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Noe-Steinmüller N, Scherbakov D, Zhuravlyova A, Wager TD, Goldstein P, Tesarz J. Defining suffering in pain. A systematic review on pain-related suffering using natural language processing. Pain 2024:00006396-990000000-00542. [PMID: 38452202 DOI: 10.1097/j.pain.0000000000003195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/26/2023] [Indexed: 03/09/2024]
Abstract
ABSTRACT Understanding, measuring, and mitigating pain-related suffering is a key challenge for both clinical care and pain research. However, there is no consensus on what exactly the concept of pain-related suffering includes, and it is often not precisely operationalized in empirical studies. Here, we (1) systematically review the conceptualization of pain-related suffering in the existing literature, (2) develop a definition and a conceptual framework, and (3) use machine learning to cross-validate the results. We identified 111 articles in a systematic search of Web of Science, PubMed, PsychINFO, and PhilPapers for peer-reviewed articles containing conceptual contributions about the experience of pain-related suffering. We developed a new procedure for extracting and synthesizing study information based on the cross-validation of qualitative analysis with an artificial intelligence-based approach grounded in large language models and topic modeling. We derived a definition from the literature that is representative of current theoretical views and describes pain-related suffering as a severely negative, complex, and dynamic experience in response to a perceived threat to an individual's integrity as a self and identity as a person. We also offer a conceptual framework of pain-related suffering distinguishing 8 dimensions: social, physical, personal, spiritual, existential, cultural, cognitive, and affective. Our data show that pain-related suffering is a multidimensional phenomenon that is closely related to but distinct from pain itself. The present analysis provides a roadmap for further theoretical and empirical development.
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Affiliation(s)
- Niklas Noe-Steinmüller
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Tor D Wager
- Dartmouth College, Hanover, NH, United States
| | | | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Collins JT, Walsh DA, Gladman JRF, Patrascu M, Husebo BS, Adam E, Cowley A, Gordon AL, Ogliari G, Smaling H, Achterberg W. The Difficulties of Managing Pain in People Living with Frailty: The Potential for Digital Phenotyping. Drugs Aging 2024; 41:199-208. [PMID: 38401025 PMCID: PMC10925563 DOI: 10.1007/s40266-024-01101-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/26/2024]
Abstract
Pain and frailty are closely linked. Chronic pain is a risk factor for frailty, and frailty is a risk factor for pain. People living with frailty also commonly have cognitive impairment, which can make assessment of pain and monitoring of pain management even more difficult. Pain may be sub-optimally treated in people living with frailty, people living with cognitive impairment and those with both these factors. Reasons for sub-optimal treatment in these groups are pharmacological (increased drug side effects, drug-drug interactions, polypharmacy), non-pharmacological (erroneous beliefs about pain, ageism, bidirectional communication challenges), logistical (difficulty in accessing primary care practitioners and unaffordable cost of drugs), and, particularly in cognitive impairment, related to communication difficulties. Thorough assessment and characterisation of pain, related sensations, and their functional, emotional, and behavioural consequences ("phenotyping") may help to enhance the assessment of pain, particularly in people with frailty and cognitive impairment, as this may help to identify who is most likely to respond to certain types of treatment. This paper discusses the potential role of "digital phenotyping" in the assessment and management of pain in people with frailty. Digital phenotyping is concerned with observable characteristics in digital form, such as those obtained from sensing-capable devices, and may provide novel and more informative data than existing clinical approaches regarding how pain manifests and how treatment strategies affect it. The processing of extensive digital and usual data may require powerful algorithms, but processing these data could lead to a better understanding of who is most likely to benefit from specific and targeted treatments.
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Affiliation(s)
- Jemima T Collins
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - David A Walsh
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | | | - Monica Patrascu
- Centre for Elderly and Nursing Home Medicine, University of Bergen, 5007, Bergen, Norway
- Neuro-SysMed Center, University of Bergen, 5007, Bergen, Norway
- Complex Systems Laboratory, University Politehnica of Bucharest, 60042, Bucharest, Romania
| | - Bettina S Husebo
- Centre for Elderly and Nursing Home Medicine, University of Bergen, 5007, Bergen, Norway
- Neuro-SysMed Center, University of Bergen, 5007, Bergen, Norway
| | - Esmee Adam
- Department of Public Health and Primary Care, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Alison Cowley
- University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adam L Gordon
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- University Hospitals of Derby and Burton NHS Trust, Derby, UK
| | - Giulia Ogliari
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hanneke Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Wilco Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands.
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, The Netherlands.
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Lawn T, Sendel M, Baron R, Vollert J. Beyond biopsychosocial: The keystone mechanism theory of pain. Brain Behav Immun 2023; 114:187-192. [PMID: 37625555 DOI: 10.1016/j.bbi.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/13/2023] [Accepted: 08/20/2023] [Indexed: 08/27/2023] Open
Abstract
Pain is a deeply personal experience, with interindividual differences in its chronification and treatment presenting a formidable healthcare challenge. The biopsychosocial model (BPSm) has been hugely influential within nascent attempts at precision pain medicine, steering the field away from a reductionist biomechanical viewpoint and emphasising complex interactions of biological, psychological, and social factors which shape the individuality of pain. However, despite offering a strong theoretical foundation and holistic perspective, we contend that the BPSm remains limited in its capacity to deliver truly mechanistically informed treatment of pain. We therefore propose the keystone model of pain which offers a pragmatic balance between the dimensionality expansive BPSm and overly reductive approaches, providing both theoretical and practical advantages for the transition from treating populations to individual people.
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Affiliation(s)
- Timothy Lawn
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Manon Sendel
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Jan Vollert
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany; Pain Research, Department of Surgery and Cancer, Imperial College, London, UK; Neurophysiology, Mannheim Centre for Translational Neuroscience MCTN, Medical Faculty Mannheim, Ruprecht Karls University, Heidelberg, Germany
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Smart KM. Pain science and practice as a 'threshold concept' within undergraduate and pre-registration physiotherapy education: a jewel of the curriculum? BMC Med Educ 2023; 23:732. [PMID: 37803373 PMCID: PMC10559438 DOI: 10.1186/s12909-023-04733-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Threshold concepts describe learning experiences that transform our understanding of a concept. Threshold concepts are variously: troublesome, transformative, irreversible, integrative and bounded. PURPOSE The aim of this narrative review is to consider the case for characterising pain science and practice as a threshold concept within undergraduate and pre-registration physiotherapy education. This article considers the underlying tenets of threshold concepts as they relate to teaching and learning and the relative merits and limitations of characterising pain science and practice as a threshold concept within undergraduate and pre-registration physiotherapy education from both pedagogical and epidemiological perspectives. By evaluating pain, as it relates to physiotherapy education and practice, according to the five defining characteristics of a threshold concept then presenting data related to the epidemiology and impact of pain, the worthiness of characterising pain science and practice as a threshold concept will be discussed and further debate invited.
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Affiliation(s)
- Keith M Smart
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland.
- UCD Centre for Translational Pain Research, Dublin, Ireland.
- Physiotherapy Department, St. Vincent's University Hospital, Dublin, Ireland.
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Shah S, Prakash V. Factors influencing physiotherapists implementation of high value care in the management of nonspecific low back pain in Indian healthcare settings: A qualitative study. Musculoskelet Sci Pract 2023; 67:102838. [PMID: 37556916 DOI: 10.1016/j.msksp.2023.102838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Non-specific low back pain is a common musculoskeletal condition that often requires the involvement of physiotherapists for effective management. However, there is limited understanding of the factors influencing physiotherapists' implementation of high-value care in the management of non-specific low back pain (NSLBP), particularly in Indian healthcare settings. OBJECTIVE The aim of this study was to explore the barriers and facilitators of implementation of high-value care in managing NSLBP from the perspective of physiotherapists practicing in Indian healthcare settings. DESIGN Descriptive qualitative design. METHODS We adopted a descriptive phenomenological approach and purposefully selected physiotherapists (N = 15) from diverse healthcare settings, encompassing varying years of clinical experience, to capture a broad range of perspectives. Semi-structured face-to-face interviews were conducted via the Zoom video conferencing platform. Each interview lasted on average for 30-45 min, and no follow-up interviews were conducted. Data were analyzed using thematic analysis with an inductive approach. RESULTS Our analysis revealed three major themes and seven sub-themes uncovering barriers and facilitators of implementation of high-value care. These themes include misconceptions about low back pain and its management among physiotherapists, their perceived lack of autonomy in clinical decision-making due to external influences, and the significance of aligning treatment plans with patient goals while considering evidence-based care. CONCLUSION The study results provide insights into the unique challenges associated with implementation of high-value care for non-specific low back pain in Indian healthcare settings.
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Affiliation(s)
- Sweni Shah
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Changa, Anand, Gujarat, India.
| | - V Prakash
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Changa, Anand, Gujarat, India
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Scott L, Dolan E, Baker N, Melia Y. Exploring attitudes of healthcare professionals towards those with fibromyalgia: A Q-methodological approach. Br J Pain 2023; 17:352-365. [PMID: 37538944 PMCID: PMC10395391 DOI: 10.1177/20494637231159502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Fibromyalgia remains a difficult condition to diagnose and treat. Research suggests that this leads to frustrating experiences for service users and healthcare professionals. This has led to negative healthcare professional attitudes towards working with those with fibromyalgia. The research to date reports negative attitudes and predominantly investigates attitudes of primary care physicians. This study explores the attitudes of a range of healthcare professionals towards those diagnosed with fibromyalgia. Using Q-methodology, 27 healthcare professionals completed a sorting task and questionnaire to prioritise statements relating to a range of different attitudes towards service users. All participants significantly loaded onto three factors that explained a total of 64% of the data variance. Factor 1 reflected the attitude 'Service users with fibromyalgia are no different to other service users and I enjoy working with them'. Factor 2 reflected the attitude 'Service users with fibromyalgia are inaccurate informants of their own condition due to lack of understanding of their condition and are not likely to engage in treatments'. Factor 3 reflected the attitude 'Service users with fibromyalgia are trustworthy with a lot of clinical problems [but I lack confidence in specialist skills to support them]'. Contrary to the current literature, there appears to be supportive attitudes from healthcare professionals towards service users diagnosed with fibromyalgia. Increased specialised training, clinical exposure to working with fibromyalgia and reflective practice spaces were identified as elements that could improve healthcare professional attitudes.
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Affiliation(s)
- Laura Scott
- Staffordshire University, Stoke-on-Trent, UK
| | - Eamon Dolan
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Nita Baker
- Midlands Partnership NHS Foundation Trust, Stafford, UK
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Booker SQ, Baker TA, Esiaka D, Minahan JA, Engel IJ, Banerjee K, Poitevien M. A historical review of pain disparities research: Advancing toward health equity and empowerment. Nurs Outlook 2023; 71:101965. [PMID: 37023670 DOI: 10.1016/j.outlook.2023.101965] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND AND PURPOSE This theory-guided review draws on 30 years of published data to examine and interrogate the current and future state of pain disparities research. METHODS Using the Hierarchy of Health Disparity Research framework, we synthesize and present an overview of "three generations" of pain disparities scholarship, while proposing directions for adopting a "fourth generation" that redefines, explains, and theorizes future pain disparities research in a diverse society. DISCUSSION Prior research has focused on describing the scope of disparities, and throughout the historical context of human existence, racialized groups have been subjected to inadequate pain care. It is imperative that research not only illuminates existing problems but also provides solutions that can be implemented and sustained across varying social milieus. CONCLUSION We must invest in new theoretical models that expand on current perspectives and ideals that position all individuals at the forefront of justice and equity in their health.
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Smart KM. The biopsychosocial model of pain in physiotherapy: past, present and future. Physical Therapy Reviews 2023. [DOI: 10.1080/10833196.2023.2177792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Keith M. Smart
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
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Sullivan MD, Sturgeon JA, Lumley MA, Ballantyne JC. Reconsidering Fordyce's classic article, "Pain and suffering: what is the unit?" to help make our model of chronic pain truly biopsychosocial. Pain 2023; 164:271-279. [PMID: 35972469 PMCID: PMC9840653 DOI: 10.1097/j.pain.0000000000002748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/26/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT The biopsychosocial model (BPS) of chronic pain aspires to be comprehensive, incorporating psychological and social factors omitted from biomedical models. Although psychosocial factors are viewed as highly influential in understanding behavioral and psychological responses to pain, these factors are usually viewed as modifiers of biological causes of the experience of pain itself, rather than as equal contributors to pain. To further advance the BPS model, we re-examine a classic 1994 article by Wilbert "Bill" Fordyce, "Pain and suffering: what is the unit?" In this article, Fordyce suggested that pain-related disability and suffering should be viewed as "transdermal," as having causes both inside and outside the body. We consider Fordyce's article theoretically important because this concept allows us to more fully break free of the medical model of chronic pain than customary formulations of the BPS model. It makes it possible to place psychological and social factors on an equal footing with biological ones in explaining pain itself and to remove distinctions between pain mechanisms and pain meanings. The brain's salience network now offers a platform on which diverse influences on pain experience-from nociception to multisensory indicators of safety or danger-can be integrated, bridging the gap between impersonal nociceptive mechanisms and personal meanings. We also argue that Fordyce's article is practically important because this concept expands the BPS model beyond the bounds of the clinical encounter, opening the door to the full range of social, psychological, and biological interventions, empowering patients and nonmedical providers to tackle chronic pain.
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Cohen M, Weisman A, Quintner J. Response to van Rysewyk S and Moseley GL et al.'s Comments on Cohen et al. J Pain 2022; 23(8):1283-1293. J Pain 2023; 24:184-5. [PMID: 36400173 DOI: 10.1016/j.jpain.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022]
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Butler SH. Pain "chronification": what is the problem with this model? Scand J Pain 2022; 23:419-423. [PMID: 36126651 DOI: 10.1515/sjpain-2022-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There appears to be an unwarranted focus on all chronic pain being a "chronification" of acute pain. Despite a plethora of studies on mechanisms to prevent this "chronification" following surgery, the positive effects have been minimal. An alternate model to explain chronic pain is presented. METHODS Research in PUBMED and accessing data from the HUNTpain examination study. RESULTS Data from the HUNT pain examination study reveal that less than 25% of individuals with chronic pain in a general population can relate the onset to an acute event. Another theory explaining the origin of chronic pain is that of priming and the accumulation of events that can be predictors along a continuum before chronic pain is apparent. This theory is presented to refocus for better prevention and treatment of chronic pain. CONCLUSIONS "Chronification" cannot explain all cases of chronic/persistent pain. The plastic changes in the pain processing system can be seen as a continuum where at some point where an acute pain event is only one of several possible tipping points on this continuum that changes potential pain to perceived pain.
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Affiliation(s)
- Stephen H Butler
- Department of Surgical Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Abstract
As an alternative to linear and unidimensional perspectives focused mainly on either organic or psychological processes, the enactive approach to life and mind-a branch of 4-E (embodied, embedded, enactive, extended) cognitive theories-offers an integrative framework to study mental disorders that encompasses and articulates organic, sensorimotor, and intersubjective dimensions of embodiment. These three domains are deeply entangled in a non-trivial manner. A question remains on how this systemic and multi-dimensional approach may be applied to our understanding of mental disorders and symptomatic behavior. Drawing on Gilbert Simondon's philosophy of individuation (focusing particularly on the concepts of tension, metastability, and preindividual), we provide some enactive conceptual tools to better understand the dynamic, interactive, and multi-dimensional nature of human bodies in mental disorders and psychopathological symptoms. One of such tools cursiva is sense-making, a key notion that captures the relational process of generating meaning by interacting with the sociomaterial environment. The article analyzes five aspects related to sense-making: temporality, adaptivity, the multiplicity of normativities it involves, the fundamental role of tension, and its participatory character. On this basis, we draw certain implications for our understanding of mental disorders and diverse symptoms, and suggest their interpretation in terms of difficulties to transform tensions and perform individuation processes, which result in a reduction of the field of potentialities for self-individuation and sense-making.
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Affiliation(s)
- Enara García
- IAS Research group, Department of Philosophy, University of the Basque Country, San Sebastián, Spain
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Cohen M, Weisman A, Quintner J. Pain is Not a "thing": How That Error Affects Language and Logic in Pain Medicine. J Pain 2022; 23:1283-93. [PMID: 35427806 DOI: 10.1016/j.jpain.2022.03.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/08/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023]
Abstract
Effectiveness in academic and clinical communication depends upon agreement on what words and concepts denote and on the consequent ability to argue logically and accurately. In the pain medicine literature there are many examples of imprecision and confusion in this respect, including misnomers and fallacies in reasoning. This article firstly critically examines some of these misnomers. Identified themes include pain being conceptualised as a "thing," conflation between nociception and pain, and confusion between stimulus and response and between the perspectives of the experiencer and the observer of "pain." Secondly, fallacies in reasoning are identified that contribute to imprecision and confusion. These include reification of pain, attributing to the brain functions that belong to whole organisms, and the illusory truth effect. Thirdly, these themes are identified also in constructs that are shown to be based more on speculation than on fact. Taken together, these observations reveal a need to review and, where necessary, modify terminology and concepts used in Pain Medicine. PERSPECTIVE: This article examines a number of words and constructs commonly found in the pain literature from the perspective of accuracy in terms of their consistency of usage, concordance with fact, degree of speculation and logical argument. A common major theme is the error of considering pain as a "thing" that has agentive properties. A need to clarify much of the language used in Pain Medicine is identified.
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Weisman A, Yona T, Gottlieb U, Masharawi Y. Attitudinal responses to current concepts and opinions from pain neuroscience education on social media. Musculoskelet Sci Pract 2022; 59:102551. [PMID: 35287028 DOI: 10.1016/j.msksp.2022.102551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/19/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pain neuroscience education (PNE) programs have become popular among clinicians and are widely promoted through social and mainstream media. PURPOSE To test the hypothesis that people with persistent pain are likely to express negative attitudes to PNE statements and compare their responses to other social media user groups. METHODS A total of 1319 respondents completed an online survey and were directed into four groups: persistent pain, healthcare professionals with persistent pain, pain-free healthcare professionals, and pain-free controls. The survey included ten statements of popular PNE concepts. Feedback was invited by offering seven attitudinal response categories (three positives, three negatives, and one neutral). A two-step hierarchical regression model was used to assess the likelihood of reporting negatively. RESULTS Compared to controls, respondents from the persistent pain group were more likely to report negatively towards all statements (OR 1.6-2.16), except for two statements (#3 and #5). Healthcare professionals were less likely to report negative attitudes for 4 out of 10 statement (OR 0.35-0.58). Health care professionals living with persistent responded to most statements like the pain-free controls (besides statement #2, OR 0.59). CONCLUSION People living with persistent pain are more likely to express negative attitudes to PNE statements on social media, unlike healthcare professionals who were less likely to express negativity. Healthcare professionals living with persistent pain responded to most PNE statements like the pain-free control group. The study's main weaknesses include the lack of psychometric information of the questionnaire used, selection bias, small samples of the healthcare professionals and the overrepresentation of young social media users.
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Affiliation(s)
- Asaf Weisman
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Tomer Yona
- Department of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Uri Gottlieb
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel
| | - Youssef Masharawi
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Mankelow J, Ryan CG, Morris H, Lauchlan D, Seenan C, Taylor P, Martin D. Charting physiotherapy students' attitudes toward people with chronic pain as they progress through their undergraduate programme: An observational study. Physiother Theory Pract 2021; 38:2658-2664. [PMID: 34496724 DOI: 10.1080/09593985.2021.1976890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Healthcare professionals' attitudes toward people with chronic pain influence their clinical practice. OBJECTIVES To investigate physiotherapy students' attitudes and beliefs toward people with chronic pain over the course of their Scottish undergraduate program. METHODS In this observational study, physiotherapy students from one university were recruited in the first year and followed up to their final year (year 1 n = 62/75, year 2 n = 68/72, year 3 n = 59/69, year 4 n = 74/74) for 4 years. The Health-Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS with scores ranging from 15 to 105) was completed annually. RESULTS A one-way ANOVA found that attitudes and beliefs improved significantly (p < .01) from the first to final year (9.2 ± 11.5 (mean±SD)). Participants showed a reduction in scores (signifying improved attitudes) annually with smaller reductions initially followed by a larger reduction in the final 2 years. CONCLUSIONS This is the first study to chart changes in the same cohort of physiotherapy students' attitudes and beliefs toward people with chronic pain over time. Future work should explore which aspects of degree courses, if any, impact upon attitudes and beliefs toward people with chronic pain so that courses can be enhanced accordingly.
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Affiliation(s)
- Jagjit Mankelow
- School of Health and Social Care, Centuria Building,Teesside University, UK
| | - Cormac G Ryan
- School of Health and Social Care, Centuria Building,Teesside University, UK
| | - Hayley Morris
- Institute of Cancer Sciences, University of Glasgow, Bearsden, Scotland
| | - Douglas Lauchlan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Christopher Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Paul Taylor
- School of Health and Social Care, Centuria Building,Teesside University, UK
| | - Denis Martin
- School of Health and Social Care, Centuria Building,Teesside University, UK
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Van Loock E, Seth P. The therapeutic encounter between being-in-pain and acupuncture: An interpretative phenomenological analysis. Eur J Integr Med 2021. [DOI: 10.1016/j.eujim.2021.101289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Yoshikawa K, Brady B, Perry MA, Devan H. Sociocultural factors influencing physiotherapy management in culturally and linguistically diverse people with persistent pain: a scoping review. Physiotherapy 2020; 107:292-305. [PMID: 32026832 DOI: 10.1016/j.physio.2019.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND People with persistent pain from culturally and linguistically diverse (CALD) communities experience significant health inequities. OBJECTIVE To synthesise the sociocultural factors influencing pain management between CALD patients with persistent pain and physiotherapists treating CALD patients. DATA SOURCES Major electronic databases MEDLINE, AMED, Scopus, Web of Science, PsycINFO and Google Scholar were searched until July 2018. STUDY SELECTION Studies were included if they explored clinical interactions between physiotherapists and patients with persistent pain from diverse ethnocultural backgrounds. STUDY APPRAISAL The methodological quality of qualitative and quantitative studies were assessed using the Critical Appraisal Skills Programme (CASP) Checklist and Mixed Methods Appraisal Tool (MMAT) respectively. SYNTHESIS METHOD A thematic synthesis approach was used to extract the common themes. RESULTS Sixteen articles from 16 studies were included. Eleven studies were qualitative and five studies were quantitative. Ten explored patients' perspectives, four explored physiotherapists' perspectives, and two explored both. Key factors included: (a) language competence; (b) active vs passive coping strategies; (c) gendered influences; (d) cultural-spiritual beliefs, illness perceptions and expression of pain; (e) treatment satisfaction and; (f) barriers to access. CONCLUSION Discordant perspectives on causation, pain management approaches, and patient autonomy in management are evident between CALD patients and physiotherapists. Such discordance potentially create stress in the therapeutic alliance and undermines the efficacy of pain management interventions. To mitigate such barriers, it is crucial to foster cultural competence in physiotherapy and equip physiotherapists with opportunities to maximise their sociocultural awareness, knowledge and skill practising physiotherapy in cultural plural societies.
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Roth M. Chronische Schmerzen und Dermoneuromodulation (DNM). Manuelle Medizin 2020. [DOI: 10.1007/s00337-019-00632-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Conversa G, Facco E, Leoni MLG, Buonocore M, Bagnasco R, Angelini L, Demartini L, Spiegel D. Quantitative Sensory Testing (QST) Estimation of Regional Cutaneous Thermal Sensitivity During Waking State, Neutral Hypnosis, and Temperature Specific Suggestions. Int J Clin Exp Hypn 2019; 67:364-381. [PMID: 31251711 DOI: 10.1080/00207144.2019.1613864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study aimed to determine the effects of neutral hypnosis and hypnotic temperature suggestions in thermal and pain thresholds compared to resting state. Sixteen healthy medium or high hypnotizable volunteers were enrolled. Hypnotizability was assessed with the Hypnotic Induction Profile (HIP); QST was checked in resting state, in neutral hypnosis, after suggestions of heat and cold, and after deinduction. A significant increase in heat threshold was recorded during hypnosis with both cold and heat suggestions compared to neutral hypnosis. HIP induction score showed a linear correlation with changes of temperature thresholds after heat and cold suggestions. Thermal suggestions may result in a significant increase of heat perception thresholds with respect to neutral hypnosis. HIP score is related to thermal threshold changes. QST is a valuable and manageable tool to measure temperature threshold change during hypnosis.
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Affiliation(s)
| | - Enrico Facco
- b University of Padua and Inst. F. Granone - Italian Center of Clinical and Experimental Hypnosis (CIICS) , Turin , Italy
| | | | | | | | | | | | - David Spiegel
- d Stanford University School of Medicine , Stanford , CA , USA
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Wallden M, Chek P. The ghost in the machine - A response to Thomson et al. J Bodyw Mov Ther 2019; 23:221-228. [DOI: 10.1016/j.jbmt.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/30/2022]
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Weisman A, Quintner J. On "A Mechanism-Based Approach to Physical Therapist Management of Pain." Chimenti RL, Frey-Law LA, Sluka KA. Phys Ther. 2018;98:302-314. Phys Ther 2018; 98:817. [PMID: 29931331 DOI: 10.1093/ptj/pzy079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Asaf Weisman
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel, and Clalit Health Services, Department of Physical Therapy, Tel Aviv-Jaffa District, Holon, Israel
| | - John Quintner
- Arthritis Foundation of Western Australia, Shenton Park, Western Australia, Australia
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Butler S. Effects of the excitatory amino acid transporter subtype 2 (EAAT-2) transporter inducer ceftriaxone (an antibiotic) on different pain modalities in rat. Scand J Pain 2018; 2:130-131. [PMID: 29913738 DOI: 10.1016/j.sjpain.2011.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Stephen Butler
- Uppsala University Hospital, Pain Center, Uppsala, Sweden
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Cohen M, Quintner J, van Rysewyk S. Reconsidering the International Association for the Study of Pain definition of pain. Pain Rep 2018; 3:e634. [PMID: 29756084 PMCID: PMC5902253 DOI: 10.1097/pr9.0000000000000634] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/23/2017] [Accepted: 11/27/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The definition of pain promulgated by the International Association for the Study of Pain (IASP) is widely accepted as a pragmatic characterisation of that human experience. Although the Notes that accompany it characterise pain as "always subjective," the IASP definition itself fails to sufficiently integrate phenomenological aspects of pain. METHODS This essay reviews the historical development of the IASP definition, and the commentaries and suggested modifications to it over almost 40 years. Common factors of pain experience identified in phenomenological studies are described, together with theoretical insights from philosophy and biology. RESULTS A fuller understanding of the pain experience and of the clinical care of those experiencing pain is achievable through greater attention to the phenomenology of pain, the social "intersubjective space" in which pain occurs, and the limitations of language. CONCLUSION Based on these results, a revised definition of pain is offered: Pain is a mutually recognizable somatic experience that reflects a person's apprehension of threat to their bodily or existential integrity.
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Affiliation(s)
- Milton Cohen
- St Vincent's Clinical School, UNSW Sydney, New South Wales, Australia
| | - John Quintner
- Arthritis and Osteoporosis WA, Shenton Park, Western Australia, Australia
| | - Simon van Rysewyk
- Department of Philosophy, School of Humanities, University of Tasmania, Tasmania, Australia
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Abstract
Pain is difficult to communicate and translate into language, yet most social research on pain experience uses questionnaires and semi-structured interviews that rely on words. In addition to the mind/body dualism prevalent in pain medicine in these studies pain communication is characterised by further value-laden binaries such as real/unreal, visible/invisible, and psychological/physical. Starting from the position that research methods play a role in constituting their object, this article examines the potential of participatory arts workshops for developing different versions of pain communication. Twenty-two participants were involved in workshops using drawing, digital photography, sound and physical theatre to explore pain communication. The use of arts materials made pain tangible. By manipulating pain-related objects, participants could consider alternative relationships to their pain. Pain's sociality was also explored, with relations with clinicians and others emerging as potentially cooperative rather than adversarial. Discussions considered whether pain felt internal or external, and whether it was possible to conceive of a self without pain. We argue that the socio-material context of participatory arts workshops enabled these alternative versions of pain. Such methods are a useful addition to medical sociology's heavy reliance on qualitative interviewing.
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Affiliation(s)
- Jen Tarr
- Department of Methodology, London School of Economics, UK
| | - Flora Cornish
- Department of Methodology, London School of Economics, UK
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Manivannan V. What we see when we digitize pain: The risk of valorizing image-based representations of fibromyalgia over body and bodily experience. Digit Health 2017; 3:2055207617708860. [PMID: 29942598 PMCID: PMC6001215 DOI: 10.1177/2055207617708860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 04/17/2017] [Indexed: 11/16/2022] Open
Abstract
Fibromyalgia is chronic pain of unknown etiology, attended by fatigue and affective dysfunction. Unapparent to the unpracticed eye or diagnostic image, it is denied the status of "real" suffering given to visually confirmable disorders. It is my customary mode of existence: a contingent landscape of swinging bridges that may or may not give way, everything a potential threat or deprivation. I don't express it within the framework of acute pain, but I am evaluated by traditional biomedical standards anyway. Ultimately, the diagnostic image of pain, and the medical and academic discourse used to interpret it, determines my functionality. Such a stance dismisses bodily senses and alternate ways of knowing in pursuit of the ocularcentric objectivity promised by digital health technologies, whose vision remains chained to the interpretive, discursive strategies of human operators and interpreters. A new poetics of pain is critical not only for rewriting the dominant metaphors that construct and delimit our imaginings of pain but also for rewiring the use and reading of digital technologies, wherein the digital image becomes the new site of the hermeneutic exercise, even when the suffering body lies in plain view. This facilitates a failure to listen and touch in patient care, and the imposition of a narrative based on visual evidence, translated into sanitized language, at the cost of intercorporeality. If pain strips sufferers of a voice, my body and its affects should be allowed to speak.
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Affiliation(s)
- Vyshali Manivannan
- Department of Communication, Information and Library Studies, Rutgers University School of Communication and Information, USA
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Abstract
Pain has been defined by the International Association for the Study of Pain (IASP) as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Chronic pain is usually described as pain that has persisted for 3–6 months and/or beyond the expected time of healing. The numerical pain rating (NPR) is the customary metric and often considered as a proxy for the subjective experience of chronic pain. This definition of pain (chronic) has been of significant heuristic value. However, the definition and the models it has spawned tend to encourage the interpretation of pain as a measurable entity and implies that the patient’s experience of pain can be fully comprehended by someone other than the person in pain. Several major models of pain have been scrutinized and found to propagate the notion of pain as a ‘thing’ and fall prey to biomedical reductionism and Cartesian (mind-body) dualism. Furthermore, the NPR does not appear to capture the complexity of chronic pain and correlates poorly with other clinically meaningful outcomes. It, and other aspects of the current notion of chronic pain, appear to be an extension of our reliance on the philosophical principles of reductionism and materialism. These and other shortcomings identified in the IASP definition have resulted in an increased interest in a reexamination and possible updating of our view of pain (chronic) and its definition. The present paper describes an alternative view of pain, in particular chronic pain. It argues that chronic pain should be understood as a separate phenomenon from, rather than an extension of, acute pain and interpreted as a hypothetical construct (HC). HCs are contrasted to intervening variables (IV) and the use of HCs in science is illustrated. The acceptance of the principles of nonlinearity and emergence are seen as important characteristics. The practical implications and barriers of this philosophical shift for assessment, treatment, and education are explored. The patient’s narrative is presented as a potential source of important phenomenological data relating to their ‘experience’ of pain. It is further proposed that educational and academic endeavors incorporate a discussion of the process of chronification and the role of complexity theory.
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Affiliation(s)
- Daniel M Doleys
- Doleys Clinic/Pain and Rehabilitation Institute, BirminghamAL, USA
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Abstract
This is a hypothesis-article suggesting an entirely new framework for understanding and treating longstanding pain. Most medical and psychological models are described with boxes and arrows. Such models are of little clinical and explanatory use when describing the phenomenon of chronification of pain due to unknown causes. To date no models that have been provided - and tested in a scientific satisfactory way - lays out a plan for specific assessment due to a specific causal explanation, and in the end serves the clinicians, patients and researcher with tools on how to address the specific pain condition to every individual pain patient's condition. By applying the Ising model (from physics) on the phenomenon of chronification of pain, one is able to detangle all these factors, and thus have a model that both suggests an explanation of the condition and outlines how one might target the treatment of chronic pain patients with the use of network science.
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Affiliation(s)
- Lars-Petter Granan
- *Division of Emergencies and Critical Care, Department of Pain Management and Research
- Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Norwegian School of Sport Sciences, Oslo Sports Trauma Research Center, Oslo, Norway
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Bradshaw P, Hariharan S, Chen D. Does preoperative psychological status of patients affect postoperative pain? A prospective study from the Caribbean. Br J Pain 2016; 10:108-15. [PMID: 27551421 DOI: 10.1177/2049463716635680] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Patients with high anxiety states in the preoperative period often have more intense postoperative pain, despite adequate pain control during the intraoperative period. This study aimed to determine the relationship between the preoperative psychological status and the pain experienced postoperatively in a sample of Caribbean patients. DESIGN AND METHODS A prospective study was conducted in elective surgical adult patients at a teaching hospital in the Caribbean. Patients' preoperative psychological status was assessed using Hospital Anxiety and Depression Scale (HADS), and a preoperative 'expected' pain score was recorded. Postoperatively, 'observed' pain scores at 4 and 24 hours and the maximum pain score during 24 hours were recorded. Demographic data and clinical details including data regarding postoperative analgesia were collected. Expected and observed pain scores were compared between patients with and without anxiety and depression. RESULTS A total of 304 patients were enrolled. The overall prevalence of anxiety and depression was 43% and 27%, respectively, based on the HADS scores. There were significant associations between the postoperative pain scores and factors such as preoperative anxiety and depression (HADS) scores, preoperative expected pain scores, patient educational level, presence of preoperative pain and surgical duration. Age, gender, ethnicity and type of anaesthesia did not impact postoperative pain scores. CONCLUSION The presence of preoperative anxiety and depression as indicated by HADS score may significantly influence postoperative pain. Other factors such as educational level, presence of preoperative pain and surgical duration may also impact postoperative pain. Some of these factors may be modifiable and must be addressed in the preoperative period.
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Affiliation(s)
- Prisca Bradshaw
- Anaesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies at St. Augustine, St. Augustine, Trinidad and Tobago
| | - Seetharaman Hariharan
- Anaesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies at St. Augustine, St. Augustine, Trinidad and Tobago
| | - Deryk Chen
- Anaesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies at St. Augustine, St. Augustine, Trinidad and Tobago
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Lachal J, Orri M, Sibeoni J, Moro MR, Revah-Levy A. Metasynthesis of youth suicidal behaviours: perspectives of youth, parents, and health care professionals. PLoS One 2015; 10:e0127359. [PMID: 26001066 PMCID: PMC4441448 DOI: 10.1371/journal.pone.0127359] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/13/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Youth suicide is a major public health issue throughout the world. Numerous theoretical models have been proposed to improve our understanding of suicidal behaviours, but medical science has struggled to integrate all the complex aspects of this question. The aim of this review is to synthesise the views of suicidal adolescents and young adults, their parents, and their healthcare professionals on the topics of suicidal behaviour and management of those who have attempted suicide, in order to propose new pathways of care, closer to the issues and expectations of each group. METHODS AND FINDINGS This systematic review of qualitative studies--Medline, PsycInfo, Embase, CINAHL, and SSCI from 1990 to 2014--concerning suicide attempts by young people used thematic synthesis to develop categories inductively from the themes identified in the studies. The synthesis included 44 studies from 16 countries: 31 interviewed the youth, 7 their parents, and 6 the healthcare professionals. The results are organised around three superordinate themes: the individual experience, that is, the individual burden and suffering related to suicide attempts in all three groups; the relational experience, which describes the importance of relationships with others at all stages of the process of suicidal behaviour; and the social and cultural experience, or how the group and society accept or reject young people in distress and their families and how that affects the suicidal process and its management. CONCLUSION The violence of the message of a suicidal act and the fears associated with death lead to incomprehension and interfere with the capacity for empathy of both family members and professionals. The issue in treatment is to be able to witness this violence so that the patient feels understood and heard, and thus to limit recurrences.
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Affiliation(s)
- Jonathan Lachal
- AP-HP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, U1178, Paris, France
| | - Massimiliano Orri
- INSERM, U1178, Paris, France
- Université Paris Sud-Paris 11, Paris, France
| | - Jordan Sibeoni
- AP-HP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, U1178, Paris, France
| | - Marie Rose Moro
- AP-HP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, U1178, Paris, France
| | - Anne Revah-Levy
- INSERM, U1178, Paris, France
- Argenteuil Hospital Centre, Centre de Soins Psychothérapeutiques de Transition pour Adolescents, Argenteuil, France
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Singla M, Jones M, Edwards I, Kumar S. Physiotherapists' assessment of patients' psychosocial status: Are we standing on thin ice? A qualitative descriptive study. ACTA ACUST UNITED AC 2015; 20:328-34. [DOI: 10.1016/j.math.2014.10.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 06/25/2014] [Accepted: 10/07/2014] [Indexed: 11/19/2022]
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Dommerholt J, Gerwin RD. A critical evaluation of Quintner et al: missing the point. J Bodyw Mov Ther 2015; 19:193-204. [PMID: 25892372 DOI: 10.1016/j.jbmt.2015.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 01/29/2014] [Accepted: 01/30/2014] [Indexed: 02/03/2023]
Abstract
The objective of this article is to critically analyze a recent publication by Quinter, Bove and Cohen, published in Rheumatology, about myofascial pain syndrome and trigger points (Quintner et al., 2014). The authors concluded that the leading trigger point hypothesis is flawed in reasoning and in science. They claimed to have refuted the trigger point hypothesis. The current paper demonstrates that the Quintner et al. paper is a biased review of the literature replete with unsupported opinions and accusations. In summary, Quintner et al. have not presented any convincing evidence to believe that the Integrated TrP Hypothesis should be laid to rest.
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Affiliation(s)
- Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA; PhysioFitness, Rockville, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | - Robert D Gerwin
- Myopain Seminars, Bethesda, MD, USA; Johns Hopkins University, Baltimore, MD, USA; Pain & Rehabilitation Medicine, Bethesda, MD, USA.
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Hensley CP, Courtney CA. Management of a patient with chronic low back pain and multiple health conditions using a pain mechanisms-based classification approach. J Orthop Sports Phys Ther 2014; 44:403-C2. [PMID: 24766360 DOI: 10.2519/jospt.2014.4861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Pain can lead to a significant reduction in quality of life. A pain mechanisms-based classification scheme has been outlined to improve management of patients with pain, but studies describing its use are limited. Evidence for physical therapy interventions in those with chronic pain and multiple health conditions is also lacking. This case report describes management of a patient with chronic pain and multiple health conditions. CASE DESCRIPTION A 29-year-old man presented with a 3-year history of low back pain and 11-month history of lower extremity paresthesia. Current health conditions included left-sided hemiparesis secondary to a stroke, pancreatic kidney transplant, left-sided blindness, and osteoporosis secondary to hyperparathyroidism. Inability to walk to school and sit through class, and pain-related sleep disruption were the primary activity and participation restrictions. Outcome measures included the numeric pain rating scale, global rating of change, Oswestry Disability Index, and pain medication usage. A score of 12 on the Leeds assessment of neuropathic symptoms and signs (LANSS) pain scale indicated the presence of neuropathic pain, but other pain mechanisms were also hypothesized to be present. Treatment was designed to improve patient goals considering these pain mechanisms. OUTCOMES The patient was seen for 20 visits over 6 months. Ten months after the initial evaluation, the patient's Oswestry Disability Index scores improved by more than 50% and the patient achieved all initially stated goals without pain medication. DISCUSSION A pain mechanisms-based approach assisted in the management of a patient with chronic pain and multiple health conditions. Using this approach may enhance clinical decision making when managing individuals with chronic pain. LEVEL OF EVIDENCE Therapy, level 4.
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Dawson L, Deary V, Amy F. The psychological and social aspects of a physical rehabilitation programme for fire service personnel. International Journal of Therapy and Rehabilitation 2014. [DOI: 10.12968/ijtr.2014.21.5.232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Linda Dawson
- Counsellor at Cumbria Partnership NHS Trust, Carlisle
| | - Vincent Deary
- Senior Lecturer at the School of Life Sciences, Northumbria University, Newcastle upon Tyne
| | - Fielden Amy
- Teaching Fellow at the School of Psychology, Newcastle University, Newcastle upon Tyne, UK
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Edwards I, Jones M, Thacker M, Swisher LL. The Moral Experience of the Patient with Chronic Pain: Bridging the Gap Between First and Third Person Ethics. Pain Med 2014; 15:364-78. [DOI: 10.1111/pme.12306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kayman-Kose S, Arioz DT, Toktas H, Koken G, Kanat-Pektas M, Kose M, Yilmazer M. Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section. J Matern Fetal Neonatal Med 2014; 27:1572-5. [DOI: 10.3109/14767058.2013.870549] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cohen M, Quintner J, Buchanan D, Nielsen M, Guy L. Response to Letter from Dr. Mark Awerbuch in Relation to the Article: “Stigmatization of Patients with Chronic Pain: The Negation of Empathy.” Cohen ML, Quintner JL, Buchanan DA, Nielsen M, Guy L. Pain Med 2011;12:1637–43. Pain Med 2012. [DOI: 10.1111/j.1526-4637.2012.01428.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The new paradigm that the brain is able change itself (neuroplasticity) is acknowledged and teased out in terms of the ramifications for mental illnesses. Parallel studies in pain (central sensitization) and mirror neurones are examined to conceptually clarify these ramifications in relation to mental health, and to expand our understanding of empathy and social inclusion beyond good ideas to being a part of our nature. The paper then focuses on making clear what the concepts, challenges, and opportunities for mental health nursing might be; even advancing possibilities for recovery through better understanding the third space or intersubjective. What ramifications this has for mental health nursing is reviewed in terms of a paradigm change and the necessity for conceptual clarity, as it relates to the uniqueness of the person right before our very eyes. The author contends that to embrace this new paradigm is not only necessary but ethically obligatory, as it opens up new possibilities for understanding ourselves and this changeable person.
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Affiliation(s)
- David Andrew Buchanan
- School of Nursing and Midwifery, University of Tasmania, Launceston, Tasmania, Australia.
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Saariaho T, Saariaho A, Karila I, Joukamaa M. Early maladaptive schema factors, pain intensity, depressiveness and pain disability: an analysis of biopsychosocial models of pain. Disabil Rehabil 2011; 34:1192-201. [DOI: 10.3109/09638288.2011.638031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hayes C, Hodson FJ. A Whole-Person Model of Care for Persistent Pain: From Conceptual Framework to Practical Application. Pain Med 2011; 12:1738-49. [DOI: 10.1111/j.1526-4637.2011.01267.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cohen M, Quintner J, Buchanan D, Nielsen M, Guy L. Stigmatization of Patients with Chronic Pain: The Extinction of Empathy. Pain Med 2011; 12:1637-43. [DOI: 10.1111/j.1526-4637.2011.01264.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Martin Picard
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- Montreal Institute of Classical Homeopathy, Montreal, Quebec, Canada
| | - Catherine M. Sabiston
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
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Davies SJ, Hayes C, Quintner JL. System plasticity and integrated care: informed consumers guide clinical reorientation and system reorganization. Pain Med 2010; 12:4-8. [PMID: 21143757 DOI: 10.1111/j.1526-4637.2010.01016.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
SETTING Two Australian public hospital multidisciplinary pain centers (MPCs) situated on opposite sides of the country. OBJECTIVE Restructuring our services to become patient-centred and patient-driven by enabling entry to our MPCs through an education portal, inclusive of both knowledge and self-management skills, and to then be free to select particular treatment options on the basis of evidence of known efficacy (risk/benefit). DESIGN Group-based education to inform our patients of the current state of uncertainty that exists in Pain Medicine, both in regard to diagnostic and therapeutic practices. Using an interprofessional team approach, we aimed to present practical and evidence-based advice on techniques of pain self-management and existing traditional medical options. RESULTS Early, resource efficient, group intervention provides many patients with sufficient information to make informed decisions and enables them to partner us in engaging a whole person approach to their care. We have implemented routine comprehensive audits of clinical services to better inform the planning and provision of health care across health services. CONCLUSIONS System plasticity is as important to the process of integrated health care as it is to our understanding of the complexity of the lived experience of pain. Better-informed consumers partnered with responsive health professionals drive the proposed paradigm shift in service delivery. The changes better align the needs of consumers with the ability of health care providers to meet them, thus achieving the twin goals of patient empowerment and system efficiency.
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Affiliation(s)
- Stephanie J Davies
- School of Physiotherapy, Curtin University, Bentley, Western Australia, Australia.
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Davies S, Quintner J, Parsons R, Parkitny L, Knight P, Forrester E, Roberts M, Graham C, Visser E, Antill T, Packer T, Schug SA. Preclinic group education sessions reduce waiting times and costs at public pain medicine units. Pain Med 2010; 12:59-71. [PMID: 21087401 DOI: 10.1111/j.1526-4637.2010.01001.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the effects of preclinic group education sessions and system redesign on tertiary pain medicine units and patient outcomes. DESIGN Prospective cohort study. SETTING Two public hospital multidisciplinary pain medicine units. PATIENTS People with persistent pain. INTERVENTIONS A system redesign from a "traditional" model (initial individual medical appointments) to a model that delivers group education sessions prior to individual appointments. Based on Patient Triage Questionnaires patients were scheduled to attend Self-Training Educative Pain Sessions (STEPS), a two day eight hour group education program, followed by optional patient-initiated clinic appointments. OUTCOME MEASURES Number of patients completing STEPS who subsequently requested individual outpatient clinic appointment(s); wait-times; unit cost per new patient referred; recurrent health care utilization; patient satisfaction; Global Perceived Impression of Change (GPIC); and utilized pain management strategies. RESULTS Following STEPS 48% of attendees requested individual outpatient appointments. Wait times reduced from 105.6 to 16.1 weeks at one pain unit and 37.3 to 15.2 weeks at the second. Unit cost per new patient appointed reduced from $1,805 Australian Dollars (AUD) to AUD$541 (for STEPS). At 3 months, patients scored their satisfaction with "the treatment received for their pain" more positively than at baseline (change score=0.88; P=0.0003), GPIC improved (change score=0.46; P<0.0001) and mean number of active strategies utilized increased by 4.12 per patient (P=0.0004). CONCLUSIONS The introduction of STEPS was associated with reduced wait-times and costs at public pain medicine units and increased both the use of active pain management strategies and patient satisfaction.
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Affiliation(s)
- Stephanie Davies
- Pain Medicine Unit, Fremantle Hospital, Alma Street, Fremantle, Western Australia.
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