenter analysis. OBJECTIVE To provide evidence on the uniqueness and usefulness of a set of potential relevant functional outcomes. SUMMARY OF BACKGROUND DATA A very high number of functional outcomes that can be utilized as variables in low back pain (LBP) trials exists. METHODS Participants (n = 1049) with and without current LBP were included. At 7 visits (baseline, 4 wk, 3 mo, 6 mo, 9 mo, 1 yr, and 2 yr), 42 different functional outcomes were assessed. Two exploratory factor analyses (for baseline-values and for changes scores to 3 mo post-baseline) were calculated (maximum likelihood extraction, varimax factor rotation). The strongest factor-loading outcomes were selected for the following hierarchical cluster analyses (average linkage, Euclidean distance measure). For each cluster, time point, and outcome, reliability analyses were subsequently calculated using intraclass correlation coefficients, standard error of measurements and coefficients of variation. RESULTS The factor analysis for the cross-sectional values revealed 9 factors with a cumulative variance explanation of 61.7% and 13 unique ones. The change-score factor analysis revealed nine factors with a total variance explanation of 61.8%, seven outcomes were unique. Ten outcomes were important for both cross-sectional and change-score analyses, 11 were most valuable for cross-sectional and four for the change scores. Patients with pain grades 1 to 3 show comparable patterns (cluster 2). Grade 0 (cluster 1) and grade 4 (cluster 3) are unique and cannot be cumulated with other grades. Most biomechanical outcomes were highly reliable and display low measurement errors. CONCLUSION We found 25 potentially meaningful functional outcomes in the context of objective functional measurements (such as trunk range of motion, dynamic and static balance, strength, and muscle fatigue resistance) and body characteristics. The present framework may help to select appropriate functional outcomes and rate effects beyond the known core set of outcomes.Level of Evidence: 1.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Tilman Engel
- University Outpatient Clinic, Centre of Sports Medicine, University of Potsdam, Potsdam, Germany
| | - Ann-Christin Pfeifer
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Pain Management, Center of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Heidrun Beck
- University Hospital Carl Gustav Carus at Technical University Dresden, Dresden, Germany
| | - Pia-Maria Wippert
- Department of Sociology of Physical Activity and Health, University of Potsdam, Potsdam, German
| | - Marcus Schiltenwolf
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Mayer
- University Outpatient Clinic, Centre of Sports Medicine, University of Potsdam, Potsdam, Germany
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19
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Semrau J, Hentschke C, Peters S, Pfeifer K. Effects of behavioural exercise therapy on the effectiveness of multidisciplinary rehabilitation for chronic non-specific low back pain: a randomised controlled trial. BMC Musculoskelet Disord 2021; 22:500. [PMID: 34051780 PMCID: PMC8164753 DOI: 10.1186/s12891-021-04353-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The long-term effects of behavioural medical rehabilitation (BMR), as a type of multidisciplinary rehabilitation, in the treatment of chronic non-specific low back pain (CLBP) have been shown. However, the specific effects of behavioural exercise therapy (BET) compared to standard exercise therapy (SET) within BMR are not well understood. The aim of the study was to assess the effectiveness of BMR + BET compared to BMR + SET in individuals with CLBP in a two-armed, pre-registered, multicentre, parallel, randomised controlled trial (RCT). METHODS A total of 351 adults with CLBP in two rehabilitation centres were online randomised based on an 'urn randomisation' algorithm to either BMR + SET (n = 175) or BMR + BET (n = 176). Participants in both study groups were non-blinded and received BMR, consisting of an multidisciplinary admission, a psychosocial assessment, multidisciplinary case management, psychological treatment, health education and social counselling. The intervention group (BMR + BET) received a manualised, biopsychosocial BET within BMR. The aim of BET was to develop self-management strategies in coping with CLBP. The control group (BMR + SET) received biomedical SET within BMR with the aim to improve mainly physical fitness. Therapists in both study groups were not blinded. The BMR lasted on average 27 days, and both exercise programmes had a mean duration of 26 h. The primary outcome was functional ability at 12 months. Secondary outcomes were e.g. pain, avoidance-endurance, pain management and physical activity. The analysis was by intention-to-treat, blinded to the study group, and used a linear mixed model. RESULTS There were no between-group differences observed in function at the end of the BMR (mean difference, 0.08; 95% CI - 2.82 to 2.99; p = 0.955), at 6 months (mean difference, - 1.80; 95% CI; - 5.57 to 1.97; p = 0.349) and at 12 months (mean difference, - 1.33; 95% CI - 5.57 to 2.92; p = 0.540). Both study groups improved in the primary outcome and most secondary outcomes at 12 months with small to medium effect sizes. CONCLUSION BMR + BET was not more effective in improving function and other secondary outcomes in individuals with CLBP compared to BMR + SET. TRIAL REGISTRATION Current controlled trials NCT01666639 , 16/08/2012.
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Affiliation(s)
- Jana Semrau
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Gebbertstraße 123 b, 91056, Erlangen, Germany.
| | | | - Stefan Peters
- Deutscher Verband für Gesundheitssport und Sporttherapie (DVGS) e.V, Vogelsanger Weg 48, 50354, Hürth-Efferen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Gebbertstraße 123 b, 91056, Erlangen, Germany
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21
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Reyes Velez J, Thompson JM, Sweet J, Busse JW, VanTil L. Cluster analysis of Canadian Armed Forces veterans living with chronic pain: Life After Service Studies 2016. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2021; 5:81-95. [PMID: 34189392 PMCID: PMC8210876 DOI: 10.1080/24740527.2021.1898278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: This study explored the heterogeneity of Canadian Armed Forces veterans living with chronic pain to inform service needs planning and research using cluster analysis. Design: We used a national cross-sectional Statistics Canada population survey. Participants: Participants included 2754 Canadian Armed Forces (CAF) Regular Force veterans released from service between 1998 and 2015 and surveyed in 2016. Methods: We used cluster analysis of veterans with chronic pain based on pain severity, mental health, and activity limitation characteristics. We compared clusters for sociodemographic, health, and service utilization characteristics. Results: Of 2754 veterans, 1126 (41%) reported chronic pain. Veterans in cluster I (47%) rarely had severe pain (2%) or severe mental health problems (8%), and none had severe activity limitations. Veterans in cluster II (26%) more often than veterans in cluster I but less often than veterans in cluster III endorsed severe pain (27%) and severe mental health problems (22%) and were most likely to report severe activity limitation (91%). Veterans in cluster III (27%) were most likely to report severe pain (36%) and severe mental health problems (96%), and a majority reported severe activity limitations (72%). There was evidence of considerable heterogeneity among individuals in terms of socioeconomic characteristics, pain characteristics, mental and physical health status, activity limitations, social integration, and service utilization indicators. Conclusions: About half of Canadian veterans living with chronic pain infrequently endorse severe pain or serious mental health issues without severe activity limitations. The other half had more complex characteristics. The heterogeneity of CAF veterans with chronic pain emphasizes the need for support systems that can address variability of needs.
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Affiliation(s)
| | - James M Thompson
- Department of Public Health Sciences, Queens University, Kingston, Ontario, Canada
| | - Jill Sweet
- VAC Research Directorate, Charlottetown, Prince Edward Island, Canada
| | - Jason W Busse
- Michael DeGroote Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Linda VanTil
- VAC Research Directorate, Charlottetown, Prince Edward Island, Canada
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22
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Skovbo MH, Agerbo K, Jakobsen A, Clausen SA, Langagergaard V, Rolving N. Description of content, structure and theoretical model of a group-based pain management programme in the treatment of patients with persistent non-specific low back pain and psychological risk factors in a secondary sector setting. Clin Rehabil 2021; 35:1077-1088. [PMID: 33586476 DOI: 10.1177/0269215521995185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present the theoretical foundation and methodological considerations for a group-based pain management programme for patients with persistent non-specific low back pain and psychosocial risk factors. METHOD The Template for Intervention Description and Replication (TIDieR) checklist was used as a framework for describing the content, structure and context of the program. The theoretical rationale underlying the pain management programme was described using the first three steps of the Intervention Mapping framework. The Fear-avoidance model and the Self-efficacy Theory were identified as the two main theories. These were used to establish specific factors addressed by the pain management programme as well as expected outcomes. INTERVENTION DESCRIPTION A multidisciplinary, group-based programme using a cognitive-behavioural approach was developed. The programme consisting of six sessions of two hours duration, took place at a spine clinic at a regional hospital in Denmark. Psychoeducation and cognitive restructuring were specific strategies hypothesised to induce changes in outcome measures. The outcomes expected to change as a result of the intervention were disability, quality of life, sick leave and physical activity. A pilot study was performed, subsequent adjustments made and the final content and educational materials completed by January 2017. CONCLUSION The theoretical foundation and underlying evidence for the hypothesised change mechanisms in the use of a cognitive-behavioural approach was presented. A theoretically sound and practically feasible intervention has been developed and its effectiveness is being determined in a randomised controlled trial, including 130 low back pain patients, which is currently underway.
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Affiliation(s)
- Mette Høj Skovbo
- Spine Clinic, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Karina Agerbo
- Spine Clinic, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Anna Jakobsen
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark
| | | | - Vivian Langagergaard
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark.,University Research Clinic for Innovative Patient Pathways, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Nanna Rolving
- Spine Clinic, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Center of Rehabilitation Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
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23
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Kragting M, Schuiling SF, Voogt L, Pool-Goudzwaard AL, Coppieters MW. Using Visual Feedback Manipulation in Virtual Reality to Influence Pain-Free Range of Motion in People with Nonspecific Neck Pain. Pain Pract 2020; 21:428-437. [PMID: 33251721 PMCID: PMC8048536 DOI: 10.1111/papr.12971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/04/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022]
Abstract
Background Based on associative learning theories it is hypothesized that pain might be a conditioned response. In people with musculoskeletal pain, the occurrence of movement‐induced pain might be a protective response, influenced by visual cues suggesting that the person is approaching a painful position. This study aimed to determine (1) whether the pain‐free range of motion (ROM) increased and decreased when visual feedback understated or overstated true rotation in people with neck pain and (2) whether this effect was more pronounced if pain was chronic. Method People with subacute and chronic nonspecific neck pain wore a VR‐headset and rotated their head to the left and right until the onset of pain. Visual feedback about the amount of movement was either equal, 20% less, or 20% greater than their actual rotation. Maximal pain‐free ROM was measured using the VR‐headset sensors. Data were analyzed using a mixed‐design ANOVA. Results There was no effect of visual feedback manipulation on pain‐free ROM (P = 0.13) and no interaction effect between the visual feedback condition and duration of pain (P = 0.86). Discussion The inability to influence pain‐free ROM by manipulating visual feedback in people with subacute or chronic neck pain does not support associative learning theories for the perception of neck pain.
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Affiliation(s)
- Maaike Kragting
- Department of Physical Therapy, Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Stefan F Schuiling
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lennard Voogt
- Department of Physical Therapy, Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Annelies L Pool-Goudzwaard
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Queensland, Australia
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24
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Mühlhauser Y, Vogt L, Niederer D. How and how fast does pain lead to disability? A multilevel mediation analysis on structural, temporal and biopsychosocial pathways in patients with chronic nonspecific low back pain. Musculoskelet Sci Pract 2020; 49:102199. [PMID: 32861361 DOI: 10.1016/j.msksp.2020.102199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 01/08/2023]
Abstract
Self-efficacy, fear of movement, and depression may mediate the sequential pathway of how pain leads to disability in nonspecific low back pain. Participants with chronic (>13 weeks) non-specific low back pain were included. They were prospectively monitored for eight consecutive weeks. Each second day, all participants filled in a survey (30 surveys pp). Questionnaires on current back pain intensity (NRS) and disability (PDI) were completed in each survey. One out of three standardized questionnaires on self-efficacy (SES), fear of movement, kinesiophobia (TSK), or depression (PHQ-9) were randomly completed each time. Multilevel mediation analyses on the within-(temporal changes) and between-patients total and indirect (mediated by SES; TSK and PHQ-9) effect of pain on disability were conducted for three temporal associations: No time delay, Simple temporal delay, and Double delay. In total, 280 questionnaires were filled in by 10 participants (m = 4; 34.4 ± 12.2 years). A moderate to strong effect of pain on disability in the no delay-model for the within-patients (0.436), and (all models) in the between-patients (0.595-0.627) models was found. The way how pain affects kinesiophobia was influenced by the time passed. Kinesiophobia itself predicted disability. Further, depression was affected by (within and between) pain intensity (NRS). In the simple delay effects mediation, depression affects disability (within) and is itself affected by the pain (between). No indirect effect of self-efficacy, fear of movement and depression in the pain-disability relationship was found. Understanding underlying mechanisms of how and when pain leads to disability might help to find accurate measures in therapy setting.
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Affiliation(s)
- Yvonne Mühlhauser
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Daniel Niederer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany.
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Ryum T, Hartmann H, Borchgrevink P, de Ridder K, Stiles TC. The effect of in-session exposure in Fear-Avoidance treatment of chronic low back pain: A randomized controlled trial. Eur J Pain 2020; 25:171-188. [PMID: 32964624 DOI: 10.1002/ejp.1659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/18/2020] [Accepted: 09/13/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Treatment based on the Fear-Avoidance (FA) model has been found to be effective with chronic low back pain (CLBP), and in-vivo exposure of fear evoking movements is proposed as a key change mechanism. Exposure tasks may be conducted in the session (in-session exposure; ISE), in other real-life situations (between sessions exposure) as part of homework assignments, or both. Utilising a randomized, controlled dismantling study design, the aim of this study was to examine the unique effects of ISE in FA-treatment of CLBP. METHODS Patients (N = 90) with CLBP as primary medical complaints were randomized to receive six sessions of either (a) FA-treatment with ISE (FA-ISE) or (b) FA-treatment without ISE (FA), allowing for between sessions exposure in both treatment groups. Patients were assessed with a large battery of outcome measures at four time-points (pre-treatment, post-treatment, after a booster-session and at 1-year follow-up) including pain intensity, pain catastrophising, self-efficacy, physical performance and quality of life. RESULTS Both treatment groups (FA-ISE, FA) demonstrated statistically significant improvements on primary and most secondary outcomes, with mostly non-significant between-group differences. CONCLUSIONS No added benefit was found for the inclusion of ISE of feared movements in FA-treatment for CLBP, delivered in a group format to participants with moderately elevated levels of fear-avoidance beliefs. Clinical trials: NCT01158339. SIGNIFICANCE This study adds to the existing research literature demonstrating FA-treatment to be effective with CLBP, but further experimental studies are needed in order to examine under what circumstances ISE of feared movements may add to positive treatment outcomes.
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Helge Hartmann
- Department of Physical Medicine and Rehabilitation, Levanger Hospital, Levanger, Norway
| | - Petter Borchgrevink
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karin de Ridder
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Urits I, Gress K, Charipova K, Habib K, Lee D, Lee C, Jung JW, Kassem H, Cornett E, Paladini A, Varrassi G, Kaye AD, Viswanath O. Use of cannabidiol (CBD) for the treatment of chronic pain. Best Pract Res Clin Anaesthesiol 2020; 34:463-477. [PMID: 33004159 DOI: 10.1016/j.bpa.2020.06.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022]
Abstract
Chronic pain can be recurrent or constant pain that lasts for longer than 3 months and can result in disability, suffering, and a physical disturbance. Related to the complex nature of chronic pain, treatments have a pharmacological and non-pharmacological approach. Due to the opioid epidemic, alternative therapies have been introduced, and components of the plant Cannabis Sativa, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have gained recent interest as a choice of treatment. The exact mechanism for CBD is currently unknown, but unlike the CBD's psychoactive counterpart, THC, the side effects of CBD itself have been shown to be overall much more benign. The current pharmaceutical products for the treatment of chronic pain are known as nabiximols, and they contain a ratio of THC combined with CBD, which has been promising. This review focuses on the treatment efficacy of CBD, THC: CBD-based treatments for chronic pain and adverse events with each.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Kyle Gress
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Kelly Habib
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - David Lee
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Christopher Lee
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA
| | - Jai Won Jung
- Georgetown University School of Medicine, Washington, DC, USA
| | - Hisham Kassem
- Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, USA
| | - Elyse Cornett
- LSUHSC, Department of Anesthesiology, Shreveport, LA, USA
| | | | | | - Alan D Kaye
- LSUHSC, Department of Anesthesiology, Shreveport, LA, USA
| | - Omar Viswanath
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; LSUHSC, Department of Anesthesiology, Shreveport, LA, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
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27
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Simula AS, Malmivaara A, Booth N, Karppinen J. A classification-based approach to low back pain in primary care - protocol for a benchmarking controlled trial. BMC FAMILY PRACTICE 2020; 21:61. [PMID: 32252643 PMCID: PMC7137427 DOI: 10.1186/s12875-020-01135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/29/2020] [Indexed: 12/03/2022]
Abstract
Background Guidelines recommend a biopsychosocial framework for low back pain (LBP) management and the avoidance of inappropriate imaging. In clinical practice, care strategies are often inconsistent with evidence and guidelines, even though LBP is the most common disabling health condition worldwide. Unhelpful beliefs, attitudes and inappropriate imaging are common. LBP is understood to be a complex biopsychosocial phenomenon with many known multidimensional risk factors (symptom- and lifestyle-related, psychological and social) for persistent or prolonged disability, which should be identified and addressed by treatment. The STarT Back Tool (SBT) was developed for early identification of individual risk factors of LBP to enable targeted care. Stratified care according SBT has been shown to improve the effectiveness of care in a primary care setting. A biopsychosocially-oriented patient education booklet, which includes imaging guidelines and information, is one possible way to increase patients’ understanding of LBP and to reduce inappropriate imaging. Premeditated pathways, education of professionals, written material, and electronic patient registry support in health care organizations could help implement evidence-based care. Methods We will use a Benchmarking Controlled Trial (BCT) design in our study. We will prospectively collect data from three health care regions before and after the implementation of a classification-based approach to LBP in primary care. The primary outcome will be change in PROMIS (Patient-Reported Outcomes Measurement Information System) (short form 20a) over 12-month follow-up. Discussion The implementation of a classification-based biopsychosocial approach can potentially improve the care of LBP patients, reduce inappropriate imaging without increasing health-care costs, and decrease indirect costs by reducing work disability. Using the BCT we will be able to evaluate the effectiveness of the improvement strategy for the entire care pathway. Trial registration ISRCTN,ISRCTN13273552, retrospectively registered 13/05/2019.
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Affiliation(s)
- A S Simula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland. .,Department of General Medicine, The South Savo Social and Health Care Authority, Mikkeli, Finland.
| | - A Malmivaara
- Centre for Health and Social Economics, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - N Booth
- Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
| | - J Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
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Cresswell C, Galantino ML, Myezwa H. The prevalence of fear avoidance and pain catastrophising amongst patients with chronic neck pain. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1326. [PMID: 32161823 PMCID: PMC7059507 DOI: 10.4102/sajp.v76i1.1326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 11/14/2019] [Indexed: 11/20/2022] Open
Abstract
Background Cognitive factors impact chronic pain, but the prevalence of fear avoidance (FA) and pain catastrophising (PC) in individuals suffering from chronic neck pain (CNP) has not been investigated in South Africa. Objectives To determine the prevalence of FA and PC in patients with CNP at private physiotherapy practices in Johannesburg. Method The Tampa Scale for Kinesiophobia-11 (TSK-11) (α = 0.80) and Pain Catastrophising Scale (α = 0.87) self-report questionnaires were used in a cross-sectional study to determine the prevalence of FA and PC, respectively. Descriptive statistics and correlations using Pearson’s or Spearman’s coefficient were conducted between demographic variables and FA and PC. Non-parametric data were tested using the Wilcoxon rank-sum or Kruskal–Wallis test. Cohen’s d-value or r-value measured strength of associations. Results A sample of 106 CNP patients with a mean age of 48.7 years (± 14.8) from 25 randomly selected private practices participated in the study. Of the participants, 81% were women (n = 86). Fear avoidance and PC had a prevalence of 25.5% (n = 27) and 15.1% (n = 16), respectively. A positive correlation was found between FA-11-Total and PC-Total (r = 0.684; p = 0.0001) and between FA (TSK-11-Total and TSK-SF (somatic focus)) and PC and its subscales (r ≥ 0.602; p = 0.0001). Participants with a secondary education (26.0 ± 3.4) showed a higher FA than those with tertiary education (21.9 ± 1.5). Effect size was moderate (Cohen’s d = 0.60). Pain intensity correlated positively with both FA (Pearson’s correlation: r = 0.33; p = 0.001) and PC (Spearman’s correlation; r = 0.39; p = 0.0001). Conclusion FA and PC affect a number of patients with CNP. A lower level of education was associated with FA and a higher pain intensity was associated with higher FA and PC. Clinical implications Identifying FA and PC in patients with CNP is important to facilitate holistic management.
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Affiliation(s)
- Clare Cresswell
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary L Galantino
- School of Health Sciences, Stockton University, Galloway, United States
| | - Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
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Maestroni L, Marelli M, Gritti M, Civera F, Rabey M. Is rotator cuff related shoulder pain a multidimensional disorder? An exploratory study. Scand J Pain 2020; 20:297-305. [DOI: 10.1515/sjpain-2019-0108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/21/2019] [Indexed: 01/13/2023]
Abstract
Abstract
Background and aims
Rotator cuff related shoulder pain has been associated with factors from multiple dimensions such as strength changes, psychosocial measures, comorbidities and level of education. However, to date little research has been undertaken to evaluate which factors explain the greatest variance in pain and disability levels in people with rotator cuff related shoulder pain. The objective of this study was therefore to evaluate which multidimensional examination findings were associated with higher pain and disability in a primary care cohort with rotator cuff related shoulder pain.
Methods
This was an exploratory cross-sectional cohort study. Sixty-seven participants with rotator cuff related shoulder pain were assessed for: pain intensity, disability; demographic, psychological, social and lifestyle characteristics, and isometric strength of shoulder internal and external rotator muscles. Univariable associations between pain intensity/disability and each variable were assessed using linear regression. Variables with univariable associations (p < 0.1) were entered into backwards stepwise multivariable regression models.
Results
The multivariable model for pain intensity included sleep and perceived persistence and explained 46.5% of the variance (37.6% uniquely by sleep, 5.4% uniquely by perceived persistence). The multivariable model for disability included sleep and sex and explained 26.8% of the variance (4.5% shared by predictors, 16.4% uniquely by sleep, 5.9% uniquely by sex).
Conclusions
Rotator cuff-related shoulder pain and disability are associated with sleep disturbance, perceived symptom persistence and sex. Rotator cuff related shoulder pain may be considered a multidimensional disorder.
Implications
Clinicians need to evaluate sleep and perceived symptom persistence in people with rotator cuff related shoulder pain. Future research may examine whether management strategies for RCRSP directed towards these factors afford improved treatment outcomes.
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Affiliation(s)
- Luca Maestroni
- Smuoviti , Bergamo (BG) , Italy
- StudioErre , Brescia (BS) , Italy
| | | | | | - Fabio Civera
- Smuoviti , Bergamo (BG) , Italy
- Centro Medico e Fisioterapico , Gorle (BG) , Italy
| | - Martin Rabey
- Thrive Physiotherapy , 66 Grande Rue , St. Martin, GY4 6LQ , Guernsey
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Psychological Subgrouping to Assess the Risk for the Development or Maintenance of Chronic Musculoskeletal Pain: Is This the Way Forward? Clin J Pain 2019; 36:172-177. [PMID: 31833912 DOI: 10.1097/ajp.0000000000000787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because musculoskeletal pain problems are so prevalent, new methods of evaluating and treating patients are needed to increase effectiveness. Subgrouping is a method wherein patients are classified into defined groups on the basis of psychosocial factors with the expectation of more specific and tailored treatments can be prescribed for them. For those seeking care for a new episode, the risk of developing chronic pain-related disability is assessed, whereas, for those with existing pain, the risk for the maintenance of the chronic pain problem is evaluated. AIM The purpose of this narrative review is to examine how patients are classified into subgroups with regard to methods of evaluation and to ascertain whether subgrouping actually facilitates treatment. RESULTS For the development of disability, screening tools, for example, the Örebro Musculoskeletal Pain Screening Questionnaire, accurately stratify patients into groups (eg, high, medium, low risk) that predict future pain-related work disability. In addition, several studies show that treatments that directly key in on risk groups enjoy enhanced outcomes compared with treatment as usual. For the maintenance of chronic musculoskeletal pain problems, there are several instruments that classify patients into specific groups or profiles, for example, on the basis of the avoidance and endurance model or the International Classification of Functioning, Disability and Health (ICF) assessment. Although some evidence shows that these classifications are related to treatment outcome, we found no study that directly tested a system for providing treatment matched to the subgrouping for maintenance. CONCLUSIONS We conclude that it is possible to reliably subgroup patients with musculoskeletal problems. Likewise, treatments that address the risk factors in the screening procedure may enhance outcomes compared with treatment as usual. More work is needed, however, to better understand the mechanism, so that assessment methods can be improved, and treatment specific to subgroups can be developed and evaluated.
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31
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Williams ACDC. Persistence of pain in humans and other mammals. Philos Trans R Soc Lond B Biol Sci 2019; 374:20190276. [PMID: 31544608 DOI: 10.1098/rstb.2019.0276] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Evolutionary models of chronic pain are relatively undeveloped, but mainly concern dysregulation of an efficient acute defence, or false alarm. Here, a third possibility, mismatch with the modern environment, is examined. In ancestral human and free-living animal environments, survival needs urge a return to activity during recovery, despite pain, but modern environments allow humans and domesticated animals prolonged inactivity after injury. This review uses the research literature to compare humans and other mammals, who share pain neurophysiology, on risk factors for pain persistence, behaviours associated with pain, and responses of conspecifics to behaviours. The mammal populations studied are mainly laboratory rodents in pain research, and farm and companion animals in veterinary research, with observations of captive and free-living primates. Beyond farm animals and rodent models, there is virtually no evidence of chronic pain in other mammals. Since evidence is sparse, it is hard to conclude that it does not occur, but its apparent absence is compatible with the mismatch hypothesis. This article is part of the Theo Murphy meeting issue 'Evolution of mechanisms and behaviour important for pain'.
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Affiliation(s)
- Amanda C de C Williams
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Vibe Fersum K, Smith A, Kvåle A, Skouen JS, O'Sullivan P. Cognitive functional therapy in patients with non‐specific chronic low back pain—a randomized controlled trial 3‐year follow‐up. Eur J Pain 2019; 23:1416-1424. [DOI: 10.1002/ejp.1399] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/17/2019] [Accepted: 04/06/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Kjartan Vibe Fersum
- Physiotherapy Research Group, Department of Public Health and Primary Health Care University of Bergen Norway
| | - Anne Smith
- School of Physiotherapy Curtin University Bentley WA Australia
| | - Alice Kvåle
- Research group Movement and Function Western Norway University of Applied Science Bergen Norway
| | - Jan Sture Skouen
- Physiotherapy Research Group, Department of Public Health and Primary Health Care University of Bergen Norway
- The Outpatient Spine Clinic, Department of Physical Medicine and Rehabilitation Haukeland University Hospital Bergen Norway
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Suso-Ribera C, Camacho-Guerrero L, Osma J, Suso-Vergara S, Gallardo-Pujol D. A Reduction in Pain Intensity Is More Strongly Associated With Improved Physical Functioning in Frustration Tolerant Individuals: A Longitudinal Moderation Study in Chronic Pain Patients. Front Psychol 2019; 10:907. [PMID: 31133917 PMCID: PMC6524714 DOI: 10.3389/fpsyg.2019.00907] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/04/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The onset and chronification of pain often has devastating consequences on the physical and mental functioning of individuals. Medical interventions are quite efficacious in reducing pain levels. However, changes in physical and mental health status after medical interventions are not proportional. In the past decades, rational/irrational beliefs, especially catastrophizing, have contributed to a better understanding of the pain experience. This study explores whether pain reduction efforts are more beneficial for individuals scoring high in rational thinking (moderation). METHODS The study design was longitudinal. Patients were assessed twice, 2 weeks prior to the start of medical treatment at the pain clinic and 6 months after. A total of 163 patients with heterogeneous pain (mostly low back and neck pain) participated in the study. Their mean age was 58.74 years (SD = 14.28) and 61.3% were female. RESULTS Overall, there was a reduction in pain intensity (t = 4.25, p < 0.001, d = 0.32). An improvement in physical functioning (t = 4.02, p < 0.001, d = 0.19), but not mental health (t = -0.66, p = 0.511, d = 0.11) was also observed. In the regression analyses, a decrease in pain intensity was moderately associated with improved physical health (β = 0.87, t = 4.96, p < 0.001, R 2 change = 0.177). This association was found to be moderated by frustration tolerance (β = -0.49, t = -2.80, p = 0.006, R 2 change = 0.039). Specifically, post hoc analyses indicated that changes in pain intensity only correlated with changes in physical health when patients reported high frustration tolerance levels (r = 0.47, p = 0.006, M = 7, n = 32), but not when patients were intolerant to frustration (r = 0.28, p = 0.078, M = 17, n = 41). CONCLUSION The results suggest that frustration tolerance may render adaptive by facilitating the positive effect that a reduction in pain intensity has on physical health status. The study findings are discussed in the context of personalized therapy with an emphasis on how to maximize the effectiveness of current interventions for pain.
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Affiliation(s)
- Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | | | - Jorge Osma
- Department of Psychology and Sociology, Instituto de Investigación Sanitaria de Aragón, Universidad de Zaragoza, Teruel, Spain
| | | | - David Gallardo-Pujol
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
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Adverse Childhood Experiences and Trauma-Informed Care in Rehabilitation Clinical Practice. Arch Rehabil Res Clin Transl 2019; 1:100003. [PMID: 33543043 PMCID: PMC7853397 DOI: 10.1016/j.arrct.2019.100003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Adverse childhood experiences (ACEs) contribute to physical, behavioral, and mental health issues throughout the lifespan and, because of their prevalence, constitute a significant public health issue. Practitioners in all health care disciplines need to be knowledgeable about ACEs and prepared to address them. ACEs can contribute to conditions that lead patients to seek rehabilitation care, and therefore a framework is needed that enables rehabilitation professionals to understand the effects of ACEs and how to discuss them with patients. This article summarizes ACE research and its clinical relevance, presents an overview of the related topic of trauma-informed care, and introduces rehabilitation professionals to practical tools for incorporating ACE- and trauma-informed care into clinical practice. There is growing acknowledgement across all health care disciplines of the impact of ACEs. ACEs are understood as stressful, potentially traumatic events that may have lasting negative effects on health and well-being. Since the 1990s, when landmark research found striking associations between early life stress and adversity and a wide range of chronic physical, behavioral, and mental health issues, international attention to ACEs as a major public health issue has grown.1, 2 ACE-related research has identified strong correlations between chronic disease, stress, and prior experience. Eighty-six percent of health care dollars in the United States are spent on chronic diseases, and a population health strategy should include empowering, person-centered, low-risk, low-cost, self-management skill-building practices to help patients manage the stress response.3 Though a relevant consideration for all care provision, the biopsychosocial framework may be particularly important for understanding and working with chronic health conditions.4, 5, 6, 7 For example, chronic pain affects 116 million in the United States8 and may be a key force in driving patients to seek rehabilitation services. Patients need their providers to skillfully and comprehensively navigate the intersection of mental, emotional, and physical components of their healing process. Given the prevalence of ACEs and their potential contribution to chronic pain, among other conditions, rehabilitation professionals should be prepared to address ACEs in the clinical setting as a possible underlying contributor to the condition for which treatment is sought. This article provides an overview of ACEs research and the health effects that can result from ACEs and introduces a trauma-informed practical guide for rehabilitation professionals to use in clinical encounters. Adverse childhood experiences (ACEs) contribute to a broad spectrum of health challenges across the lifespan and constitute a significant public health issue. Rehabilitation professionals routinely work with individuals experiencing health challenges that may be linked to ACEs. Models of trauma-informed care and resilience-building approaches assist rehabilitation professionals in contributing to a solution to the prevalence of ACEs and chronic stress in the population. A novel schema is presented to assist rehabilitation professionals in navigating the topic of ACEs in clinical care.
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Matheve T, De Baets L, Bogaerts K, Timmermans A. Lumbar range of motion in chronic low back pain is predicted by task-specific, but not by general measures of pain-related fear. Eur J Pain 2019; 23:1171-1184. [PMID: 30793429 DOI: 10.1002/ejp.1384] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/30/2019] [Accepted: 02/17/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Most studies fail to show an association between higher levels of pain-related fear and protective movement behaviour in patients with chronic low back pain (CLBP). This may be explained by the fact that only general measures of pain-related fear have been used to examine the association with movement patterns. This study explored whether task-specific, instead of general measures of pain-related fear can predict movement behaviour. METHODS Fifty-five patients with CLBP and 54 healthy persons performed a lifting task while kinematic measurements were obtained to assess lumbar range of motion (ROM). Scores on the Photograph Daily Activities Series-Short Electronic Version (PHODA-SeV), Tampa Scale for Kinesiophobia and its Activity Avoidance and Somatic Focus subscales were used as general measures of pain-related fear. The score on a picture of the PHODA-SeV, showing a person lifting a heavy object with a bent back, was used as task-specific measure of pain-related fear. RESULTS Lumbar ROM was predicted by task-specific, but not by general measures of pain-related fear. Only the scores on one other picture of the PHODA-SeV, similar to the task-specific picture regarding threat value and movement characteristics, predicted the lumbar ROM. Compared to healthy persons, patients with CLBP used significantly less ROM, except the subgroup with a low score on the task-specific measure of pain-related fear, who used a similar ROM. CONCLUSIONS Our results suggest to use task-specific measures of pain-related fear when assessing the relationship with movement. It would be of interest to investigate whether reducing task-specific fear changes protective movement behaviour. SIGNIFICANCE This study shows that lumbar range of motion in CLBP is predicted by task-specific, but not by general measures of pain-related fear. This suggests that both in clinical practice and for research purposes, it might be recommended to use task-specific measures of pain-related fear when assessing the relationship with movement behaviour. This may help to disentangle the complex interactions between pain-related fear, movement and disability in patients with CLBP.
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Affiliation(s)
- Thomas Matheve
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Liesbet De Baets
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Katleen Bogaerts
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Health Psychology, University of Leuven, Leuven, Belgium
| | - Annick Timmermans
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Why wait to address high-risk cases of acute low back pain? A comparison of stepped, stratified, and matched care. Pain 2019; 159:2437-2441. [PMID: 29905653 DOI: 10.1097/j.pain.0000000000001308] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kongsted A, Ris I, Kjaer P, Vach W, Morsø L, Hartvigsen J. GLA:D ® Back: implementation of group-based patient education integrated with exercises to support self-management of back pain - protocol for a hybrid effectiveness-implementation study. BMC Musculoskelet Disord 2019; 20:85. [PMID: 30777049 PMCID: PMC6380042 DOI: 10.1186/s12891-019-2443-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 01/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Reassuring patient education and exercise therapy are widely recommended interventions for back pain in clinical guidelines. However, many patients are offered non-guideline endorsed options, and strategies for effective implementation of guideline-based care have not yet been developed. This protocol outlines the evaluation of a strategy for nationwide implementation of standardised patient education and exercise therapy for people with persistent or recurrent back pain in a hybrid implementation-effectiveness design. The strategy and the evaluation were planned using the framework of the Behaviour Change Wheel. METHODS The main activity of the implementation strategy is a two-days course for physiotherapists and chiropractors in delivering patient education and exercise therapy that is aimed at supporting patient self-management. This comes with ready-to-use patient education materials and exercise programs. The clinical intervention is a group-based program consisting of two sessions of patient education and 8 weeks of supervised exercises. The program uses a cognitive-behavioural approach and the aim of the exercise component is to restore the patient's ability and confidence to move freely. The implementation process is evaluated in a dynamic process monitoring the penetration, adoption and fidelity of the clinical intervention. The clinical intervention and potential effect mechanisms will be evaluated at the patient-level using measures of knowledge, skills, beliefs, performance, self-efficacy and success in self-management. The education of clinicians will be evaluated via clinician-level outcomes, including the Pain Attitudes and Beliefs Scale, the Practitioner Confidence Scale, and the Determinants of Implementation Behaviour Questionnaire. Effects at a national level will be investigated via data from national registries of health care utilisation and sick-leave. DISCUSSION This implementation-effectiveness study is designed to evaluate the process of implementing an evidence-based intervention for back pain. It will inform the development of strategies for implementing evidence-based care for musculoskeletal pain conditions, it will enhance the understanding of mechanisms for developing patient self-management skills, and it will demonstrate the outcomes that are achievable in everyday clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT03570463 . Registered 27 June 2018.
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Affiliation(s)
- Alice Kongsted
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Applied Health Science, University College Lillebaelt, Odense, Denmark
| | - Werner Vach
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Lars Morsø
- Centre for Quality, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Di Tella M, Ghiggia A, Testa S, Castelli L, Adenzato M. The Fear of Pain Questionnaire: Factor structure, validity and reliability of the Italian translation. PLoS One 2019; 14:e0210757. [PMID: 30682182 PMCID: PMC6347221 DOI: 10.1371/journal.pone.0210757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/31/2018] [Indexed: 01/06/2023] Open
Abstract
Background The Fear of Pain Questionnaire-III (FPQ-III) is a self-report instrument developed to assess fear of different stimuli usually causing pain. The present study aimed to construct an Italian version of the FPQ-III and examine its psychometric properties in a heterogeneous sample of Italian healthy individuals. Methods The questionnaire was translated following the forward-backward method and completed by 511 Italian adults who met the inclusion criteria. Within 2 months of the first assessment, a subgroup of participants (n = 164) was re-tested. The factorial structure of the FPQ-III was assessed by confirmatory factor analysis (CFA). To better comprehend the FPQ-III’s factorial structure, a CFA was also performed for each of the two reduced versions of the FPQ-III, namely the FPQ-Short Form and the FPQ-9. Divergent validity, test-retest reliability, and gender/age measurement invariance were also evaluated. Results The results of the CFA revealed that the original three-factor model poorly fitted the data, but it became satisfactory after allowing correlated error terms. Concerning divergent validity, correlations between FPQ-III scores and pain intensity, depression, and anxiety were found to be positive but weak in magnitude (< .20). FPQ-III subscales and total scores showed good internal consistency and time reliability. Finally, scalar invariance was only partially obtained, whereas all the other types of invariance were fully respected both for gender and age. Conclusions The current findings indicate that the Italian version of the FPQ-III provides valid and reliable scores for the assessment of fear of pain in the Italian population.
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Affiliation(s)
| | - Ada Ghiggia
- Department of Psychology, University of Turin, Via Verdi, Turin, Italy
| | - Silvia Testa
- Department of Psychology, University of Turin, Via Verdi, Turin, Italy
- * E-mail:
| | - Lorys Castelli
- Department of Psychology, University of Turin, Via Verdi, Turin, Italy
| | - Mauro Adenzato
- Department of Psychology, University of Turin, Via Verdi, Turin, Italy
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Abstract
Low back pain affects individuals of all ages and is a leading contributor to disease burden worldwide. Despite advancements in assessment and treatment methods, the management of low back pain remains a challenge for researchers and clinicians alike. One reason for the limited success in identifying effective treatments is the large variation in the manifestations, possible causes, precipitating and maintaining factors, course, prognosis and consequences in terms of activity interference and quality of life. However, despite these challenges, steady progress has been achieved in the understanding of back pain, and important steps in the understanding of the psychological and social risk factors, genetics and brain mechanisms of low back pain have been made. These new findings have given impetus to the development of new diagnostic procedures, evidence-based screening methods and more targeted interventions, which underscore the need for a multidisciplinary approach to the management of low back pain that integrates biological, psychological and social aspects.
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Kjaer P, Kongsted A, Ris I, Abbott A, Rasmussen CDN, Roos EM, Skou ST, Andersen TE, Hartvigsen J. GLA:D ® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence. BMC Musculoskelet Disord 2018; 19:418. [PMID: 30497440 PMCID: PMC6267880 DOI: 10.1186/s12891-018-2334-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/31/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Clinical guidelines recommend that people with back pain be given information and education about their back pain, advice to remain active and at work, and exercises to improve mobility and physical activity. Guidelines, however, rarely describe how this is best delivered. The aim of this paper is to present the development, theories, and underlying evidence for 'GLA:D Back' - a group education and exercise program that translates guideline recommendations into a clinician-delivered program for the promotion of self-management in people with persistent/recurrent back pain. METHODS GLA:D Back, which included a rationale and objectives for the program, theory and evidence for the interventions, and program materials, was developed using an iterative process. The content of patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements hypothesised to improve back pain beliefs and management skills. The program was tested on eight people with persistent back pain in a university clinic and 152 patients from nine primary care physiotherapy and chiropractic clinics. Following feedback from the clinicians and patients involved, the working version of the program was created. RESULTS Educational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between the sum of demands and the individual's capacity. These were operationalised in PowerPoint presentations with supporting text to aid clinicians in delivering two one-hour patient education lectures. The exercise program included 16 supervised one-hour sessions over 8 weeks, each comprising a warm-up section and eight types of exercises for general flexibility and strengthening of six different muscle groups at four levels of difficulty. The aims of the exercises were to improve overall back fitness and, at the same time, encourage patients to explore variations in movement by incorporating education content into the exercise sessions. CONCLUSION From current best evidence about prognostic factors in back pain and effective treatments for back pain, research and clinical experts developed a ready-to-use structured program - GLA:D® Back - to support self-management for people with persistent/recurrent back pain.
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Affiliation(s)
- Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Department of Applied Health Services, University College Lillebaelt, Niels Bohrs Alle 1, 5230 Odense M, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
| | - Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Allan Abbott
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Sandbäcksgatan 7/3, University Hospital Campus, Linköping University, 581 83 Linköping, Sweden
| | | | - Ewa M. Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Tonny Elmose Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
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Faraji E, Allami M, Feizollahi N, Karimi A, Yavari A, Soroush M, Moudi M. Health concerns of veterans with high-level lower extremity amputations. Mil Med Res 2018; 5:36. [PMID: 30360763 PMCID: PMC6203280 DOI: 10.1186/s40779-018-0183-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/07/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The aim of the study was to identify health concerns of veterans with high-level lower extremity amputations. METHODS Through a cross-sectional study, general practitioners, an orthopedic specialist, psychologists, psychiatrists, physiotherapist and prosthetists examined 100 veterans using a short-form health-related quality of life questionnaire (SF-36) that assessed their ability to perform activities of daily living (ADL), instrumental activities of daily living (IADL) and life satisfaction (SWLS) after hip disarticulation or hemi-pelvectomy amputations. The assessment tool was designed to gather statistically useful information about their health needs. RESULTS The means of the Physical Component Summary (PCS), Mental Component Summary (MCS), SWLS, ADL and IADL were 48.58 ± 29.6, 33.33 ± 22.0, 19.30 ± 7.7, 48.10 ± 10.5 and 5.08 ± 1.8, respectively. Somatization, depression, and anxiety were the most prevalent disorders; among the veterans who were visited by psychiatrists, 11.6% had a history of hospitalization in a psychiatry section, and 53.2% had a psychiatric visit. Regardless of their injury in battle, 34% of veterans were hospitalized. Hearing problems were common, and about four-fifths of the participants suffered from at least one orthopedic condition. Neuroma (49%) was the most common stump-related complication during orthopedic evaluations, though the prevalence of phantom pain was 81% during the pain assessment. A total of 87% of the participants had a history of wearing a prosthesis, but only 29% wore a prosthesis at the time of the present study. The Canadian-type of prosthesis was uncomfortable and not useful (27%) and excessively heavy (10%) according to the amputees. CONCLUSIONS Understanding veterans' characteristics and special needs are important to make sure that enough facilities and services are afforded to them. These findings emphasize the importance of paying close attention to different dimensions of health in veterans and can help health providers identify health needs and make regular assessments.
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Affiliation(s)
- Elahe Faraji
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran
| | - Mostafa Allami
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran.
| | - Nafiseh Feizollahi
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran
| | - Amir Karimi
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran
| | - Amir Yavari
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran
| | - Mohammadreza Soroush
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran
| | - Majid Moudi
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran
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Darnall BD, Colloca L. Optimizing Placebo and Minimizing Nocebo to Reduce Pain, Catastrophizing, and Opioid Use: A Review of the Science and an Evidence-Informed Clinical Toolkit. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 139:129-157. [PMID: 30146045 PMCID: PMC6175287 DOI: 10.1016/bs.irn.2018.07.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pain, a noxious psychosensory experience, motivates escape behavior to assure protection and survival. Psychological factors alter the experience and trajectory of pain, as well as behavior and treatment response. In the context of pain, the placebo effect (expectation for pain relief) releases endogenous opioids and facilitates analgesia from exogenously administered opioids. Nocebo hyperalgesia (expectation for persistent or worsening pain) opposes endogenous opioid analgesia and patient engagement in prescription opioid tapering. Reductions in nocebo hyperalgesia and pain catastrophizing may enhance descending modulation of pain, mediate adaptive structural brain changes and promote patient engagement in opioid tapering. Interventions that minimize nocebo and optimize placebo may adaptively shape the central nervous system toward pain relief and potentially opioid reduction. Here we provide a critical description of catastrophizing and its impact on pain, placebo and nocebo effects. We also consider the importance of minimizing nocebo and optimizing placebo effects during prescription opioid tapering, and offer a clinical toolkit of resources to accomplish these goals clinically.
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Affiliation(s)
- Beth D Darnall
- School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Psychiatry and Behavioral Sciences (by courtesy), Stanford University, Palo Alto, CA, United States.
| | - Luana Colloca
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States; Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, United States; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, United States
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Ehrström J, Kettunen J, Salo P. Physiotherapy pain curricula in Finland: a faculty survey. Scand J Pain 2018; 18:593-601. [DOI: 10.1515/sjpain-2018-0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/30/2018] [Indexed: 01/09/2023]
Abstract
Abstract
Background and aims
Despite the recognition of pain as a global health problem and advancements achieved in what is known about effective pain management, pain education for undergraduate health care professionals remains insufficient. This study investigated the content of pain curricula and the time allocated to pain education on physiotherapy programs at bachelor’s level at Universities of Applied Sciences (UASs) in Finland.
Methods
A web-based survey questionnaire was sent to the directors of the physiotherapy programs at all the Finnish UASs (n=15) where physiotherapy is taught at bachelor’s level. The questionnaire consisted of 14 questions covering basic concepts and the science of pain, pain assessment, pain management, and the adequacy of pain curricula. Each UAS completed one questionnaire i.e. returned one official opinion.
Results
The response rate was 80% (n=12). The mean for the total number of contact hours of pain education was 74 (standard deviation 34.2). All UASs had integrated pain education. In addition to this 42% (n=5) of the UASs had a separate pain course. The UASs offering such a course over and above the integrated pain education had twice the amount of pain content education compared to those UASs that only had integrated pain education (mean 103 h vs. 53 h, p=0.0043). Most of the education was devoted to conditions where pain is commonly a feature, manual therapy, and electrical agents for pain control. The biopsychosocial model of pain, cognitive behavioral methods of pain management, physician management, and multidisciplinary management were the least covered topics. Five UASs (42%) payed attention to the International Association for the Study of Pain curriculum outline and only 33% (n=4) considered their pain education to be sufficient.
Conclusions
Our results indicate that more contact hours are devoted to pain education on the Finnish UASs’ physiotherapy programs at bachelor’s level, than has previously been reported in faculty surveys. A separate pain course is one way to ensure a sufficient amount of pain education. Overall, despite a sufficient time devoted to pain education, some essential pain contents were inadequately covered.
Implications
The study contributes information on how pain education can be organized on physiotherapy programs at undergraduate level. Besides a sufficient amount of pain education, which can be ensured by a separate pain course, attention should be paid to pain education content being up-to-date. This could help in estimating the different proportions of pain content needed in educational settings. Efforts should also be made at keeping integrated pain education well-coordinated and purposeful. There is a need for further research estimating the effectiveness of pain education according to the different ways in which it is organized. There is also a need to investigate whether more hours allocated to pain education results in better understanding and professional skills.
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Affiliation(s)
- Jolanda Ehrström
- Åbo Akademi University , Faculty of Education and Welfare Studies , Vaasa , Finland
- Fysios FTK Töölö , Urheilukatu 38 A , 00250 Helsinki , Finland , Tel.: +358 50 531 8635
| | - Jyrki Kettunen
- Arcada University of Applied Sciences , Department of Health and Welfare , Helsinki , Finland
| | - Petri Salo
- Åbo Akademi University , Faculty of Education and Welfare Studies , Vaasa , Finland
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George SZ, Greenspan AI. Nonpharmacological Management of Pain: Convergence in Priorities Fuels the Drive for More Evidence. Phys Ther 2018; 98:287-289. [PMID: 29617872 DOI: 10.1093/ptj/pzy034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Steven Z George
- Duke Clinical Research Institute, and Vice Chair of Clinical Research, Orthopaedic Surgery, Duke University, Durham, North Carolina. He is a Catherine Worthingham Fellow of the American Physical Therapy Association
| | - Arlene I Greenspan
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Dr Greenspan's contribution as guest co-editor was done as a personal outside activity. The content of this editorial is that of the authors and does not necessarily represent the official position of the Centers for Disease Control and Prevention
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