51
|
Bitenc-Jasiejko A, Konior K, Lietz-Kijak D. Meta-Analysis of Integrated Therapeutic Methods in Noninvasive Lower Back Pain Therapy (LBP): The Role of Interdisciplinary Functional Diagnostics. Pain Res Manag 2020; 2020:3967414. [PMID: 32256908 PMCID: PMC7109562 DOI: 10.1155/2020/3967414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/07/2020] [Indexed: 12/12/2022]
Abstract
Introduction. Lower back pain (LBP) is almost a problem of civilizations. Quite often, it is a consequence of many years of disturbed distribution of tension within the human body caused by local conditions (injuries, hernias, stenoses, spondylolisthesis, cancer, etc.), global factors (postural defects, structural integration disorders, lifestyle, type of activity, etc.), or systemic diseases (connective tissue, inflammation, tumours, abdominal aneurysm, and kidney diseases, including urolithiasis, endometriosis, and prostatitis). Therefore, LBP rehabilitation requires the use of integrated therapeutic methods, combining the competences of interdisciplinary teams, both in the process of diagnosis and treatment. Aim of the Study. Given the above, the authors of the article conducted meta-analysis of the literature in terms of integrated therapeutic methods, indicating the techniques focused on a holistic approach to the patient. The aim of the article is to provide the reader with comprehensive knowledge about treating LBP using noninterventional methods. Material and Methods. An extensive search for the materials was conducted online using PubMed, the Cochrane database, and Embase. The most common noninterventional methods have been described, as well as the most relevantly updated and previously referenced treatment of LBP. The authors also proposed noninvasive (measurable) diagnostic procedures for the functional assessment of the musculoskeletal system, including initial, systematic, and cross-sectional control. All figures and images have been prepared by the authors and are their property. Results This review article goes beyond combining a detailed description of each procedure with full references, as well as a comprehensive discussion of this very complex and troublesome problem. Conclusions Lower back pain is a serious health problem, and this review article will help educate physicians and physiotherapists dealing with LBP in the options of evidence-based treatment. Ultimately, the article introduces and postulates the need to systematize therapeutic procedures in LBP therapy, with a long-term perspective.
Collapse
Affiliation(s)
- Aleksandra Bitenc-Jasiejko
- Department of Propedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Danuta Lietz-Kijak
- Department of Propedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
| |
Collapse
|
52
|
Pain Education With Therapeutic Exercise in Chronic Nonspecific Low Back Pain Rehabilitation: A Critically Appraised Topic. J Sport Rehabil 2020; 29:1204-1209. [PMID: 32106086 DOI: 10.1123/jsr.2019-0345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/15/2019] [Accepted: 01/02/2020] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Low back pain is widely prevalent in the general population as well as in athletes. Therapeutic exercise is a low-risk and effective treatment option for chronic pain that can be utilized by all rehabilitation clinicians. However, therapeutic exercise alone does not address the psychosocial aspects that are associated with chronic low back pain. Pain education is the umbrella term utilized to encompass any type of education to the patient about their chronic pain. Therapeutic exercise in combination with pain education may allow for more well-rounded and effective treatment for patients with chronic nonspecific low back pain (NS-LBP). Clinical Question: Does pain education combined with therapeutic exercise, compared with therapeutic exercise alone, improve patient pain in adults with chronic NS-LBP over a 2- to 3-month treatment period? Summary of Key Findings: A thorough literature review yielded 8 studies potentially relevant to the clinical question, and 3 studies that met the inclusion criteria were included. The 3 studies included reports that exercise therapy reduced symptoms. Two of the 3 included studies support the claim that exercise therapy reduces the symptoms of chronic NS-LBP when combined with pain education, whereas one study found no difference between pain education with therapeutic exercise. Clinical Bottom Line: There is moderate evidence to support the use of pain education along with therapeutic exercise when attempting to reduce symptoms of pain and disability in patients with chronic NS-LBP. Educational interventions should be created to educate patients about the foundation of pain, and pain education should be implemented as a part of the clinician's strategy for the rehabilitation of patients with chronic NS-LBP. Strength of Recommendation: Grade B evidence exists to support the use of patient education with therapeutic exercise for decreasing pain in patients with chronic NS-LBP.
Collapse
|
53
|
The short-term effects of neuroscience pain education on quality of life in patients with chronic low back pain: A single-blinded randomized controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2019.101046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
54
|
Hamasaki T, Pelletier R, Bourbonnais D, Harris P, Choinière M. Pain-related psychological issues in hand therapy. J Hand Ther 2019; 31:215-226. [PMID: 29449064 DOI: 10.1016/j.jht.2017.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/16/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Literature review. INTRODUCTION Pain is a subjective experience that results from the modulation of nociception conveyed to the brain via the nervous system. Perception of pain takes place when potential or actual noxious stimuli are appraised as threats of injury. This appraisal is influenced by one's cognitions and emotions based on her/his pain-related experiences, which are processed in the forebrain and limbic areas of the brain. Unarguably, patients' psychological factors such as cognitions (eg, pain catastrophizing), emotions (eg, depression), and pain-related behaviors (eg, avoidance) can influence perceived pain intensity, disability, and treatment outcomes. Therefore, hand therapists should address the patient pain experience using a biopsychosocial approach. However, in hand therapy, a biomedical perspective predominates in pain management by focusing solely on tissue healing. PURPOSE OF THE STUDY This review aims to raise awareness among hand therapists of the impact of pain-related psychological factors. METHODS AND RESULTS This literature review allowed to describe (1) how the neurophysiological mechanisms of pain can be influenced by various psychological factors, (2) several evidence-based interventions that can be integrated into hand therapy to address these psychological issues, and (3) some approaches of psychotherapy for patients with maladaptive pain experiences. DISCUSSION AND CONCLUSION Restoration of sensory and motor functions as well as alleviating pain is at the core of hand therapy. Numerous psychological factors including patients' beliefs, cognitions, and emotions alter their pain experience and may impact on their outcomes. Decoding the biopsychosocial components of the patients' pain is thus essential for hand therapists.
Collapse
Affiliation(s)
- Tokiko Hamasaki
- Research Center of the CHUM, Montreal, Québec, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Hand Center, CHUM, Montreal, Québec, Canada
| | - René Pelletier
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Daniel Bourbonnais
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Québec, Canada
| | - Patrick Harris
- Hand Center, CHUM, Montreal, Québec, Canada; Department of Surgery, Plastic Surgery Service, CHUM, Montreal, Québec, Canada; Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Manon Choinière
- Research Center of the CHUM, Montreal, Québec, Canada; Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada.
| |
Collapse
|
55
|
Neurophysiological Pain Education for Patients With Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Clin J Pain 2019; 34:778-786. [PMID: 29443723 DOI: 10.1097/ajp.0000000000000594] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the effect of neurophysiological pain education (NPE) for patients with chronic low back pain (CLBP). METHODS A systematic search was performed in 6 electronic databases. Eligible randomized-controlled trials were those with at least 50 % of patients with CLBP and in which NPE was compared with no intervention or usual care. Methodological quality was assessed independently by 2 of the authors using the Cochrane Collaboration Risk of Bias Tool. The effect of NPE was summarized in a random effect meta-analysis for pain, disability, and behavioral attitudes. Effect was estimated as weighted mean difference (WMD) if outcomes were on the same scale or as standardized mean difference (SMD). The overall quality of evidence was evaluated according to GRADE guidelines. RESULTS Seven randomized-controlled trial studies (6 low and 1 high quality) were included. Statistically significant differences in pain, in favor of NPE, were found after treatment, WMD=-1.03 (95% confidence interval [CI], -0.55 to -1.52), and after 3 months, WMD=-1.09 (95% CI, -2.17 to 0.00). Furthermore statistically significant lower disability was found in the NPE group after treatment, SMD=-0.47 (95% CI, -0.80 to -0.13) and after 3 months SMD=-0.38 (95% CI, -0.74 to -0.02). The difference in favor of NPE in reduction in Tampa Scale of Kinesiophobia was not statistically significant, WMD=-5.73 (95% CI, -13.60 to 2.14) and after 3 months WMD=-0.94 (95% CI, -6.28 to 4.40). DISCUSSION There was moderate evidence supporting the hypothesis that NPE has a small to moderate effect on pain and low evidence of a small to moderate effect on disability immediately after the intervention. NPE has a small to moderate effect on pain and disability at 3 months follow-up in patients with CLBP.
Collapse
|
56
|
Joypaul S, Kelly F, McMillan SS, King MA. Multi-disciplinary interventions for chronic pain involving education: A systematic review. PLoS One 2019; 14:e0223306. [PMID: 31577827 PMCID: PMC6774525 DOI: 10.1371/journal.pone.0223306] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There have been growing recommendations to include education in multi-disciplinary interventions targeting chronic pain management. However, effects of this strategy on short- and long-term self-management of chronic pain, remain largely unexplored. OBJECTIVES 1. To provide an updated overview of studies that report on the impact of patient education in multi-disciplinary interventions, on self-management of chronic pain; 2. To explore associations between education and chronic pain self-management techniques; and 3. To identify the format and duration of suitable chronic pain interventions targeted at patient self-management. METHODS Design: Narrative systematic literature review of randomised or controlled study designs. Data Sources: PubMed, CINAHL, EMBASE, PsycINFO. Participants: Adult patients with chronic pain of any aetiology participating in multi-disciplinary programs that included education. Main outcome measures: Assessments of level of pain, function, quality of life, self-efficacy, self-management, and any other relevant assessments. Study Appraisal and Synthesis Methods: PRISMA guidelines, Cochrane Risk of Bias tool, and TIDieR model. RESULTS Database searching identified 485 potential papers. After removal of duplicates, and irrelevant articles by title and abstract, 120 full-text articles were reviewed and 27 studies were included in this systematic review. Studies were predominantly from the United States (n = 8; 29.6%). Over one hundred outcome measures were identified across all studies, with significant variation also observed in terms of how chronic pain duration was defined, and how education was delivered to participants. Overall, positive benefits of education were reported. CONCLUSIONS Education, as part of multi-disciplinary programs, is likely to improve self-management and self-efficacy in people with chronic pain of any aetiology. Heterogeneity in terms of: chronic pain duration; educational resources; healthcare professionals; and outcome measures, were identified as limitations. Further research, in the form of Randomised Controlled Trials addressing these limitations, is recommended.
Collapse
Affiliation(s)
- Shirdhya Joypaul
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Fiona Kelly
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Sara S. McMillan
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Michelle A. King
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| |
Collapse
|
57
|
Conservative Interventions Reduce Fear in Individuals With Chronic Low Back Pain: A Systematic Review. Arch Phys Med Rehabil 2019; 101:329-358. [PMID: 31473206 DOI: 10.1016/j.apmr.2019.08.470] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To systematically review and critically appraise the effectiveness of conservative and surgical interventions to reduce fear in studies of people with chronic low back pain, based on the analysis of randomized controlled trials for which fear was a primary or secondary outcome. DATA SOURCES Electronic databases PubMed, CINAHL, PsycINFO, PEDro, and CENTRAL, as well as manual searches and grey literature were searched from inception until May 2019. STUDY SELECTION Randomized controlled trials analyzing the effectiveness of conservative and surgical interventions to reduce fear were included. DATA EXTRACTION Two reviewers independently conducted the search strategy, study selection, data extraction, risk of bias assessment, and quality of the evidence judgment. DATA SYNTHESIS Sixty-one studies (n=7201) were included. A large number of fear-related search terms were used but only 3 fear constructs (kinesiophobia, fear-avoidance beliefs, fear of falling) were measured in the included studies. Multidisciplinary and psychological interventions as well as exercise reduced kinesiophobia. Fear-avoidance beliefs were reduced by the aforementioned interventions, manual therapy, and electrotherapy. A multidisciplinary intervention reduced the fear of falling. There was moderate evidence of multidisciplinary interventions and exercise to reduce kinesiophobia. There was moderate evidence of manual therapy and electrotherapy to reduce fear-avoidance beliefs. CONCLUSIONS The present systematic review highlights the potential effectiveness of conservative interventions to reduce kinesiophobia and fear-avoidance beliefs in individuals with chronic low back pain. This information can help health professionals to reduce fear when treating patients with this condition.
Collapse
|
58
|
Strunce J, Spoonemore S, Golding J, Randall T, Krok M, Lee S, Bordt D, Walker-Ferrell W, Cordel D. Physical rehabilitation therapists' perspective of the opioid crisis with evidence-based recommendations. Pain Manag 2019; 9:483-495. [PMID: 31452447 DOI: 10.2217/pmt-2019-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In 2017, the Secretary of Health and Human Services and Office of the Surgeon General declared the opioid crisis of our nation to be a public health emergency. In response to the Office of the Assistant Secretary of Health and Office of the Surgeon General's 'Call to Action', the Therapist category of the US Public Health Service commissioned a nine-member task force consisting of pain science subject matter experts to study the Therapists' role in effectively reducing chronic pain and opioid abuse. This article addresses the opioid epidemic, how patients with chronic pain have been managed inappropriately, and five key, evidence-based recommendations from this task force.
Collapse
Affiliation(s)
- Joseph Strunce
- Rehabilitation Department, Four Corners Regional Health Center, Red Mesa, AZ 86514, USA
| | - Stephen Spoonemore
- Rehabilitation Department, Physical Therapy & Exercise Southcentral Foundation, Anchorage, AK 99508, USA
| | - Joseph Golding
- Rehabilitation Department, Parker Indian Health Center, Parker, AZ 85344, USA
| | - Tarri Randall
- Rehabilitation Department, Whiteriver Indian Hospital, Whiteriver, AZ 85941, USA
| | - Michael Krok
- Rehabilitation Department, Womack Army Medical Center, Fort Bragg, NC 28310, USA
| | - Steven Lee
- Rehabilitation Department, Valley Native Primary Care Center, Wasilla, AK 99654, USA
| | - Daniel Bordt
- Rehabilitation Department, Federal Medical Center Rochester, Rochester, MN 55904, USA
| | - Wendy Walker-Ferrell
- Rehabilitation Department, Chinle Comprehensive Health Care Facility, Chinle, AZ 86503, USA
| | - Douglas Cordel
- Rehabilitation Department, Four Corners Regional Health Center, Red Mesa, AZ 86514, USA
| |
Collapse
|
59
|
Marris D, Theophanous K, Cabezon P, Dunlap Z, Donaldson M. The impact of combining pain education strategies with physical therapy interventions for patients with chronic pain: A systematic review and meta-analysis of randomized controlled trials. Physiother Theory Pract 2019; 37:461-472. [PMID: 31250682 DOI: 10.1080/09593985.2019.1633714] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Study Design: Systematic Review with meta-analysis.Background: Rehabilitation providers have begun to incorporate pain education into their treatment protocols to influence the patient's experience and knowledge to improve their condition. The purpose of this systematic review is to determine if the addition of pain education strategies to physical therapy treatments is beneficial in reducing pain intensity and disability for those with chronic musculoskeletal pain.Methods: A systematic database search was conducted for randomized control trials that investigated the concurrent use of pain education and physical therapy. Standardized methods for article identification, inclusion, and quality appraisal was utilized. Where possible, studies were pooled for meta-analysis, with pain and disability as the primary outcomes.Results: Fourteen articles were included in this review, of which all fourteen were rated as high quality using the PEDro scale of quality assessment. Meta-analyses were conducted on pain and disability constructs at short term (< 12 weeks) and long-term (≥ 12 weeks) for the studies that allowed for quantitative pooling of effect sizes. Thirteen out of the fourteen included studies demonstrated a decrease in pain and disability with the use of combined interventions. There was a large effect on short-term pain (SMD 0.837), long-term pain (SMD 0.964), and long-term disability (SMD 1.374). A moderate effect on with short-term disability (SMD 0.791).Conclusion: The results of this systematic review support the conclusion that utilizing pain education strategies in conjunction with interventions provided by physical therapists demonstrates a moderate to large effect sizes on pain and disability constructs but lack pooled statistical significance.
Collapse
Affiliation(s)
- Danielle Marris
- Department of Physical Therapy, Walsh University; North Canton, OH, USA
| | | | - Pablo Cabezon
- Department of Physical Therapy, Walsh University; North Canton, OH, USA
| | - Zachary Dunlap
- Department of Physical Therapy, Walsh University; North Canton, OH, USA
| | - Megan Donaldson
- School of Medicine, Public Health and Community Medicine, Tufts University, Boston, MA, USA
| |
Collapse
|
60
|
Wang XQ, Gu W, Chen BL, Wang X, Hu HY, Zheng YL, Zhang J, Zhang HY, Chen PJ. Effects of whole-body vibration exercise for non-specific chronic low back pain: an assessor-blind, randomized controlled trial. Clin Rehabil 2019; 33:1445-1457. [PMID: 31099264 DOI: 10.1177/0269215519848076] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To confirm the benefits of whole-body vibration exercise for pain intensity and functional disability in patients with non-specific chronic low back pain. DESIGN Single-blind randomized controlled trial. SETTING Outpatient. SUBJECTS Eighty-nine patients with non-specific chronic low back pain met the inclusion criteria, they were randomly allocated to either the intervention group (n = 45) or the control group (n = 44). INTERVENTION The intervention group received whole-body vibration exercises three times a week for 12 weeks. The control group received general exercise protocol three times a week for 12 weeks. MAIN OUTCOMES The primary outcome measures were pain intensity and functional disability measured by the visual analog scale scores and Oswestry Disability Index. The secondary outcome measures included lumbar joint position sense, quality of life (Short Form Health Survey 36) and overall treatment effect (Global Perceived Effect). RESULTS A total of 84 subjects completed the 12-week study program. After 12 weeks, compared with the control group, the mean visual analog scale and Oswestry Disability Index scores decreased by additional 1 point (95% confidence interval (CI) = -1.22 to -0.78; P < 0.001), 3.81 point (95% CI, -4.98, -2.63; P < 0.001) based on adjusted analysis in the intervention group. And the intervention group provided additional beneficial effects for in terms of lumbar joint position sense (P < 0.05), quality of life (P < 0.05), and Global Perceived Effect (P = 0.012). CONCLUSION The study demonstrated that whole-body vibration exercise could provide more benefits than general exercise for relieving pain and improving functional disability in patients with non-specific chronic low back pain.
Collapse
Affiliation(s)
- Xue-Qiang Wang
- 1 Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.,2 Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
| | - Wei Gu
- 3 Department of Rehabilitation Medicine, Affiliated to Traditional Chinese Medicine Faculty, Changhai Hospital, Shanghai, China
| | - Bing-Lin Chen
- 1 Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xin Wang
- 3 Department of Rehabilitation Medicine, Affiliated to Traditional Chinese Medicine Faculty, Changhai Hospital, Shanghai, China
| | - Hao-Yu Hu
- 1 Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yi-Li Zheng
- 1 Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Juan Zhang
- 1 Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Han-Yu Zhang
- 1 Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Pei-Jie Chen
- 1 Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.,2 Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
| |
Collapse
|
61
|
Watson JA, Ryan CG, Cooper L, Ellington D, Whittle R, Lavender M, Dixon J, Atkinson G, Cooper K, Martin DJ. Pain Neuroscience Education for Adults With Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2019; 20:1140.e1-1140.e22. [PMID: 30831273 DOI: 10.1016/j.jpain.2019.02.011] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/03/2019] [Accepted: 02/23/2019] [Indexed: 12/16/2022]
Abstract
Chronic musculoskeletal pain (CMP) is an urgent global public health concern. Pain neuroscience education (PNE) is an intervention used in the management of CMP aiming to reconceptualize an individual's understanding of their pain as less threatening. This mixed-methods review undertook a segregated synthesis of quantitative and qualitative studies to investigate the clinical effectiveness, and patients' experience of, PNE for people with CMP. Electronic databases were searched for studies published between January 1, 2002, and June 14, 2018. Twelve randomized, controlled trials (n = 755 participants) that reported pain, disability, and psychosocial outcomes and 4 qualitative studies (n = 50 participants) that explored patients experience of PNE were included. The meta-analyzed pooled treatment effects for PNE versus control had low clinical relevance in the short term for pain (-5.91/100; 95% confidence interval [CI], -13.75 to 1.93) and disability (-4.09/100; 95% CI, -7.72 to -.45) and in the medium term for pain (-6.27/100; 95% CI, -18.97 to 6.44) and disability (-8.14/100; 95% CI, -15.60 to -.68). The treatment effect of PNE for kinesiophobia was clinically relevant in the short term (-13.55/100; 95% CI, -25.89 to -1.21) and for pain catastrophizing in the medium term (-5.26/52; 95% CI, -10.59 to .08). A metasynthesis of 23 qualitative findings resulted in the identification of 2 synthesized findings that identified several key components important for enhancing the patient experience of PNE, such as allowing the patient to tell their own story. These components can enhance pain reconceptualization, which seems to be an important process to facilitate patients' ability to cope with their condition. The protocol was published on PROSPERO (CRD42017068436). Perspective: We outline the effectiveness of PNE for the management of pain, disability, and psychosocial outcomes in adults with CMP. Key components that can enhance the patient experience of PNE, such as allowing the patient to tell their own story, are also presented. These components may enhance pain reconceptualization.
Collapse
Affiliation(s)
- James A Watson
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom.
| | - Cormac G Ryan
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom
| | - Lesley Cooper
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom
| | - Dominic Ellington
- North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Hardwick Road, Stockton on Tees, Cleveland, TS19 8PE, United Kingdom
| | - Robbie Whittle
- North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Hardwick Road, Stockton on Tees, Cleveland, TS19 8PE, United Kingdom
| | - Michael Lavender
- North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Hardwick Road, Stockton on Tees, Cleveland, TS19 8PE, United Kingdom
| | - John Dixon
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom
| | - Greg Atkinson
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom
| | - Kay Cooper
- The Scottish Centre for Evidenced-Based, Multi-professional Practice: A Joanna Briggs Institute Centre of Excellence, School of Health Sciences, Robert Gordon University, Aberdeen, AB10 7QG, United Kingdom
| | - Denis J Martin
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom
| |
Collapse
|
62
|
Orhan C, Cagnie B, Favoreel A, Van Looveren E, Akel U, Mukhtar NB, De Meulemeester K, Pas R, Lenoir D, Meeus M. Development of culturally sensitive Pain Neuroscience Education for first-generation Turkish patients with chronic pain: A modified Delphi study. Musculoskelet Sci Pract 2019; 39:1-9. [PMID: 30439644 DOI: 10.1016/j.msksp.2018.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/05/2018] [Accepted: 10/30/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pain Neuroscience Education (PNE) has been recognized as an efficacious approach for chronic pain, but evidence for these findings have mainly been gathered in Caucasian patient populations. In recent years, it has been proposed that the treatment of pain and patient information materials should be culturally sensitive for different ethnic populations and cultures since cultural variations in pain beliefs and cognitions. OBJECTIVES To culturally adapt PNE material for first-generation Turkish patients with chronic pain. DESIGN A modified Delphi study with three consecutive rounds. METHOD A total of 10 participants (8 experts and 2 first-generation Turkish patients with chronic pain) were recruited for this study. Three online questionnaire rounds were conducted to synthesize the perspectives and to reach agreement on the suggested PNE materials. RESULTS Results on multiple-choice questions from the first round revealed that the compatibility of the visual information and the clarity of the message obtained lower scores. Examples, visual information (illustrations, pictures), and metaphors in the teaching materials and the home education leaflet were revised based on suggestions in Rounds 1 and 2. In Round 3, respondents reached an acceptable agreement level for the clinical usefulness of the PNE teaching materials and the home education material. CONCLUSIONS Culturally sensitive PNE materials were produced for first-generation Turkish patients. Since the results of the present study only reveal perspectives of the experts, further validation of education materials may be required before they are recommended for Turkish patients in clinical practices.
Collapse
Affiliation(s)
- Ceren Orhan
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium.
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium.
| | | | - Eveline Van Looveren
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium; Pain in Motion International Research Group, Belgium.
| | - Umit Akel
- Fysio Point Maastricht, Maastricht, Netherlands.
| | | | | | - Roselien Pas
- Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium; Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.
| | - Dorine Lenoir
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium; Pain in Motion International Research Group, Belgium.
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium; Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium.
| |
Collapse
|
63
|
Zheng YL, Wang XF, Chen BL, Gu W, Wang X, Xu B, Zhang J, Wu Y, Chen CC, Liu XC, Wang XQ. Effect of 12-Week Whole-Body Vibration Exercise on Lumbopelvic Proprioception and Pain Control in Young Adults with Nonspecific Low Back Pain. Med Sci Monit 2019; 25:443-452. [PMID: 30644383 PMCID: PMC6342063 DOI: 10.12659/msm.912047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nonspecific low back pain (NSLBP) accounts for a large proportion of low back pain cases. The present study aimed to investigate the effect of the whole-body vibration (WBV) exercise on lumbar proprioception in NSLBP patients. It was hypothesized that WBV exercise enhances lumbar proprioception. MATERIAL AND METHODS Forty-two patients with NSLBP performed an exercise program 3 times a week for a total of 12 weeks of WBV. The lumbar proprioception was measured by joint position sense. Outcomes were lumbar angle deviation and visual analogue scale (VAS) score. RESULTS After the 12-week WBV exercise, lumbar flexion angle deviation was reduced from 3.65±2.26° to 1.90±1.07° (P=0.0001), and extension angle deviation was reduced from 3.06±1.85° to 1.61±0.75° (P=0.0001), significantly lower than baseline. After participating in the 12-week WBV exercise, a significant pain reduction was observed (P=0.0001). Men in the whole group (n=32) indicated significantly lower angle deviations in flexion and extension, whereas women (n=10) indicated significantly lower flexion angle deviation (P=0.037), and no significant difference was found in extension angle deviation (P=0.052). However, by subdividing the entire group (n=42) into poor and good proprioceptive groups, WBV exercise presented significant enhancement of lumbar proprioceptive ability in the poor flexion proprioception subgroup, poor extension proprioception subgroup, and good extension proprioception subgroup (each P=0.0001), but not in the subgroup with good flexion proprioceptive ability (P=0.165). CONCLUSIONS Lumbar flexion and extension proprioception as measured by joint position sense was significantly enhanced and pain was significantly reduced after 12-week WBV exercise in NSLBP patients. However, the patients with good flexion proprioceptive ability had limited proprioceptive enhancement.
Collapse
Affiliation(s)
- Yi-Li Zheng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland).,Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China (mainland)
| | - Xiao-Feng Wang
- Department of Spinal Surgery, Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou Affiliated Hospital of Zhejiang Chinese Medicine University, Wenzhou, Zhejiang, China (mainland)
| | - Bing-Lin Chen
- College of Medical Technology, Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland)
| | - Wei Gu
- Department of Rehabilitation Medicine, Affiliated to Traditional Chinese Medicine Faculty, Changhai Hospital, Shanghai, China (mainland)
| | - Xin Wang
- Department of Rehabilitation Medicine, Affiliated to Traditional Chinese Medicine Faculty, Changhai Hospital, Shanghai, China (mainland)
| | - Bing Xu
- Department of Spinal Surgery, Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou Affiliated Hospital of Zhejiang Chinese Medicine University, Wenzhou, Zhejiang, China (mainland)
| | - Juan Zhang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland)
| | - Ya Wu
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China (mainland)
| | - Chang-Cheng Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland)
| | - Xiao-Chen Liu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland)
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland).,Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China (mainland)
| |
Collapse
|
64
|
Marques ES, Meziat Filho NADM, Ferreira PDS, Andrade FGD, Ramsay EM, Amaral Corrêa L, Nogueira LAC. Group pain neuroscience education combined with supervised exercises reduces pain and improves function of Brazilian women with central sensitisation and a low level of education: a single-subject study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1531922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Elen Soares Marques
- Rehabilitation Science Postgraduate Program at Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Physiotherapy Department at Faculdade de Ciências Médias e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, Brazil
| | | | | | | | | | - Leticia Amaral Corrêa
- Rehabilitation Science Postgraduate Program at Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduate Program at Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Physiotherapy Department at Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| |
Collapse
|
65
|
Wood L, Hendrick PA. A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability. Eur J Pain 2018; 23:234-249. [DOI: 10.1002/ejp.1314] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 08/22/2018] [Accepted: 08/29/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Lianne Wood
- Centre for Spinal Studies and Surgery; Nottingham University Hospitals NHS Trust; Nottingham UK
- Research Institute for Primary Care and Health Sciences; Keele University; Staffordshire, ST5 5PB
| | - Paul A. Hendrick
- Division of Physiotherapy and Rehabilitation Sciences; School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus); Nottingham UK
| |
Collapse
|
66
|
Chimenti RL, Frey-Law LA, Sluka KA. A Mechanism-Based Approach to Physical Therapist Management of Pain. Phys Ther 2018; 98:302-314. [PMID: 29669091 PMCID: PMC6256939 DOI: 10.1093/ptj/pzy030] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 02/12/2018] [Indexed: 12/11/2022]
Abstract
Pain reduction is a primary goal of physical therapy for patients who present with acute or persistent pain conditions. The purpose of this review is to describe a mechanism-based approach to physical therapy pain management. It is increasingly clear that patients need to be evaluated for changes in peripheral tissues and nociceptors, neuropathic pain signs and symptoms, reduced central inhibition and enhanced central excitability, psychosocial factors, and alterations of the movement system. In this Perspective, 5 categories of pain mechanisms (nociceptive, central, neuropathic, psychosocial, and movement system) are defined, and principles on how to evaluate signs and symptoms for each mechanism are provided. In addition, the underlying mechanisms targeted by common physical therapist treatments and how they affect each of the 5 categories are described. Several different mechanisms can simultaneously contribute to a patient's pain; alternatively, 1 or 2 primary mechanisms may cause a patient's pain. Further, within a single pain mechanism, there are likely many possible subgroups. For example, reduced central inhibition does not necessarily correlate with enhanced central excitability. To individualize care, common physical therapist interventions, such as education, exercise, manual therapy, and transcutaneous electrical nerve stimulation, can be used to target specific pain mechanisms. Although the evidence elucidating these pain mechanisms will continue to evolve, the approach outlined here provides a conceptual framework for applying new knowledge as advances are made.
Collapse
Affiliation(s)
- Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa
| | - Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, 1-242 MEB, University of Iowa, Iowa City, IA 52242 (USA)
| |
Collapse
|
67
|
Louw A, Zimney K, Reed J, Landers M, Puentedura EJ. Immediate preoperative outcomes of pain neuroscience education for patients undergoing total knee arthroplasty: A case series. Physiother Theory Pract 2018; 35:543-553. [PMID: 29589782 DOI: 10.1080/09593985.2018.1455120] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Standard preoperative education for total knee arthroplasty (TKA) has been shown to have no effect on postoperative outcomes. This may be because such education programs fail to educate patients about pain. Pain neuroscience education (PNE) focuses on teaching people more about pain from a neurobiological and neurophysiological perspective. DESIGN AND SETTING Case Series. AIM To determine the immediate effects, if any, of providing PNE before TKA surgery on patient self-report measures. PARTICIPANTS Twelve patients (female = 10) prior to TKA for knee osteoarthritis (OA). INTERVENTION Preoperative educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet. MAIN OUTCOME MEASURES Comparison of pre- and post-PNE self-report measures on knee pain (NPRS), Pain Catastrophization Scale (PCS), fear of movement (TSK), and beliefs about TKA; as well as three physical performance measures - knee flexion active range of motion, 40 m self-paced walk, and pressure pain threshold (PPT). RESULTS Immediately following the PNE, patients had statistically significant lower TSK scores, increased PPT, and improved beliefs about their upcoming surgery. There were no significant changes in knee pain, function, or flexion active range of motion. CONCLUSIONS Results appear to suggest that immediately after PNE, patients scheduled for TKA had statistically significant changes in fear of movement, decreased sensitivity to pain and positive shifts in their beliefs about their future knee surgery. Larger trials with control/comparison groups are warranted to determine the true effects of preoperative PNE for patients about to undergo TKA.
Collapse
Affiliation(s)
- Adriaan Louw
- a International Spine and Pain Institute , Story City , IA , USA
| | - Kory Zimney
- b Department of Physical Therapy, School of Health Sciences , University of South Dakota , Vermillion , SD , USA
| | - Jordan Reed
- c Rehabilitation Services , Spencer Hospital , Spencer , IA , USA
| | - Merrill Landers
- d Department of Physical Therapy, School of Allied Health Sciences , University of Nevada Las Vegas , Las Vegas , NV , USA
| | - Emilio J Puentedura
- d Department of Physical Therapy, School of Allied Health Sciences , University of Nevada Las Vegas , Las Vegas , NV , USA
| |
Collapse
|
68
|
Andias R, Neto M, Silva AG. The effects of pain neuroscience education and exercise on pain, muscle endurance, catastrophizing and anxiety in adolescents with chronic idiopathic neck pain: a school-based pilot, randomized and controlled study. Physiother Theory Pract 2018; 34:682-691. [DOI: 10.1080/09593985.2018.1423590] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Rosa Andias
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
| | | | - Anabela G. Silva
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
- CINTESIS.UA, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
| |
Collapse
|
69
|
Black N, Sullivan S, Mani R. A biopsychosocial understanding of lower back pain: Content analysis of online information. Eur J Pain 2017; 22:728-744. [DOI: 10.1002/ejp.1158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/06/2022]
Affiliation(s)
- N.M. Black
- Centre for Health, Activity and Rehabilitation Research; School of Physiotherapy; University of Otago; Dunedin New Zealand
| | - S.J. Sullivan
- Centre for Health, Activity and Rehabilitation Research; School of Physiotherapy; University of Otago; Dunedin New Zealand
| | - R. Mani
- Centre for Health, Activity and Rehabilitation Research; School of Physiotherapy; University of Otago; Dunedin New Zealand
| |
Collapse
|
70
|
Colleary G, O’Sullivan K, Griffin D, Ryan C, Martin D. Effect of pain neurophysiology education on physiotherapy students’ understanding of chronic pain, clinical recommendations and attitudes towards people with chronic pain: a randomised controlled trial. Physiotherapy 2017; 103:423-429. [DOI: 10.1016/j.physio.2017.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/10/2017] [Indexed: 10/19/2022]
|
71
|
Pain Neurophysiology Education and Therapeutic Exercise for Patients With Chronic Low Back Pain: A Single-Blind Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 99:338-347. [PMID: 29138049 DOI: 10.1016/j.apmr.2017.10.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/08/2017] [Accepted: 10/25/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the effect of a pain neurophysiology education (PNE) program plus therapeutic exercise (TE) for patients with chronic low back pain (CLBP). DESIGN Single-blind randomized controlled trial. SETTING Private clinic and university. PARTICIPANTS Patients with CLBP for ≥6 months (N=56). INTERVENTIONS Participants were randomized to receive either a TE program consisting of motor control, stretching, and aerobic exercises (n=28) or the same TE program in addition to a PNE program (n=28), conducted in two 30- to 50-minute sessions in groups of 4 to 6 participants. MAIN OUTCOMES MEASURES The primary outcome was pain intensity rated on the numerical pain rating scale which was completed immediately after treatment and at 1- and 3-month follow-up. Secondary outcome measures were pressure pain threshold, finger-to-floor distance, Roland-Morris Disability Questionnaire, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Patient Global Impression of Change. RESULTS At 3-month follow-up, a large change in pain intensity (numerical pain rating scale: -2.2; -2.93 to -1.28; P<.001; d=1.37) was observed for the PNE plus TE group, and a moderate effect size was observed for the secondary outcome measures. CONCLUSIONS Combining PNE with TE resulted in significantly better results for participants with CLBP, with a large effect size, compared with TE alone.
Collapse
|
72
|
Booth J, Moseley GL, Schiltenwolf M, Cashin A, Davies M, Hübscher M. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care 2017; 15:413-421. [PMID: 28371175 DOI: 10.1002/msc.1191] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Chronic musculoskeletal pain (CMP) refers to ongoing pain felt in the bones, joints and tissues of the body that persists longer than 3 months. For these conditions, it is widely accepted that secondary pathologies or the consequences of persistent pain, including fear of movement, pain catastrophizing, anxiety and nervous system sensitization appear to be the main contributors to pain and disability. While exercise is a primary treatment modality for CMP, the intent is often to improve physical function with less attention to secondary pathologies. Exercise interventions for CMP which address secondary pathologies align with contemporary pain rehabilitation practices and have greater potential to improve patient outcomes above exercise alone. Biopsychosocial treatment which acknowledges and addresses the biological, psychological and social contributions to pain and disability is currently seen as the most efficacious approach to chronic pain. This clinical update discusses key aspects of a biopsychosocial approach concerning exercise prescription for CMP and considers both patient needs and clinician competencies. There is consensus for individualized, supervised exercise based on patient presentation, goals and preference that is perceived as safe and non-threatening to avoid fostering unhelpful associations between physical activity and pain. The weight of evidence supporting exercise for CMP has been provided by aerobic and resistance exercise studies, although there is considerable uncertainty on how to best apply the findings to exercise prescription. In this clinical update, we also provide evidence-based guidance on exercise prescription for CMP through a synthesis of published work within the field of exercise and CMP rehabilitation.
Collapse
Affiliation(s)
- John Booth
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - G Lorimer Moseley
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Marcus Schiltenwolf
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Germany
| | - Aidan Cashin
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | | | - Markus Hübscher
- Neuroscience Research Australia, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| |
Collapse
|
73
|
Pain Neuroscience Education: State of the Art and Application in Pediatrics. CHILDREN-BASEL 2016; 3:children3040043. [PMID: 28009822 PMCID: PMC5184818 DOI: 10.3390/children3040043] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/06/2016] [Accepted: 12/12/2016] [Indexed: 01/16/2023]
Abstract
Chronic pain is a widespread problem in the field of pediatrics. Many interventions to ameliorate pain-related dysfunction have a biobehavioral focus. As treatments for chronic pain (e.g., increased movement) often stand in stark contrast to treatments for an acute injury (e.g., rest), providing a solid rationale for treatment is necessary to gain patient and parent buy-in. Most pain treatment interventions incorporate psychoeducation, or pain neuroscience education (PNE), as an essential component, and in some cases, as a stand-alone approach. The current topical review focuses on the state of pain neuroscience education and its application to pediatric chronic pain. As very little research has examined pain neuroscience education in pediatrics, we aim to describe this emerging area and catalyze further work on this important topic. As the present literature has generally focused on adults with chronic pain, pain neuroscience education merits further attention in the realm of pediatric pain in order to be tailored and implemented in this population.
Collapse
|
74
|
Louw A, Puentedura E“LJ, Zimney K. Teaching patients about pain: It works, but what should we call it? Physiother Theory Pract 2016; 32:328-31. [DOI: 10.1080/09593985.2016.1194669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
75
|
Minguez-Zuazo A, Grande-Alonso M, Saiz BM, La Touche R, Lara SL. Therapeutic patient education and exercise therapy in patients with cervicogenic dizziness: a prospective case series clinical study. J Exerc Rehabil 2016; 12:216-25. [PMID: 27419118 PMCID: PMC4934967 DOI: 10.12965/jer.1632564.282] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/30/2016] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to evaluate the effectiveness of a treatment for patients with cervicogenic dizziness that consisted of therapeutic education and exercises. The Dizziness Handicap Inventory and Neck Disability Index were used. Secondary outcomes included range of motion, postural control, and psychological variables. Seven patients (two males and five females) aged 38.43±14.10 with cervicogenic dizziness were included. All the participants received eight treatment sessions. The treatment was performed twice a week during a four weeks period. Outcome measures included a questionnaire (demographic data, body chart, and questions about pain) and self-reported disability, pain, and psychological variables. Subjects were examined for cervical range of motion and postural control. All of these variables were assessed pre- and postintervention. Participants received eight sessions of therapeutic education patient and therapeutic exercise. The majority of participants showed an improvement in catastrophism (mean change, 11.57±7.13; 95% confidence interval [CI], 4.96–18.17; d=1.60), neck disability (mean change, 5.14±2.27.28; 95% CI, 3.04–7.24; d=1.32), and dizziness disability (mean change, 9.71±6.96; 95% CI, 3.26–16.15; d=1.01). Patients also showed improved range of motion in the right and left side. Therapeutic patient education in combination with therapeutic exercise was an effective treatment. Future research should investigate the efficacy of therapeutic patient education and exercise with larger sample sizes of patients with cervicogenic dizziness.
Collapse
Affiliation(s)
- Ana Minguez-Zuazo
- Departamento de Fisioterapia. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain; La Salle-Optomic Balance Researching Chair: Sensorio-Motor Rehabilitation and Posturography, Madrid, Spain
| | - Mónica Grande-Alonso
- Departamento de Fisioterapia. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain; La Salle-Optomic Balance Researching Chair: Sensorio-Motor Rehabilitation and Posturography, Madrid, Spain; Research Gruop Motion in Brains. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain
| | - Beatriz Moral Saiz
- Departamento de Fisioterapia. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain; La Salle-Optomic Balance Researching Chair: Sensorio-Motor Rehabilitation and Posturography, Madrid, Spain; Movement Analysis Laboratory Niño Jesús University Hospital, Madrid, Spain
| | - Roy La Touche
- Departamento de Fisioterapia. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain; La Salle-Optomic Balance Researching Chair: Sensorio-Motor Rehabilitation and Posturography, Madrid, Spain; Movement Analysis Laboratory Niño Jesús University Hospital, Madrid, Spain
| | - Sergio Lerma Lara
- Departamento de Fisioterapia. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain; La Salle-Optomic Balance Researching Chair: Sensorio-Motor Rehabilitation and Posturography, Madrid, Spain; Research Gruop Motion in Brains. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain; Movement Analysis Laboratory Niño Jesús University Hospital, Madrid, Spain
| |
Collapse
|
76
|
Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract 2016; 32:332-55. [PMID: 27351541 DOI: 10.1080/09593985.2016.1194646] [Citation(s) in RCA: 377] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Systematic review of randomized control trials (RCTs) for the effectiveness of pain neuroscience education (PNE) on pain, function, disability, psychosocial factors, movement, and healthcare utilization in individuals with chronic musculoskeletal (MSK) pain. DATA SOURCES Systematic searches were conducted on 11 databases. Secondary searching (PEARLing) was undertaken, whereby reference lists of the selected articles were reviewed for additional references not identified in the primary search. STUDY SELECTION All experimental RCTs evaluating the effect of PNE on chronic MSK pain were considered for inclusion. Additional Limitations: Studies published in English, published within the last 20 years, and patients older than 18 years. No limitations were set on specific outcome measures. DATA EXTRACTION Data were extracted using the participants, interventions, comparison, and outcomes (PICO) approach. DATA SYNTHESIS Study quality of the 13 RCTs used in this review was assessed by 2 reviewers using the PEDro scale. Narrative summary of results is provided for each study in relation to outcomes measurements and effectiveness. CONCLUSIONS Current evidence supports the use of PNE for chronic MSK disorders in reducing pain and improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization.
Collapse
Affiliation(s)
- Adriaan Louw
- a International Spine and Pain Institute , Story City , IA , USA
| | - Kory Zimney
- b Department of Physical Therapy, School of Health Sciences , University of South Dakota , Vermillion , SD , USA
| | - Emilio J Puentedura
- c Department of Physical Therapy, School of Allied Health Sciences , University of Nevada, Las Vegas , Las Vegas , NV , USA
| | - Ina Diener
- d Department of Physiotherapy , Stellenbosch University , Stellenbosch , South Africa
| |
Collapse
|
77
|
Louw A, Zimney K, O’Hotto C, Hilton S. The clinical application of teaching people about pain. Physiother Theory Pract 2016; 32:385-95. [DOI: 10.1080/09593985.2016.1194652] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
78
|
Wasser JG, Vasilopoulos T, Zdziarski LA, Vincent HK. Exercise Benefits for Chronic Low Back Pain in Overweight and Obese Individuals. PM R 2016; 9:181-192. [PMID: 27346092 DOI: 10.1016/j.pmrj.2016.06.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/09/2016] [Accepted: 06/14/2016] [Indexed: 11/28/2022]
Abstract
Overweight and obese individuals with chronic low back pain (LBP) struggle with the combined physical challenges of physical activity and pain interference during daily life; perceived disability increases, pain symptoms worsen, and performance of functional tasks and quality of life (QOL) decline. Consistent participation in exercise programs positively affects several factors including musculoskeletal pain, perceptions of disability due to pain, functional ability, QOL, and body composition. It is not yet clear, however, what differential effects occur among different easily accessible exercise modalities in the overweight-obese population with chronic LBP. This narrative review synopsizes available randomized and controlled, or controlled and comparative, studies of easily accessible exercise programs on pain severity, QOL, and other outcomes, such as physical function or body composition change, in overweight-obese persons with chronic LBP. We identified 16 studies (N = 1,351) of various exercise programs (aerobic exercise [AX], resistance exercise [RX], aquatic exercise [AQU], and yoga-Pilates) that measured efficacy on LBP symptoms, and at least one other outcome such as perceived disability, QOL, physical function, and body composition. RX, AQU, and Pilates exercise programs demonstrated the greatest effects on pain reduction, perceived disability, QOL, and other health components. The highest adherence rate occurred with RX and AQU exercise programs, indicating that these types of programs may provide a greater overall impact on relevant outcomes for overweight-obese LBP patients. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Joseph G Wasser
- Department of Orthopaedics and Rehabilitation, Division of Research, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL∗
| | - Terrie Vasilopoulos
- Department of Orthopaedics and Rehabilitation, Division of Research, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL(†)
| | - Laura Ann Zdziarski
- Department of Orthopaedics and Rehabilitation, Division of Research, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL(‡)
| | - Heather K Vincent
- Department of Orthopedics and Rehabilitation, Division of Research, UF Orthopaedics and Sports Medicine Institute (OSMI), PO Box 112727, Gainesville, FL 32611(§).
| |
Collapse
|
79
|
A qualitative exploration of people's experiences of pain neurophysiological education for chronic pain: The importance of relevance for the individual. ACTA ACUST UNITED AC 2016; 22:56-61. [DOI: 10.1016/j.math.2015.10.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 10/01/2015] [Accepted: 10/04/2015] [Indexed: 11/20/2022]
|
80
|
Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials. ACTA ACUST UNITED AC 2016; 22:31-41. [DOI: 10.1016/j.math.2015.10.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/19/2015] [Accepted: 10/25/2015] [Indexed: 01/05/2023]
|
81
|
Abstract
Chronic pain is incredibly complex, and so are decisions as to its treatment. During physical therapy care, pain neuroscience education (PNE) aims to help patients understand more about their pain from a biological and physiological perspective. Accompanying the growing evidence for the ability of PNE to reduce pain and disability in patients with chronic pain is an increased interest in PNE from scientists, educators, clinicians, and conference organizers. However, the rise in popularity of PNE has highlighted a historical paradox of increased knowledge not necessarily corresponding with improved care. This Viewpoint discusses the growth and popularity of PNE as well as critical future considerations such as clinical application, clinical research, appropriate outcome measures, and the blending of pain education with exercise and manual therapy.
Collapse
|
82
|
Moseley GL, Butler DS. Fifteen Years of Explaining Pain: The Past, Present, and Future. THE JOURNAL OF PAIN 2015; 16:807-13. [DOI: 10.1016/j.jpain.2015.05.005] [Citation(s) in RCA: 364] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/15/2015] [Accepted: 05/11/2015] [Indexed: 11/25/2022]
|