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Dubé MO, Dillon S, Gallagher K, Ryan J, McCreesh K. One and Done? The Effectiveness of a Single Session of Physiotherapy Compared With Multiple Sessions to Reduce Pain and Improve Function and Quality of Life in Patients With a Musculoskeletal Disorder: A Systematic Review With Meta-analyses. Arch Phys Med Rehabil 2024; 105:1171-1180. [PMID: 37805175 DOI: 10.1016/j.apmr.2023.09.017] [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: 04/23/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To compare single and multiple physiotherapy sessions to improve pain, function, and quality of life (QoL) in patients with musculoskeletal disorders (MSKDs). DATA SOURCES AMED, Cinahl, SportsDiscus, Medline, Cochrane Register of Clinical Trials, Physiotherapy Evidence Database, and reference lists. STUDY SELECTION Randomized controlled trials (RCTs) comparing single and multiple physiotherapy sessions for MSKDs. DATA EXTRACTION Two reviewers extracted data and assessed risk of bias and certainty of evidence using Cochrane Risk of Bias tool 2.0 and Grading of Recommendation Assessment, Development, and Evaluation. DATA SYNTHESIS Six RCTs (n=2090) were included (conditions studied: osteoporotic vertebral fracture, neck, knee, and shoulder pain). Meta-analyses with low-certainty evidence showed a significant pain improvement at 6 months in favor of multiple sessions compared with single session interventions (3 RCTs; n=1035; standardized mean difference [SMD]: 0.29; 95% CI: 0.05 to 0.53; P=.02) but this significant difference in pain improvement was not observed at 3 months (4 RCTs; n=1312; SMD: 0.39; 95% CI: -0.11 to 0.89; P=.13) and at 12 months (4 RCTs; n=1266; SMD: -0.05; 95% CI: -0.49 to 0.39; P=.82). Meta-analyses with low-certainty evidence showed no significant differences in function at 3 (4 RCTs; n=1583; SMD: 0.05; 95% CI: -0.11 to 0.21; P=.56), 6 (4 RCTs; n=1538; SMD: 0.06; 95% CI: -0.12 to 0.23; P=.53) and 12 months (4 RCTs; n=1528; SMD: 0.08; 95% CI: -0.08 to 0.25; P=.30) and QoL at 3 (4 RCTs; n=1779; SMD: 0.08; 95% CI: -0.02 to 0.17; P=.12), 6 (3 RCTs; n=1206; SMD: 0.03; 95% CI: -0.08 to 0.14; P=.59), and 12 months (4 RCTs; n=1729; SMD: -0.03; 95% CI: -0.12 to 0.07; P=.58). CONCLUSIONS Low certainty meta-analyses found no clinically significant differences in pain, function, and QoL between single and multiple physiotherapy sessions for MSKD management for the conditions studied. Future research should compare the cost-effectiveness of those different models of care.
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Affiliation(s)
- Marc-Olivier Dubé
- Rehabilitation Department, Faculty of Medicine, Université Laval, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada.
| | - Sarah Dillon
- School of Allied Health, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kevin Gallagher
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Jake Ryan
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
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Baumbach L, Feddern W, Kretzler B, Hajek A, König HH. Cost-Effectiveness of Treatments for Musculoskeletal Conditions Offered by Physiotherapists: A Systematic Review of Trial-Based Evaluations. SPORTS MEDICINE - OPEN 2024; 10:38. [PMID: 38613739 PMCID: PMC11016054 DOI: 10.1186/s40798-024-00713-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Musculoskeletal conditions are a leading contributor to disability worldwide. The treatment of these conditions accounts for 7% of health care costs in Germany and is often provided by physiotherapists. Yet, an overview of the cost-effectiveness of treatments for musculoskeletal conditions offered by physiotherapists is missing. This review aims to provide an overview of full economic evaluations of interventions for musculoskeletal conditions offered by physiotherapists. METHODS We systematically searched for publications in Medline, EconLit, and NHS-EED. Title and abstracts, followed by full texts were screened independently by two authors. We included trial-based full economic evaluations of physiotherapeutic interventions for patients with musculoskeletal conditions and allowed any control group. We extracted participants' information, the setting, the intervention, and details on the economic analyses. We evaluated the quality of the included articles with the Consensus on Health Economic Criteria checklist. RESULTS We identified 5141 eligible publications and included 83 articles. The articles were based on 78 clinical trials. They addressed conditions of the spine (n = 39), the upper limb (n = 8), the lower limb (n = 30), and some other conditions (n = 6). The most investigated conditions were low back pain (n = 25) and knee and hip osteoarthritis (n = 16). The articles involved 69 comparisons between physiotherapeutic interventions (in which we defined primary interventions) and 81 comparisons in which only one intervention was offered by a physiotherapist. Physiotherapeutic interventions compared to those provided by other health professionals were cheaper and more effective in 43% (18/42) of the comparisons. Ten percent (4/42) of the interventions were dominated. The overall quality of the articles was high. However, the description of delivered interventions varied widely and often lacked details. This limited fair treatment comparisons. CONCLUSIONS High-quality evidence was found for physiotherapeutic interventions to be cost-effective, but the result depends on the patient group, intervention, and control arm. Treatments of knee and back conditions were primarily investigated, highlighting a need for physiotherapeutic cost-effectiveness analyses of less often investigated joints and conditions. The documentation of provided interventions needs improvement to enable clinicians and stakeholders to fairly compare interventions and ultimately adopt cost-effective treatments.
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Affiliation(s)
- Linda Baumbach
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Wiebke Feddern
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Benedikt Kretzler
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Passias PG, Naessig S, Williamson TK, Tretiakov PS, Imbo B, Joujon-Roche R, Ahmad S, Passfall L, Owusu-Sarpong S, Krol O, Ahmad W, Pierce K, O'Connell B, Schoenfeld AJ, Vira S, Diebo BG, Lafage R, Lafage V, Cheongeun O, Gerling M, Dinizo M, Protopsaltis T, Campello M, Weiser S. The psychological burden of disease among patients undergoing cervical spine surgery: Are we underestimating our patients' inherent disability? Neurochirurgie 2023; 69:101395. [PMID: 36502878 DOI: 10.1016/j.neuchi.2022.101395] [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: 05/22/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies have utilized psychological questionnaires to identify the psychological distress among certain surgical populations. RESEARCH QUESTION Is there an additional psychological burden among patients undergoing surgical treatment for their symptomatic degenerative cervical disease? MATERIALS AND METHODS Patients>18 years of age with symptomatic, degenerative cervical spine disease were included and prospectively enrolled. Correlations and multivariable logistic regression analysis assessed the relationship between these mental health components (PCS, FABQ) and the severity of disability described by the NDI, EQ-5D, and mJOA score. Patient distress scores were compared to previously published benchmarks for other diagnoses. RESULTS 47 patients were enrolled (age: 56.0 years,BMI: 29.7kg/m2). Increasing neck disability and decreasing EQ-5D were correlated with greater PCS and FABQ(all P<0.001). Patients with severe psychological distress at baseline were more likely to report severe neck disability, while physician-reported mJOA had weaker associations. Compared to historical controls of lumbar patients, patients in our study had greater levels of psychological distress, as measured by FABQ (40.0 vs. 17.6; P<0.001) and PCS (27.4 vs. 19.3;P<0.001). DISCUSSION AND CONCLUSION Degenerative cervical spine patients seeking surgery were found to have a significant level of psychological distress, with a large portion reporting severe fear avoidance beliefs and catastrophizing pain at baseline. Strong correlation was seen between patient-reported functional metrics, but less so with physician-reported signs and symptoms. Additionally, this population demonstrated higher psychological burden in certain respects than previously identified benchmarks of patients with other disorders. Preoperative treatment to help mitigate this distress, impact postoperative outcomes, and should be further investigated. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- P G Passias
- Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital/New York Spine Institute, New York, NY, USA.
| | - S Naessig
- Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital/New York Spine Institute, New York, NY, USA
| | - T K Williamson
- Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital/New York Spine Institute, New York, NY, USA
| | - P S Tretiakov
- Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital/New York Spine Institute, New York, NY, USA
| | - B Imbo
- Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital/New York Spine Institute, New York, NY, USA
| | - R Joujon-Roche
- Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital/New York Spine Institute, New York, NY, USA
| | - S Ahmad
- Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital/New York Spine Institute, New York, NY, USA
| | - L Passfall
- Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital/New York Spine Institute, New York, NY, USA
| | - S Owusu-Sarpong
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - O Krol
- Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital/New York Spine Institute, New York, NY, USA
| | - W Ahmad
- Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital/New York Spine Institute, New York, NY, USA
| | - K Pierce
- Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital/New York Spine Institute, New York, NY, USA
| | - B O'Connell
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - A J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Vira
- Department of Orthopedic and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - B G Diebo
- Department of Orthopedic Surgery, SUNY Downstate Medical Center, New York, NY, USA
| | - R Lafage
- Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - V Lafage
- Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - O Cheongeun
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - M Gerling
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - M Dinizo
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - T Protopsaltis
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - M Campello
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - S Weiser
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Smith T, Mansfield M, Hanson S, Welsh A, Khoury R, Clark A, Dures E, Adams J. Caregiving for older people living with chronic pain: analysis of the English longitudinal study of ageing and health survey for England. Br J Pain 2022; 17:166-181. [PMID: 37057251 PMCID: PMC10088417 DOI: 10.1177/20494637221144250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Chronic pain is a disabling condition. Many people with chronic pain seek informal support for everyday activities of daily living (ADL). However, there remains uncertainty on the type of people with chronic pain who access this support, what types of support they need and who provides such support. The purpose of this analysis was to answer these uncertainties. Methods Data from the Health Survey for England (HSE) and English Longitudinal Study of Ageing (ELSA) were accessed. People who reported chronic pain (moderate or above for minimum of 12 months) were identified. From these cohorts, we determined if individuals self-reported receiving informal care. Data on caregiver profiles and caregiving activities were reported through descriptive statistics. Logistic regression analyses were performed to compare health status outcomes between people with pain who received and who did not receive informal care. Results 2178 people with chronic pain from the ELSA cohort and 571 from the HSE cohort were analysed. People who received care were frequently female, older aged with several medical morbidities including musculoskeletal diseases such as arthritis. People with chronic pain received informal care for several diverse tasks. Most frequently these related to instrumental activities of daily living (IADL) such as shopping and housework. They were most frequently provided by partners or their children. Although they reported greater disability and symptoms ( p < 0.001), people who received care did not report differences in health status, loneliness or wellbeing ( p = 0.27; p = 0.46). Conclusions Whilst it may be possible to characterise people living in chronic pain who receive informal care, there is some uncertainty on the impact of informal caregiving on their health and wellbeing. Consideration should now be made on how best to support both care recipients and informal caregivers, to ensure their health and quality of life is promoted whilst living with chronic pain.
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Affiliation(s)
- Toby Smith
- Warwick Medical School, University of Warwick, Coventry, UK
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Michael Mansfield
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Sarah Hanson
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Allie Welsh
- School of Education, University of East Anglia, Norwich, UK
| | - Reema Khoury
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Allan Clark
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Emma Dures
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Jo Adams
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- School of Health Sciences, University of Southampton, Southampton, UK
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5
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Stress Mindset and Social Identification in Chronic Pain Patients and Their Relationship to Coping, Well-Being & Depression. J Clin Psychol Med Settings 2022; 30:153-168. [PMID: 35576086 PMCID: PMC10042901 DOI: 10.1007/s10880-022-09883-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
We predicted that chronic pain patients have a more negative stress mindset and a lower level of social identification than people without chronic pain and that this, in turn, influences well-being through less adaptive coping. 1240 participants (465 chronic pain patients; 775 people in the control group) completed a cross-sectional online-survey. Chronic pain patients had a more negative stress mindset and a lower level of social identification than people without chronic pain. However, a positive stress mindset was linked to better well-being and fewer depressive symptoms, through the use of the adaptive coping behaviors positive reframing and active coping. A higher level of social identification did not impact well-being or depression through the use of instrumental and emotional support coping, but through the more frequent use of positive reframing and active coping. For chronic pain therapy, we propose including modules that foster social identification and a positive stress mindset.
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6
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Luque-Reca O, Soriano-Maldonado A, Gavilán-Carrera B, Acosta-Manzano P, Ariza-Vega P, Del Paso GAR, Álvarez-Gallardo IC, Estévez-López F. Longitudinal associations of physical fitness and affect with depression, anxiety and life satisfaction in adult women with fibromyalgia. Qual Life Res 2022; 31:2047-2058. [PMID: 35098387 DOI: 10.1007/s11136-021-03058-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE This study analysed the longitudinal associations of physical fitness and affect with depression, anxiety and life satisfaction at 2- and 5-year follow-up. METHODS In 312 adult women with fibromyalgia, physical fitness was measured by performance-based tests and affect, depression, anxiety and life satisfaction were self-reported using the Positive and Negative Affect Schedule (PANAS), Beck Depression Inventory-second edition (BDI-II), State Trait Anxiety Inventory-I (STAI) and Satisfaction with Life Scale (SWLS), respectively. We conducted sequential linear regression analyses adjusted for baseline levels of depression, anxiety, life satisfaction, age, body fat percentage and education. RESULTS At the 2-year follow-up, all the associations under study were significant. At the 5-year follow-up, a number of associations remained significant. First, lowering negative affect was independently associated with lower depression, anxiety and higher life satisfaction (β's from 0.14 to 0.31). Second, favourable changes in positive affect were independently associated with lower anxiety (β = 0.21) and higher life satisfaction (β = 0.28). Third, enhancing physical fitness was related to higher life satisfaction (β = 0.16). CONCLUSION Reductions in negative affect were associated with more favourable depression, anxiety and life satisfaction at the 2- and 5-year follow-up. Improvements in positive affect were associated with more favourable anxiety and life satisfaction and enhancements in physical fitness were associated with higher life satisfaction. If corroborated in clinical-experimental research, these findings may guide the development of interventions that are tailored to the levels of physical fitness, affect and the outcome of interest (i.e. depression, anxiety or life satisfaction) in women with fibromyalgia.
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Affiliation(s)
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain.
| | - Blanca Gavilán-Carrera
- Physical Activity for Health Promotion Research Group (PA-HELP), Department of Physical Education and Sport, Faculty of Sport Sciences and Sport and Health University Research Institute (iMUDS), Granada, Spain.,Department of Physical Education, Faculty of Education Sciences and Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, University of Cádiz, Cádiz, Spain
| | - Pedro Acosta-Manzano
- Physical Activity for Health Promotion Research Group (PA-HELP), Department of Physical Education and Sport, Faculty of Sport Sciences and Sport and Health University Research Institute (iMUDS), Granada, Spain
| | - Patrocinio Ariza-Vega
- Occupational Therapy Division, Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - Inmaculada C Álvarez-Gallardo
- Department of Physical Education, Faculty of Education Sciences and Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, University of Cádiz, Cádiz, Spain
| | - Fernando Estévez-López
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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7
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He C, Chen H, Guo L, Xu L, Liu Q, Zhang J, Hu X. Prevalence and factors associated with comorbid depressive symptoms among people with low back pain in China: A cross-sectional study. Front Psychiatry 2022; 13:922733. [PMID: 35958630 PMCID: PMC9357880 DOI: 10.3389/fpsyt.2022.922733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Low back pain is a common medical condition among the general population that is associated with many adverse health effects when comorbid with depressive symptoms. However, little is known about depressive symptoms in the population with low back pain in China. Our study evaluated the prevalence of depressive symptoms and analyzed the factors associated with this condition in the Chinese population with low back pain. METHODS We conducted a cross-sectional analysis of data from the 2018 China Health and Retirement Longitudinal Study. We collected low back pain information for each participant and identified depressive symptoms using the brief version of the Center for Epidemiologic Studies Depression Scale. A wide range of sociodemographic and health-related characteristics of the subjects were extracted. We measured the prevalence of depressive symptoms comorbid with low back pain and analyzed the associated factors by multiple logistic regression. RESULTS A total of 5,779 respondents aged 45 and over with low back pain formed the sample, 41.8% of whom reported depressive symptoms. Multiple logistic regression analysis indicated greater vulnerability to depressive symptoms among females (OR = 1.41, 95% CI, 1.16-1.73), relatively younger persons (60-74 years: OR = 0.72, 95% CI, 0.63-0.83; ≥ 75 years: OR = 0.62, 95% CI, 0.49-0.79, reference: 45-59 years), those from the central and western regions (central: OR = 1.39, 95% CI, 1.18-1.64; western: OR = 1.56, 95% CI, 1.33-1.83), participants with extremely short sleep duration (OR = 2.74, 95% CI, 2.33-3.23), those with poor self-perceived health status (OR = 2.91, 95% CI, 2.34-3.63,), multisite pain (OR = 1.54, 95% CI, 1.20-1.98) and disability in activities of daily living (Basic: OR = 1.70, 95% CI, 1.47-1.98; Instrumental: OR = 1.95, 95% CI, 1.70-2.24). CONCLUSION Depressive symptoms were highly prevalent in the Chinese population ≥ 45 years with low back pain. More attention should be paid to the individuals at high-risk confirmed by this study to facilitate early identification and intervention against depressive symptoms.
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Affiliation(s)
- Chunxia He
- West China School of Nursing, Sichuan University/Institute for Disaster Management and Reconstruction, and Innovation Center of Nursing Research, West China Hospital, Sichuan University, Chengdu, China.,Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.,Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hongxiu Chen
- West China School of Nursing, Sichuan University/Institute for Disaster Management and Reconstruction, and Innovation Center of Nursing Research, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Guo
- West China School of Nursing, Sichuan University/Institute for Disaster Management and Reconstruction, and Innovation Center of Nursing Research, West China Hospital, Sichuan University, Chengdu, China
| | - Lisheng Xu
- West China School of Nursing, Sichuan University/Institute for Disaster Management and Reconstruction, and Innovation Center of Nursing Research, West China Hospital, Sichuan University, Chengdu, China
| | - Qingquan Liu
- West China School of Nursing, Sichuan University/Institute for Disaster Management and Reconstruction, and Innovation Center of Nursing Research, West China Hospital, Sichuan University, Chengdu, China
| | - Jiali Zhang
- Cheng Du Shang Jin Nan Fu Hospital, Chengdu, China
| | - Xiuying Hu
- West China School of Nursing, Sichuan University/Institute for Disaster Management and Reconstruction, and Innovation Center of Nursing Research, West China Hospital, Sichuan University, Chengdu, China.,Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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8
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Morales-Fernández Á, Jiménez Martín JM, Vergara-Romero M, Morales-Asencio JM, Mora-Bandera AM, Gomez-Ortigosa MI, Aranda-Gallardo M, Canca-Sánchez JC. Gender differences in perceived pain and health-related quality of life in people with chronic non-malignant pain: a cross-sectional study. Contemp Nurse 2021; 57:280-289. [PMID: 34709980 DOI: 10.1080/10376178.2021.1999836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chronic pain has a disproportionate impact on members of vulnerable population groups, and women are at substantially greater risk than men of suffering multiple chronic pain disorders. Moreover, one of the aspects most affected by the presence of chronic pain is that of health-related quality of life (HRQoL), worsening over time, as the disease persists. OBJECTIVES To describe the profile of patients who suffer non-malignant chronic pain, from a gender perspective, and to identify factors related to their HRQoL and mental health. DESIGN A cross-sectional study was carried out in patients with chronic non-cancer pain. METHODS Sociodemographic variables, pain intensity at rest and in motion, SF-36 health questionnaire, anxiety, and depression were evaluated. RESULTS The study population consisted of 531 subjects, of whom 64.2% were women. The mean age was 52.9 (SD: 10.4) years. The pain intensity recorded on the visual analogue scale was 6 (SD: 2.7) at rest and 8 (SD: 2) in motion. Physical component score and mental component score of quality of life were worse in women vs men: 33.73 (6.77) vs 32.33 (6.20), for the physical component; 36.89 (12.77) vs 32.91 (11.51), for mental component. Anxiety, depression and pain intensity, showed poorer results in women. CONCLUSION Gender is a factor that should be considered in assessing and managing chronic pain, due to its influence on the perception of pain, and HRQoL. IMPACT STATEMENT Gender is an important modifier of the perception of pain, and HRQoL. To achieve a patient-centred approach, nurses should incorporate gender as a differential factor to adapt and individualize pain management and patient education.
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Affiliation(s)
- Ángeles Morales-Fernández
- Agencia Sanitaria Costa del Sol, Marbella, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - José Manuel Jiménez Martín
- Agencia Sanitaria Costa del Sol, Marbella, Spain.,Department of Nursing, Universidad de Málaga, Faculty of Health Sciences, Málaga, Spain
| | | | - José Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Department of Nursing, Universidad de Málaga, Faculty of Health Sciences, Málaga, Spain
| | - Ana María Mora-Bandera
- Agencia Sanitaria Costa del Sol, Marbella, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Department of Nursing, Universidad de Málaga, Faculty of Health Sciences, Málaga, Spain
| | | | - Marta Aranda-Gallardo
- Agencia Sanitaria Costa del Sol, Marbella, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - José Carlos Canca-Sánchez
- Agencia Sanitaria Costa del Sol, Marbella, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Department of Nursing, Universidad de Málaga, Faculty of Health Sciences, Málaga, Spain
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9
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Fibromyalgia: Evidence for Deficits in Positive Psychology Resources. A Case-Control Study from the Al-Ándalus Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212021. [PMID: 34831775 PMCID: PMC8618469 DOI: 10.3390/ijerph182212021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 01/07/2023]
Abstract
Positive psychology is the study of positive subjective experience and individual traits. Identifying deficits in positive psychology regarding fibromyalgia may inform targets for management. Therefore, the aim of the present case–control study was to compare the levels of positive affect, negative affect, satisfaction with life, optimism and emotional repair in a large sample of women with fibromyalgia (cases) and age-matched peers without fibromyalgia (controls). This case–control study included 437 women with fibromyalgia (51.6 ± 7.1 years old) and 206 age-matched women without fibromyalgia (50.6 ± 7.2 years old). Participants self-reported their levels of (i) subjective well-being on the Positive and Negative Affect Schedule and the Satisfaction with Life Scale, (ii) dispositional optimism on the Life Orientation Test-Revised and (iii) emotional repair on the Trait Meta-Mood Scale. Women with fibromyalgia showed lower levels of positive affect, satisfaction with life, optimism and emotional repair and higher levels of negative affect. Large effect sizes were found for positive affect, negative affect and satisfaction with life (all, Cohen’s d ≥ 0.80) and small-to-moderate for emotional repair and optimism (both, Cohen’s d ≥ 0.50). Women with fibromyalgia experience deficits of positive psychology resources. Thus, developing tailored therapies for fibromyalgia focusing on reducing deficits in positive psychology resources may be of clinical interest, though this remains to be corroborated in future research.
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10
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Evers C, Jordan S, Maurer B, Becker MO, Mihai C, Dobrota R, Hoederath P, Distler O. Pain chronification and the important role of non-disease-specific symptoms in patients with systemic sclerosis. Arthritis Res Ther 2021; 23:34. [PMID: 33468227 PMCID: PMC7816465 DOI: 10.1186/s13075-021-02421-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pain is a frequent, yet inadequately explored challenge in patients with systemic sclerosis (SSc). This study aimed to conduct an extensive pain assessment, examining pain chronification and its association with disease manifestations. Methods Consecutive SSc patients attending their annual assessment were included. SSc-specific features were addressed as defined by the European Scleroderma Trials and Research (EUSTAR) guidelines. Pain analysis included intensity, localization, treatment, chronification grade according to the Mainz Pain Staging System (MPSS), general well-being using the Marburg questionnaire on habitual health findings (MFHW) and symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Results One hundred forty-seven SSc patients completed a pain questionnaire, and 118/147 patients reporting pain were included in the analysis. Median pain intensity was 4/10 on a numeric rating scale (NRS). The most frequent major pain localizations were hand and lower back. Low back pain as the main pain manifestation was significantly more frequent in patients with very early SSc (p = 0.01); those patients also showed worse HADS and MFHW scores. Regarding pain chronification, 34.8% were in stage I according to the MPSS, 45.2% in stage II and 20.0% in stage III. There was no significant correlation between chronification grade and disease severity, but advanced chronification was significantly more frequent in patients with low back pain (p = 0.024). It was also significantly associated with pathological HADS scores (p < 0.0001) and linked with decreased well-being and higher use of analgesics. Conclusions Our study implies that also non-disease-specific symptoms such as low back pain need to be considered in SSc patients, especially in early disease. Since low back pain seems to be associated with higher grades of pain chronification and psychological problems, our study underlines the importance of preventing pain chronification in order to enhance the quality of life.
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Affiliation(s)
- Caroline Evers
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Mike Oliver Becker
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Rucsandra Dobrota
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Petra Hoederath
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland.,Centre of Neurosurgery Hirslanden Ostschweiz, Paintherapy Stephanshorn, Brauerstrasse 95a, 9016, St. Gallen, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland.
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López-Martínez AE, Ramírez-Maestre C, Serrano-Ibáñez ER, Ruiz-Párraga GT, Peters ML, Esteve R. Using vignettes to assess the contribution of goal adjustment in the adaptation to chronic musculoskeletal pain. Qual Life Res 2020; 29:2137-2148. [PMID: 32236774 DOI: 10.1007/s11136-020-02487-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The quality of life of individuals with chronic musculoskeletal pain partly depends on their capacity to adjust their personal goals. Vignettes have been rarely used to assess this ability. Therefore, this study aimed to test the relationships between vignettes assessing different goal strategies and chronic pain adaptation (i.e., daily functioning, pain-related impairment, and psychological well-being). METHODS The sample comprised 258 individuals with chronic musculoskeletal pain who completed a series of questionnaires and vignettes. The vignettes presented a short description of a situation in which a person with chronic pain experienced a threat to a valued domain-specific goal and had to choose a possible goal management solution (i.e., goal persistence, flexibility reengagement, and disengagement). Hierarchical regression analyses were used to predict chronic pain adaptation using the selected vignette strategies as predictors. RESULTS After controlling for age, sex, pain intensity, and the responses to the dispositional goal management scales, persistence, reengagement, and disengagement goal strategies presented in the case scenarios predicted daily functioning (p < .001). Persistence, flexibility, disengagement (p < .001), and reengagement (p < .05) predicted pain-related impairment. Persistence, disengagement (p < .001), and flexibility (p < .05) predicted psychological well-being scores. CONCLUSION The use of vignettes could be useful to assess goal adjustment because this methodology enables respondents to provide more context-specific responses. The results of this approach could be used to improve clinical practice aimed at helping people with chronic musculoskeletal pain to better cope with this health condition.
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Affiliation(s)
- Alicia E López-Martínez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain.
| | - Carmen Ramírez-Maestre
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain
| | - Elena R Serrano-Ibáñez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain
| | - Gema T Ruiz-Párraga
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain
| | - Madelon L Peters
- Department of Psychology and Neuroscience, Clinical Psychological Science, Behavioural Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rosa Esteve
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain
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12
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Rawang P, Janwantanakul P, Correia H, Jensen MP, Kanlayanaphotporn R. Cross-cultural adaptation, reliability, and construct validity of the Thai version of the Patient-Reported Outcomes Measurement Information System-29 in individuals with chronic low back pain. Qual Life Res 2019; 29:793-803. [DOI: 10.1007/s11136-019-02363-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
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13
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Lewis R, Gómez Álvarez CB, Rayman M, Lanham-New S, Woolf A, Mobasheri A. Strategies for optimising musculoskeletal health in the 21 st century. BMC Musculoskelet Disord 2019; 20:164. [PMID: 30971232 PMCID: PMC6458786 DOI: 10.1186/s12891-019-2510-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/17/2019] [Indexed: 12/19/2022] Open
Abstract
We live in a world with an ever-increasing ageing population. Studying healthy ageing and reducing the socioeconomic impact of age-related diseases is a key research priority for the industrialised and developing countries, along with a better mechanistic understanding of the physiology and pathophysiology of ageing that occurs in a number of age-related musculoskeletal disorders. Arthritis and musculoskeletal disorders constitute a major cause of disability and morbidity globally and result in enormous costs for our health and social-care systems.By gaining a better understanding of healthy musculoskeletal ageing and the risk factors associated with premature ageing and senescence, we can provide better care and develop new and better-targeted therapies for common musculoskeletal disorders. This review is the outcome of a two-day multidisciplinary, international workshop sponsored by the Institute of Advanced Studies entitled "Musculoskeletal Health in the 21st Century" and held at the University of Surrey from 30th June-1st July 2015.The aim of this narrative review is to summarise current knowledge of musculoskeletal health, ageing and disease and highlight strategies for prevention and reducing the impact of common musculoskeletal diseases.
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Affiliation(s)
- Rebecca Lewis
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Constanza B Gómez Álvarez
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Margaret Rayman
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Susan Lanham-New
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Anthony Woolf
- Department of Rheumatology, Royal Cornwall Hospital, Truro, UK
| | - Ali Mobasheri
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK. .,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Queen's Medical Centre, Nottingham, UK. .,Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania. .,The D-BOARD FP7 Consortium, . .,The APPROACH IMI Consortium, .
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14
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Scala E, Decosterd I, Faouzi M, Burnand B, Rodondi PY. Level of readiness of chronic pain patients to practise active self-care. Eur J Pain 2018; 22:1800-1812. [PMID: 29956872 DOI: 10.1002/ejp.1276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Given the limited alleviation of chronic pain with pharmacological treatments, various nonpharmacological and self-care approaches are often proposed that require patients' motivation. OBJECTIVE To evaluate the level of readiness (LOR) to practise different types of active self-care among chronic pain patients. METHOD A quantitative cross-sectional survey was conducted among all chronic pain patients seeking care at the Pain Center of an academic hospital from June 2013 to March 2015. Sociodemographic data, pain characteristics, treatments and the LOR to practise active self-care were investigated. RESULTS Among the 1524 eligible patients, 639 (41.9%) were included. The median pain duration was 8.5 years (interquartile range = 7.5). Two-thirds (63.7%) of the patients reported high pain-related disability, and 64.6% had used opioids during the previous six months. Most patients had a high (44.1%) or moderate (24.6%) LOR to practise active self-care. Multivariable multinomial regression analysis showed that independent factors associated with a high LOR were a higher level of education (relative risk ratio (RRR) = 3.42, 95% confidence interval (CI): 1.90-6.13, p < 0.001), unemployed status due to medical condition (RRR = 2.92, 95% CI: 1.30-6.56, p = 0.009), the use of dietary supplements 'against pain' (RRR = 2.77, 95% CI: 1.52-5.04, p = 0.001) and neuropathic pain characteristics (RRR = 1.80, 95% CI: 1.40-3.12, p = 0.036). Older age was a factor predicting a lower LOR (RRR = 0.97, 95% CI: 0.94-0.99, p = 0.039). Long-term chronic pain, severe pain-related disability and the presence of a mood disorder were not associated with a lower LOR. CONCLUSION Most chronic pain patients, including those severely affected, indicated their readiness to practise active self-care methods. SIGNIFICANCE Most chronic pain patients, even those severely affected, appeared to be ready to practise active self-care therapies and we believe that further studies are needed to investigate their impact on pain and quality of life.
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Affiliation(s)
- E Scala
- Pain Center and Center for integrative and complementary medecine (CEMIC), Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - I Decosterd
- Pain Center and Center for integrative and complementary medecine (CEMIC), Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - M Faouzi
- Institute of Social and Preventive Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - B Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - P-Y Rodondi
- Institute of Social and Preventive Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
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15
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Faoro MW, Olinto MTA, Paniz VMV, Macagnan J, Henn RL, Garcez A, Pattussi MP. Work-related musculoskeletal pain and its association with common mental disorders among employees of a poultry producing company in Southern Brazil. Rev Bras Med Trab 2018; 16:136-144. [PMID: 32270078 DOI: 10.5327/z1679443520180200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/26/2018] [Indexed: 01/22/2023] Open
Abstract
Background Musculoskeletal pain is one of the most common occupational problems in the industrial society and its prevalence is potentially associated with mental disorders. Objective To estimate the prevalence of work-related musculoskeletal pain and its association with occurrence of common mental disorders among employees of a poultry processing company in Southern Brazil. Methods Cross-sectional study conducted in 2010 with 1,103 employees aged 18 to 52 years old. Musculoskeletal pain was investigated based on a human figure adapted from the Standardized Nordic Questionnaire. We considered reported work-related pain in any part of the body in the past 12 months. Occurrence of common mental disorders was assessed- by the Self-Reporting Questionnaire (SRQ-20). Crude and adjusted prevalence ratios (PR) and corresponding 95% confidence interval (95%CI) were obtained by Poisson regression with robust variance. Results The prevalence of work-related musculoskeletal pain was 40.3% (95%CI 37.4-43.2) for the total sample, 46.8% (95%CI 43.2-50.5) for women and 27.8% (95%CI 23.2-32.3) for men. The prevalence of musculoskeletal pain was twice higher for the participants with common mental disorders compared to those without this condition (PR=2.27; 95%CI 1.99-2.58). This effect remained significant after adjustment for sociodemographic, behavioral, health-related and occupational variables. Conclusion The results of the present study point to the relevance of preventive measures to promote the mental and physical health of workers in order to reduce or minimize the occurrence of pain.
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Affiliation(s)
- Mariana Wentz Faoro
- Graduate Program in Collective Health, University of the Sinos River Valley (Universidade do Vale do Rio dos Sinos - UNISINOS) - São Leopoldo (RS), Brazil
| | - Maria Teresa Anselmo Olinto
- Graduate Program in Collective Health, University of the Sinos River Valley (Universidade do Vale do Rio dos Sinos - UNISINOS) - São Leopoldo (RS), Brazil
| | - Vera Maria Vieira Paniz
- Graduate Program in Collective Health, University of the Sinos River Valley (Universidade do Vale do Rio dos Sinos - UNISINOS) - São Leopoldo (RS), Brazil
| | - Jamile Macagnan
- Department of Nursing, State University of Santa Catarina (Universidade do Estado de Santa Catarina - UDESC) - Palmitos (SC), Brazil
| | - Ruth Liane Henn
- Graduate Program in Collective Health, University of the Sinos River Valley (Universidade do Vale do Rio dos Sinos - UNISINOS) - São Leopoldo (RS), Brazil
| | - Anderson Garcez
- Graduate Program in Collective Health, University of the Sinos River Valley (Universidade do Vale do Rio dos Sinos - UNISINOS) - São Leopoldo (RS), Brazil
| | - Marcos Pascoal Pattussi
- Graduate Program in Collective Health, University of the Sinos River Valley (Universidade do Vale do Rio dos Sinos - UNISINOS) - São Leopoldo (RS), Brazil
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16
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Ng SK, Cicuttini FM, Davis SR, Bell R, Botlero R, Fitzgibbon BM, Urquhart DM. Poor general health and lower levels of vitality are associated with persistent, high-intensity low back pain and disability in community-based women: A prospective cohort study. Maturitas 2018; 113:7-12. [PMID: 29903650 DOI: 10.1016/j.maturitas.2018.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/15/2018] [Indexed: 11/30/2022]
Abstract
While low back pain significantly impacts on an individual's well-being, our understanding of the role of well-being in the natural history of low back pain is limited. This cohort study aimed to investigate the association between psychological and general well-being and the development and progression of low back pain and disability in community-based women over a 2-year period. 506 women recruited from a research database were invited to participate. Overall psychological and general well-being and its subdomains were assessed at baseline using the Psychological General Well-Being Index (PGWB). The intensity of and degree of disability arising from low back pain were examined using the Chronic Pain Grade Questionnaire at baseline and at 2-year follow-up. Participants were categorized as having no, developing, resolving, or persistent high-intensity pain and disability. 444 participants (87.8%) completed the study. Women with persistent high-intensity pain had lower PGWB scores at baseline than those with no high-intensity pain at follow-up, after adjusting for confounders (M(SE) = 69.9(2.55) vs 80.1(2.63), p < 0.005). Furthermore, women with persistent high disability scores had lower well-being scores than those without persistent high disability scores (M(SE) = 69.1(3.49) vs. 81.2(0.802), p = 0.001). Moreover, lower scores in the well-being subdomains of general health and vitality were associated with persistent high pain intensity and disability (all p < 0.007). In summary, lower levels of general health and vitality were associated with persistent high-intensity low back pain and disability, suggesting that improving these aspects of well-being has the potential to reduce high levels of chronic low back pain and disability in community-based women.
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Affiliation(s)
- Sin Ki Ng
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia; Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University, 4/607 St Kilda Road, Melbourne, VIC 3004, Australia.
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Susan R Davis
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Robin Bell
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Roslin Botlero
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Bernadette M Fitzgibbon
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University, 4/607 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Donna M Urquhart
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
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17
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Lascelles BDX, Brown DC, Maixner W, Mogil JS. Spontaneous painful disease in companion animals can facilitate the development of chronic pain therapies for humans. Osteoarthritis Cartilage 2018; 26:175-183. [PMID: 29180098 DOI: 10.1016/j.joca.2017.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/17/2017] [Accepted: 11/13/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To outline the role that spontaneous osteoarthritis (OA) in companion animals can play in translational research and therapeutic pharmacological development. OUTLINE Narrative review summarizing the opportunities and limitations of naturally occurring, spontaneous OA as models of human OA pain, with a focus on companion animal pets. The background leading to considering inserting spontaneous disease models in the translational paradigm is provided. The utility of this model is discussed in terms of outcome measures that have been validated as being related to pain, and in terms of the potential for target discovery is outlined. The limitations to using companion animal pets as models of human disease are discussed. CONCLUSIONS Although many steps along the translational drug development pathway have been identified as needing improvement, spontaneous painful OA in companion animals offers translational potential. Such 'models' may better reflect the complex genetic, environmental, temporal and physiological influences present in humans and current data suggests the predictive validity of the models are good. The opportunity for target discovery exists but is, as yet, unproven.
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Affiliation(s)
- B D X Lascelles
- Comparative Pain Research Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA; Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA; Center for Pain Research and Innovation, UNC School of Dentistry, Chapel Hill, NC, USA; Center for Translational Pain Research, Department of Anesthesiology, Duke University, Durham, NC, USA.
| | - D C Brown
- Translational Comparative Medicine Research, Elanco Animal Health, Greenfield, IN, USA
| | - W Maixner
- Center for Translational Pain Research, Department of Anesthesiology, Duke University, Durham, NC, USA
| | - J S Mogil
- Department of Psychology, Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada; Department of Anesthesia, Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
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Fernando S, Biggs SN, Horne RSC, Vollenhoven B, Lolatgis N, Hope N, Wong M, Lawrence M, Lawrence A, Russell C, Leong K, Thomas P, Rombauts L, Wallace EM. The impact of melatonin on the sleep patterns of women undergoing IVF: a double blind RCT. Hum Reprod Open 2018; 2017:hox027. [PMID: 30895239 PMCID: PMC6276665 DOI: 10.1093/hropen/hox027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/29/2017] [Accepted: 12/18/2017] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION Does melatonin result in a dose–response effect on sleep quality and daytime sleepiness in women undergoing IVF? SUMMARY ANSWER Melatonin, even when given at high doses twice per day, does not cause significant daytime sleepiness or change night time sleep quantity or quality. WHAT IS KNOWN ALREADY Melatonin is being increasingly used as an adjuvant therapy for women undergoing IVF owing to its antioxidative effects. It is widely considered to be sedative but there are scant objective data on the effects of melatonin on sleep in the setting of IVF. STUDY DESIGN SIZE, DURATION The study was a double-blind placebo-controlled randomized trial of 116 women recruited between September 2014 and September 2016. PARTICIPANTS/MATERIALS, SETTING, METHOD Women who were undergoing their first cycle of IVF at private IVF centers were recruited into the RCT and randomized to receive either placebo, 2 mg, 4 mg or 8 mg of melatonin, twice per day (BD) from Day 2 of their cycle until the day before oocyte retrieval. Each participant wore an accelerometer that provides an estimate of sleep and wake activity for up to 1 week of baseline and throughout treatment (up to 2 weeks). They also kept sleep diaries and completed a Karolinska sleepiness score detailing their night time sleep activity and daytime sleepiness, respectively. MAIN RESULTS AND THE ROLE OF CHANCE In total, 116 women were included in the intention-to-treat analysis (placebo BD (n = 32), melatonin 2 mg BD (n = 29), melatonin 4 mg BD (n = 26), melatonin 8 mg BD (n = 29)). There were no significant differences in daytime Karolinska sleepiness score between groups (P = 0.4), nor was there a significant dose–response trend (β=0.05, 95% CI −0.22–0.31, P = 0.7). There were no differences in objective measures of sleep quantity or quality, including wake after sleep onset time, sleep onset latency, and sleep efficiency before and after treatment or between groups. There was an improvement in subjective sleep quality scores from baseline to during treatment in all groups, except 8 mg BD melatonin: placebo (percentage change −13.3%, P = 0.01), 2 mg (−14.1%, P = 0.03), 4 mg (−8.6%, P = 0.01) and 8 mg (−7.8%, P = 0.07). LIMITATIONS, REASONS FOR CAUTION As this was a subset of a larger trial, the melatonin in ART (MIART) trial, it is possible that the sample size was too small to detect statistically significant differences between the groups. WIDER IMPLICATIONS OF THE FINDINGS While this study suggests that melatonin can be used twice per day at high doses to achieve sustained antioxidation effects, with the reassurance that this will not negatively impact daytime sleepiness or night time sleep habits, the sample size is small and may have missed a clinically significant difference. Nevertheless, our findings may have implications not only for future studies of fertility treatments (including meta-analyses), but also in other medical fields where sustained antioxidation is desired. STUDY FUNDING/COMPETING INTERESTS This study was funded by the Monash IVF Research and Education Foundation (PY12_15). S.F. is supported by the National Health and Medical Research Council (Postgraduate Scholarship APP1074342) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Ella Macknight Memorial Scholarship. E.W. is supported by an National Health and Medical Research Council Program Grant (APP1113902). S.F., E.W., R.H., B.V., N.L., N.H., M.W., M.L., A.L., P.T., K.L. have nothing to declare. L.R. is a Minority shareholder in Monash IVF Group, has unrestricted grants from MSD®, Merck-Serono® and Ferring® and receives consulting fees from Ferring®. S.N.B. reports consulting fees from Johnson & Johnson Consumer Inc®, outside the submitted work. TRIAL REGISTRATION NUMBER This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (Project ID: ACTRN12613001317785). TRIAL REGISTRATION DATE 27/11/2013 DATE OF FIRST PATIENT’S ENROLMENT 1/9/2014
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Affiliation(s)
- Shavi Fernando
- Departments of Obstetrics and Gynaecology.,Hudson Institute of Medical Research, 27-31 Wright st, Clayton, Victoria3168, Australia.,Monash Women's, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
| | - Sarah Nichole Biggs
- Paediatrics, Monash University, Wellington Rd, Clayton, Victoria 3800, Australia.,Hudson Institute of Medical Research, 27-31 Wright st, Clayton, Victoria3168, Australia
| | - Rosemary Sylvia Claire Horne
- Paediatrics, Monash University, Wellington Rd, Clayton, Victoria 3800, Australia.,Hudson Institute of Medical Research, 27-31 Wright st, Clayton, Victoria3168, Australia
| | - Beverley Vollenhoven
- Departments of Obstetrics and Gynaecology.,Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia.,Monash Women's, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
| | | | - Nicole Hope
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | - Melissa Wong
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | - Mark Lawrence
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | | | - Chris Russell
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | - Kenneth Leong
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | - Philip Thomas
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia.,Monash Women's, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
| | - Luk Rombauts
- Departments of Obstetrics and Gynaecology.,Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia.,Monash Women's, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
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Poorman GW, Passias PG, Horn SR, Frangella NJ, Daniels AH, Hamilton DK, Kim H, Sciubba D, Diebo BG, Bortz CA, Segreto FA, Kelly MP, Smith JS, Neuman BJ, Shaffrey CI, LaFage V, LaFage R, Ames CP, Hart R, Mundis GM, Eastlack R. Despite worse baseline status depressed patients achieved outcomes similar to those in nondepressed patients after surgery for cervical deformity. Neurosurg Focus 2017; 43:E10. [DOI: 10.3171/2017.8.focus17486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDepression and anxiety have been demonstrated to have negative impacts on outcomes after spine surgery. In patients with cervical deformity (CD), the psychological and physiological burdens of the disease may overlap without clear boundaries. While surgery has a proven record of bringing about significant pain relief and decreased disability, the impact of depression and anxiety on recovery from cervical deformity corrective surgery has not been previously reported on in the literature. The purpose of the present study was to determine the effect of depression and anxiety on patients’ recovery from and improvement after CD surgery.METHODSThe authors conducted a retrospective review of a prospective, multicenter CD database. Patients with a history of clinical depression, in addition to those with current self-reported anxiety or depression, were defined as depressed (D group). The D group was compared with nondepressed patients (ND group) with a similar baseline deformity determined by propensity score matching of the cervical sagittal vertical axis (cSVA). Baseline demographic, comorbidity, clinical, and radiographic data were compared among patients using t-tests. Improvement of symptoms was recorded at 3 months, 6 months, and 1 year postoperatively. All health-related quality of life (HRQOL) scores collected at these follow-up time points were compared using t-tests.RESULTSSixty-six patients were matched for baseline radiographic parameters: 33 with a history of depression and/or current depression, and 33 without. Depressed patients had similar age, sex, race, and radiographic alignment: cSVA, T-1 slope minus C2–7 lordosis, SVA, and T-1 pelvic angle (p > 0.05). Compared with nondepressed individuals, depressed patients had a higher incidence of osteoporosis (21.2% vs 3.2%, p = 0.028), rheumatoid arthritis (18.2% vs 3.2%, p = 0.012), and connective tissue disorders (18.2% vs 3.2%, p = 0.012). At baseline, the D group had greater neck pain (7.9 of 10 vs 6.6 on a Numeric Rating Scale [NRS], p = 0.015), lower mean EQ-5D scores (68.9 vs 74.7, p < 0.001), but similar Neck Disability Index (NDI) scores (57.5 vs 49.9, p = 0.063) and myelopathy scores (13.4 vs 13.9, p = 0.546). Surgeries performed in either group were similar in terms of number of levels fused, osteotomies performed, and correction achieved (baseline to 3-month measurements) (p < 0.05). At 3 months, EQ-5D scores remained lower in the D group (74.0 vs 78.2, p = 0.044), and NDI scores were similar (48.5 vs 39.0, p = 0.053). However, neck pain improved in the D group (NRS score of 5.0 vs 4.3, p = 0.331), and modified Japanese Orthopaedic Association (mJOA) scores remained similar (14.2 vs 15.0, p = 0.211). At 6 months and 1 year, all HRQOL scores were similar between the 2 cohorts. One-year measurements were as follows: NDI 39.7 vs 40.7 (p = 0.878), NRS neck pain score of 4.1 vs 5.0 (p = 0.326), EQ-5D score of 77.1 vs 78.2 (p = 0.646), and mJOA score of 14.0 vs 14.2 (p = 0.835). Anxiety/depression levels reported on the EQ-5D scale were significantly higher in the depressed cohort at baseline, 3 months, and 6 months (all p < 0.05), but were similar between groups at 1 year postoperatively (1.72 vs 1.53, p = 0.416).CONCLUSIONSClinical depression was observed in many of the study patients with CD. After matching for baseline deformity, depression symptomology resulted in worse baseline EQ-5D and pain scores. Despite these baseline differences, both cohorts achieved similar results in all HRQOL assessments 6 months and 1 year postoperatively, demonstrating no clinical impact of depression on recovery up until 1 year after CD surgery. Thus, a history of depression does not appear to have an impact on recovery from CD surgery.
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Affiliation(s)
- Gregory W. Poorman
- 1Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Peter G. Passias
- 1Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Samantha R. Horn
- 1Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Nicholas J. Frangella
- 1Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Alan H. Daniels
- 2Department of Orthopaedic Surgery, Brown University Alpert Medical School, Providence, Rhode Island
| | - D. Kojo Hamilton
- 3Department of Neurologic Surgery, University of Pittsburgh, Pennsylvania
| | - Hanjo Kim
- 4Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Daniel Sciubba
- 5Department of Neurologic Surgery, Johns Hopkins Medical Center, Baltimore, Maryland
| | - Bassel G. Diebo
- 6Department of Orthopaedic Surgery, University Hospital of Brooklyn, New York, New York
| | - Cole A. Bortz
- 1Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Frank A. Segreto
- 1Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Michael P. Kelly
- 7Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Justin S. Smith
- 8Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Brian J. Neuman
- 5Department of Neurologic Surgery, Johns Hopkins Medical Center, Baltimore, Maryland
| | - Christopher I. Shaffrey
- 8Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Virginie LaFage
- 4Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Renaud LaFage
- 4Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Christopher P. Ames
- 9Department of Neurological Surgery, University of California, San Francisco, California
| | - Robert Hart
- 10Swedish Neuroscience Institute, Seattle, Washington; and
| | | | - Robert Eastlack
- 11San Diego Center for Spinal Disorders, La Jolla, California
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20
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Elsesser K, Cegla T. Long-term treatment in chronic noncancer pain: Results of an observational study comparing opioid and nonopioid therapy. Scand J Pain 2017; 17:87-98. [DOI: 10.1016/j.sjpain.2017.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 12/17/2022]
Abstract
Abstract
Background and aims
Recent studies reveal high prevalence rates of patients receiving long-term opioids. However, well designed studies assessing effectiveness with longer than 3 months follow-up are sparse. The present study investigated the outcomes of long-term opioid therapy compared to nonopioid treatment in CNCP patients with respect to measures of pain, functional disability, psychological wellbeing, and quality of life (QoL).
Methods
Three hundred and thirty three consecutive patients at our pain clinic were included and divided into patients with continuous opioid treatment for at least 3 months (51%) and patients receiving nonopioid analgesics (49%). Further, outcome of different doses of opioid (<120 mg vs. >120 mg morphine equivalents) and differences between high and low potency opioids were examined.
Results
The opioid and nonopioid groups did not differ with regard to pain intensity or satisfaction with analgesic. Patients with continuous opioids treatment reported higher neuropathic like pain, longer duration of pain disorder, lower functional level, wellbeing, and physical QoL in comparison to patients receiving nonopioid analgesics. Higher opioid doses were associated with male gender, intake of high potency opioids and depression but there were no differences with regard to pain relief or improvement of functional level between high and low doses. Similarly, patients on high potency opioids reported more psychological impairment than patients on low potency opioids but no advantage with regard to pain relief. Overall, remaining level of pain, functional disability and poor QoL were quite high irrespective of the analgesic used or opioid dosing.
Conclusions
In the long-term no clear advantage of opioid vs. non-opioid analgesics could be revealed. In terms of remaining pain intensity, functional disability and quality of life, treatment with pain medication proved insufficient. Additionally, with higher doses of opioids the benefit to risk relationship becomes worse and patients on high potency opioids reported more psychological impairment than patients on low potency opioids but no advantage with regard to pain relief.
Implications
Our results raise questions about the long-term effectiveness of analgesic treatment regimens irrespective of analgesics type employed and call for more multidisciplinary treatment strategies.
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Affiliation(s)
- Karin Elsesser
- Sankt Josef Krankenhaus , Clinic of Pain Medicine, Bergstr , 6-12, 42105 Wuppertal , Germany
| | - Thomas Cegla
- Sankt Josef Krankenhaus , Clinic of Pain Medicine, Bergstr , 6-12, 42105 Wuppertal , Germany
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21
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Björnsdóttir SV, Triebel J, Arnljótsdóttir M, Tómasson G, Valdimarsdóttir UA. Long-lasting improvements in health-related quality of life among women with chronic pain, following multidisciplinary rehabilitation. Disabil Rehabil 2017; 40:1764-1772. [DOI: 10.1080/09638288.2017.1312565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sigrún Vala Björnsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- HNLFI Rehabilitation Clinic, Hveragerði, Iceland
| | - Jan Triebel
- HNLFI Rehabilitation Clinic, Hveragerði, Iceland
- Department of Orthopaedic Surgery, Akademiska, University Hospital Uppsala, Sweden
| | | | - Gunnar Tómasson
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Unnur Anna Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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22
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Majuta LA, Guedon JMG, Mitchell SAT, Ossipov MH, Mantyh PW. Anti-nerve growth factor therapy increases spontaneous day/night activity in mice with orthopedic surgery-induced pain. Pain 2017; 158:605-617. [PMID: 28301858 PMCID: PMC5370196 DOI: 10.1097/j.pain.0000000000000799] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are 2 of the most common and successful surgical interventions to relieve osteoarthritis pain. Control of postoperative pain is critical for patients to fully participate in the required physical therapy which is the most influential factor in effective postoperative knee rehabilitation. Currently, opiates are a mainstay for managing postoperative orthopedic surgery pain including TKA or THA pain. Recently, issues including efficacy, dependence, overdose, and death from opiates have made clinicians and researchers more critical of use of opioids for treating nonmalignant skeletal pain. In the present report, a nonopiate therapy using a monoclonal antibody raised against nerve growth factor (anti-NGF) was assessed for its ability to increase the spontaneous activity of the operated knee joint in a mouse model of orthopedic surgery pain-induced by drilling and coring the trochlear groove of the mouse femur. Horizontal activity and velocity and vertical rearing were continually assessed over a 20 hours day/night period using automated activity boxes in an effort to reduce observer bias and capture night activity when the mice are most active. At days 1 and 3, after orthopedic surgery, there was a marked reduction in spontaneous activity and vertical rearing; anti-NGF significantly attenuated this decline. The present data suggest that anti-NGF improves limb use in a rodent model of joint/orthopedic surgery and as such anti-NGF may be useful in controlling pain after orthopedic surgeries such as TKA or THA.
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Affiliation(s)
- Lisa A. Majuta
- Department of Pharmacology, University of Arizona, Tucson, AZ 85724
| | | | | | | | - Patrick W. Mantyh
- Department of Pharmacology, University of Arizona, Tucson, AZ 85724
- Cancer Center, University of Arizona, Tucson, AZ 85724
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Hung CI, Liu CY, Yang CH, Wang SJ. Headache: an important factor associated with muscle soreness/pain at the two-year follow-up point among patients with major depressive disorder. J Headache Pain 2016; 17:57. [PMID: 27233897 PMCID: PMC4883023 DOI: 10.1186/s10194-016-0648-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 05/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No study has compared the associations of headache, anxiety, and depression at baseline with muscle soreness or pain (MS/P) at baseline and at the two-year follow-up point among outpatients with major depressive disorder (MDD). This study aimed to investigate the above issue. METHODS This study enrolled 155 outpatients with MDD at baseline, and 131 attended a two-year follow-up appointment. At baseline, migraine was diagnosed based on the International Classification of Headache Disorders, 2(nd) edition. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale was used to evaluate the intensities of headache and MS/P in the neck, shoulder, back, upper limbs, and lower limbs. Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale. Multiple linear regressions were used to compare the associations of these factors with MS/P. RESULTS Compared with anxiety disorders, migraine was more strongly associated with MS/P in all areas at baseline and in the upper and lower limbs at follow-up. Headache intensity at baseline was the factor most strongly associated with MS/P in all areas at baseline and follow-up after controlling for depression and anxiety. Headache intensity at baseline predicted MS/P at baseline and follow-up. CONCLUSIONS Migraine and headache intensity are important factors related to MS/P at baseline and follow-up among patients with MDD. Integrating depression and headache treatment might be indicated to improve MS/P.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Ching-Hui Yang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine and Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Neurology, Taipei Veterans General Hospital, No. 201 Shi-Pai Road, Section 2, Taipei, 112, Taiwan.
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24
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Maakip I, Keegel T, Oakman J. Workstyle and Musculoskeletal Discomfort (MSD): Exploring the Influence of Work Culture in Malaysia. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:696-706. [PMID: 25808991 DOI: 10.1007/s10926-015-9577-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Workstyle can be defined as an individual pattern of cognitions, behaviours and physiological reactivity that can occur while performing job tasks. Workstyle has been associated with the development of musculoskeletal disorders (MSDs) amongst office workers in developed countries. However, little is known about the contribution of workstyle on MSDs in developing countries such as Malaysia. The objective of this cross-sectional study was to examine the relationship between workstyle and musculoskeletal discomfort in a sample of office workers in Malaysia. METHODS Office workers (N = 417; response rate 65.5 %) from four organisations completed a survey measuring physical and psychosocial hazards, job satisfaction, work-life balance, workstyle, and MSD discomfort levels. Hierarchical regression analyses were undertaken to examine predictors associated with self-reported musculoskeletal discomfort, and more specifically the relationship between workstyle and MSD discomfort. RESULTS Musculoskeletal discomfort was significantly associated with working through pain, mental health, physical demands, gender and work-life balance (R (2) = 50.2, adjusted R (2) = 0.48; F (13, 324) = 25.09, p = 0.001). Working through pain is the strongest risk factor associated with MSD discomfort (ß = 0.49, p = 0.001) compared to other potential risk factors. CONCLUSIONS Working through pain is influenced by work, social culture and religious beliefs. Workplace MSDs interventions that focus on the impact of physical and psychosocial hazards with emphasis on addressing adverse workstyles should take into account aspects related to work and social culture of the target population. Changes are recommended at both employee and management levels such as better communications and understanding concerning workplace problems with regards to minimizing MSDs at work.
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Affiliation(s)
- Ismail Maakip
- Centre for Ergonomics and Human Factors, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, 3086, Australia.
- Faculty of Psychology and Education, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia.
| | - Tessa Keegel
- Centre for Ergonomics and Human Factors, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3800, Australia
| | - Jodi Oakman
- Centre for Ergonomics and Human Factors, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
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25
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Abstract
Chronic pain is associated with large societal costs, but few studies have investigated the total costs of chronic pain with respect to elderly subjects. The elderly usually require informal care, care performed by municipalities, and care for chronic diseases, all factors that can result in extensive financial burdens on elderly patients, their families, and the social services provided by the state. This study aims to quantify the societal cost of chronic pain in people of age 65 years and older and to assess the impact of chronic pain on quality of life. This study collected data from 3 registers concerning health care, drugs, and municipal services and from 2 surveys. A postal questionnaire was used to collect data from a stratified sample of the population 65 years and older in southeastern Sweden. The questionnaire addressed pain intensity and quality of life variables (EQ-5D). A second postal questionnaire was used to collect data from relatives of the elderly patients suffering from chronic pain. A total of 66.5% valid responses of the 10,000 subjects was achieved; 76.9% were categorized as having no or mild chronic pain, 18.9% as having moderate chronic pain, and 4.2% as having severe chronic pain. Consumed resources increased with the severity of chronic pain. Clear differences in EQ-5D were found with respect to the severity of pain. This study found an association between resource use and severity of chronic pain in elderly subjects: the more severe the chronic pain, the more extensive (and expensive) the use of resources.
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26
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Hoogwout SJ, Paananen MV, Smith AJ, Beales DJ, O'Sullivan PB, Straker LM, Eastwood PR, McArdle N, Champion D. Musculoskeletal pain is associated with restless legs syndrome in young adults. BMC Musculoskelet Disord 2015; 16:294. [PMID: 26467305 PMCID: PMC4607251 DOI: 10.1186/s12891-015-0765-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 10/08/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In recent years, there is considerable evidence of a relationship between the sensorimotor disorder restless legs syndrome (RLS) and pain disorders, including migraine and fibromyalgia. An association between multi-site pain and RLS has been reported in adult women. In the current study, we explored the association between musculoskeletal (MSK) pain and RLS in a large cohort of young adults. METHODS Twenty two year olds (n = 1072), followed since birth of part of the Western Australian Pregnancy Cohort (Raine) Study, provided data on MSK pain (duration, severity, frequency, number of pain sites). RLS was considered present when 4 diagnostic criteria recommended by the International Restless Legs Syndrome Study Group were met (urge to move, dysaesthesia, relief by movement, worsening symptoms during the evening/night) and participants had these symptoms at least 5 times per month. Associations between MSK pain and RLS were analyzed by multivariable logistic regression with bias-corrected bootstrapped confidence intervals, with final models adjusted for sex, psychological distress and sleep quality. RESULTS The prevalence of RLS was 3.0 % and MSK pain was reported by 37.4 % of the participants. In multivariable logistic regression models, strong associations were found between RLS-diagnosis and long duration (three months or more) of MSK pain (odds ratio 3.6, 95 % confidence interval 1.4-9.2) and reporting three or more pain sites (4.9, 1.6-14.6). CONCLUSIONS Different dimensions of MSK pain were associated with RLS in young adults, suggestive of shared pathophysiological mechanisms. Overlap between these conditions requires more clinical and research attention.
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Affiliation(s)
- Stijn J Hoogwout
- Faculty of Medical Sciences, University of Groningen, PO Box 72, 9700 AB, Groningen, The Netherlands.
- , Offenbachlaan 14, 2253 CR, Voorschoten, The Netherlands.
| | - Markus V Paananen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland.
| | - Anne J Smith
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Darren J Beales
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Peter B O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Leon M Straker
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Peter R Eastwood
- Centre for Sleep Science, School of Anatomy, Physiology & Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Nigel McArdle
- Centre for Sleep Science, School of Anatomy, Physiology & Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - David Champion
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia.
- University of New South Wales, UNSW, Sydney, NSW, 2052, Australia.
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27
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Björnsdóttir SV, Arnljótsdóttir M, Tómasson G, Triebel J, Valdimarsdóttir UA. Health-related quality of life improvements among women with chronic pain: comparison of two multidisciplinary interventions. Disabil Rehabil 2015; 38:828-36. [DOI: 10.3109/09638288.2015.1061609] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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28
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Egloff N, von Känel R, Müller V, Egle UT, Kokinogenis G, Lederbogen S, Durrer B, Stauber S. Implications of proposed fibromyalgia criteria across other functional pain syndromes. Scand J Rheumatol 2015; 44:416-24. [DOI: 10.3109/03009742.2015.1010103] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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29
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Lundberg G, Gerdle B. The relationships between pain, disability, and health-related quality of life: an 8-year follow-up study of female home care personnel. Disabil Rehabil 2015; 38:235-44. [PMID: 25864984 DOI: 10.3109/09638288.2015.1035459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the development of pain conditions, disability, and health-related quality of life over an 8-year period in home care personnel. METHOD In earlier studies of 607 women, we reported baseline data concerning home care personnel. This study reports the results from an 8-year follow-up using a postal questionnaire. RESULTS The questionnaire was completed by 87%. Prevalences of pain in upper back, lower back, and knees as well as pain intensity of the low back had decreased. Participants with the highest pain intensities of the low back at baseline had relatively lower pain intensities at follow-up. Anatomical spreading of pain was associated with higher average pain intensity. Disability had increased significantly during the time period. In the regression of disability at follow-up, average pain intensity together with disability rating index at baseline were the most important regressors; a similar pattern was found for quality of life. CONCLUSIONS The development of disability differed from that of low-back pain intensity. Spreading of pain and pain intensity across the anatomical regions influenced disability and quality of life over 8 years. When assessing pain, it seems important to determine the spread of pain rather than just focusing on the area with intense pain. IMPLICATIONS FOR REHABILITATION Spreading of pain and the average intensity of pain across the involved anatomical regions have importance for future pain and disability and quality of life. The clinical assessment of subjects with chronic pain prior to rehabilitation interventions has to determine the spreading of pain rather than just focusing on the area with the most intense pain. The different developments over time for pain intensity and disability indicate the need for applying a bio-psycho-social view of pain both when assessing the patient with pain and when discussing the prognosis and course of the actual pain condition with the patient.
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Affiliation(s)
- Gunnar Lundberg
- a Department of Pain and Rehabilitation Centre and.,b Department of Medical and Health Sciences (IMH), Faculty of Health Sciences , Linköping University , Linköping , Sweden
| | - Björn Gerdle
- a Department of Pain and Rehabilitation Centre and.,b Department of Medical and Health Sciences (IMH), Faculty of Health Sciences , Linköping University , Linköping , Sweden
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30
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Kim SH, Sun JM, Yoon KB, Moon JH, An JR, Yoon DM. Risk factors associated with clinical insomnia in chronic low back pain: a retrospective analysis in a university hospital in Korea. Korean J Pain 2015; 28:137-43. [PMID: 25852836 PMCID: PMC4387459 DOI: 10.3344/kjp.2015.28.2.137] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 01/23/2023] Open
Abstract
Background Insomnia is becoming increasingly recognized as a clinically important symptom in patients with chronic low back pain (CLBP). In this retrospective study, we have determined risk factors associated with clinical insomnia in CLBP patients in a university hospital in Korea. Methods Data from four-hundred and eighty one CLBP patients was analyzed in this study. The Insomnia Severity Index (ISI) was used to determine the presence of clinical insomnia (ISI score ≥ 15). Patients' demographics and pain-related factors were evaluated by logistic regression analysis to identify risk factors of clinical insomnia in CLBP. Results It was found that 43% of patients reported mild to severe insomnia after the development of back pain. In addition, 20% of patients met the criteria for clinically significant insomnia (ISI score ≥ 15). In a stepwise multivariate analysis, high pain intensity, the presence of comorbid musculoskeletal pain and neuropathic pain components, and high level of depression were strongly associated with clinical insomnia in CLBP. Among these factors, the presence of comorbid musculoskeletal pain other than back pain was the strongest determinant, with the highest odds ratio of 8.074 (95% CI 4.250 to 15.339) for predicting clinical insomnia. Conclusions Insomnia should be addressed as an integral part of pain management in CLBP patients with these risk factors, especially in patients suffering from CLBP with comorbid musculoskeletal pain.
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Affiliation(s)
- Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Min Sun
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Bong Yoon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Hwa Moon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Rin An
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Duck Mi Yoon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Slater J, Kolber MJ, Schellhase KC, Patel CK, Rothschild CE, Liu X, Hanney WJ. The Influence of Exercise on Perceived Pain and Disability in Patients With Lumbar Spinal Stenosis: A Systematic Review of Randomized Controlled Trials. Am J Lifestyle Med 2015; 10:136-147. [PMID: 30202267 DOI: 10.1177/1559827615571510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 11/10/2014] [Accepted: 12/03/2014] [Indexed: 12/28/2022] Open
Abstract
Lumbar spinal stenosis (LSS) is an increasingly prevalent condition that has major health and economic implications. While there are many options for the treatment of LSS, exercise is widely considered a first-line intervention as it is associated with reduced complications and cost as compared to more invasive options. Currently, it is not clear if exercise is an effective approach to managing pain and perceived disability in patients with symptomatic LSS. Therefore, the purpose of this systematic review is to evaluate the published literature that has investigated exercise as a primary intervention for LSS. A search was conducted in electronic databases including PubMed, PEDro, SPORTDiscus, CINAHL, and AMED using the key words lumbar spinal stenosis, exercise, physical therapy, rehabilitation, and conservative treatment. Inclusion criteria consisted of published randomized controlled trials written in English that included exercise as the primary treatment in at least one of the groups, and had reported measures of pain and disability clearly stated. The search identified 310 studies of which 5 met all the inclusion parameters. Exercise appears to be an efficacious intervention for pain, disability, analgesic intake, depression, anger, and mood disturbance among patients with LSS. Further research is needed to determine which type of exercise is the most effective in managing symptoms associated with lumbar spinal stenosis.
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Affiliation(s)
- Jarrett Slater
- University of Central Florida, Orlando, Florida (JS, KCS, CER, XL, WJH).,Nova Southeastern University, Ft Lauderdale, Florida (MJK).,Spine Health Institute, Altamonte Springs, Florida (CKP)
| | - Morey J Kolber
- University of Central Florida, Orlando, Florida (JS, KCS, CER, XL, WJH).,Nova Southeastern University, Ft Lauderdale, Florida (MJK).,Spine Health Institute, Altamonte Springs, Florida (CKP)
| | - Kristen C Schellhase
- University of Central Florida, Orlando, Florida (JS, KCS, CER, XL, WJH).,Nova Southeastern University, Ft Lauderdale, Florida (MJK).,Spine Health Institute, Altamonte Springs, Florida (CKP)
| | - Chetan K Patel
- University of Central Florida, Orlando, Florida (JS, KCS, CER, XL, WJH).,Nova Southeastern University, Ft Lauderdale, Florida (MJK).,Spine Health Institute, Altamonte Springs, Florida (CKP)
| | - Carey E Rothschild
- University of Central Florida, Orlando, Florida (JS, KCS, CER, XL, WJH).,Nova Southeastern University, Ft Lauderdale, Florida (MJK).,Spine Health Institute, Altamonte Springs, Florida (CKP)
| | - Xinliang Liu
- University of Central Florida, Orlando, Florida (JS, KCS, CER, XL, WJH).,Nova Southeastern University, Ft Lauderdale, Florida (MJK).,Spine Health Institute, Altamonte Springs, Florida (CKP)
| | - William J Hanney
- University of Central Florida, Orlando, Florida (JS, KCS, CER, XL, WJH).,Nova Southeastern University, Ft Lauderdale, Florida (MJK).,Spine Health Institute, Altamonte Springs, Florida (CKP)
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32
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Jeitler M, Brunnhuber S, Meier L, Lüdtke R, Büssing A, Kessler C, Michalsen A. Effectiveness of jyoti meditation for patients with chronic neck pain and psychological distress--a randomized controlled clinical trial. THE JOURNAL OF PAIN 2014; 16:77-86. [PMID: 25451627 DOI: 10.1016/j.jpain.2014.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 10/12/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Chronic neck pain is a common medical complaint partly mediated by psychosocial distress and having a high socioeconomic impact. There is preliminary evidence that stress reduction by meditation might be beneficial in chronic pain syndromes. We aimed to evaluate the effectiveness of an 8-week meditation program (jyoti meditation) in patients with chronic neck pain by means of a randomized clinical trial. Eighty-nine patients (aged 49.7 ± 10.5 years, 73 female) with chronic neck pain who scored >40 mm on a 100-mm visual analog scale and had concomitant increased perceived stress were randomized to an 8-week meditation program (jyoti meditation) with weekly 90-minute classes (n = 45) or to a home-based exercise program (n = 44) with a wait list offer for meditation. Both groups were instructed to practice at home. Outcomes were assessed at baseline and after 8 weeks. Primary outcome measure was change of mean pain at rest (visual analog scale score) from baseline to week 8. Secondary outcomes included pain at motion, functional disability, pain-related bothersomeness, perceived stress, quality of life, and psychological outcomes. Patients had neck pain for a mean of 11 years. Eighteen patients in the meditation group and 16 patients in the exercise group were lost to follow-up. Meditation training significantly reduced pain when compared to the exercise group after 8 weeks (reduction of 45.5 ± 23.3 mm to 21.6 ± 17.2 mm in the meditation group, and 43.8 ± 22.0 mm to 37.7 ± 21.5 mm in the exercise group; mean difference: 13.2 mm [95% confidence interval: 2.1, 24.4; P = .02]). Pain-related bothersomeness decreased more in the meditation group (group difference 11.0 mm [95% confidence interval: 1.0, 21.0; P = .03]). No significant treatment effects were found for pain at motion, psychological scores, and quality of life, although the meditation group showed nonsignificant greater improvements compared to the exercise group. In conclusion, meditation may support chronic pain patients in pain reduction and pain coping. Further well-designed studies including more active control comparisons and longer-term follow-up are warranted. PERSPECTIVE This article presents the results of a randomized controlled trial on the clinical effects of an 8-week meditation program or self-care exercise in patients with chronic neck pain. Meditation reduced pain at rest but not disability and might be a useful treatment option for pain management of chronic neck pain.
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Affiliation(s)
- Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany; Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Stefan Brunnhuber
- Department for Psychiatry and Psychotherapy, University Hospital Salzburg, Salzburg, Austria
| | - Larissa Meier
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany; Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Rainer Lüdtke
- Karl and Veronica Carstens Foundation, Essen, Germany
| | - Arndt Büssing
- University Witten-Herdecke, Chair of Integrative Medicine, Witten, Germany
| | - Christian Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany; Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany; Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany.
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