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McConnell R, Lane E, Webb G, LaPeze D, Grillo H, Fritz J. A multicenter feasibility randomized controlled trial using a virtual reality application of pain neuroscience education for adults with chronic low back pain. Ann Med 2024; 56:2311846. [PMID: 38354690 PMCID: PMC10868420 DOI: 10.1080/07853890.2024.2311846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) is a highly prevalent condition among adults and is correlated to high levels of pain, high disability, and lower quality of life. Pain neuroscience education (PNE) helps to explain the pain experience and can affect psychosocial factors, such as fear of movement, anxiety, socioeconomic status, work life satisfaction, etc. More recently, virtual reality (VR) programs have emerged allowing for immersive PNE experiences. OBJECTIVE The purpose of this randomized clinical trial is to determine the feasibility of using a VR application for the delivery of immersive PNE (VR-PNE) and other activity training for patients with CLBP presenting to outpatient physical therapy (PT) clinics. METHODS A two-arm, parallel group, randomized controlled feasibility trial of patients was conducted at 12 outpatient PT clinics from March 9, 2022, through September 9, 2022. The intervention group received PT as usual and VR-PNE while the control group received PT as usual. Between group feasibility, acceptability outcomes and other patient-reported outcomes were assessed at six weeks. RESULTS A total of 595 individuals were evaluated for low back pain during the recruitment period. Seventy individuals were eligible and met definition for CLBP, 52 enrolled and 32 completed the trial. Participant adherence was 63.6% for VR-PNE and 63.2% for PT as usual. Participants found VR-PNE acceptable and reported satisfaction scores (0-100) of 87.37 ± 11.05 compared to 81.17 ± 23.72 in the PT as usual group. There were no significant differences between groups for the BBQ, BRS, FABQ-PA, FABQ-W, GROC, NPRS, NPQ, PCS, and PSEQ at 6 weeks. CONCLUSION The results of the trial suggest that VR-PNE may be acceptable and feasible for patients with CLBP. Study procedures and PT delivery modifications should be considered for the next iteration of this study to improve follow-up assessment rates.
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Affiliation(s)
- Ryan McConnell
- Department of Physical Therapy, Belmont University, Nashville, TN, USA
- Benchmark Physical Therapy, Chattanooga, TN, USA
| | | | - Grace Webb
- Benchmark Physical Therapy, Chattanooga, TN, USA
| | - Dana LaPeze
- Benchmark Physical Therapy, Chattanooga, TN, USA
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Salazar-Méndez J, Cuyul-Vásquez I, Ponce-Fuentes F, Guzmán-Muñoz E, Núñez-Cortés R, Huysmans E, Lluch-Girbés E, Viscay-Sanhueza N, Fuentes J. Pain neuroscience education for patients with chronic pain: A scoping review from teaching-learning strategies, educational level, and cultural perspective. PATIENT EDUCATION AND COUNSELING 2024; 123:108201. [PMID: 38387389 DOI: 10.1016/j.pec.2024.108201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE (1) To identify the characteristics of PNE programs in terms of teaching-learning strategies, session modality, content delivery format, number of sessions, total minutes and instructional support material used in patients with chronic musculoskeletal pain, (2) to describe PNE adaptations for patients with different educational levels or cultural backgrounds, and (3) to describe the influence of the patient's educational level or cultural background on the effects of PNE. METHODS The PRISMA guideline for scoping reviews was followed. Nine databases were systematically searched up to July 8, 2023. Articles that examined clinical or psychosocial variables in adults with chronic musculoskeletal pain who received PNE were included. RESULTS Seventy-one articles were included. Studies found benefits of PNE through passive/active teaching-learning strategies with group/individual sessions. However, PNE programs presented great heterogeneity and adaptations to PNE were poorly reported. Most studies did not consider educational level and culture in the effects of PNE. CONCLUSIONS Despite the large number of studies on PNE and increased interest in this intervention, the educational level and culture are poorly reported in the studies. PRACTICAL IMPLICATIONS It is recommended to use passive and/or active teaching-learning strategies provided in individual and/or group formats considering the patient's educational level and culture.
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Affiliation(s)
| | - Iván Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Chile; Facultad de las Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
| | - Felipe Ponce-Fuentes
- Escuela de Kinesiología, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Temuco, Chile
| | - Eduardo Guzmán-Muñoz
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile; Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels 1090, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels 1090, Belgium; Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Enrique Lluch-Girbés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels 1090, Belgium
| | | | - Jorge Fuentes
- Clinical Research Lab, Department of Physical Therapy, Catholic University of Maule, Chile; Faculty of Rehab Medicine, University of Alberta, Edmonton, Canada.
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Lorimer Moseley G, Leake HB, Beetsma AJ, Watson JA, Butler DS, van der Mee A, Stinson JN, Harvie D, Palermo TM, Meeus M, Ryan CG. Teaching Patients About Pain: The Emergence of Pain Science Education, its Learning Frameworks and Delivery Strategies. THE JOURNAL OF PAIN 2024; 25:104425. [PMID: 37984510 DOI: 10.1016/j.jpain.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
Since it emerged in the early 2000's, intensive education about 'how pain works', widely known as pain neuroscience education or explaining pain, has evolved into a new educational approach, with new content and new strategies. The substantial differences from the original have led the PETAL collaboration to call the current iteration 'Pain Science Education'. This review presents a brief historical context for Pain Science Education, the clinical trials, consumer perspective, and real-world clinical data that have pushed the field to update both content and method. We describe the key role of educational psychology in driving this change, the central role of constructivism, and the constructivist learning frameworks around which Pain Science Education is now planned and delivered. We integrate terminology and concepts from the learning frameworks currently being used across the PETAL collaboration in both research and practice-the Interactive, Constructive, Active, Passive framework, transformative learning theory, and dynamic model of conceptual change. We then discuss strategies that are being used to enhance learning within clinical encounters, which focus on the skill, will, and thrill of learning. Finally, we provide practical examples of these strategies so as to assist the reader to drive their own patient pain education offerings towards more effective learning. PERSPECTIVE: Rapid progress in several fields and research groups has led to the emergence 'Pain Science Education'. This PETAL review describes challenges that have spurred the field forward, the learning frameworks and educational strategies that are addressing those challenges, and some easy wins to implement and mistakes to avoid.
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Affiliation(s)
- G Lorimer Moseley
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia.
| | - Hayley B Leake
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Anneke J Beetsma
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, the Netherlands
| | - James A Watson
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK; Integrated Musculoskeletal Service, Community Pain Management, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - David S Butler
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Annika van der Mee
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Consumer Representative, Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, the Netherlands
| | - Jennifer N Stinson
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Child Health Evaluative Sciences, The Research Institute, The Hospital for Sick Children and Lawrence S. Bloomberg, Faculty of Nursing, The University of Toronto, Toronto, Ontario, Canada
| | - Daniel Harvie
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Tonya M Palermo
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Mira Meeus
- The Pain Education Team to Advance Learning (PETAL) Collaboration; MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Cormac G Ryan
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Harper B, Price P, Steele M. The efficacy of manual therapy on HRV in those with long-standing neck pain: a systematic review. Scand J Pain 2023; 23:623-637. [PMID: 37261845 DOI: 10.1515/sjpain-2023-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Long-standing neck pain (LNP) is a clinical condition frequently encountered in the physical therapy clinic. LNP is a complex, multifactorial condition affecting multiple body systems including the autonomic nervous system (ANS). Traditionally, research on the impact of physical therapy on LNP has focused on self-report measures and pain scales. Heart rate variability (HRV) is an objective measure of the ANS, allowing for quantification of effects of treatment. This systematic review is intended to evaluate if manual therapy acutely affects heart rate variability in adults with long-standing neck pain. METHODS Pubmed, Medline, CINAHL, Google Scholar, Web of Science, and Cochrane library were used to retrieve the randomized controlled trials for this review between the years 2010-2021. Search terms included: chronic neck pain, neck pain, cervical pain, manual therapy, mobilization, manipulation, osteopathy, osteopathic or chiropractic. Heart rate variability, HRV, heart rate variation, effects, outcomes, benefits, impacts or effectiveness. RESULTS Of 139 articles located and screened, three full-text articles were selected for full qualitative synthesis, with a combined population of 112 subjects, 91 of which were female, with an average age of 33.7 ± 6.8 years for all subjects. MT techniques in three studies were statistically significant in improving HRV in people with LNP; however, techniques were differed across studies, while one study showed no benefit. The studies were found to be of high quality with PEDro scores ≥6. CONCLUSIONS Although no clear cause and effect relationship can be established between improvement in HRV with manual therapy, results supported the use of MT for an acute reduction in HRV. No one particular method of MT has proven superior, MT has been found to produce a statistically significant change in HRV. These HRV changes are consistent with decreased sympathetic tone and subjective pain.
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Affiliation(s)
- Brent Harper
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA, USA
- Department of Physical Therapy, Azusa Pacific University, Azusa, CA, USA
| | - Parker Price
- Department of Physical Therapy, Azusa Pacific University, Azusa, CA, USA
| | - Megan Steele
- Department of Physical Therapy, Azusa Pacific University, Azusa, CA, USA
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Peng L, Song Y, Lv B, Jing C. The effect of implementation of pain neuroscience education and rehabilitation exercise on post-operative pain and recovery after laparoscopic colorectal surgery: a prospective randomized controlled trial. J Anesth 2023; 37:775-786. [PMID: 37528250 DOI: 10.1007/s00540-023-03235-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/22/2023] [Indexed: 08/03/2023]
Abstract
PURPOSES To optimize the efficacy of analgesia and post-operative recovery for patients undergoing laparoscopic colorectal surgery by integrating a composite psycho-somatic analgesia algorithm involving peri-operative rehabilitation exercise and pain neuroscience education into multi-modal analgesia. METHODS A prospective randomized controlled trial was conducted to compare conventional peri-operative analgesia (group CA) and the addition of rehabilitation exercise and pain neuroscience education into it (group REPNE) for patients undergoing laparoscopic colorectal surgery. Acute and chronic post-operative pain, characteristics of pain (pain catastrophizing, sensitization, and trends of neuropathic transformation), and quality of post-operative recovery calibrated with EuroQol Five Dimensions Questionnaire (EQ-5D-5L) were investigated and compared between two groups. RESULTS A total of 175 patients consented to participate in this study. Compared with those receiving conventional analgesia (group CA, N = 89), patients in group REPNE (N = 86) reported reduced intensity of pain 24 h after surgery, less risk of pain catastrophizing and sensitization, and better quality of life during hospitalization recovery till 1 month after surgery (p < 0.05). No statistical difference was found for neuropathic transformation of post-operative pain or for the incidence of chronic post-operative pain (p > 0.05). CONCLUSIONS The addition of peri-operative rehabilitation exercise and pain neuroscience education into multi-modal analgesia provided better analgesic effect compared with routine practice for patients receiving laparoscopic colorectal surgery and also facilitated better post-operative recovery. This composite psycho-somatic algorithm for peri-operative analgesia merits further application in clinical practice.
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Affiliation(s)
- Lihua Peng
- The Department of Anesthesia and Pain Medicine, The First Affiliated Hospital of Chongqing Medical University, #1 Road Youyi Road, Yuanjiagang Community, Yuzhong District, Chongqing, 400016, China.
| | - Yun Song
- The Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children Hospital of Chongqing Medical University, 120# Longshan Road, Yubei District, Chongqing, 401147, China.
| | - Biqiong Lv
- The Department of Anesthesia and Surgical Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chen Jing
- The Department of Anesthesia and Pain Medicine, The First Affiliated Hospital of Chongqing Medical University, #1 Road Youyi Road, Yuanjiagang Community, Yuzhong District, Chongqing, 400016, China
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Johnson MI, Hudson M, Ryan CG. Perspectives on the insidious nature of pain metaphor: we literally need to change our metaphors. FRONTIERS IN PAIN RESEARCH 2023; 4:1224139. [PMID: 37781218 PMCID: PMC10540619 DOI: 10.3389/fpain.2023.1224139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Metaphorical language is used to convey one thing as representative or symbolic of something else. Metaphor is used in figurative language but is much more than a means of delivering "poetic imagination". A metaphor is a conceptual tool for categorising, organizing, thinking about, and ultimately shaping reality. Thus, metaphor underpins the way humans think. Our viewpoint is that metaphorical thought and communication contribute to "painogenicity", the tendency of socio-ecological environments (settings) to promote the persistence of pain. In this perspectives article, we explore the insidious nature of metaphor used in pain language and conceptual models of pain. We explain how metaphor shapes mental organisation to govern the way humans perceive, navigate and gain insight into the nature of the world, i.e., creating experience. We explain how people use metaphors to "project" their private sensations, feelings, and thoughts onto objects and events in the external world. This helps people to understand their pain and promotes sharing of pain experience with others, including health care professionals. We explore the insidious nature of "warmongering" and damage-based metaphors in daily parlance and demonstrate how this is detrimental to health and wellbeing. We explore how metaphors shape the development and communication of complex, abstract ideas, theories, and models and how scientific understanding of pain is metaphorical in nature. We argue that overly simplistic neuro-mechanistic metaphors of pain contribute to fallacies and misnomers and an unhealthy focus on biomedical research, in the hope of developing medical interventions that "prevent pain transmission [sic]". We advocate reconfiguring pain language towards constructive metaphors that foster a salutogenic view of pain, focusing on health and well-being. We advocate reconfiguring metaphors to align with contemporary pain science, to encourage acceptance of non-medicalised strategies to aid health and well-being. We explore the role of enactive metaphors to facilitate reconfiguration. We conclude that being cognisant of the pervasive nature of metaphors will assist progress toward a more coherent conceptual understanding of pain and the use of healthier pain language. We hope our article catalyses debate and reflection.
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Affiliation(s)
- Mark I. Johnson
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds, United Kingdom
| | - Matt Hudson
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds, United Kingdom
- Mind Help Limited, Durham, United Kingdom
| | - Cormac G. Ryan
- Centre for Rehabilitation, Teesside University, Middlesbrough, United Kingdom
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
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7
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Edwards KA, Reed DE, Anderson D, Harding K, Turner AP, Soares B, Suri P, Williams RM. Opening the black box of psychological treatments for chronic pain: A clinical perspective for medical providers. PM R 2023; 15:999-1011. [PMID: 36633497 DOI: 10.1002/pmrj.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Karlyn A Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University, Stanford, California, USA
| | - David E Reed
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Administration Puget Sound Health Care, Seattle, Washington, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Derek Anderson
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
| | - Kaitlin Harding
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
| | - Aaron P Turner
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Bosco Soares
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Pradeep Suri
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, Washington, USA
| | - Rhonda M Williams
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
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8
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Meyer-Junco L. Cognitive-Based Pain Self-Management Strategies in Serious Illness #460. J Palliat Med 2023; 26:1012-1014. [PMID: 37428967 DOI: 10.1089/jpm.2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
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Purcell C, Duignan C, Fullen BM, Ryan S, Ward T, Caulfield B. Comprehensive assessment and classification of upper and lower limb pain in athletes: a scoping review. Br J Sports Med 2023; 57:535-542. [PMID: 36759138 DOI: 10.1136/bjsports-2022-106380] [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: 01/24/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Upper and lower limb (peripheral) pain is prevalent in athletes. Contemporary research prioritises multidimensional pain assessment and classification. This study aims to review comprehensive athlete pain assessment practices against the reference standard (International Olympic Committee, IOC Athlete Pain framework), identifying trends and highlighting gaps. METHODS AND ANALYSIS Six databases were searched using a comprehensive search strategy. This review followed the Joanna Briggs Institute standardised methodology for scoping reviews and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Title and abstract, full-text screening and data charting were completed by two independent reviewers. INCLUSION CRITERIA Original research, systematic reviews and clinical practice guidelines reporting assessment or classification of pain in athletes of any age with chronic or acute peripheral pain in English on human participants from database inception. RESULTS 470 studies with 175 different pain assessment tools were mapped against the IOC Athlete Pain Framework. Papers included tools from neurophysiological (470/100%), biomechanical (425/90%), affective (103/22%), cognitive (59/13%) and socioenvironmental (182/39%) domains. Pain classification was included in 108 studies (23%). 4 studies (0.85%) defined pain. Athletes with physical disability were included in 13 (3%) studies and no studies included athletes with intellectual disabilities. Socioeconomic factors were addressed in 29 (6%) studies. DISCUSSION Neurophysiological and biomechanical domains are frequently addressed. Affective, socioenvironmental and cognitive tools are under-represented. Potential tools for use by researchers and clinicians are highlighted. Defining and classifying pain and determining predominant pain mechanisms is needed in both research and clinical practice. More work on underrepresented populations is needed. CONCLUSION This review informs researchers and clinicians working with athletes in pain how pain assessment and classification is currently conducted and highlights future priorities.
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Affiliation(s)
- Ciarán Purcell
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland .,Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Ciara Duignan
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland.,Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Brona M Fullen
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland
| | - Shiofra Ryan
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland.,Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Tomas Ward
- Insight Centre for Data Analytics, School of Computing, Dublin City University, Dublin, Ireland
| | - Brian Caulfield
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland.,Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
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Mohamed B, Ramachandran R, Rabai F, Price CC, Polifka A, Hoh D, Seubert CN. Frailty Assessment and Prehabilitation Before Complex Spine Surgery in Patients With Degenerative Spine Disease: A Narrative Review. J Neurosurg Anesthesiol 2023; 35:19-30. [PMID: 34354024 PMCID: PMC8816967 DOI: 10.1097/ana.0000000000000787] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/18/2021] [Indexed: 02/07/2023]
Abstract
Degenerative spine disease increases in prevalence and may become debilitating as people age. Complex spine surgery may offer relief but becomes riskier with age. Efforts to lessen the physiological impact of surgery through minimally invasive techniques and enhanced recovery programs mitigate risk only after the decision for surgery. Frailty assessments outperform traditional tools of perioperative risk stratification. The extent of frailty predicts complications after spine surgery such as reoperation for infection and 30-day mortality, as well as elements of social cost such as hospital length of stay and discharge to an advanced care facility. Symptoms of spine disease overlap with phenotypic markers of frailty; therefore, different frailty assessment tools may perform differently in patients with degenerative spine disease. Beyond frailty, however, cognitive decline and psychosocial isolation may interact with frailty and affect achievable surgical outcomes. Prehabilitation, which has reduced perioperative risk in colorectal and cardiac surgery, may benefit potential complex spine surgery patients. Typical prehabilitation includes physical exercise, nutrition supplementation, and behavioral measures that may offer symptomatic relief even in the absence of surgery. Nonetheless, the data on the efficacy of prehabilitation for spine surgery remains sparse and barriers to prehabilitation are poorly defined. This narrative review concludes that a frailty assessment-potentially supplemented by an assessment of cognition and psychosocial resources-should be part of shared decision-making for patients considering complex spine surgery. Such an assessment may suffice to prompt interventions that form a prehabilitation program. Formal prehabilitation programs will require further study to better define their place in complex spine care.
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Affiliation(s)
- Basma Mohamed
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
| | - Ramani Ramachandran
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
| | - Ferenc Rabai
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, University of Florida College of Medicine, Gainesville, Florida
| | - Catherine C. Price
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, University of Florida College of Medicine, Gainesville, Florida
| | - Adam Polifka
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
| | - Daniel Hoh
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
| | - Christoph N. Seubert
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, University of Florida College of Medicine, Gainesville, Florida
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Khosrokiani Z, Letafatkar A, Hadadnezhad M, Sokhanguei Y. The comparison between the effects of pain education interventions with online and face-to-face exercise and the control group received biomedical education + standardized physical therapy in patients with chronic nonspecific neck pain during COVID-19: protocol for a parallel-group randomized controlled trial. Trials 2022; 23:1031. [PMID: 36539843 PMCID: PMC9763812 DOI: 10.1186/s13063-022-06932-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Various psychological issues and serious health concerns during the imposed lockdown by coronavirus disease 2019 (COVID-19) have induced many changes in the treatment of patients. More effective self-management strategies through tele-rehabilitation are suggested to be applied for patients with chronic neck pain to reduce referrals to health cares and disability support through COVID-19. Also, the pain neuroscience education (PNE) approach is an educational method used by health professionals to assist patients in understanding the biology, physiology, and psychosocial factors affecting their pain experience and aligning with the cognitions and beliefs associated with pain and recurrent disability. PNE combined with tele-rehabilitation could be a new solution to encourage patients to manage their condition by themselves and increase the continuity of practice instead of face-to-face sessions. OBJECTIVE This randomized control trial (RCT) aims to investigate the effects of PNE with online and face-to-face exercise interventions, and the control group received biomedical education + standardized physical therapy on neck pain and disability, psychological factors, and function in non-traumatic chronic neck pain. METHODS/DESIGN Patients with non-traumatic chronic neck pain (patient-centered care and active involvement of patients and the public) will be recruited via flyers displayed in hospitals and universities to participate in an RCT with two experimental and one control group designed to investigate the effects of PNE with online and face-to-face exercise interventions, and the control group received biomedical education + standardized physical therapy on neck pain and disability, psychological factors, and function in non-traumatic chronic neck pain. The outcomes will be measured at baseline, after PNE, and after 3 months of an exercise intervention. All outcomes are presented as mean ± SD, and statistical significance was set at α level of < 0.05. The normal distribution of the variables was verified by the Kolmogorov-Smirnov test, following a descriptive analysis. DISCUSSION It seems that PNE plus online and face-to-face exercise interventions are appropriate educational models for the treatment of patients with neck pain during COVID-19. Also, online training seems to encourage patients to continue their treatment. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20150503022068N5. Registered on 09 September 2021.
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Affiliation(s)
- Zohre Khosrokiani
- grid.412265.60000 0004 0406 5813Biomechanics and Corrective Exercise Laboratory, Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, 00982122258084 Iran
| | - Amir Letafatkar
- grid.412265.60000 0004 0406 5813Biomechanics and Corrective Exercise Laboratory, Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, 00982122258084 Iran
| | - Malihe Hadadnezhad
- grid.412265.60000 0004 0406 5813Biomechanics and Corrective Exercise Laboratory, Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, 00982122258084 Iran
| | - Yahya Sokhanguei
- grid.472458.80000 0004 0612 774XUniversity of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Andias R, Sa-Couto P, Silva AG. Blended-Learning Pain Neuroscience Education and Exercise in High School Students With Chronic Neck Pain: A Randomized Controlled Trial. Phys Ther 2022; 102:6575293. [PMID: 35485186 DOI: 10.1093/ptj/pzac048] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/07/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pain neuroscience education (PNE) and exercise have emerged as potential interventions in adolescents with chronic pain; however, very few studies have explored their effectiveness. Blended-learning approaches combining face-to-face and online educational sessions have also emerged as facilitating methods of health education. This study aimed to compare the effectiveness of exercises and PNE versus exercise alone in adolescents with chronic neck pain (NP). METHODS A randomized controlled trial with 6-month follow-up was conducted in 2 high schools. Over 8 weeks, a total of 127 adolescents with chronic NP were randomly allocated to either (1) perform functional and region-specific exercises, including generalized neuromuscular control, endurance, and strength exercises, as well as exercises targeting the deep neck flexor and extensor muscles and scapular stabilizer muscles; or (2) perform the same exercise-based intervention plus PNE. Pain intensity (primary outcome), disability, sleep, catastrophizing, fear of movement, self-efficacy, and knowledge of pain neuroscience were assessed at baseline, postintervention, and 6-month follow-up. Neck and scapular muscle endurance and pressure pain thresholds were assessed at baseline and postintervention. Patient's Global Impression of Change was assessed postintervention and at 6-month follow-up. RESULTS There was a significant decrease in pain intensity from baseline to postintervention and from baseline to follow-up in both groups, but there were no between-group differences or interactions between time and groups. These results were similar for the secondary outcomes, except for knowledge of pain neuroscience, for which a significant group and time interaction was found. CONCLUSION Exercise and exercise plus PNE were similarly effective in treating adolescents with chronic NP, and the results were maintained for up to 6 months. Further studies are needed to explore the effect of these interventions for longer follow-ups.
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Affiliation(s)
- Rosa Andias
- School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal.,Center for Health Technology and Services Research (CINTESIS), Piso 2, Edifício nascente, Porto, Portugal
| | - Pedro Sa-Couto
- CINTESIS@RISE, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Anabela G Silva
- School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal.,Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, Aveiro, Portugal
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13
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Weisman A, Yona T, Gottlieb U, Masharawi Y. Attitudinal responses to current concepts and opinions from pain neuroscience education on social media. Musculoskelet Sci Pract 2022; 59:102551. [PMID: 35287028 DOI: 10.1016/j.msksp.2022.102551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/19/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pain neuroscience education (PNE) programs have become popular among clinicians and are widely promoted through social and mainstream media. PURPOSE To test the hypothesis that people with persistent pain are likely to express negative attitudes to PNE statements and compare their responses to other social media user groups. METHODS A total of 1319 respondents completed an online survey and were directed into four groups: persistent pain, healthcare professionals with persistent pain, pain-free healthcare professionals, and pain-free controls. The survey included ten statements of popular PNE concepts. Feedback was invited by offering seven attitudinal response categories (three positives, three negatives, and one neutral). A two-step hierarchical regression model was used to assess the likelihood of reporting negatively. RESULTS Compared to controls, respondents from the persistent pain group were more likely to report negatively towards all statements (OR 1.6-2.16), except for two statements (#3 and #5). Healthcare professionals were less likely to report negative attitudes for 4 out of 10 statement (OR 0.35-0.58). Health care professionals living with persistent responded to most statements like the pain-free controls (besides statement #2, OR 0.59). CONCLUSION People living with persistent pain are more likely to express negative attitudes to PNE statements on social media, unlike healthcare professionals who were less likely to express negativity. Healthcare professionals living with persistent pain responded to most PNE statements like the pain-free control group. The study's main weaknesses include the lack of psychometric information of the questionnaire used, selection bias, small samples of the healthcare professionals and the overrepresentation of young social media users.
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Affiliation(s)
- Asaf Weisman
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Tomer Yona
- Department of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Uri Gottlieb
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel
| | - Youssef Masharawi
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Ziegler AM, Minkalis AL, Langdon ER, Vining R. Learning the neurobiology of pain: A scoping review of pain education from an instructional design perspective. PATIENT EDUCATION AND COUNSELING 2022; 105:1379-1401. [PMID: 34579995 DOI: 10.1016/j.pec.2021.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 05/14/2023]
Abstract
OBJECTIVES Learning modern pain biology concepts can improve important clinical outcomes for people with chronic pain. The primary purpose of this scoping review is to examine and report characteristics of chronic musculoskeletal pain education programs from an instructional design perspective. METHODS Following PRISMA-ScR guidelines, PubMed, Medline, and CINAHL databases were systematically searched. Articles included expert recommendations and those reporting pain education programs used in clinical trials enrolling adults with chronic neuromusculoskeletal pain and published in English between 1990 and 2021. Three authors independently evaluated articles for eligibility through title, abstract, and full text review. Instructional design characteristics such as learning outcomes, support materials, learning assessment methods, and key concepts communicated were summarized. RESULTS The search revealed 5260 articles of which 40 were included: 27 clinical studies, 7 expert recommendations, and 6 articles reporting on pain education from participant perspectives. Detailed reporting of instructional design characteristics informing replication in subsequent studies is sparse. Most included trials used only lecture and did not assess participant learning. CONCLUSIONS More comprehensive reporting of pain education programs is needed to facilitate replicability. PRACTICAL IMPLICATIONS This article proposes detailed and standardized reporting of trials using pain education programs employing a modified version of the TIDieR checklist.
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Affiliation(s)
- Anna-Marie Ziegler
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA 52803, USA.
| | - Amy L Minkalis
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA 52803, USA.
| | | | - Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA 52803, USA.
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Kim KS, An J, Kim JO, Lee MY, Lee BH. Effects of Pain Neuroscience Education Combined with Lumbar Stabilization Exercise on Strength and Pain in Patients with Chronic Low Back Pain: Randomized Controlled Trial. J Pers Med 2022; 12:jpm12020303. [PMID: 35207790 PMCID: PMC8876043 DOI: 10.3390/jpm12020303] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/27/2022] [Accepted: 02/11/2022] [Indexed: 12/02/2022] Open
Abstract
Chronic low back pain that lasts more than 12 weeks causes mental and physical distress. This study investigated the effects of pain neuroscience education combined with lumbar stabilization exercises on strength, pain, flexibility, and activity disorder index in female patients with chronic low back pain. Thirty-five female patients with chronic low back pain were randomly divided into two groups: the pain neuroscience education (PNE) combined with lumbar stabilization exercises (LSEs) group (n = 18, experimental group) and the lumbar stabilization exercises alone group (n = 17, control group). The experimental group underwent PNE combined with LSEs for 30 min per session, twice per week for 8 weeks, and the control group underwent LSEs only. The primary outcomes were strength (sit-up and back-up movements), Numerical Pain Rating Scale (NPRS), Korean Pain Catastrophizing Scale (K-PCS), and Tampa Scale of Kinesio-phobia-11 (TSK-11) for pain. The secondary outcomes were modified–modified Schober’s test (MMST) and finger to floor test (FFT) for flexibility and activity disorder (Roland–Morris Disability Questionnaire index). A significant difference was observed in the primary outcomes after intervention in the abdominal muscle strength (group difference, mean, −7.50; 95% CI, −9.111 to –5.889, F = 9.598; ANCOVA p = 0.005), the back muscle strength (group difference, mean, −9.722; 95% CI, −10.877 to –8.568, F = 7.102; ANCOVA p = 0.014), the NPRS (group difference, mean, 1.89; 95% CI,1.65 to 2.12, F = 24.286; ANCOVA p < 0.001), K-PCS (group difference, mean, 7.89; 95% CI, 7.02 to 8.76, F = 11.558; ANCOVA p = 0.003), and TSK-11 (group difference, mean, 16.79; 95% CI, 13.99 to 19.59, F = 13.179; ANCOVA p = 0.014) for pain. In the secondary outcomes, there was a significant difference in the FFT (group difference, mean, −0.66; 95%CI, −0.99 to −0.33, F = 4.327; ANCOVA p = 0.049), whereas the difference in flexibility (MMST) and activity disorder index of the secondary outcomes did not reach significance. Therefore, this study confirmed that PNE combined with LSEs is an effective intervention compared to LSE alone in improving muscle strength and pain in female patients with chronic low back pain.
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Affiliation(s)
- Ki-Sang Kim
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea; (K.-S.K.); (J.A.); (J.-O.K.)
| | - Jungae An
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea; (K.-S.K.); (J.A.); (J.-O.K.)
| | - Ju-O Kim
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea; (K.-S.K.); (J.A.); (J.-O.K.)
| | - Mi-Young Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
- Correspondence: ; Tel.: +82-2-3399-1634
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Van Bogaert W, Putman K, Coppieters I, Goudman L, Nijs J, Moens M, Buyl R, Ickmans K, Huysmans E. Health-related quality of life deviations from population norms in patients with lumbar radiculopathy: associations with pain, pain cognitions, and endogenous nociceptive modulation. Qual Life Res 2021; 31:745-757. [PMID: 34342846 DOI: 10.1007/s11136-021-02964-5] [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: 07/26/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE The primary goal of this study was to compare the health-related quality of life (HRQoL) of people with lumbar radiculopathy to age- and sex-adjusted population norms. Additionally, it aimed to explore the associations between the HRQoL difference scores and measures related to pain cognitions, pain intensity, and endogenous nociceptive modulation. METHODS Using answers from the Short Form 36-item Health Survey and UK population norms, SF-6D difference scores were calculated. A one-sample t test was used to assess the SF-6D difference scores. Univariate and multivariate regression analyses were used to assess the associations between SF-6D difference scores and pain intensity [Visual Analogue Scale (VAS) for back and leg pain], pain cognitions [Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Pain Vigilance and Awareness Questionnaire (PVAQ)], and correlates for endogenous nociceptive modulation using quantitative sensory testing. RESULTS One hundred and twenty people with lumbar radiculopathy scheduled for surgery were included in this study. The mean SF-6D difference score of - 0.26 [SD = 0.09] was found to be significantly less than 0 [95%CI: - 0.27 to - 0.24]. Univariate analyses showed a significant influence from PCS, TSK, and PVAQ on the SF-6D difference scores. The final multivariate regression model included PCS and PVAQ, with only PCS maintaining a statistically significant regression coefficient [b = - 0.002; 95% CI: - 0.004 to - 0.001]. CONCLUSION People diagnosed with lumbar radiculopathy report significantly lower HRQoL scores when compared with age- and sex-adjusted UK norm values. Even though all examined pain cognitions were found to have a significant association, pain catastrophizing showed the most significant relation to the SF-6D difference scores. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier No. NCT02630732. Date of registration: November 25, 2015.
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Affiliation(s)
- Wouter Van Bogaert
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
- Interuniversity Center for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
- Research Foundation-Flanders (FWO), Brussels, Belgium.
| | - Koen Putman
- Interuniversity Center for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Iris Coppieters
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Lisa Goudman
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ronald Buyl
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kelly Ickmans
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Eva Huysmans
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Interuniversity Center for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
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Barbari V, Storari L, Maselli F, Testa M. Applicability of pain neuroscience education: Where are we now? J Back Musculoskelet Rehabil 2021; 34:511-520. [PMID: 33749636 DOI: 10.3233/bmr-200091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Explaining pain to patients through pain neuroscience education (PNE) is currently a widespread treatment studied in the musculoskeletal context. Presently, there is sufficient evidence supporting the effectiveness of PNE in patients with chronic musculoskeletal disorders. However, clinicians must pay attention to the actual possibility to transfer research findings in their specific clinical context. OBJECTIVE We analysed the applicability of results of studies focused on PNE, which has not been done previously. METHODS A detailed discussion on PNE applicability is provided, starting from published randomized controlled trials that investigated the effectiveness of PNE. RESULTS This paper markedly points out the awareness of clinicians on the need for an accurate contextualization when choosing PNE as an intervention in clinical practice.
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Sillevis R, Trincado G, Shamus E. The immediate effect of a single session of pain neuroscience education on pain and the autonomic nervous system in subjects with persistent pain, a pilot study. PeerJ 2021; 9:e11543. [PMID: 34131526 PMCID: PMC8174152 DOI: 10.7717/peerj.11543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/10/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The autonomic nervous system is a system that operates at the subconscious level and has been associated with neurobehavioral aspects of pain. Overall, persistent pain has a stimulating effect on the sympathetic nervous system. A promising emerging nonpharmacological treatment to manage persistent pain is neuroscience-based pain education. The overarching goal of neuroscience-based pain education is to change cognitions about pain and the pain experience through education. The aim was to determine the immediate and short-term impact of a neuroscience-based pain education video on the autonomic nervous system and pain in a subgroup of individuals with persistent pain. METHODS A convenience sample of 26 subjects were recruited for this study. Each subject indicated their pain level at the time of testing using a Visual Analogue Scale. Automated pupillometry was utilized to measure pupil diameter. After two minutes of accommodation to the goggles, the pupil was measured continuously for 60 s. Following this a 5-minute video presentation "Understanding Pain" was watched, followed by a continuous pupil measurement for 60 s. Three minutes after this measure, the final pupil diameter measurement was taken for 60 s. After completing the final pupil measure, the subject was asked to fill out a second Visual Analogue Scale and a Global Rate of Change. OUTCOMES Each subject completed a Global Rating of Change Scale and the mean score was 1.14 (SD = 1.61 and a SEM = 0.), supporting the hypothesis of an overall self-perceived benefit from the intervention. There was a statistically significant difference in pain following the video, P < 0.01. A significant correlation was observed between the self-perceived decrease in pain level and the Global Rating of Change score, p = 0.02. There was no statistically significant difference in the mean pupil diameter following the video with p = 0.76 for the right eye and p = 0.250 for the left eye. DISCUSSION This pilot study demonstrated that a 5-minute neuroscience-based pain education video reduced perceived pain in a small sample of subjects with persistent pain. Watching the neuroscience-based pain education video did not seem to result in an immediate generalized autonomic nervous system response. However, it resulted in a different reaction on each eye. This unequal response might be the result of the hemispheric lateralization of the ANS. This study supports the fact that the pain experience is determined by the balance between conscious cognitive processes and subconscious processes based on previous psychological experiences.
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Affiliation(s)
- Rob Sillevis
- Rehabilitations Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States of America
| | - Gabriel Trincado
- Rehabilitations Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States of America
| | - Eric Shamus
- Rehabilitations Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States of America
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Can a Single Trial of a Thoracolumbar Myofascial Release Technique Reduce Pain and Disability in Chronic Low Back Pain? A Randomized Balanced Crossover Study. J Clin Med 2021; 10:jcm10092006. [PMID: 34067152 PMCID: PMC8125255 DOI: 10.3390/jcm10092006] [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: 03/26/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 01/14/2023] Open
Abstract
Although manual therapy for pain relief has been used as an adjunct in treatments for chronic low back pain (CLBP), there is still the belief that a single session of myofascial release would be effective. This study was a crossover clinical trial aimed to investigate whether a single session of a specific myofascial release technique reduces pain and disability in subjects with CLBP. 41 participants over 18 years old were randomly enrolled into 3 situations in a balanced and crossover manner: experimental, placebo, and control. The subjects underwent a single session of myofascial release on thoracolumbar fascia and the results were compared with the control and placebo groups. The outcomes, pain and functionality, were evaluated using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), and Oswestry Disability Index (ODI). There were no effects between-tests, within-tests, nor for interaction of all the outcomes, i.e., NPRS (η 2 = 0.32, F = 0.48, p = 0.61), PPT (η2 = 0.73, F = 2.80, p = 0.06), ODI (η2 = 0.02, F = 0.02, p = 0.97). A single trial of a thoracolumbar myofascial release technique was not enough to reduce pain intensity and disability in subjects with CLBP.
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Barone M, Imaz F, Bordachar D, Ferreira I, Intelangelo L. Effect of pain neuroscience education and transcutaneous electrical nerve stimulation on trigeminal postherpetic neuralgia. A case report. Physiother Theory Pract 2021; 38:1813-1822. [PMID: 33541188 DOI: 10.1080/09593985.2021.1878567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Postherpetic neuralgia (PHN) is a complex neuropathic painful condition in which pain is a direct consequence of the response to peripheral nerve damage experienced during herpes zoster attack. PHN is the most common chronic complication of herpes zoster and it causes considerable suffering, affecting the physical functioning and psychological well-being of patients. Objective: To describe the effect of a conservative treatment using pain neuroscience education (PNE) and transcutaneous electrical nerve stimulation (TENS) in a patient with trigeminal PHN. Case Description: A 67-year-old woman sought care for pain, dysfunction, and sensory loss in the left jaw. The assessment included: 1) pain, using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), Douleur Neuropathique 4 (DN4), McGill Pain Questionnaire (MPQ), Graded Chronic Pain Scale (GCPS), and classic body charts of the cranial region; 2) somatosensory function, by means of mechanical detection threshold (MDT) and pressure pain threshold (PPT); 3) jaw function, using the Jaw Functional Limitation Scale-20 (JFLS-20); and 4) psychosocial features, by means of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorders Questionnaire-7 (GAD-7). Treatment consisted of 12 sessions of PNE and TENS. Outcomes: After treatment, a clinically significant improvement in NPRS, DN4, MDT, GCPS, and PHQ-9 was observed. Conclusion: In this case report, a treatment based on the combination of PNE and TENS seemed to have contributed to improving pain, sensory abnormalities, and jaw function. Psychosocial factors also showed a trend to improve after the treatment.
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Affiliation(s)
- Mauro Barone
- Department of Physical Therapy, Musculoskeletal Research Unit - UIM, University Center for Assistance, Teaching and Research - CUADI, University of Gran Rosario - UGR, CP 2000, Rosario, Argentina
| | - Fernando Imaz
- Department of Physical Therapy, Musculoskeletal Research Unit - UIM, University Center for Assistance, Teaching and Research - CUADI, University of Gran Rosario - UGR, CP 2000, Rosario, Argentina
| | - Diego Bordachar
- Department of Physical Therapy, Musculoskeletal Research Unit - UIM, University Center for Assistance, Teaching and Research - CUADI, University of Gran Rosario - UGR, CP 2000, Rosario, Argentina
| | - Isabella Ferreira
- Department of Physical Therapy, Musculoskeletal Research Group - NIME, Federal University of Juiz De Fora, Minas Gerais, Brazil
| | - Leonardo Intelangelo
- Department of Physical Therapy, Musculoskeletal Research Unit - UIM, University Center for Assistance, Teaching and Research - CUADI, University of Gran Rosario - UGR, CP 2000, Rosario, Argentina
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Shala R, Roussel N, Lorimer Moseley G, Osinski T, Puentedura EJ. Can we just talk our patients out of pain? Should pain neuroscience education be our only tool? J Man Manip Ther 2021; 29:1-3. [PMID: 33427587 DOI: 10.1080/10669817.2021.1873259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Rilind Shala
- Department of Physiotherapy, Faculty of Medicine, University of Prishtina , Prishtina, Kosovo
| | - Nathalie Roussel
- Faculty of Medicine and Health Sciences, Research Group MOVANT, University of Antwerp , Antwerp, Belgium
| | - G Lorimer Moseley
- Neuroscience Research Australia , Randwick, Australia.,IMPACT in Health, University of South Australia , Australia
| | - Thomas Osinski
- UR 20201 ERPHAN, Université Versailles Saint Quenti, Hôpital R. Poincaré/Garches (92)
| | - Emilio J Puentedura
- Baylor University Doctor of Physical Therapy Program, Robbins College of Health and Human Services , Texas, USA
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