Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews

The Oslo University Hospital Pain Registry: development of a digital chronic pain registry and baseline data from 1,712 patients

Background and aims Chronic pain is a leading cause to years lived with disability worldwide. However, few of the interventions used in pain medicine have proven efficacy, and evidence from the existing studies may not be valid for the general pain population. Therefore, it is of utmost need that we describe chronic pain conditions in their most relevant aspects, their various guises, as well as the real world outcomes of our clinical interventions. The most obvious and crude way to make these assessments are through large registries where patient characteristics, treatment characteristics (including but not limited to what, when, how often and by whom), treatment outcomes and patient outcomes are scrutinized and recorded. Methods and results This article describes in detail the design and baseline data of the comprehensive Oslo University Hospital Pain Registry (OPR). OPR is the local registry of the largest university and interdisciplinary outpatient pain clinic in Norway. Data registration started in October 2015, and approximately 1,000 patients are assessed and treated at the clinic each year. During the first 2 years of running the OPR (through September 2017), a total of 1,712 patient baseline reports were recorded from 2,001 patients. Clinicians enter data about relevant treatments and interventions, while patients provide self-reported data on aspects related to pain and pain management. The patients complete an electronic registration immediately before their first consultation at the outpatient pain clinic. The baseline questions of the OPR cover: Basic demographics; The Modified Oswestry Disability Index to assess general function; A pain drawing to assess pain location; Questions regarding the temporal aspects of pain; Six 0-10 Numeric Rating Scales to assess pain intensity and bothersomeness; The EQ-5D-5L to measure health-related quality of life; The Hopkins Symptom Check List-25 to assess psychological distress; A single question about self-rated health; The general self-efficacy scale to assess the patient's perceived self-efficacy; The Bodily Distress Syndrome checklist to assess functional disorders; The Injustice Experience Questionnaire to assess whether the patients experience injustice; Chalder Fatigue Questionnaire to assess fatigue; The Insomnia Severity Index to assesses the levels of insomnia symptoms; The Pain Catastrophizing Scale to measure pain catastrophizing and exaggerated negative orientation toward pain stimuli and pain experience; And the SF36v2 to assess patients' self-report of generic health and wellbeing. The baseline data show that chronic pain patients have a high degree of negative impact in all aspects of their lives. Conclusions and implications The OPR is the most comprehensive pain registry for multidisciplinary and interdisciplinary outpatient pain clinics in Norway. Detailed design of the registry and key baseline data are presented. Registries are of great value in that they enable real world effectiveness outcomes for patients with chronic pain conditions. The OPR can thus serve as a model for similar initiatives elsewhere. The OPR cohort may also serve as a historical control in future studies, both with experimental and observational design.

Noninvasive brain stimulation combined with exercise in chronic pain: a systematic review and meta-analysis

Background: The use of noninvasive brain stimulation (NIBS) combined with exercise could produce synergistic effects on chronic pain conditions. This study aims to evaluate the efficacy and safety of NIBS combined with exercise to treat chronic pain as well as to describe the parameters used to date in this combination.Methods: The search was carried out in Medline, Central, Scopus, Embase, and Pedro until November 2019. Randomized clinical trials (RCTs) and quasi-experimental studies reporting the use of noninvasive brain stimulation and exercise on patients with chronic pain were selected and revised.Results: The authors included eight studies (RCTs), reporting eight comparisons (219 participants). Authors found a significant and homogeneous pain decrease (ES: -0.62, 95% CI:-0.89 to -0.34; I2 = 0.0%) in favor of the combined intervention compared to sham NIBS + exercise, predominantly by excitatory (anodal tDCS/rTMS) motor cortex stimulation. Regarding NIBS techniques, the pooled effect sizes were significant for both tDCS (ES: -0.59, 95% CI: -0.89 to -0.29, I2 = 0.0%) and rTMS (ES: -0.76, 95% CI: -1.41 to -0.11, I2 = 0.0%).Conclusions: This meta-analysis suggests a significant moderate to large effects of the NIBS and exercise combination in chronic pain. The authors discuss the potential theoretical framework for this synergistic effect.

Trauma-affected refugees treated with basic body awareness therapy or mixed physical activity as augmentation to treatment as usual-A pragmatic randomised controlled trial

BACKGROUND

The prevalence of post-traumatic stress disorder (PTSD) is estimated to be as high as 30% among refugees. The coexistence of prevalent chronic pain is believed to maintain symptoms of PTSD and add complexity to the condition. Despite this, little evidence exists on how to treat PTSD and comorbid conditions best in trauma-affected refugees.

AIM

The aim of the present study was to investigate if adding either BBAT or mixed physical activity to the treatment as usual (TAU) for trauma-affected refugees with PTSD would increase the treatment effect compared to TAU alone.

METHOD

Randomised controlled trial, 3-armed parallel group superiority study, conducted at Competence Centre for Transcultural Psychiatry, Denmark. Participants were adult trauma-affected refugees with PTSD. Allocation ratio was 1:1:1, stratified for PTSD severity and gender. An open-label design was applied due to the nature of the intervention. Participants were randomised to receive either individual basic body awareness therapy (group B) or individual mixed physical activity (group M) one hour/week for 20 weeks plus TAU, or TAU only (group C). The primary outcome was PTSD severity measured by Harvard Trauma Questionnaire (HTQ). Trial registration: ClinicalTrials.gov, NCT01955538.

RESULTS

Of the 338 patients included (C/B/M = 110/114/114), 318 patients were eligible for intention-to-treat analysis (C/B/M = 104/105/109). On the primary outcome, intention-to-treat as well as per-protocol analyses showed small but significant improvement on scores from pre- to post-treatment in all three groups but with no significant difference in improvement between groups.

CONCLUSIONS

The findings do not provide evidence that either BBAT or mixed physical activity as add-on treatment bring significantly larger improvement on symptoms of PTSD compared to TAU alone for adult, trauma-affected refugees. There is a need for studies on potential subpopulations of trauma-affected refugees who could benefit from physical activity as a part of their treatment.

Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people

Background

Pain is an independent risk factor for falling. One in two older community-dwelling people with musculoskeletal pain fall each year. This study examined physical, psychological and medical factors as potential mediators to explain the relationship between knee pain and falls.

Methods

Three hundred and thirty-three community-dwelling people aged 70+ years (52% women) participated in this cohort study with a 1-year follow-up for falls. Participants completed questionnaires (medical history, general health and concern about falls) and underwent physical performance tests. Participants were classified into ‘pain’ and ‘no pain’ groups based on self-reported knee pain. Poisson Regression models were computed to determine the Relative Risk (RR) of having multiple falls and potential mediators for increased fall risk.

Results

One hundred and eighteen (36%) participants were categorised as having knee pain. This group took more medications and had more medical conditions (P < 0.01) compared to the no pain group. The pain group had poorer balance, physical function and strength and reported increased concern about falls. Sixty one participants (20%) reported ≥2 falls, with the pain group twice as likely to experience multiple falls over the 12 month follow up (RR = 2.0, 95% confidence interval (CI) = 1.27–3.13). Concern about falls, knee extension torque and postural sway with eyes closed were identified as significant and independent mediators of fall risk, and when combined explained 23% of the relationship between knee pain and falls.

Conclusion

This study has identified several medical, medication, psychological, sensorimotor, balance and mobility factors to be associated with knee pain, and found the presence of knee pain doubles the risk of multiple falls in older community living people. Alleviating knee pain, as well as addressing associated risk factors may assist in preventing falls in older people with knee pain.

Interventional pain management for chronic pain: a survey of physicians in Canada

PURPOSE

The use of interventional pain management (IPM) modalities to alleviate chronic pain is increasing despite the lack of high-quality evidence. We undertook this survey to explore patterns, training, and attributes of IPM practice.

METHODS

We administered a 32-item survey via seven Canadian physician member organizations, whose members were engaged in the management of chronic pain.

RESULTS

Of 777 physicians contacted, 256 (33%) responded: 45 (6%) declined to participate and 211 (27%) agreed to participate; the number of participants answering any given question varied. One hundred and sixty-nine of 194 (87%) practiced IPM and 103 of 194 (53%) managed only non-cancer pain. Pain management training of ≥ six months was associated with higher odds of IPM training (odds ratio [OR], 2.98; 95% confidence interval [CI], 1.32 to 6.7), but not necessarily ongoing IPM practice (OR, 1.97; 95% CI, 0.74 to 5.3). A substantial percentage of physicians (108 of 168 [64%]) practiced IPM based only on training received during either their base residency program or courses. Only 48 of 186 (26%) felt that there were adequate opportunities for IPM training, and 69 of 186 (37%) believed that their colleagues practiced IPM in accordance with the best current evidence.

CONCLUSIONS

Our survey indicates that IPM practice and training were not uniform, and that interventional therapies for chronic pain may not be performed in accordance with the best available evidence. Our survey highlights a lack of IPM training opportunities, which may result in substandard training. Concerted efforts involving physician organizations and regulators are needed to standardize IPM training and develop clinical guidelines to optimize evidence-based practice.

Health Perception According to the Lifestyle of University Students

University students are characterized by having inadequate eating habits, along with an unhealthy lifestyle, which, among other factors, can affect the perception they have of their state of health. The aim of the study was to evaluate the health perception of a group of university students according to lifestyle. A cross-sectional observational study was carried out on 214 university students from different universities and branches of knowledge. Anthropometric data were collected. Three questionnaires were administered: PREDIMED (Mediterranean Diet (MD) adherence), SF-36 (perception of health state) and GPAQ (physical activity (PA)). The differences between variables were analyzed using Student-t or Mann-Whitney U, Kruskal-Wallis and Pearson Chi-Square tests. Statistical significance was reached at p < 0.05. Most students were found to be normal weighted. The subjects presented an moderate MD adherence, this being better in Health Sciences students. 75.7% practiced light PA. The health perception is worse for most of the subscales analyzed than that of the reference population (except physical-function, physical-role, and emotional-role). There is an association between PA and health perception: students with intense PA have less body pain and better physical function; the less active, the less vitality. The more physically active subjects the greater MD adherence. Lifestyle and eating habits of health sciences students are healthier than that of students from other branches of knowledge. The physically active subjects have a better perception of quality of life-related to health and greater MD adherence.

'Function First-Be Active, Stay Independent'-promoting physical activity and physical function in people with long-term conditions by primary care: a protocol for a realist synthesis with embedded co-production and co-design

INTRODUCTION

People with long-term conditions typically have reduced physical functioning, are less physically active and therefore become less able to live independently and do the things they enjoy. However, assessment and promotion of physical function and physical activity is not part of routine management in primary care. This project aims to develop evidence-based recommendations about how primary care can best help people to become more physically active in order to maintain and improve their physical function, thus promoting independence.

METHODS AND ANALYSIS

This study takes a realist synthesis approach, following RAMESES guidance, with embedded co-production and co-design. Stage 1 will develop initial programme theories about physical activity and physical function for people with long-term conditions, based on a review of the scientific and grey literature, and two multisector stakeholder workshops using LEGO® SERIOUS PLAY®. Stage 2 will involve focused literature searching, data extraction and synthesis to provide evidence to support or refute the initial programme theories. Searches for evidence will focus on physical activity interventions involving the assessment of physical function which are relevant to primary care. We will describe 'what works', 'for whom' and 'in what circumstances' and develop conjectured programme theories using context, mechanism and outcome configurations. Stage 3 will test and refine these theories through individual stakeholder interviews. The resulting theory-driven recommendations will feed into Stage 4 which will involve three sequential co-design stakeholder workshops in which practical ideas for service innovation in primary care will be developed.

ETHICS AND DISSEMINATION

Healthcare and Medical Sciences Academic Ethics Committee (Reference 2018-16308) and NHS Wales Research Ethics Committee 5 approval (References 256 729 and 262726) have been obtained. A knowledge mobilisation event will address issues relevant to wider implementation of the intervention and study findings. Findings will be disseminated through peer-reviewed journal publications, conference presentations and formal and informal reports.

PROSPERO REGISTRATION NUMBER

CRD42018103027.

Exercise promotion in physiotherapy: A qualitative study providing insights into German physiotherapists' practices and experiences

BACKGROUND

Although exercise promotion is a central task of physiotherapists, there is limited evidence about physiotherapists' experiences with exercise promotion and their promotion practices.

OBJECTIVES

To investigate how physiotherapists working in outpatient settings in Germany promote exercise and to explore their experiences with and views on exercise promotion.

DESIGN

Qualitative study with semi-structured interviews.

METHODS

We conducted qualitative semi-structured interviews with a purposive sample of physiotherapists. Data were analysed following Mayring's content analytical approach using deductive and inductive methods. Physiotherapists' methods of exercise promotion were classified using the behaviour change technique (BCT) taxonomy by Michie and colleagues. Further categories were formed in an inductive manner.

RESULTS

Six female and three male physiotherapists (age: 21-55 years, professional experience: 0.5-31 years) were interviewed. We identified the use of 17 distinct BCTs across the interviews (6-13 per interview), most commonly goal setting (behaviour), instruction on how to perform a behaviour and behavioural practice/rehearsal. Four inductive main categories were formed: "barriers and challenges", "facilitators", "responsibilities" and "dealing with setbacks". Lack of patient interest and motivation was named as a main challenge. While the therapists feel responsible for instructing exercise, not all of them regard it as their role to motivate patients. Resistance or lacking compliance lead therapists to either apply strategies to proceed or quit exercise promotion.

CONCLUSIONS

Our research implies substantial individual differences in exercise promotion between therapists. A more consistent approach, more competencies to support unmotivated patients as well as a clearer definition of physiotherapists' role in exercise promotion might be needed.

Negative health consequences of pain catastrophizing among retired National Football League athletes

OBJECTIVE

This study examined the association between pain catastrophizing with pain interference, depressive symptoms, and health-related quality of life (HRQoL) among National Football League (NFL) retirees.

METHOD

Former NFL athletes from the Retired NFL Players Association (N = 90) were recruited from 2018 to 2019 via telephone and were administered measures of pain, substance use, depressive symptoms, and HRQoL. Multiple linear and binomial regression analyses examined the association of pain catastrophizing with pain interference, depressive symptoms, and HRQoL while controlling for covariates (i.e., pain intensity, concussions, opioid use, binge alcohol use, years since NFL retirement, and marital status).

RESULTS

Many retired NFL athletes reported moderate-severe depressive symptoms as well as poorer perceived physical health compared with general medical patients. Greater pain catastrophizing was associated with more severe pain interference, greater odds of reporting moderate-severe depressive symptoms, and lower odds of reporting average and above physical and mental HRQoL after adjusting for relevant covariates. Concussions were not associated with any of the study outcomes.

CONCLUSIONS

Given the findings from this study, health care professionals should monitor symptoms of catastrophizing among current and retired NFL athletes. Assessment and requisite treatment of pain catastrophizing may assist these elite athletes in reducing depressive symptoms, while improving pain interference and HRQoL in this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Physical Activity Induces Nucleus Accumbens Genes Expression Changes Preventing Chronic Pain Susceptibility Promoted by High-Fat Diet and Sedentary Behavior in Mice

Recent findings from rodent studies suggest that high-fat diet (HFD) increases hyperalgesia independent of obesity status. Furthermore, weight loss interventions such as voluntary physical activity (PA) for adults with obesity or overweight was reported to promote pain reduction in humans with chronic pain. However, regardless of obesity status, it is not known whether HFD intake and sedentary (SED) behavior is underlies chronic pain susceptibility. Moreover, differential gene expression in the nucleus accumbens (NAc) plays a crucial role in chronic pain susceptibility. Thus, the present study used an adapted model of the inflammatory prostaglandin E2 (PGE2)-induced persistent hyperalgesia short-term (PH-ST) protocol for mice, an HFD, and a voluntary PA paradigm to test these hypotheses. Therefore, we performed an analysis of differential gene expression using a transcriptome approach of the NAc. We also applied a gene ontology enrichment tools to identify biological processes associated with chronic pain susceptibility and to investigate the interaction between the factors studied: diet (standard diet vs. HFD), physical activity behavior (SED vs. PA) and PH-ST (PGE vs. saline). Our results demonstrated that HFD intake and sedentary behavior promoted chronic pain susceptibility, which in turn was prevented by voluntary physical activity, even when the animals were fed an HFD. The transcriptome of the NAc found 2,204 differential expression genes and gene ontology enrichment analysis revealed 41 biologic processes implicated in chronic pain susceptibility. Taking these biological processes together, our results suggest that genes related to metabolic and mitochondria stress were up-regulated in the chronic pain susceptibility group (SED-HFD-PGE), whereas genes related to neuroplasticity were up-regulated in the non-chronic pain susceptibility group (PA-HFD-PGE). These findings provide pieces of evidence that HFD intake and sedentary behavior provoked gene expression changes in the NAc related to promotion of chronic pain susceptibility, whereas voluntary physical activity provoked gene expression changes in the NAc related to prevention of chronic pain susceptibility. Finally, our findings confirmed previous literature supporting the crucial role of voluntary physical activity to prevent chronic pain and suggest that low levels of voluntary physical activity would be helpful and highly recommended as a complementary treatment for those with chronic pain.

Mutually beneficial effects of intensive exercise and GABAergic neural progenitor cell transplants in reducing neuropathic pain and spinal pathology in rats with spinal cord injury

Spinal cord injury (SCI) produces both locomotor deficits and sensory dysfunction that greatly reduce the overall quality of life. Mechanisms underlying chronic pain include increased neuro-inflammation and changes in spinal processing of sensory signals, with reduced inhibitory GABAergic signaling a likely key player. Our previous research demonstrated that spinal transplantation of GABAergic neural progenitor cells (NPCs) reduced neuropathic pain while intensive locomotor training (ILT) could reduce development of pain and partially reverse already established pain behaviors. Therefore, we evaluate the potential mutually beneficial anti-hypersensitivity effects of NPC transplants cells in combination with early or delayed ILT. NPC transplants were done at 4 weeks post-SCI. ILT, using a progressive ramping treadmill protocol, was initiated either 5 days post-SCI (early: pain prevention group) or at 5 weeks post-SCI (delayed: to reverse established pain) in male Sprague Dawley rats. Results showed that either ILT alone or NPCs alone could partially attenuate SCI neuropathic pain behaviors in both prevention and reversal paradigms. However, the combination of ILT with NPC transplants significantly enhanced neuropathic pain reduction on most of the outcome measures including tests for allodynia, hyperalgesia, and ongoing pain. Immunocytochemical and neurochemical analyses showed decreased pro-inflammatory markers and spinal pathology with individual treatments; these measures were further improved by the combination of either early or delayed ILT and GABAergic cellular transplantation. Lumbar dorsal horn GABAergic neuronal and process density were nearly restored to normal levels by the combination treatment. Together, these interventions may provide a less hostile and more supportive environment for promoting functional restoration in the spinal dorsal horn and attenuation of neuropathic pain following SCI. These findings suggest mutually beneficial effects of ILT and NPC transplants for reducing SCI neuropathic pain.

Pre-consultation biopsychosocial data from patients admitted for management at pain centers in Norway

Background and aims

A bio-psycho-social approach has been recommended in multidisciplinary pain clinics, and in Norway patients with severe chronic nonmalignant pain (CNMP, defined as pain that has persisted for more than 3 months) might be treated at a regional multidisciplinary pain center. The specific aims of this study were (1) to describe characteristics of a sample of outpatients referred and accepted for treatment/management to three regional multidisciplinary pain centers in Norway, (2) to examine patient differences between the centers and (3) to study associations between symptom scores (insomnia, fatigue, depression, anxiety) and patient characteristics.

Methods

Patients, aged 17 years or older with CNMP admitted to and given a date for first consultation at one of three tertiary, multidisciplinary pain centers: St. Olavs Hospital Trondheim University Hospital (STO), Haukeland University Hospital (HUS) and University Hospital of North Norway (UNN), were included in the study. Data on demographics, physical activity, characteristics of pain, previous traumatic events, social network, Insomnia Severity Index (ISI), Chalder Fatigue Questionnaire (CFQ), Hopkins Symptom Checklist-25 (HSCL-25) and SF-36v2® were retrieved from the local quality registry at each pain center.

Results

Data from 1563 patients [mean age 42 (SD 15) years and 63% females] were available for analyses. Average years with pain were 9.3 (SD 9.1). Primary education as highest level of education was reported by 20%, being actively working/student/military by 32%, and no physical activity by 31%. Further, 48% reported widespread pain, 61% reported being exposed to serious life event(s), and 77% reported having a close friend to talk to. Non-worker status, no physical activity, lack of social network, reports of being exposed to serious life event(s) and widespread pain were all characteristics repeatedly associated with clinically high symptom scores. No significant differences between the centers were found in the proportions of patients reporting fatigue nor mean levels of insomnia symptoms. However, the proportion of patients reporting symptoms of anxiety and depression was a little lower at UNN compared with STO and HUS.

Conclusions

Analyses of registry data from three tertiary multidisciplinary pain centers in Norway support previous findings from other registry studies regarding patient characterized: A large proportion being women, many years of pain, low employment rate, low physical activity rate, and a large proportion reporting previous traumatic event(s). Characteristics such as non-work participation, no physical activity, lack of social network, have been exposed to serious life event(s), and chronic widespread pain were all associated with high clinical score levels of insomnia, fatigue, and mental distress. Health related quality of life was low compared to what has been reported for a general population and a range of other patient groups.

Implications

The findings of this study indicate that physical activity and work participation might be two important factors to address in the rehabilitation of patients with chronic non-malignant pain. Future studies should also explore whether pre consultation self-reported data might give direction to rehabilitation modalities.

Modified Outpatient Physical Therapy Improvement in Movement Assessment Log (mOPTIMAL): A Responsive and Reliable Tool for Patients with Non-Operative Shoulder Pain

BACKGROUND

Medicare regulations require that physical therapists report functional limitations and severity modifiers utilizing a claims-based data collection tool. The Modified Outpatient Physical Therapy Improvement in Movement Assessment Log (mOPTIMAL) captures key constructs about patient confidence and difficulty but has not been evaluated for responsiveness/ reliability during a routine clinical encounter with patients who have shoulder pathology. The purposes of this retrospective study are to 1) explore if mOPTIMAL changes after a single session with a physical therapist, and 2) determine if the tool is reliable among people with non-operative shoulder pain.

METHODS

We included 106 individuals (58% female; mean age 45.8; range: 18-94 yrs.) with "non-operative" shoulder pathology who were seen in outpatient physical therapy from 2011 to 2012. Subjects completed a mOPTIMAL survey and a pain scale before and immediately after the initial physical therapy visit. The mOPTIMAL is a patient-centered instrument that assesses how much "Difficulty" and "Confidence" a client has in performing a battery of functional tasks. T-tests, Cronbach's Alpha, and Intra-class Correlations were used to assess responsiveness, internal consistency, and reliability, respectively.

RESULTS

After a single visit, participants reported improved Confidence with sleeping, dressing/ bathing, throwing, carrying, and lifting (adjusted for ceiling effects; p<0.002) but no change in pain. Cronbach's Alpha and Intra-class Correlations were excellent (0.821-0.923; 0.967, respectively).

CONCLUSIONS

mOPTIMAL is a reliable and responsive tool with excellent internal consistency. This observational study revealed that patient Confidence may change independent of Pain after a single physical therapy visit. Taken together, the mOPTIMAL appears to be an excellent tool to report severity modifiers in compliance with Medicare regulations.Level of Evidence: IV.

Correlates of nonmedical use of prescription opioids among a cohort of adolescents in Ontario, Canada

INTRODUCTION

Mortality and morbidity rates related to prescription opioid analgesics have been rising in North America and may be a gateway to the nonmedical use of prescription opioids (NUPO). The purpose of this study was to explore correlates of NUPO in the adolescent population given the scarce literature in this area.

METHODS

Cross-sectional data from 10,163 middle- and high-school students (15.1 ± 1.8 years old; 57.0% female; 55.6% White ethnic background) in Ontario were derived from the 2017 Ontario Student Drug Use and Health Survey. Potential correlates of NUPO in the past year included sociodemographic, behavioral, parental, and school characteristics.

RESULTS

Overall prevalence of NUPO was 10.7%. In the final multivariable model, NUPO was significantly associated with 8 of the 21 correlates examined. Students who used prescription opioids nonmedically were of black, South Asian, and "other" ethnic backgrounds (OR 2.83, OR 1.77, and OR 1.67, respectively); reported a lower subjective socioeconomic status (OR 0.92), lower parental support (OR 0.90), and lower academic performance (OR 0.86); met physical activity recommendations (OR 1.48); consumed energy drinks (OR 1.42); smoked tobacco cigarettes (OR 2.33); and used cannabis (OR 1.84).

CONCLUSIONS

Findings from this study show a wide variety of correlates of NUPO among Canadian adolescents, and highlight the need for further research and the value in targeted prevention and multi-level intervention programs for NUPO in this population.

Not a Painless Condition: Rheumatological and Musculoskeletal Symptoms in Type 2 Diabetes, and the Implications for Exercise Participation

OBJECTIVES

People with type 2 diabetes (T2D) are more likely to develop a range of rheumatological and musculoskeletal symptoms (RMS), and experience both chronic and widespread pain, compared with the general population. However, these symptoms are not commonly acknowledged by researchers, which hampers our understanding of the impact on this population. Since exercise is a key lifestyle management strategy for T2D and participation levels are typically low, understanding the potential impact of RMS on exercise participation is critical. The aim of this review is to summarise the literature regarding the prevalence and pathophysiology of RMS in T2D, the evidence for the benefits and risks associated with exercise on RMS, and the currently available tools for the reporting of RMS in both research studies and community settings.

METHODS

A narrative review.

RESULTS

There are numerous exercise trials in T2D, but few have sufficiently reported pain-related adverse events and even fewer have investigated the effects of exercise on RMS and chronic pain.

DISCUSSION

Recommendations for future research are provided.

Improving chronic pain management with eHealth and mHealth: study protocol for a randomised controlled trial

INTRODUCTION

Chronic pain has become a matter of public health concern due to its high prevalence and because public costs associated with treatment and disability increase each year. Research suggests that limitations in the traditional assessment of chronic pain patients limit the effectiveness of current medical treatments. The use of technology might serve change patient traditional monitoring into ecological momentary assessments, which might be visualised by physicians live. This study describes a randomised control trial designed to test the utility of a technology-based solution for pain telemonitoring consisting of a smartphone app for patients and a web application for physicians. The goal of this study will be to explore whether this combination of eHealth and mHealth improves the effectiveness of existing pain treatments.

METHODS AND ANALYSIS

Participants will be 250 patients randomly assigned to one of these two conditions: treatment-as-usual (TAU) and TAU +app+ web. All participants will receive the usual treatment for their pain. Only the TAU +app+ web group use Pain Monitor app, which generates alarms that are sent to the physicians in the face of previously established undesired events. Physicians will be able to monitor app reports using a web application, which might result in an adjustment of treatment. We anticipate that the use of Pain Monitor plus the therapist web will result in a reduction of pain intensity and side effects of the medication. Improvements on secondary outcomes, namely fatigue, mood, pain interference, rescue medication use and quality of life, are also expected. Mixed repeated-measure multivariate analyses of variances will be conducted to investigate whether there are differences between preassessment and postassessment scores as a function of the experimental condition.

ETHICS AND DISSEMINATION

Ethical approval from the Hospital General Universitari de Castellon was obtained. The findings will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT03606265.

Exercise modulates neuronal activation in the micturition circuit of chronically stressed rats: A multidisciplinary approach to the study of urologic chronic pelvic pain syndrome (MAPP) research network study

BACKGROUND

Rats exposed to water avoidance stress (WAS) show increased urinary frequency, increased somatosensory nociceptive reflex responses, as well as altered brain responses to bladder distension, analogous to similar observations made in patients with urologic chronic pelvic pain syndrome (UCPPS). Exercise has been proposed as a potential treatment option for patients with chronic urinary frequency and urgency. We examined the effects of exercise on urinary voiding parameters and functional brain activation during bladder distension in rats exposed to WAS.

METHODS

Adult, female Wistar Kyoto rats were exposed to 10 days of WAS and thereafter randomized to either voluntary exercise for 3 weeks or sedentary groups. Voiding parameters were assessed at baseline, post-WAS, and weekly for 3 weeks. Thereafter, cerebral blood flow (CBF) mapping was performed during isotonic bladder distension (20 cm H₂O) after intravenous bolus injection of [¹⁴C]-iodoantipyrine. Regional CBF was quantified in autoradiographs of brain slices and analyzed in 3-D reconstructed brains by statistical parametric mapping. Functional connectivity was examined between regions of the micturition circuit through interregional correlation analysis.

RESULTS

WAS exposure in sedentary animals (WAS/no-EX) increased voiding frequency and decreased urinary volumes per void. Exercise exposure in WAS animals (WAS/EX) resulted in a progressive decline in voiding frequency back to the baseline, as well as increased urinary volumes per void. Within the micturition circuit, WAS/EX compared to WAS/no-EX demonstrated a significantly lower rCBF response to passive bladder distension in Barrington's nucleus that is part of the spinobulbospinal voiding reflex, as well as in the periaqueductal gray (PAG) which modulates this reflex. Greater rCBF was noted in WAS/EX animals broadly across corticolimbic structures, including the cingulate, medial prefrontal cortex (prelimbic, infralimbic areas), insula, amygdala, and hypothalamus, which provide a 'top-down' decision point where micturition could be inhibited or triggered. WAS/EX showed a significantly greater positive brain functional connectivities compared to WAS/no-EX animals within regions of the extended reflex loop (PAG, Barrington's nucleus, intermediodorsal thalamic nucleus, pons), as well as within regions of the corticolimbic decision-making loop of the micturition circuit, with a strikingly negative correlation between these pathways. Urinary frequency was positively correlated with rCBF in the pons, and negatively correlated with rCBF in the cingulate cortex.

CONCLUSION

Our results suggest that chronic voluntary exercise may decrease urinary frequency at two points of control in the micturition circuit. During the urine storage phase, it may diminish the influence of the reflex micturition circuit itself, and/or it may increase corticolimbic control of voiding. Exercise may be an effective adjunct therapeutic intervention for modifying the urinary symptoms in patients with UCPPS.

Prioritizing a sequence of short-duration groups as the standardized pathway for chronic noncancer pain at an Australian tertiary multidisciplinary pain service: preliminary outcomes

Supplemental Digital Content is Available in the Text.

Objective:

To describe implementation and report preliminary outcomes of a resource-efficient, standardized group pathway for chronic noncancer pain.

Design:

Descriptive cross-sectional study of a group-based pain management pathway in comparison with an Australasian benchmarking data set.

Setting:

An Australian tertiary multidisciplinary pain service.

Subjects:

Patients with chronic noncancer pain actively participating in the group pathway in 2016.

Methods:

Referred patients were prioritized to a short-duration group–based standardized pain management pathway linking education, assessment, and treatment groups. Measures of pain, mood, self-efficacy, and catastrophizing and reduction in daily opioid use were collated from the Australasian data set.

Results:

In 2016, 928 patients were actively engaged with the pain service. More patients were prioritized to receive treatment in a group format in comparison with other Australasian services (68.4% vs 22%). A greater percentage of patients attended their first clinical contact within 3 months of referral (81.4%) compared with the Australasian average (68.6%). Comparable improvements in average pain intensity, pain interference, depression, anxiety, stress, pain catastrophizing, and self-efficacy were observed. There was significantly greater reduction in opioid use, including for those taking more than 40 mg of oral morphine equivalent daily dose.

Conclusion:

Implementation of a sequence of short-duration groups as the default clinical pathway resulted in shorter waiting times and noninferior outcomes in key areas for patients completing the program, compared with Australasian averages. Given the resource efficiencies of the group process, this finding has implications for service design.

The Physiotherapy Intervention for Shoulder Pain in Patients Treated for Breast Cancer: Systematic Review

Pain and joint dysfunction of the upper limb following treatment for mammary carcinoma are defined as the most frequent side effects of surgery for mammary carcinoma by calculating a prevalence range in the USA that varies between 12% and 51% with regard to pain and between 1.5% and 50% for joint dysfunction. This objective of this study was to describe physiotherapy interventions that demonstrate efficacy based on the type of pain present in patients with shoulder pain who have been treated for breast cancer.

We conducted a search for relevant publications in the last 10 years (2009-2019) on the PubMed, Medline, CINAHL, and Cochrane databases. The articles obtained were selected on the basis of correlation criteria, with themes concerning shoulder pain after mammary carcinoma and physiotherapy performed to treat this pain.

Studies suggest treating musculoskeletal pain through active exercises, joint and tissue mobilization techniques, with accessory joint mobilization and neurodynamics performed by experienced physiotherapists. In order to treat radio-induced and drug-induced neuropathic pain, both aerobic and strengthening exercises are supervised by an experienced physiotherapist and carried out twice weekly for a total of 150 minutes of exercise. Finally, the treatment suggested to deal with chronic pain uses a multidisciplinary approach, including pain education interventions, pharmacological interventions, psychological interventions, and physiotherapy interventions.

To conclude. the classification of different types of shoulder pain following mammary carcinoma treatments requires specific and targeted physiotherapy interventions in which active therapeutic exercise has a central role.

Development And Early Feasibility Testing Of A Mind-Body Physical Activity Program For Patients With Heterogeneous Chronic Pain; The GetActive Study

Background

Increasing physical function is a challenging, yet imperative goal of pain management programs. Physical activity can improve physical function, but uptake is low due to chronic pain misconceptions, poor pain management skills, and doing too much too soon.

Purpose

To increase physical function by 1) adapting an evidence-based, group, mind-body program to address the needs of patients with heterogeneous chronic pain and to facilitate individually tailored quota-based pacing with a Fitbit (GetActive with Fitbit) or without it (GetActive) (phase 1), and 2) assessing preliminary feasibility benchmarks (phase 2).

Methods

We followed evidence based frameworks for developing interventions and for early feasibility testing. In phase 1 we conducted 4 focus groups with 22 patients with heterogeneous chronic pain and adapted the mind-body program. In phase 2 we conducted a nonrandomized pilot trial of the 2 programs (N=7 and 6) with qualitative exit interviews.

Results

Focus groups showed high interest in increasing activity, a preference for walking linked to pleasurable activities, using a Fitbit to track number of steps, and learning skills to manage pain and aid with increased activity. Both programs had good to excellent feasibility markers. Participation in both programs was associated with signal of improvements in physical and emotional function, as well as intervention targets. Exit interviews confirmed high satisfaction and suggested modification.

Conclusion

Results informed subsequent adaptations of the 2 programs and methodology for an ongoing pilot randomized controlled trial (RCT) of the 2 programs, necessary before an efficacy RCT of the 2 programs against an education control.

Cardiovascular phenotyping for personalized lifestyle treatments of chronic abdominal pain in Irritable Bowel Syndrome: A randomized pilot study

BACKGROUND

Different physical exercise interventions for pain and other related symptoms largely follow non-personalized guidelines and show a high degree of variability in outcome. These interventions are considered to have different pathways toward improvement in autonomic regulation of energy metabolism. The current pilot study was conducted to assess the predictive value of individual cardiovascular (CV) activity markers at rest to predict clinical outcomes for two popular exercise-based interventions (walking and yoga) in patients with Irritable Bowel Syndrome (IBS).

METHODS

Twenty-seven adult participants with IBS were randomly assigned to a 16-biweekly Iyengar yoga or walking program. They completed pre- and post-treatment assessments on IBS symptom severity, affective and somatic complaints, and various measures of resting autonomic function including blood pressure (BP), heart rate and its variability, baroreceptor sensitivity (BRS) to activations and inhibitions with gains of brady- and tachycardiac baro-responses, and BP start points for these spontaneous baroreflexes.

RESULTS

Pretreatment BRS was differentially related to clinical response for the treatment groups. Specifically, a significant decrease in pain severity was found in response to yoga for those participants who had lower resting BRS to activations, but decreased pain severity was associated with higher resting BRS for those in the walking group. The effect was not related to affective symptom relief. Other CV measures showed similar associations with clinical outcomes for both groups.

CONCLUSIONS

The data suggest therefore that CV based phenotypes may be useful in personalizing clinical interventions for IBS. They may also point to autonomic mechanisms that are targets for such interventions.

Pain neuroscience education and physical exercise for patients with chronic spinal pain in primary healthcare: a randomised trial protocol

BACKGROUND

Chronic musculoskeletal pain affects more than 20% of the population, and the prevalence is increasing, causing suffering, loss of quality of life, disability, and an enormous expenditure on healthcare resources. The most common location for chronic pain is the spine. Many of the treatments used are mainly passive (pharmacological and invasive) and poor outcomes. The treatments currently applied in the public health system do not comply with the recommendations of the main clinical practice guidelines, which suggest the use of educational measures and physical exercise as the first-line treatment. A protocol based on active coping strategies is described, which will be evaluated through a clinical trial and which could facilitate the transfer of the recommendations of the clinical practice guidelines to a primary care setting.

METHODS

Randomised and multicentre clinical trials, which will be carried out in 10 Primary Care centres. The trial will compare the effect of a Pain Neuroscience Education program (six sessions, 10 h) and group physical exercise (18 sessions program carried out in six weeks, 18 h), with usual care physiotherapy treatment. Group physical exercise incorporates dual tasks, gaming, and reinforcement of contents of the educational program. The aim is to assess the effect of the intervention on quality of life, as well as on pain, disability, catastrophism, kinesiophobia, central sensitisation, and drug use. The outcome variables will be measured at the beginning of the intervention, after the intervention (week 11), at six months, and a year.

DISCUSSION

Therapeutic interventions based on active coping strategies are essential for the treatment of chronic pain and the sustainability of the Public Health System. Demonstrating whether group interventions have an effect size is essential for optimising resources in such a prevalent problem.

TRIAL REGISTRATION

NCT03654235 "Retrospectively registered" 31 August 2018.

EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies

The therapeutic management of Sjögren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. In view of this scenario, the European League Against Rheumatism (EULAR) promoted and supported an international collaborative study (EULAR SS Task Force) aimed at developing the first EULAR evidence and consensus-based recommendations for the management of patients with SjS with topical and systemic medications. The aim was to develop a rational therapeutic approach to SjS patients useful for healthcare professionals, physicians undergoing specialist training, medical students, the pharmaceutical industry and drug regulatory organisations following the 2014 EULAR standardised operating procedures. The Task Force (TF) included specialists in rheumatology, internal medicine, oral health, ophthalmology, gynaecology, dermatology and epidemiology, statisticians, general practitioners, nurses and patient representatives from 30 countries of the 5 continents. Evidence was collected from studies including primary SjS patients fulfilling the 2002/2016 criteria; when no evidence was available, evidence from studies including associated SjS or patients fulfilling previous sets of criteria was considered and extrapolated. The TF endorsed the presentation of general principles for the management of patients with SjS as three overarching, general consensus-based recommendations and 12 specific recommendations that form a logical sequence, starting with the management of the central triplet of symptoms (dryness, fatigue and pain) followed by the management of systemic disease. The recommendations address the use of topical oral (saliva substitutes) and ocular (artificial tear drops, topical non-steroidal anti-inflammatory drugs, topical corticosteroids, topical CyA, serum tear drops) therapies, oral muscarinic agonists (pilocarpine, cevimeline), hydroxychloroquine, oral glucocorticoids, synthetic immunosuppressive agents (cyclophosphamide, azathioprine, methotrexate, leflunomide and mycophenolate), and biological therapies (rituximab, abatacept and belimumab). For each recommendation, levels of evidence (mostly modest) and TF agreement (mostly very high) are provided. The 2019 EULAR recommendations are based on the evidence collected in the last 16 years in the management of primary 2002 SjS patients and on discussions between a large and broadly international TF. The recommendations synthesise current thinking on SjS treatment in a set of overarching principles and recommendations. We hope that the current recommendations will be broadly applied in clinical practice and/or serve as a template for national societies to develop local recommendations.

Therapeutic Exercise in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-Analysis

BACKGROUND

Dysmenorrhea is a health problem with a high impact on health and society. Some drugs have been shown to be effective at treating dysmenorrhea. Therapeutic exercise is another option for reducing the symptomatology of this health problem, with a low cost and the absence of side effects.

PURPOSE

The purposes of this review were to study the efficacy of physical exercise for pain intensity in primary dysmenorrhea and to assess its effectiveness in decreasing the duration of pain and improving quality of life.

DATA SOURCES

Searches were conducted between February 2017 and May 2017 in the databases Web of Science, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, CINAHL, and Dialnet, using the terms dysmenorrhea, exercise therapy, exercise movement technique, exercise, physical therapy, physical therapy speciality, treatment, primary dysmenorrhea, prevention, etiology, epidemiology, and pain.

STUDY SELECTION

We included randomized controlled trial studies conducted on women who were 16 to 25 years old and had primary dysmenorrhea, studies that included exercise as a type of therapy, studies that assessed the intensity and duration of pain and quality of life, and studies published in English or Spanish. Studies that included women with irregular cycles, women diagnosed with a gynecological disease, women who had had surgery, women with serious diseases, or women who used intracavitary or oral contraceptives were excluded. We started with 455 studies; 16 were included in the systematic review, and 11 were included in the 3 meta-analyses that were carried out.

DATA EXTRACTION

Two authors selected the studies and extracted their characteristics (participants, intervention, comparators, and outcomes) and results. The evaluation of the methodological quality of the studies was carried out by PEDro scale.

DATA SYNTHESIS

There was moderate evidence that therapeutic exercise can be considered a useful tool in the treatment of primary dysmenorrhea in terms of a reduction in pain intensity. Regarding the duration of pain and quality of life, there was low evidence and very low evidence, respectively. In the 3 meta-analyses, the results were significantly positive in favor of exercise for decreases in both the intensity and the duration of pain.

LIMITATIONS

Limitations of this study include the great heterogeneity of the interventions applied in the studies in terms of type of exercise, in combination or alone, and dosage. This review includes a small number of studies with risk of bias, so the present findings must be interpreted with caution.

CONCLUSIONS

Therapeutic exercise reduces pain intensity in patients with primary dysmenorrhea.

Effect of a Moderate-Intensity Aerobic Training on Joint Biomarkers and Functional Adaptations in Rats Subjected to Induced Knee Osteoarthritis

Background

Knee osteoarthritis (_kOA) is a common chronic disease that induces changes in redox status and inflammatory biomarkers, cell death, and motor impairment. Aerobic training can be a non-pharmacological alternative to prevent the progression of the disease.

Objective

To evaluate the effects of an 8 weeks moderate-intensity treadmill aerobic training program on redox status and inflammatory biomarkers and motor performance in _kOA-like changes induced by monosodium iodoacetate (MIA) in rats.

Methods

Twenty-seven rats were randomly divided into three groups: SHAM; induced _kOA (OA); and induced _kOA + aerobic training (OAE). Motor performance was evaluated by the number of falls on rotarod test, the total time of displacement and the number of failures on a 100 cm footbridge. Data for cytokines and histology were investigated locally, whereas plasma was used for redox status biomarkers.

Results

The OA group, compared to the SHAM group, increased 1.13 times the total time of displacement, 6.05 times the number of failures, 2.40 times the number of falls. There was also an increase in cytokine and in thiobarbituric acid reactive substances (TBARS) (IL1β: 5.55-fold, TNF: 2.84-fold, IL10: 1.27-fold, IL6: 1.50-fold, TBARS: 1.14-fold), and a reduction of 6.83% in the total antioxidant capacity (FRAP), and of 35% in the number of chondrocytes. The aerobic training improved the motor performance in all joint function tests matching to SHAM scores. Also, it reduced inflammatory biomarkers and TBARS level at values close to those of the SHAM group, with no change in FRAP level. The number of falls was explained by IL1β and TNF (58%), and the number of failures and the total time of displacement were also explained by TNF (29 and 21%, respectively).

Conclusion

All findings indicate the efficacy of moderate-intensity aerobic training to regulate inflammatory biomarkers associated with improved motor performance in induced _kOA-like changes, thus preventing the loss of chondrocytes.

Occupational Rehabilitation Is Associated With Improvements in Cognitive Functioning

Introduction

Occupational rehabilitation may be offered to workers on long-term sick leave who often report problems with cognitive functioning, anxiety, depression, pain, and reduced work ability. The empirical knowledge is sparce on how occupational rehabilitation may influence cognitive and emotional functioning and patients have not previously been subjected to comprehensive objective testing. The main aim of this study was to assess possible changes in cognitive and emotional functioning such as memory, attention, executive function, and emotion recognition among patients in occupational rehabilitation.

Methods

A large sample of 280 sick-listed workers referred to inpatient and outpatient occupational rehabilitation was recruited. The rehabilitation programs had a mean duration of 28 days and comprised physical activity, cognitive behavior treatment components and collaboration with the workplace. A pre-post design was applied to investigate possible changes in cognitive and emotional functioning (primary outcomes) and work and health measures (secondary outcomes), comparing the rehabilitation group with a control group of 70 healthy workers. Individuals in the control group were tested at random time points with an approximately 28 day interval between pre- and post-test, thus coinciding with the duration of rehabilitation. Repeated measures analysis of variance was used for the main analyses.

Results

Compared to the control group, the rehabilitation group had greater gains from pre- to post-test in focused and sustained attention, as well as greater improvements in work ability and reduction in subjective health complaints (SHC), helplessness, pain, pain related to work, anxiety, and depression. In the rehabilitation group, exploratory correlational analysis indicated that improvements in focused and sustained attention were associated with improvements in return-to-work self-efficacy, work ability as well as a reduction in SHC.

Conclusion

The sick-listed workers improved in focused and sustained attention and work and health measures after participating in occupational rehabilitation. This study is one of the first to systematically investigate changes in cognitive and emotional functioning during occupational rehabilitation. Clinical practice should benefit from increased knowledge about all cognitive functions and should be specifically aware of the improvements in focused and sustained attention, while memory, executive function and emotion recognition remained unchanged. The results can be used as a motivation to tailor specific interventions to gain further improvements in all cognitive and emotional functions.

Pain Intensity And Attribution Mediate The Impact Of Patient Weight And Gender On Activity Recommendations For Chronic Pain

Background and purpose

Despite the notable benefits of physical activity for chronic pain, a large proportion of patients with chronic pain report that they do not receive activity-related recommendations from their providers. Research suggests that patient factors such as weight and gender influence activity-related recommendations for chronic pain. Research also suggests that appraisals of the intensity and cause of pain may explain these weight and gender effects. We investigated the influence of patient weight and gender on observers’ likelihood of recommending activity-related treatments for pain. We also explored the mediating effects of observers’ ratings of pain severity and the extent to which pain was due to medical and lifestyle factors (pain attribution).

Patients and methods

Healthy young adults (N=616; 76% female) viewed videos (Ghent Pain Videos of Daily Activities) and vignettes of 4 patients with chronic back pain performing a standardized functional task. Patients varied by gender (female, male) and weight (normal, obese), but were otherwise equivalent on demographic characteristics and pain behaviors. Participants rated how much pain they perceived the patients to be experiencing, the extent to which they attributed the pain to medical and lifestyle factors, and their likelihood of recommending exercise, physical therapy (PT), and rest.

Results

Patient weight and gender significantly interacted to influence exercise, PT, and rest recommendations. Both pain intensity and pain attribution mediated the relationships between patient weight and activity recommendations; however, these mediation effects differed across gender and recommendation type.

Conclusion

Patient weight and gender influenced laypeople’s activity recommendations for chronic pain. Moreover, the results suggest that observers’ perceptions of pain intensity and pain attributions are mechanisms underlying these effects. If these findings are replicated in providers, interventions may need to be developed to reduce provider biases and increase their recognition of the benefits of physical activity for chronic pain.

Persistence of pain in humans and other mammals

Evolutionary models of chronic pain are relatively undeveloped, but mainly concern dysregulation of an efficient acute defence, or false alarm. Here, a third possibility, mismatch with the modern environment, is examined. In ancestral human and free-living animal environments, survival needs urge a return to activity during recovery, despite pain, but modern environments allow humans and domesticated animals prolonged inactivity after injury. This review uses the research literature to compare humans and other mammals, who share pain neurophysiology, on risk factors for pain persistence, behaviours associated with pain, and responses of conspecifics to behaviours. The mammal populations studied are mainly laboratory rodents in pain research, and farm and companion animals in veterinary research, with observations of captive and free-living primates. Beyond farm animals and rodent models, there is virtually no evidence of chronic pain in other mammals. Since evidence is sparse, it is hard to conclude that it does not occur, but its apparent absence is compatible with the mismatch hypothesis. This article is part of the Theo Murphy meeting issue 'Evolution of mechanisms and behaviour important for pain'.

Physical Condition Factors that Predict a Better Quality of Life in Women with Fibromyalgia

What physical qualities can predict the quality of life (QoL) in women with fibromyalgia (FM)? QoL is a very complex outcome affected by multiple comorbidities in people with fibromyalgia. This study aims to determine which physical qualities can predict the quality of life in women with FM. Also, a comparison between the physical qualities of women with FM and healthy counterparts was conducted. In total, 223 women participated in this cross-sectional study, 123 with FM, with ages ranging between 45 and 70 years. The study was conducted at several fibromyalgia associations and specialized medical units. QoL was measured as the main outcome. In addition, functional capacity, muscular strength, maintenance of thoracic posture, postural control, flexibility, pain threshold, and anxiety were measured. Prediction of the QoL was conducted with multiple linear regression analysis and comparison between groups, using the Mann–Whitney U test. There were significant differences between groups in all the variables measured (p < 0.01). The multiple linear regression model showed that factors influencing QoL in women with FM for all the variables measured were functional capacity, handgrip strength and bicep strength, maintenance of thoracic posture, pain threshold, and anxiety (R² = 0.53, p < 0.05). To conclude, women with FM show a significantly lower QoL than their healthy counterparts, and the factors that predict their perceived QoL are functional capacity, muscular strength, postural maintenance, pain threshold, and anxiety.

#MindinBody - feasibility of vigorous exercise (Bikram yoga versus high intensity interval training) to improve persistent pain in women with a history of trauma: a pilot randomized control trial

BACKGROUND

The neurobiology of persistent pain shares common underlying psychobiology with that of traumatic stress. Modern treatments for traumatic stress often involve bottom-up sensorimotor retraining/exposure therapies, where breath, movement, balance and mindfulness, are used to target underlying psychobiology. Vigorous exercise, in particular Bikram yoga, combines many of these sensorimotor/exposure therapeutic features. However, there is very little research investigating the feasibility and efficacy of such treatments for targeting the underlying psychobiology of persistent pain.

METHODS

This study was a randomized controlled trail (RCT) comparing the efficacy of Bikram yoga versus high intensity interval training (HIIT), for improving persistent pain in women aged 20 to 50 years. The participants were 1:1 randomized to attend their assigned intervention, 3 times per week, for 8 weeks. The primary outcome measure was the Brief Pain Inventory (BPI) and further pain related biopsychosocial secondary outcomes, including SF-36 Medical Outcomes and heart rate variability (HRV), were also explored. Data was collected pre (t0) and post (t1) intervention via an online questionnaire and physiological testing.

RESULTS

A total of 34 women were recruited from the community. Analyses using ANCOVA demonstrated no significant difference in BPI (severity plus interference) scores between the Bikram yoga (n = 17) and the HIIT (n = 15). Women in the Bikram yoga group demonstrated significantly improved SF-36 subscale physical functioning: [ANCOVA: F(1, 29) = 6.17, p = .019, partial eta-squared effect size (η_p²) = .175 and mental health: F(1, 29) = 9.09, p = .005, η_p² = .239; and increased heart rate variability (SDNN): F(1, 29) = 5.12, p = .013, η_p² = .150, scores compared to the HIIT group. Across both groups, pain was shown to decrease, no injuries were experienced and retention rates were 94% for Bikram yoga and 75% for HIIT .

CONCLUSIONS

Bikram yoga does not appear a superior exercise compared to HIIT for persistent pain. However, imporvements in quality of life measures and indicator of better health were seen in the Bikram yoga group. The outcomes of the present study suggest vigorous exercise interventions in persistent pain cohorts are feasible.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ( ACTRN12617001507370 , 26/10/2017).

Effects of thermotherapy and transcutaneous electrical nerve stimulation on patients with primary dysmenorrhea: A randomized, placebo-controlled, double-blind clinical trial

OBJECTIVES

To evaluate the effects of thermotherapy and transcutaneous electrical nerve stimulation (TENS) on pain intensity, pressure pain threshold (PPT) and conditioned pain modulation (CPM) in patients with primary dysmenorrhea (PD).

DESIGN

A randomized, placebo-controlled, double-blind clinical trial.

SETTING

Physiotherapy Department of the Universidade Cidade de São Paulo, São Paulo (Brazil).

INTERVENTIONS

Eighty-eight dysmenorrheic women were randomly allocated into four groups: Thermotherapy + TENS(n = 22), Thermotherapy(n = 22), TENS(n = 22) and Placebo(n = 22). Thermotherapy was applied by microwave diathermy (20 min), and TENS (200 μs, 100 Hz, 30 min), into the lower abdomen both.

MAIN OUTCOME MEASURES

Pain intensity was measured using the numeric rating scale (NRS) and the McGill Pain Questionnaire (Br-MPQ). PPT and CPM were recorded from women's abdominal and lumbar. The evaluation was done in 5 times: baseline, after 20, 50, 110 min and 24 h from intervention.

RESULTS

There was a significant decrease in the NRS for Thermotherapy + TENS vs. TENS, for Thermotherapy vs. TENS and for Placebo, after 20 min; for Thermotherapy vs. TENS and for Placebo, after 110 min and 24 h. Abdome PPT increased in the Thermotherapy + TENS vs. TENS and Placebo, after 50 min; for Thermotherapy + TENS vs. Placebo and for Thermotherapy vs. Placebo, after 110 min. No changes in lumbar PPT and CPM were observed.

CONCLUSIONS

The use of thermotherapy reduced NRS compared to the TENS and Placebo after 20, 110 min and 24 h. Thermotherapy demonstrated an increase in the PPT in the abdomen after 50 and 110 min and decreased the Br-MPQ scores after 110 min in patients with PD.

[Fear avoidance beliefs, pain-related self-efficacy, and subjective work ability among back pain patients : A pilot study with voluntary subjects]

BACKGROUND

Work-related fear avoidance beliefs play an important role when considering subjective work ability among people with back pain. Pain-related self-efficacy is known as a predictor for physical activity and subjective work ability.

OBJECTIVES

The present longitudinal study aims to investigate the relationships between work-related fear avoidance beliefs, pain-related self-efficacy, and subjective work ability among back pain patients.

MATERIALS AND METHODS

A total of 93 people with back pain (M = 35.58 years, SD = 13.45; range: 18-69) were assessed at baseline and 4 weeks later. Of the participants, 54.83% (n = 51) were female. Data analysis was performed with SPSS 25 using descriptive statistics and multiple regression methods.

RESULTS

Work-related fear avoidance beliefs were negatively related with subjective work ability at baseline. Pain-related self-efficacy moderated this relationship. The relationship was stronger at low and medium levels of pain-related self-efficacy. The moderation effect was not found when considering subjective work ability after 4 weeks.

CONCLUSION

Work-related fear avoidance beliefs among back pain patients seem to be important for subjective work ability in the short term. This especially holds true when patients have low self-efficacy beliefs. The investigated constructs should be emphasized in the patient-centered therapy. Longitudinal studies with larger samples and more frequent follow-ups should be investigated in future studies.

Immersive Virtual Reality and Virtual Embodiment for Pain Relief

A significant body of experimental evidence has demonstrated that it is possible to induce the illusion of ownership of a fake limb or even an entire fake body using multisensory correlations. Recently, immersive virtual reality has allowed users to experience the same sensations of ownership over a virtual body inside an immersive virtual environment, which in turn allows virtual reality users to have the feeling of being "embodied" in a virtual body. Using such virtual embodiment to manipulate body perception is starting to be extensively investigated and may have clinical implications for conditions that involve altered body image such as chronic pain. Here, we review experimental and clinical studies that have explored the manipulation of an embodied virtual body in immersive virtual reality for both experimental and clinical pain relief. We discuss the current state of the art, as well as the challenges faced by, and ideas for, future research. Finally, we explore the potentialities of using an embodied virtual body in immersive virtual reality in the field of neurorehabilitation, specifically in the field of pain.

Sedentary behaviour facilitates conditioned pain modulation in middle-aged and older adults with persistent musculoskeletal pain: a cross-sectional investigation

Introduction:

Higher physical activity (PA) and lower sedentary behaviour (SB) levels have demonstrated beneficial effects on temporal summation (TS) and conditioned pain modulation (CPM) in healthy adults. This cross-sectional study investigated the relationships between PA and SB and TS/CPM responses in individuals with chronic musculoskeletal pain.

Methods:

Sixty-seven middle-aged and older adults with chronic musculoskeletal pain were recruited from the community. Questionnaires measuring demographics, pain, and psychological measures were completed. Physical activity/SB levels were measured using the International Physical Activity Questionnaire—short form and Sedentary Behaviour Questionnaire, respectively. Semmes monofilament was used to assess mechanical TS (MTS) at the most symptomatic (MTS-S) and a reference region (MTS-R); change in the pain scores (baseline-10th application) was used for analysis. Conditioned pain modulation procedure involved suprathreshold pressure pain threshold (PPT-pain4) administered before and after (CPM30sec, CPM60sec, and CPM90sec) conditioning stimulus (2 minutes; ∼12°C cold bath immersion). For analysis, PPT-pain4 (%) change scores were used.

Results:

PPT-pain4 (%) change scores at CPM30sec and CPM60sec demonstrated significant weak positive correlations with SB levels and weak negative correlations with PA measures. After adjusting for confounding variables, a significant positive association was found between SB (h/d) and PPT-pain4 (%) change scores at CPM30sec and CPM60sec. No significant associations between MTS and PA/SB measures.

Conclusion:

Sedentariness is associated with higher pain inhibitory capacity in people with chronic musculoskeletal pain. The observed relationship may be characteristic of a protective (sedentary) behaviour to enhance pain modulatory mechanism. Prospective longitudinal studies using objective PA/SB measures are required to validate the observed relationship in a larger sample size.

Chronic pain: a review of its epidemiology and associated factors in population-based studies

Chronic pain is a common, complex, and distressing problem that has a profound impact on individuals and society. It frequently presents as a result of a disease or an injury; however, it is not merely an accompanying symptom, but rather a separate condition in its own right, with its own medical definition and taxonomy. Studying the distribution and determinants of chronic pain allows us to understand and manage the problem at the individual and population levels. Targeted and appropriate prevention and management strategies need to take into account the biological, psychological, socio-demographic, and lifestyle determinants and outcomes of pain. We present a narrative review of the current understanding of these factors.

Management of pain in individuals with spinal cord injury: Guideline of the German-Speaking Medical Society for Spinal Cord Injury

Introduction: Pain is a prominent complication in spinal cord injury (SCI). It can either occur as a direct or as an indirect consequence of SCI and it often heavily influences the quality of life of affected individuals. In SCI, nociceptive and neuropathic pain can equally emerge at the same time above or below the level of injury. Thus, classification and grading of pain is frequently difficult. Effective treatment of SCI-related pain in general and of neuropathic pain in particular is challenging. Current treatment options are sparse and their evidence is considered to be limited. Considering these aspects, a clinical practice guideline was developed as basis for an optimized, comprehensive and standardized pain management in SCI-related pain.

Methods: The German-Speaking Medical Society for Spinal Cord Injury (Deutschsprachige Medizinische Gesellschaft für Paraplegiologie – DMGP) developed a clinical practice guideline that received consensus from seven further German-speaking medical societies and one patient organization. The evidence base from clinical trials and meta-analyses was summarized and subjected to a structured consensus-process in accordance with the regulations of the Association of Scientific Medical Societies in Germany (AWMF) and the methodological requirements of the “German instrument for methodological guideline appraisal”.

Results: This consensus-based guideline (S2k classification according to the AWMF guidance manual and rules) resulted in seven on-topic statements and 17 specific recommendations relevant to the classification, assessment and therapy of pain directly or indirectly caused by SCI. Recommended therapeutic approaches comprise pharmacological (e.g. nonsteroidal anti-inflammatory drugs or anticonvulsants) and non-pharmacological (e.g. physical activity or psychotherapeutic techniques) strategies for both nociceptive and neuropathic pain.

Discussion: Assessment of SCI-related pain is standardized and respective methods in terms of examination, classification and grading of pain are already in use and validated in German language. In contrast, valid, evidence-based and efficient therapeutic options are limited and ask for further clinical studies, ideally randomized controlled trials and meta-analyses.

Effectiveness of Tai Chi on fibromyalgia patients: A meta-analysis of randomized controlled trials

OBJECTIVE

To identify empirical evidence on the effectiveness of Tai Chi in treating fibromyalgia (FM).

METHOD

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the effectiveness of Tai Chi and standard care or conventional therapeutic exercise in patients with FM. PubMed, Medline, and Physiotherapy Evidence Database were searched for relevant studies published before May 2019. Treatment effectiveness was evaluated using the fibromyalgia impact questionnaire (FIQ), and the total score, pain score, sleep quality index, fatigue, depression, and quality of life were assessing among the patients.

RESULTS

Six RCTs with 657 patients were included. Results of our meta-analysis indicated that Tai Chi exerts significant positive effects on reducing the total FIQ score at 12-16 weeks (standard mean difference [SMD]: -0.61; 95% confidence interval [CI]: -0.90 to -0.31) and pain score (SMD: -0.88; 95% CI: -1.58 to -0.18), improving sleep quality (SMD: -0.57; 95% CI: -0.86 to -0.28), relieving fatigue (SMD: -0.92; 95% CI: -1.81 to -0.04), alleviating depression (SMD: -0.49; 95% CI: -0.97 to -0.01), and enhancing quality of life physically (SMD: 6.21; 95% CI: 3.18-9.24) and psychologically (SMD: 5.15; 95% CI: 1.50-8.81).

CONCLUSION

Tai Chi exerts significantly greater effects on patients with FM than standard care; therefore, we suggest that Tai Chi can be used as an alternative treatment. However, more large-scale, high-quality, and multicenter trials are required to provide stronger evidence on the effectiveness of Tai Chi, as an alternative to aerobic exercise, compared with conventional therapeutic exercise.

Physical Fitness and the Level of Pain Intensity in Adolescents: A School-based Study

Background: The main aim of the study was to explore the association between objectively measured physical fitness and the level of pain intensity. Methods: In this cross-sectional study, we included 1036 adolescents (m_age ± SD = 16.3 ± 1.1 years; m_height ± SD = 1.74 ± 0.1 m; m_weight ± SD = 64.7 ± 12.4 kg; m_{body-mass index} ± SD = 21.3 ± 3.0 kg/m²) from 11 secondary schools located in the city of Zagreb (Croatia). Physical fitness was determined by using waist circumference, sit-ups in 1 min, standing long jump and sit-and-reach tests. Overall physical fitness index was calculated by summing the z-score values of each physical fitness test. The level of pain intensity was assessed with the Numeric Pain Rating Scale, a one-dimensional measure of pain intensity. Associations were calculated with correlation analyses. Results: In boys, pain intensity was associated with sit-ups in 1 min (r = -0.16, p < 0.001), standing long jump (r = -0.14, p = 0.003) and overall physical fitness index (r = -0.13, p = 0.004), while no significant associations with waist circumference (r = 0.04, p = 0.438) and sit-and-reach test (r = -0.01, p = 0.822) were observed. In girls, pain intensity was associated with standing long jump (r = -0.17, p < 0.001) and overall physical fitness index (r = -0.10, p = 0.018), while no significant associations with waist circumference (r = 0.01, p = 0.735), sit-ups in 1 min (r = -0.06, p = 0.126) and sit-and-reach test (r = -0.05, p = 0.232) were observed. When we adjusted for self-rated health, sleep duration, smoking status, alcohol consumption, screen-time and psychological distress, similar associations remained. Conclusions: Our study shows a weak association between physical fitness and pain intensity in a large sample of adolescents. Although a cross-sectional design, health-professionals should use physical fitness as a screening tool to assess the level of pain intensity.

Motor control using cranio-cervical flexion exercises versus other treatments for non-specific chronic neck pain: A systematic review and meta-analysis

BACKGROUND

Chronic neck pain affects a significant percentage of the adult population. Commonly, the pain is of unknown origin. In those cases, some alterations in motor control (MC) can appear in the deep cervical muscles. The specific training of these muscles could improve muscular function and reduce pain and disability.

OBJECTIVE

To determine whether MC, using cranio-cervical flexion (CCF), is more effective than other treatments for non-specific chronic neck pain (NSCNP).

DESIGN

Systematic review with meta-analysis.

METHODS

A search was done in journals and in a variety of databases, between December 2017 and March 2018. Randomized clinical trials (RCTs) and systematic reviews of RCTs comparing MC with other treatments in adults with NSCNP, regarding pain and disability, were included. Risk of bias was analysed using the Cochrane risk of bias tool. Data was analysed using a random effects model. Heterogeneity was evaluated using the I²statistic. The quality of the evidence was measured using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Ten articles were included for qualitative review; nine were used for a quantitative analysis about the effect of MC on pain and eight for the analysis regarding disability. The meta-analysis comparing MC versus other treatments showed significant differences regarding pain and disability.

CONCLUSIONS

MC interventions for NSCNP patients reduces pain and disability. MC seems to be more effective to reduce pain and disability than other treatments.

Walking increases pain tolerance in humans: an experimental cross-over study

Background and aims

Exercise is commonly used as treatment for chronic pain with positive long-term effects on pain and pain-related disability. In pain-free subjects, hypoalgesia following an acute bout of exercise compared with a control condition has consistently been demonstrated also known as exercise-induced hypoalgesia (EIH). Walking exercise, a low intensity aerobic exercise, is frequently used in clinical practice as an easily applicable intervention for patients with chronic pain. Walking exercise is furthermore recommended as an effective treatment for patients with chronic musculoskeletal pain conditions to alleviate pain and reduce disability, however, the effect of walking on pain sensitivity is currently unknown. The aims of the present study were to investigate (1) the acute effect of walking on pain sensitivity, and (2) the relative (between-subjects) and absolute (within-subject) test-retest reliability of the hypoalgesic response across two sessions separated by 1 week.

Methods

In this randomised experimental cross-over study including two identical sessions, 35 pain-free subjects performed a standardized 6 min walking test and a duration-matched quiet rest condition in a randomized and counterbalanced order in each session. Before and after both conditions, handheld pressure pain thresholds (PPTs) were assessed at the thigh and shoulder, and pressure pain thresholds (cPPT) and pain tolerance (cPTT) were assessed with computer-controlled cuff algometry at the lower leg. Change in the pain sensitivity measures were analysed with repeated-measures ANOVAs, and test-retest reliability with intraclass correlation coefficients (ICC) and agreements in classification of EIH responders/non-responders between the two sessions.

Results

All subjects completed the walking conditions in both session 1 and session 2. The perceived intensity of walking assessed with rating of perceived exertion (RPE) and walking distance did not differ significantly between session 1 (distance: 632.5 ± 75.2 meters, RPE: 10.9 ± 1.9) and session 2 (distance: 642.1 ± 80.2 meters, RPE: 11.0 ± 2.4) (p > 0.11). Moreover, RPE showed excellent relative reliability with an ICC value of 0.95 [95%CI: 0.90–0.97]. Walking increased pain tolerance (mean difference: 2.6 kPa [95%CI: 0.5–4.9 kPa; p = 0.02]), but not pain thresholds compared with rest in both sessions. Hypoalgesia after walking demonstrated fair to good relative reliability (ICC = 0.61), however the agreement in classification of EIH responders/non-responders (absolute reliability) across sessions was low and not significant (κ = 0.19, p = 0.30).

Conclusions

Walking consistently increased pain tolerance but not pain thresholds compared with a duration-matched control condition with fair to good relative reliability between sessions. Based on classification of EIH responders/non-responders the absolute reliability between the two sessions was low indicating individual variance in the EIH response. Future studies should investigate the hypoalgesic effect of a walking exercise in a clinical pain population.

The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study

BACKGROUND

Approximately one in four adults do not meet the World Health Organisation physical activity recommendations. While health promotion (i.e., physical activity) is common within chiropractic settings, little is known about chiropractors discussing this public health issue with their patients. The aim of our study is to examine the prevalence and characteristics of Australian chiropractors who frequently discuss patient physical activity.

METHODS

A national cross-sectional survey of chiropractors focusing upon practitioner characteristics, practice settings and clinical management characteristics. Regression analyses were conducted on 1924 survey respondents to identify factors associated with practitioners who frequently discuss physical activity with patients.

RESULTS

Eighty-five percent of Australian chiropractors reported 'often' discussing physical activity as part of their patient management. The strongest factors associated with chiropractors who frequently discuss physical activity obtained from the multivariate analysis include: often discussing occupational health and safety (odds ratio [OR] = 6.10; 95%CI: 3.88, 9.59), often discussing diet/nutrition (OR = 4.56; 95%CI: 3.12, 6.66), often discussing smoking/drugs/alcohol (OR = 4.41; 95%CI: 2.06, 9.40), often use of specific exercise therapy/rehabilitation/injury taping (OR = 3.76; 95%CI: 2.62, 5.39) and often caring for athletes or sports people (OR = 2.18; 95%CI: 1.56, 3.06) within their practice setting.

CONCLUSION

Discussing physical activity is a frequent feature of patient management among most chiropractors in Australia. The association between these practitioners and discussion of other costly public health burdens could suggest chiropractors have a valuable role to play in chronic disease prevention. Given the growing need for practitioner-led promotion of patient physical activity further research examination of the role and contribution of chiropractors in promoting this important public health topic among patients and communities is needed.

Evaluation of the effect of cooling strategies on recovery after surgical intervention

Introduction

Different cooling strategies exist for emergency treatments immediately after sports trauma or after surgery. The aim of this study was to investigate the effects of three cooling regimen during the immediate postoperative phase as well as in the rehabilitation phase.

Methods

36 patients undergoing anterior cruciate ligament reconstruction received either no cooling (control-group, Con, N=12), were cooled with a menthol-containing cooling bandage (Mtl, N=12) or cooled with an ice containing cold pack (CP, N=12). During a 12-week physiotherapy treatment the cross section of the vastus medialis muscle was examined (day—1; 30; 60; 90) and painkiller consumption was documented.

Results

A significant reduction in the cross section area 30 days after surgery was observed in CP and Con (Mtl: −3.2±1.7%, p=0.14, CP: −8.8±4.3%, p<0.01, Con: −7.2±8.1%, p<0.05). After 90 days of therapy, a significant increase in muscle cross section area was observed in Mtl (Mtl: 4.6%±6.1%, p<0.05, CP: 1.9%± 8.1%, p=0.29, Con: 3.3%±9.4%, p=0.31). The absolute painkiller consumption was lower for Mtl (25.5±3.7 tablets) than for CP (39.5±6.9 tablets) or Con (34.8±4.2 tablets).

Conclusion

We observed a beneficial effect of cooling by a menthol-containing bandage during the rehabilitation phase. Reduction of muscle cross section within 30 days after surgery was prevented which highly contributed to rehabilitation success after 90 days of therapy. Painkiller consumption was reduced with Mtl.

A Clinical Case Demonstrating the Effectiveness of an Individualized Multimodal Intervention for Chronic Pain and Cognitive Sequelae Secondary to Traumatic Brain Injury

Chronic pain and cognitive difficulties are common secondary to traumatic brain injury (TBI); however, given the vast heterogeneity in TBI presentation, no empirically supported treatments specific to TBI exist. This case demonstrates the effectiveness of an empirically informed multimodal treatment, in which treatment components were selected based on the patient’s individual symptoms and delivered in a manner cognizant of the patient’s cognitive profile. Treatment incorporated components of cognitive behavioral therapy, physical intervention, mindfulness, sleep hygiene, distress tolerance, and cognitive rehabilitation. Pain, sleep, and therapy-related activities were logged daily. Treatment progress was further measured with the Beck Depression Inventory–II, Beck Anxiety Inventory, Satisfaction With Life Scale, and Insomnia Severity Index. The patient reported a significant reduction in pain (average pain rating reduced from 8.5-9 to 6.90 on the numerical rating scale [NRS]) and reported experiencing his least painful day in “years” (i.e., pain rating of 3). The patient reported improvements in mood and sleep, increased engagement in physical/other pleasant activities, and improved academic performance. The patient is currently not pursuing opioids or surgical intervention for pain. This case demonstrates the importance of utilization of neuropsychological data in the identification of treatment goals, appropriate treatment selection, and implementation of suitable techniques. This approach can provide neurologically atypical individuals with interventions that better address their symptom presentation and maximize prognosis.

The Turkish Society of Physical Medicine and Rehabilitation (TSPMR) guideline recommendations for the management of fibromyalgia syndrome

In the present study, we aimed to establish a national guideline including recommendations of the Turkish Society of Physical Medicine and Rehabilitation (TSPMR) for the management of Fibromyalgia (FM) syndrome. This guideline was built mainly in accordance with the 2017 revised European League Against Rheumatism (EULAR) guideline recommendations for the management of FM. A total of 46 physical medicine and rehabilitation specialists were included. A systematic literature search was carried out in PubMed, Scopus, Cochrane, and Turkish Medical Index between 2000 and 2018. Evidence levels of the publications were evaluated, and the levels of recommendation were graded on the basis of relevant levels of evidence, The Assessment of Level of Agreement with opinions by task force members was established using the electronic Delphi technique. Recommendations were assessed by two Delphi rounds and 7 of 10 points were deemed necessary for agreement. The treatment recommendations were classified as non-pharmacological therapies (6 main items), pharmacological treatments (10 items), and complementary therapies (5 items). These were recommended in the light of evidence, depending on the clinical and general condition of each patient. This is the first national TSPMR guideline recommendations for the management of FM in Turkey. We believe our effort would be helpful for the physicians who are interested in the treatment of FM.

Effectiveness of movement and body awareness therapies in patients with fibromyalgia: a systematic review and meta-analysis

INTRODUCTION

Fibromyalgia is a long-term condition that is associated with widespread pain and is recognized as one of the major common causes of disability. The standard clinical guidance for fibromyalgia includes both pharmacological and non-pharmacological interventions. In the latter, different interventions are implemented such as aerobic exercises, flexibility exercises, strength training, stretching and body awareness (BA) therapies. The aims of this review were to provide a summary of movement and BA therapies in patients with fibromyalgia and to compare the different therapies in relation to outcomes.

EVIDENCE ACQUISITION

The search strategy was undertaken using the following databases from inception to October 2018: PubMed, Cinahl, PEDro, PsychoInfo and The Cochrane Library. Articles were eligible if they were randomized controlled trials (RCTs) comparing movement and BA therapies with another intervention.

EVIDENCE SYNTHESIS

Two authors independently extracted data and assessed trial quality; 418 studies were found, twenty-two of which met the inclusion criteria. Pain symptom was improved with movement and BA therapies such as, affective self-awareness, t'ai chi, yoga, belly dance, strengthening program and Resseguier method. Forest plot analysis in short term confirms positive trend in favor of BA; however, a great heterogeneity was found between trials.

CONCLUSIONS

This systematic review and meta-analysis shows positive results in favor of movement and BA therapies as adjunct treatment to usual care in patients who suffer from fibromyalgia. Further work in identifying the mechanism of action by which BA therapies benefit outcomes should be undertaken.

Japanese cross-cultural validation study of the Pain Stage of Change Questionnaire

Introduction:

Although evidence supports efficacy of treatments that enhance self-management of chronic pain, the efficacy of these treatments has been hypothesized to be influenced by patient readiness for self-management. The Pain Stage of Change Questionnaire (PSOCQ) is a reliable and valid measure of patient readiness to self-manage pain. However, there is not yet a Japanese version of the PSOCQ (PSOCQ-J), which limits our ability to evaluate the role of readiness for pain self-management in function and treatment response in Japanese patients with chronic pain.

Objective:

Here, we sought to develop the PSOCQ-J and evaluate its psychometric properties.

Methods:

We recruited 201 patients with chronic pain. The study participants were asked to complete the PSOCQ-J and other measures assessing pain severity, pain interference, catastrophizing, self-efficacy, and pain coping strategies.

Results:

The results supported a 4-factor structure of the PSOCQ-J. We also found good to excellent internal consistencies and good test–retest reliabilities for the 4 scales. The Precontemplation scale had weak to moderate positive correlations with measures of pain-related dysfunction and maladaptive coping. The Action and Maintenance scales had weak to moderate positive correlations with measures of self-efficacy and adaptive coping. The Contemplation scale had weak positive correlations with measures of pain interference and both adaptive and maladaptive coping.

Conclusions:

The PSOCQ-J demonstrated adequate psychometric properties in a sample of Japanese patients with chronic pain. This measure can be used to evaluate the role that readiness to self-manage pain may play in adjustment to chronic pain in Japanese pain populations.

Mental State Can Influence the Degree of Postoperative Axial Neck Pain Following Cervical Laminoplasty

STUDY DESIGN

A retrospective cohort study.

OBJECTIVE

To investigate factors influencing the incidence of moderate to severe postoperative axial neck pain following cervical laminoplasty.

METHODS

We reviewed 125 patients with cervical myelopathy who underwent double-door laminoplasty. The primary outcomes were the Numerical Rating Scale score (NRS score, 0-10) for neck pain, the Short Form 36 (SF-36) Health Survey score (Physical and Mental Component Summary scores [PCS and MCS, respectively]), and satisfaction. Imaging parameters on plain radiographs and magnetic resonance imaging were also evaluated. Patients with moderate to severe postoperative neck pain (NRS ≥ 5) were compared with those with no or mild neck pain (NRS ≤ 4).

RESULTS

One hundred and three patients (82%) with complete data were eligible for inclusion. There were 67 men and 36 women, with a mean age of 65 years (32-89 years). Twenty-five patients (23%) had moderate to severe postoperative axial pain (NRS ≥ 5) and were compared with the other 78 patients (NRS ≤ 4), which revealed several predictive factors, including female sex, the presence of preoperative neck pain, low postoperative PCS, low preoperative and postoperative MCS, and satisfaction with the treatment. Multivariable logistic regression analysis revealed that the postoperative MCS (P = .002) was a risk factor for postoperative neck pain, although the preoperative MCS did not reach statistical significance (P = .06).

CONCLUSIONS

Patients with a low mental state, possibly before surgery, are at a high risk for postoperative axial neck pain. None of the imaging parameters were statistically different.