301
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Orhan C, Lenoir D, Favoreel A, Van Looveren E, Yildiz Kabak V, Mukhtar NB, Cagnie B, Meeus M. Culture-sensitive and standard pain neuroscience education improves pain, disability, and pain cognitions in first-generation Turkish migrants with chronic low back pain: a pilot randomized controlled trial. Physiother Theory Pract 2019; 37:633-645. [PMID: 31280694 DOI: 10.1080/09593985.2019.1639231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To compare the effectiveness of culture-sensitive and standard pain neuroscience education (PNE) on pain knowledge, pain intensity, disability, and pain cognitions in first-generation Turkish migrants with chronic low back pain (CLBP).Methods: Twenty-nine Turkish first-generation migrants with CLBP were randomly assigned to the culture-sensitive (n = 15) or standard PNE (n = 14) groups. Primary (pain knowledge, pain intensity, and disability) and secondary outcomes (pain beliefs, catastrophization, and fear of movement) were evaluated at baseline, immediately after the second session of PNE (week 1), and after 4 weeks.Results: There was a significant main effect of time in pain knowledge (p < .001), pain intensity (p = .03), disability (p = .002), organic and psychological pain beliefs (p = .002, p = .01), catastrophization (p = .002), and fear of movement (p = .02). However, no significant difference was found between groups in terms of all outcome measures (p > .05).Conclusions: Both PNE programs resulted in improvements in knowledge of pain, pain intensity, perceived disability, and pain cognitions. Nevertheless, the superiority of the culture-sensitive PNE approach could not be proved. Therefore, maybe migrants who are living in the host country for longer length of time do not need culturally adapted therapies due to cultural integration, while these adaptations might be essential for the recent migrants or the autochthonous population in Turkey. Further research is required to investigate the effects of culture-sensitive PNE alone or in combination with physiotherapy interventions in recent migrants or Turkish natives with CLBP.
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Affiliation(s)
- Ceren Orhan
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Dorine Lenoir
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Belgium
| | - An Favoreel
- Department of Physiotherapy, De Sleep Health Center, Ghent, Belgium
| | - Eveline Van Looveren
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Belgium
| | - Vesile Yildiz Kabak
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Naziru Bashir Mukhtar
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
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302
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Best-Evidence Rehabilitation for Chronic Pain Part 2: Pain during and after Cancer Treatment. J Clin Med 2019; 8:jcm8070979. [PMID: 31284377 PMCID: PMC6678417 DOI: 10.3390/jcm8070979] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/24/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022] Open
Abstract
Pain during, and especially after, cancer remains underestimated and undertreated. Moreover, both patients and health care providers are not aware of potential benefits of rehabilitation strategies for the management of pain during and following cancer treatment. In this paper, we firstly provided a state-of-the-art overview of the best evidence rehabilitation modalities for patients having (persistent) pain during and following cancer treatment, including educational interventions, specific exercise therapies, manual therapies, general exercise therapies and mind-body exercise therapies. Secondly, the findings were summarized from a clinical perspective and discussed from a scientific perspective. In conclusion, best evidence suggests that general exercise therapy has small pain-relieving effects. Supporting evidence for mind-body exercise therapy is available only in breast cancer patients. At this moment, there is a lack of high-quality evidence to support the use of specific exercises and manual therapy at the affected region for pain relief during and after cancer treatment. No clinically relevant results were found in favor of educational interventions restricted to a biomedical approach of pain. To increase available evidence these rehabilitation modalities should be applied according to, and within, a multidisciplinary biopsychosocial pain management approach. Larger, well-designed clinical trials tailored to the origin of pain and with proper evaluation of pain-related functioning and the patient’s pain experience are needed.
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303
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Fletcher R, Braithwaite FA, Woodhouse M, MacInnes A, Stanton TR. Does readiness to change influence pain-related outcomes after an educational intervention for people with chronic pain? A pragmatic, preliminary study. Physiother Theory Pract 2019; 37:608-619. [PMID: 31267821 DOI: 10.1080/09593985.2019.1636436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: There is a strong association between chronic pain and unhelpful pain cognitions. Educating patients on pain neuroscience has been shown to reduce pain catastrophization, kinesiophobia, and self-perceived disability. This study investigated whether a group-based pain neuroscience education (PNE) session influenced pain-related outcomes, and whether readiness to change moderated these outcomes.Method: In a pragmatic pre-post-intervention study using a convenience sample, adults with chronic pain participated in one, 90-120 minute PNE session. Pain-related outcomes (i.e. pain catastrophization, kinesiophobia, disability, and pain neuroscience knowledge) and the Pain Stage of Change Questionnaire (PSOCQ) were assessed at baseline and immediately post-intervention. Paired t-tests evaluated pre-post changes in outcomes, and linear regression examined the impact of PSOCQ score changes on PNE-induced changes in clinical outcomes.Results: Sixty-five participants were recruited. All outcomes showed positive intervention effects (p < .01). Relationships between changes in PSOCQ subscale scores and change in post-intervention pain-related outcomes were found; 'Pre-Contemplation' was positively associated with pain catastrophization (p = .01), and 'Action' was negatively associated with kinesiophobia (p = .03).Conclusion: Consistent with previous research, there were improvements in outcomes associated with chronic pain after PNE. Some of these improvements were predicted by changes in PSOCQ scores, however, these findings are preliminary and require further investigation using controlled research designs.
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Affiliation(s)
- Roland Fletcher
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland.,Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Fraser Health Authority, JPOCSC Pain Management Clinic, Surrey, British Columbia, Canada
| | - Felicity A Braithwaite
- Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mellissa Woodhouse
- Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Aaron MacInnes
- Fraser Health Authority, JPOCSC Pain Management Clinic, Surrey, British Columbia, Canada.,Faculty of Medicine, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tasha R Stanton
- Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
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304
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Matias BA, Vieira I, Pereira A, Duarte M, Silva AG. Pain neuroscience education plus exercise compared with exercise in university students with chronic idiopathic neck pain. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2018.0084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background/AimsNeck pain is a common complaint. Its prevalence is particularly high in university students. This study examined the effects of pain neuroscience education plus exercise when compared with exercise only in university students with chronic idiopathic neck pain.MethodsUniversity students with chronic neck pain were randomly allocated to receive pain neuroscience education plus exercise, or exercise only intervention, and assessed at baseline, after the intervention and at 3-month follow-up. Pain intensity (primary outcome), disability, fear of movement, catastrophising, knowledge of pain neurophysiology, pressure pain thresholds and neck and scapular muscle endurance were measured to determine the impact of the interventions.ResultsIt was found that disability (F=17.3, P<0.001; partial eta2=0.48), fear of movement (F=5.3, P=0.009; partial eta2=0.22), catastrophising (F=16.4, P<0.001; partial eta2=0.48) and neck extensor endurance (F=11.0, P=0.002; partial eta2=0.19) changed significantly over time. There was a significant increase in neurophysiology of pain questionnaire score for the group receiving pain neuroscience education plus exercise but not for the group receiving exercise only (group vs time interaction: F=19.8, P<0.001; partial eta2=0.51). No other significant differences were found.ConclusionsPain neuroscience education plus exercise has comparable results to exercise only, with the exception of knowledge about pain neurophysiology. The impact of this difference needs to be explored in future studies.
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Affiliation(s)
- Beatriz A Matias
- Physiotherapist, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Isabel Vieira
- Physiotherapist, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Artur Pereira
- Physiotherapist, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Mário Duarte
- Physiotherapist, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Anabela G Silva
- Assistant Professor, School of Health Sciences, University of Aveiro, Aveiro, Portugal
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305
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Marris D, Theophanous K, Cabezon P, Dunlap Z, Donaldson M. The impact of combining pain education strategies with physical therapy interventions for patients with chronic pain: A systematic review and meta-analysis of randomized controlled trials. Physiother Theory Pract 2019; 37:461-472. [PMID: 31250682 DOI: 10.1080/09593985.2019.1633714] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Study Design: Systematic Review with meta-analysis.Background: Rehabilitation providers have begun to incorporate pain education into their treatment protocols to influence the patient's experience and knowledge to improve their condition. The purpose of this systematic review is to determine if the addition of pain education strategies to physical therapy treatments is beneficial in reducing pain intensity and disability for those with chronic musculoskeletal pain.Methods: A systematic database search was conducted for randomized control trials that investigated the concurrent use of pain education and physical therapy. Standardized methods for article identification, inclusion, and quality appraisal was utilized. Where possible, studies were pooled for meta-analysis, with pain and disability as the primary outcomes.Results: Fourteen articles were included in this review, of which all fourteen were rated as high quality using the PEDro scale of quality assessment. Meta-analyses were conducted on pain and disability constructs at short term (< 12 weeks) and long-term (≥ 12 weeks) for the studies that allowed for quantitative pooling of effect sizes. Thirteen out of the fourteen included studies demonstrated a decrease in pain and disability with the use of combined interventions. There was a large effect on short-term pain (SMD 0.837), long-term pain (SMD 0.964), and long-term disability (SMD 1.374). A moderate effect on with short-term disability (SMD 0.791).Conclusion: The results of this systematic review support the conclusion that utilizing pain education strategies in conjunction with interventions provided by physical therapists demonstrates a moderate to large effect sizes on pain and disability constructs but lack pooled statistical significance.
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Affiliation(s)
- Danielle Marris
- Department of Physical Therapy, Walsh University; North Canton, OH, USA
| | | | - Pablo Cabezon
- Department of Physical Therapy, Walsh University; North Canton, OH, USA
| | - Zachary Dunlap
- Department of Physical Therapy, Walsh University; North Canton, OH, USA
| | - Megan Donaldson
- School of Medicine, Public Health and Community Medicine, Tufts University, Boston, MA, USA
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306
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Ernstzen DV, Hillier SL, Louw QA. An innovative method for clinical practice guideline contextualisation for chronic musculoskeletal pain in the South African context. BMC Med Res Methodol 2019; 19:134. [PMID: 31253087 PMCID: PMC6599395 DOI: 10.1186/s12874-019-0771-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/06/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Clinical guidelines produced in developed nations may not be appropriate in resource-constrained environments, due to differences in cultural, societal, economic and policy contexts. The purpose of this article is to describe an innovative and resource-efficient method to develop a clinical practice guideline (CPG), using the CPG contextualisation approach. METHODS The four phased contextualisation framework was applied to produce a contextualised, multidisciplinary CPG for the primary health care of adults with chronic musculoskeletal pain (CMSP) in the South African context. The four phases were: a contextual analysis, evidence synthesis, contextual integration and external evaluation. Qualitative methodology was used to investigate context factors influencing health care in this environment. A systematic review was conducted to identify current, high-quality CPGs on the topic, and to synthesise a core set of clinical recommendations from the CPGs. Consensus methods were used to integrate context information with recommendations. A multidisciplinary panel of local experts authenticated and contextualised recommendations. The resultant CPG was externally reviewed using a survey. RESULTS The results from the contextual analysis phase indicated a wide range of contextual factors that could influence the applicability and implementability of the recommendations, including: the personal characteristics of the patient and clinician, social and environmental circumstances, healthcare interventions available, and healthcare system factors. During phase two, six existent high quality CPGs were identified and a core set of multidisciplinary recommendations were sourced from them. The contextual integration phase produced the validated recommendations, accompanied by its underpinning body of evidence and context specific information. The outcome of phase four (external review) was that the recommendations were confirmed as relevant for the intended setting. CONCLUSION CPG contextualisation was found to be a practical approach to develop a contextualised multidisciplinary CPG for the primary health care of adults with CMSP in a South African setting. The contextualisation approach enhanced the integration of multiple stakeholder perspectives and highlighted the importance of considering clinical, social and economic complexities during CPG development. Attention to contextual information is advocated to enhance the uptake of CPG recommendations, particularly in resource constrained settings. TRIAL REGISTRATION Health Research Ethics Committee of Stellenbosch University, South Africa (S14/01/018); the review protocol was registered on PROSPERO (registration number CRD42015022098 ).
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Affiliation(s)
- D V Ernstzen
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
| | - S L Hillier
- Faculty of Medicine and Health Sciences, Stellenbosch University, P O Box 241, Cape Town, 8000, South Africa.,Division of Health Sciences, University of South Australia, Adelaide, 5000, Australia
| | - Q A Louw
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
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307
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Benedict TM, Nitz AJ, Abt JP, Louw A. Development of a pain neuroscience education program for post-traumatic stress disorder and pain. Physiother Theory Pract 2019; 37:473-485. [PMID: 31232667 DOI: 10.1080/09593985.2019.1633717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction: Individuals with co-morbid post-traumatic stress disorder (PTSD) and pain have higher disability, pain, and pain catastrophizing beliefs than patients without PTSD. Pain neuroscience education (PNE) may be an effective tool to help those with PTSD and pain reduce maladaptive beliefs about pain. The purpose of this paper is to report the development and evaluation of a PNE curriculum for participants with PTSD and pain. Methods: After writing an initial draft of PNE for PTSD and pain, a panel of medical experts in PNE, PTSD, and rehabilitation reviewed the booklet. After addressing recommendations from the medical panel (n = 29), individuals with (n = 13) and without (n = 20) PTSD reviewed the booklet. Results: Overall, 89% of participants recommended the PNE booklet and 90% thought it would help patients with PTSD and pain. Although patients with PTSD rated the PNE booklet more critically than other participants, a particular support group (n = 4) rated the PNE booklet significantly different (p < .05) than remaining participants with PTSD (n = 9). Individuals with PTSD and pain were able to comprehend the PNE booklet at a comparable rate to an expert medical panel and participants without PTSD after adjusting for education levels (p = .12). Conclusions: Many patients with PTSD and pain avoid painful activities because they believe they are harmful. This research demonstrates that individuals with PTSD and pain can comprehend PNE that challenges these beliefs. The PNE curriculum developed by this research may provide a logical explanation for the link between PTSD symptoms and pain and should be tested for clinical effectiveness.
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Affiliation(s)
- Timothy M Benedict
- Army Public Health Center, Aberdeen Proving Ground, MD, USA.,Department of Rehabilitation Sciences, University of Kentucky, Lexington, KY, USA
| | - Arthur J Nitz
- Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - John P Abt
- Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA
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308
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Louw A, Puentedura EJ, Reed J, Zimney K, Grimm D, Landers MR. A controlled clinical trial of preoperative pain neuroscience education for patients about to undergo total knee arthroplasty. Clin Rehabil 2019; 33:1722-1731. [DOI: 10.1177/0269215519857782] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study was to determine if a preoperative pain neuroscience education program would result in superior outcomes compared to usual preoperative education for total knee arthroplasty. Design: Controlled clinical trial with alternating allocation. Setting: Community-based hospital. Subjects: Consecutive sample of 120 patients scheduled for total knee arthroplasty. Intervention: Traditional hospital preoperative total knee arthroplasty education program on its own, or with an additional 30-minute group pain neuroscience education session. Main measures: Primary outcomes were measurements at one, three, and six months for pain, function, fear of movement, and pain catastrophization. We also compared opioid usage, healthcare expenses, and patient satisfaction between groups. Results: There were no statistically significant differences in any outcome measures between the two groups over time, except for patient satisfaction. Those in the experimental group had more agreement with statements about “preparation for surgery” ( P = .038), “would do again” ( P = .032), and “met expectations” ( P = .033) compared to those in the control group averaged over the three measurement times. Patients improved in several outcome measures over time regardless of group assignment, with a 34% improvement in pain, 36% improvement in function, 16% improvement in fear of movement, and 23% improvement in pain catastrophization scores. Conclusion: Adding a brief 30-minute pain neuroscience education session to a traditional preoperative total knee arthroplasty education program did not result in any significant improvements, except patient satisfaction.
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Affiliation(s)
- Adriaan Louw
- International Spine Pain Institute, Story City, IA, USA
| | - Emilio J Puentedura
- International Spine Pain Institute, Story City, IA, USA
- Department of Physical Therapy, Baylor University, Waco, TX, USA
| | - Jordan Reed
- Department of Physical Therapy, Spencer Hospital, Spencer, IA, USA
| | - Kory Zimney
- International Spine Pain Institute, Story City, IA, USA
- Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
| | - Derek Grimm
- Department of Pharmacy Services, Spencer Hospital, Spencer, IA, USA
| | - Merrill R Landers
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
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309
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Fernández-de-Las-Peñas C, Nijs J. Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res 2019; 12:1899-1911. [PMID: 31354339 PMCID: PMC6590623 DOI: 10.2147/jpr.s154728] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/24/2019] [Indexed: 02/06/2023] Open
Abstract
Myofascial pain syndrome is a pain condition characterized by the presence of trigger points. Current evidence, mostly experimental studies, clearly supports a role of trigger points on peripheral and central sensitization since they are able to contribute to sensitization of peripheral nociceptors, spinal dorsal horn neurons, and the brainstem. Several interventions are proposed for treating trigger points, dry needling being one of the most commonly used by clinicians. There is no consensus on the clinical application of trigger point dry needling: some authors propose that local twitch responses should be elicited during the needling intervention to be effective, whereas others do not. The application of trigger point dry needling is able to reduce the excitability of the central nervous system by reducing peripheral nociception associated to the trigger point, by reducing dorsal horn neuron activity, and by modulating pain-related brainstem areas. However, the effects are mainly observed in the short-term, and effect sizes are moderateto small. Therefore, the current review proposes that the application of trigger point dry needling should be integrated into current pain neuroscience paradigm by combining its application with pain neuroscience education, graded exercise and manual therapy. Additionally, patient’s expectations, beliefs, previous experiences and patient–clinician interaction should be considered when integrating trigger point dry needling into a comprehensive treatment approach.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Jo Nijs
- Faculty of Physical Education and Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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310
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Polonowita AD, Thomson WM, Thorburn DN. Clinical efficacy of a simplified approach to managing chronic temporomandibular disorders: evidence from a 1-year case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:227-234. [PMID: 31285165 DOI: 10.1016/j.oooo.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 05/26/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Chronic temporomandibular disorder (cTMD) produces orofacial pain and limited jaw function and impacts on quality of life. A clinical case series of patients referred to a hospital specialist service is described here. STUDY DESIGN In a 1-year consecutive case series of 162 patients with cTMDs, each patient had been managed with self-awareness and jaw exercises, as well as oral appliances. Pain severity and chewing function were scored by using a visual analogue scale (VAS), and quality of life was assessed by using the Oral Health Impact Profile-Temporomandibular Dysfunction (OHIP-TMD). RESULTS Females comprised 87% (average age 49 years). Treatment time averaged 20.8 months, and the average pain duration was 2.8 years. The mean VAS pain score fell from 6.9 (standard deviation [SD] 1.6) to 2.0 (SD 1.9) after treatment, giving a "large" effect size of 3.1. Chewing difficulty improvement also showed a "large" effect size (2.5). For the 33 patients for whom longitudinal OHIP-TMD data were available, the mean pretreatment and posttreatment scores of 51.2 (SD 20.9) and 26.2 (SD 17.7) showed a "large" effect size of 1.2. CONCLUSIONS A simple noninvasive protocol for managing cTMD with self-help, exercises, and oral devices resulted in clinically and statistically meaningful improvements in pain, function, and quality of life.
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Affiliation(s)
- Ajith D Polonowita
- Oral Medicine Specialist, Christchurch Hospital, NZ; Head of Discipline in Oral Medicine, The University of Otago, Dunedin, New Zealand.
| | - W Murray Thomson
- Professor of Dental Epidemiology and Public Health, The University of Otago, Dunedin, New Zealand
| | - Dennis N Thorburn
- Formerly Oral Medicine specialist, Christchurch Hospital, New Zealand
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311
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Louw A, Farrell K, Choffin B, Foster B, Lunde G, Snodgrass M, Sweet R, Weitzel M, Wilder R, Puentedura EJ. Immediate effect of pain neuroscience education for recent onset low back pain: an exploratory single arm trial. J Man Manip Ther 2019; 27:267-276. [PMID: 31161919 DOI: 10.1080/10669817.2019.1624006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Study Design: A prospective, single-arm, pre-postintervention study.Objective: To determine the preliminary usefulness of providing pain neuroscience education (PNE) on improving pain and movement in patients presenting with non-chronic mechanical low back pain (LBP).Background: PNE has been shown to be an effective intervention for the treatment of chronic LBP but its usefulness in patients with non-chronic LBP has not been examined.Methods: A single group cohort pilot study was conducted. Eighty consecutive patients with LBP < 3 months completed a demographics questionnaire, leg and LBP rating (Numeric Pain Rating Scale - NPRS), disability (Oswestry Disability Index), fear-avoidance (Fear-Avoidance Beliefs Questionnaire), pain catastrophizing (Pain Catastrophizing Scale), central sensitization (Central Sensitization Inventory), pain knowledge (Revised Neurophysiology of Pain Questionnaire), risk assessment (Keele STarT Back Screening Tool), active trunk flexion and straight leg raise (SLR). Patients received a 15-minute verbal, one-on-one PNE session, followed by repeat measurement of LBP and leg pain (NPRS), trunk flexion and SLR.Results: Immediately after intervention, LBP and leg pain improved significantly (p < 0.001), but the mean change did not exceed minimal clinically important difference (MCID) of 2.0. Active trunk flexion significantly improved (p < 0.001), with the mean improvement (4.7 cm) exceeding minimal detectible change (MDC). SLR improved significantly (p = 0.002), but mean change did not exceed MDC.Conclusions: PNE may be an interesting option in the treatment of patients with non-chronic mechanical LBP. The present pilot study provides the rationale for studying larger groups of patients in controlled studies over longer periods of time.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA.,Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Kevin Farrell
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Breanna Choffin
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Brooke Foster
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Grace Lunde
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Michelle Snodgrass
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Robert Sweet
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Matthew Weitzel
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Rebecca Wilder
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Emilio J Puentedura
- International Spine and Pain Institute, Story City, IA, USA.,Doctor of Physical Therapy Program, Baylor University Graduate School, Waco, TX, USA
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312
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Heathcote LC, Allen JM, Gunn KM, Fox S, Harvie DS, Olver I, Skinner IW, Smith AG, Stanton TR, Whitford HS, Moseley GL. Pain Education for Adolescents and Young Adults Living Beyond Cancer: An Interdisciplinary Meeting Report. J Adolesc Young Adult Oncol 2019; 8:529-533. [PMID: 31150299 DOI: 10.1089/jayao.2019.0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pain is an understudied and undertreated consequence of cancer survival. Pain education is now a recommended treatment approach for persistent non-cancer pain, yet it has not been well applied to the context of adolescent and young adult (AYA) cancer survival. In March 2018, an interdisciplinary meeting was held in Adelaide, South Australia to set a research agenda for pain education in AYA cancer survivors. We identified that AYAs with persistent pain and those with heightened pain-related fear have the potential to benefit from pain education. We identified a number of unique challenges of engaging AYA survivors in pain education, and point towards future research directions.
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Affiliation(s)
- Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Stanford, California
| | - Julie M Allen
- The Pentimento Project, Tarragindi, Queensland, Australia
| | - Kate M Gunn
- School of Health Sciences/University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Simonie Fox
- AIA Australia, Sydney, New South Wales, Australia
| | - Daniel S Harvie
- The Hopkins Centre, Menzies Health Institute QLD, Griffith University, Gold Coast, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Ian Olver
- School of Health Sciences/University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Ian W Skinner
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Andrew G Smith
- Leukaemia Foundation of Australia, Melbourne, Victoria, Australia
| | - Tasha R Stanton
- School of Health Sciences/University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.,Neuroscience Research Australia, Sydney, Australia
| | - Hayley S Whitford
- School of Health Sciences/University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - G Lorimer Moseley
- School of Health Sciences/University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.,Neuroscience Research Australia, Sydney, Australia
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Larsen DB, Graven-Nielsen T, Boudreau SA. Pain-Induced Reduction in Corticomotor Excitability Is Counteracted by Combined Action-Observation and Motor Imagery. THE JOURNAL OF PAIN 2019; 20:1307-1316. [PMID: 31077798 DOI: 10.1016/j.jpain.2019.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/22/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Abstract
Musculoskeletal pain reduces corticomotor excitability (CE) and methods modulating such CE reduction remain elusive. This study aimed to modulate pain-induced CE reduction by performing action observation and motor imagery (AOMI) during experimental muscle pain. Twelve healthy participants participated in 3 cross-over and randomized sessions separated by 1 week. During the AOMI session subjects performed an AOMI task for 10 minutes. In the AOMI+PAIN session, hypertonic saline was injected in the first dorsal interosseous muscle before performing the AOMI task. In the PAIN session, participants remained at rest for 10 minutes or until pain-resolve after the hypertonic saline injection. CE was assessed using transcranial magnetic stimulation motor-evoked potentials (TMS-MEPs) of the first dorsal interosseous muscle at baseline, during, immediately after, and 10 minutes after AOMI and/or PAIN. Facilitated TMS-MEPs were found after 2 and 4 minutes of AOMI performance (P < .017) whereas a reduction in TMS-MEPs occurred at 4 minutes (P < .017) during the PAIN session. Performing the AOMI task during pain counteracted the reduction in CE, as evident by no change in TMS-MEPs during the AOMI+PAIN session (P > .017). Pain intensity was similar between the AOMI+PAIN and PAIN sessions (P = .71). This study, which may be considered a pilot, demonstrated the counteracting effects of AOMI on pain-induced decreases in CE and warrants further studies in a larger population. PERSPECTIVE: This is the first study to demonstrate a method counteracting the reduction in CE associated with acute pain and advances therapeutic possibilities for individuals with chronic musculoskeletal pain.
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Affiliation(s)
- Dennis Boye Larsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Faculty of Medicine, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Faculty of Medicine, Aalborg, Denmark
| | - Shellie Ann Boudreau
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Faculty of Medicine, Aalborg, Denmark.
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314
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315
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Potential Nervous System Sensitization in Patients With Persistent Lower Extremity Tendinopathies: 3 Case Reports. J Orthop Sports Phys Ther 2019; 49:272-279. [PMID: 30759356 DOI: 10.2519/jospt.2019.8600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tendinopathy is a condition often associated with pain and functional and sport performance limitations. While targeted exercise prescriptions are often effective, many patients with tendinopathy develop persistent symptoms. Emerging evidence suggests a possible link between nervous system sensitization and tendinopathy. If so, identifying and treating specific pain mechanisms may improve outcomes. CASE DESCRIPTION Three patients were seen in physical therapy for complaints of ongoing chronic tendon pain and self-reported disability, despite being treated previously and receiving evidence-informed care. Upon examination, each patient demonstrated signs consistent with possible dysfunction of central pain mechanisms. Joint mobilization, pain neuroscience education, and aerobic exercise were primary interventions in each case to decrease pain and improve function. OUTCOMES The 3 patients were treated for 5 sessions over the course of 8 weeks. Clinically significant improvement was noted in measures of pain, self-reported function, and pressure pain thresholds. At discharge, all patients were able to run without symptoms, and improvement was maintained at 1-year follow-up. DISCUSSION Tendinopathy, while often described as local pain and dysfunction, may be associated with dysfunction of the nervous system. Identifying and treating pain mechanisms in addition to relevant impairments may be an appropriate intervention approach for individuals with tendinopathy. LEVEL OF EVIDENCE Therapy, level 4. J Orthop Sports Phys Ther 2019;49(4):272-279. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8600.
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316
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Heathcote LC, Pate JW, Park AL, Leake HB, Moseley GL, Kronman CA, Fischer M, Timmers I, Simons LE. Pain neuroscience education on YouTube. PeerJ 2019; 7:e6603. [PMID: 30923652 PMCID: PMC6432903 DOI: 10.7717/peerj.6603] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/11/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The Internet in general, and YouTube in particular, is now one of the most popular sources of health-related information. Pain neuroscience education has become a primary tool for managing persistent pain, based in part on the discovery that information about pain can change pain. Our objective was to examine the availability, characteristics, and content of YouTube videos that address the neuroscience of pain. METHODS We conducted a systematic review of videos on YouTube using the search terms "pain education", "what is pain", and "pain brain" in January 2018. Videos were included if they were in English, were under 10 minutes long, and included information on the neuroscience of pain. Videos were coded for (i) descriptive characteristics (e.g., number of views, duration on YouTube), (ii) source and style, (iii) whether or not they addressed seven pre-determined target concepts of pain neuroscience education (e.g., 'Pain is not an accurate marker of tissue state'), and (iv) how engaging they were. RESULTS We found 106 unique videos that met the inclusion criteria. The videos ranged from having four views to over five million views (Mdn = 1,163 views), with the three most highly viewed videos accounting for 75% of the total views. Animated videos were much more highly viewed than non-animated videos. Only a small number of videos had been posted by a clearly-identifiable reputable source such as an academic or medical institution (10%), although a number of videos were posted by healthcare professionals and professional medical societies. For a small number of videos (7%), the source was unclear. We found 17 videos that addressed at least one target concept of pain neuroscience science education, only nine of which were considered to be at least somewhat engaging. The target concept 'Pain is a brain output' was considered to be well addressed by the most videos (N = 11), followed by 'Pain is a protector' (N = 10). We found only one video that adequately addressed all seven target concepts of pain neuroscience education. DISCUSSION YouTube contains a variety of videos that practitioners, patients, and families may view to access pain neuroscience education information. A small portion of these videos addressed one or more target concepts of pain neuroscience education in an engaging manner. It is yet to be determined to what extent patients are able to learn information from these videos, to what extent the videos promote behavior change, and thus to what extent the videos may be useful for clinical practice.
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Affiliation(s)
- Lauren C. Heathcote
- Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Joshua W. Pate
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Anna L. Park
- Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Hayley B. Leake
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - G. Lorimer Moseley
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Corey A. Kronman
- Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Molly Fischer
- Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Inge Timmers
- Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Laura E. Simons
- Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
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317
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Rice D, Nijs J, Kosek E, Wideman T, Hasenbring MI, Koltyn K, Graven-Nielsen T, Polli A. Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions. THE JOURNAL OF PAIN 2019; 20:1249-1266. [PMID: 30904519 DOI: 10.1016/j.jpain.2019.03.005] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/24/2019] [Accepted: 03/15/2019] [Indexed: 12/11/2022]
Abstract
Exercise is considered an important component of effective chronic pain management and it is well-established that long-term exercise training provides pain relief. In healthy, pain-free populations, a single bout of aerobic or resistance exercise typically leads to exercise-induced hypoalgesia (EIH), a generalized reduction in pain and pain sensitivity that occurs during exercise and for some time afterward. In contrast, EIH is more variable in chronic pain populations and is more frequently impaired; with pain and pain sensitivity decreasing, remaining unchanged or, in some cases, even increasing in response to exercise. Pain exacerbation with exercise may be a major barrier to adherence, precipitating a cycle of physical inactivity that can lead to long-term worsening of both pain and disability. To optimize the therapeutic benefits of exercise, it is important to understand how EIH works, why it may be impaired in some people with chronic pain, and how this should be addressed in clinical practice. In this article, we provide an overview of EIH across different chronic pain conditions. We discuss possible biological mechanisms of EIH and the potential influence of sex and psychosocial factors, both in pain-free adults and, where possible, in individuals with chronic pain. The clinical implications of impaired EIH are discussed and recommendations are made for future research, including further exploration of individual differences in EIH, the relationship between exercise dose and EIH, the efficacy of combined treatments and the use of alternative measures to quantify EIH. PERSPECTIVE: This article provides a contemporary review of the acute effects of exercise on pain and pain sensitivity, including in people with chronic pain conditions. Existing findings are critically reviewed, clinical implications are discussed, and recommendations are offered for future research.
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Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand; Waitemata Pain Services, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand.
| | - Jo Nijs
- Pain in Motion International Research Group(#); Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Spine Center, Löwenströmska Hospital, Upplands Väsby, Sweden
| | - Timothy Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Monika I Hasenbring
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
| | - Kelli Koltyn
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Andrea Polli
- Pain in Motion International Research Group(#); Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; Research Foundation - Flanders (FWO), Brussels, Belgium
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318
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Nijs J, Polli A, Willaert W, Malfliet A, Huysmans E, Coppieters I. Central sensitisation: another label or useful diagnosis? Drug Ther Bull 2019; 57:60-63. [PMID: 30858291 DOI: 10.1136/dtb.2018.000035] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Jo Nijs
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium.,Chronic pain rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
| | - Andrea Polli
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Ward Willaert
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Anneleen Malfliet
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium.,Chronic pain rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Eva Huysmans
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium.,Chronic pain rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium.,Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Iris Coppieters
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium.,Chronic pain rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Belgium
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319
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Watson JA, Ryan CG, Cooper L, Ellington D, Whittle R, Lavender M, Dixon J, Atkinson G, Cooper K, Martin DJ. Pain Neuroscience Education for Adults With Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2019; 20:1140.e1-1140.e22. [PMID: 30831273 DOI: 10.1016/j.jpain.2019.02.011] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/03/2019] [Accepted: 02/23/2019] [Indexed: 12/16/2022]
Abstract
Chronic musculoskeletal pain (CMP) is an urgent global public health concern. Pain neuroscience education (PNE) is an intervention used in the management of CMP aiming to reconceptualize an individual's understanding of their pain as less threatening. This mixed-methods review undertook a segregated synthesis of quantitative and qualitative studies to investigate the clinical effectiveness, and patients' experience of, PNE for people with CMP. Electronic databases were searched for studies published between January 1, 2002, and June 14, 2018. Twelve randomized, controlled trials (n = 755 participants) that reported pain, disability, and psychosocial outcomes and 4 qualitative studies (n = 50 participants) that explored patients experience of PNE were included. The meta-analyzed pooled treatment effects for PNE versus control had low clinical relevance in the short term for pain (-5.91/100; 95% confidence interval [CI], -13.75 to 1.93) and disability (-4.09/100; 95% CI, -7.72 to -.45) and in the medium term for pain (-6.27/100; 95% CI, -18.97 to 6.44) and disability (-8.14/100; 95% CI, -15.60 to -.68). The treatment effect of PNE for kinesiophobia was clinically relevant in the short term (-13.55/100; 95% CI, -25.89 to -1.21) and for pain catastrophizing in the medium term (-5.26/52; 95% CI, -10.59 to .08). A metasynthesis of 23 qualitative findings resulted in the identification of 2 synthesized findings that identified several key components important for enhancing the patient experience of PNE, such as allowing the patient to tell their own story. These components can enhance pain reconceptualization, which seems to be an important process to facilitate patients' ability to cope with their condition. The protocol was published on PROSPERO (CRD42017068436). Perspective: We outline the effectiveness of PNE for the management of pain, disability, and psychosocial outcomes in adults with CMP. Key components that can enhance the patient experience of PNE, such as allowing the patient to tell their own story, are also presented. These components may enhance pain reconceptualization.
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Affiliation(s)
- James A Watson
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom.
| | - Cormac G Ryan
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom
| | - Lesley Cooper
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom
| | - Dominic Ellington
- North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Hardwick Road, Stockton on Tees, Cleveland, TS19 8PE, United Kingdom
| | - Robbie Whittle
- North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Hardwick Road, Stockton on Tees, Cleveland, TS19 8PE, United Kingdom
| | - Michael Lavender
- North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Hardwick Road, Stockton on Tees, Cleveland, TS19 8PE, United Kingdom
| | - John Dixon
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom
| | - Greg Atkinson
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom
| | - Kay Cooper
- The Scottish Centre for Evidenced-Based, Multi-professional Practice: A Joanna Briggs Institute Centre of Excellence, School of Health Sciences, Robert Gordon University, Aberdeen, AB10 7QG, United Kingdom
| | - Denis J Martin
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom
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320
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Benedict TM, Singleton MD, Nitz AJ, Shing TL, Kardouni JR. Effect of Chronic Low Back Pain and Post-Traumatic Stress Disorder on the Risk for Separation from the US Army. Mil Med 2019; 184:431-439. [DOI: 10.1093/milmed/usz020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/14/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractIntroductionCo-morbid post-traumatic stress disorder (PTSD) and low back pain (LBP) are common reasons for increased disability in the Veteran communities. Medical discharge from the military represents a considerable financial cost to society. Little is currently known about the impact of LBP and PTSD as longitudinal risk factors for medical discharge from Active Duty military service.Materials and MethodsA retrospective analysis of US Army Active Duty Soldiers from 2002 to 2012 was performed to determine the risk for medical discharge. Four levels of exposure for were identified as independent variables: no chronic LBP or PTSD, chronic LBP only, PTSD only, and co-morbid PTSD present with chronic LBP. Statistical analysis utilized modified Poisson regression controlling for sex, age, rank, time in service, deployment, mental health, sleep disorders, alcohol use, tobacco use, obesity, and military occupation. This study was approved by a Department of Defense Institutional Review Board.ResultsAfter controlling for potential confounding variables, the RR for chronic LBP and PTSD independently was 3.65 (95% CI: 3.59–3.72) and 3.64 (95% CI: 3.53–3.75), respectively, and 5.17 (95% CI: 5.01–5.33) when both were present.ConclusionsThis is the first study to identify a history of both chronic LBP and PTSD as substantial risk factors for medical discharge from the US Army. PTSD and chronic LBP may mutually reinforce one another and deplete active coping strategies, making Soldiers less likely to be able to continue military service. Future research should target therapies for co-morbid PTSD and chronic LBP as these conditions contribute a substantial increase in risk of medical discharge from the US Army.
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Affiliation(s)
- Timothy M Benedict
- Department of Rehabilitation Sciences, University of Kentucky, 900 S. Limestone Ave Lexington, KY
| | - Michael D Singleton
- Department of Biostatistics, University of Kentucky, 111 Washington Ave, Lexington, KY
| | - Arthur J Nitz
- Department of Rehabilitation Sciences, University of Kentucky, 900 S. Limestone Ave Lexington, KY
| | - Tracie L Shing
- U.S. Army Research Institute of Environmental Medicine, Kansas St, Natick, MA
| | - Joseph R Kardouni
- U.S. Army Research Institute of Environmental Medicine, Kansas St, Natick, MA
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321
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A Holistic Approach to Pain Management in the Rheumatic Diseases. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00116-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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322
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Louis-Charles K, Biggie K, Wolfinbarger A, Wilcox B, Kienstra CM. Pelvic Floor Dysfunction in the Female Athlete. Curr Sports Med Rep 2019; 18:49-52. [DOI: 10.1249/jsr.0000000000000563] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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323
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Orhan C, Cagnie B, Favoreel A, Van Looveren E, Akel U, Mukhtar NB, De Meulemeester K, Pas R, Lenoir D, Meeus M. Development of culturally sensitive Pain Neuroscience Education for first-generation Turkish patients with chronic pain: A modified Delphi study. Musculoskelet Sci Pract 2019; 39:1-9. [PMID: 30439644 DOI: 10.1016/j.msksp.2018.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/05/2018] [Accepted: 10/30/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pain Neuroscience Education (PNE) has been recognized as an efficacious approach for chronic pain, but evidence for these findings have mainly been gathered in Caucasian patient populations. In recent years, it has been proposed that the treatment of pain and patient information materials should be culturally sensitive for different ethnic populations and cultures since cultural variations in pain beliefs and cognitions. OBJECTIVES To culturally adapt PNE material for first-generation Turkish patients with chronic pain. DESIGN A modified Delphi study with three consecutive rounds. METHOD A total of 10 participants (8 experts and 2 first-generation Turkish patients with chronic pain) were recruited for this study. Three online questionnaire rounds were conducted to synthesize the perspectives and to reach agreement on the suggested PNE materials. RESULTS Results on multiple-choice questions from the first round revealed that the compatibility of the visual information and the clarity of the message obtained lower scores. Examples, visual information (illustrations, pictures), and metaphors in the teaching materials and the home education leaflet were revised based on suggestions in Rounds 1 and 2. In Round 3, respondents reached an acceptable agreement level for the clinical usefulness of the PNE teaching materials and the home education material. CONCLUSIONS Culturally sensitive PNE materials were produced for first-generation Turkish patients. Since the results of the present study only reveal perspectives of the experts, further validation of education materials may be required before they are recommended for Turkish patients in clinical practices.
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Affiliation(s)
- Ceren Orhan
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium.
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium.
| | | | - Eveline Van Looveren
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium; Pain in Motion International Research Group, Belgium.
| | - Umit Akel
- Fysio Point Maastricht, Maastricht, Netherlands.
| | | | | | - Roselien Pas
- Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium; Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.
| | - Dorine Lenoir
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium; Pain in Motion International Research Group, Belgium.
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium; Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium.
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324
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325
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Sole G, Mącznik AK, Ribeiro DC, Jayakaran P, Wassinger CA. Perspectives of participants with rotator cuff-related pain to a neuroscience-informed pain education session: an exploratory mixed method study. Disabil Rehabil 2019; 42:1870-1879. [PMID: 30634871 DOI: 10.1080/09638288.2018.1542037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To explore perceptions and initial outcomes of patients with rotator cuff-related pain to a pain education session.Materials and Methods: Ten individuals with persistent rotator cuff-related pain (≥3 months duration) attended an individual pain education session. They completed patient-reported outcomes measures on a weekly basis, three weeks prior and three weeks following the session. Individual semi-structured interviews were conducted three weeks following the pain education. Interviews were recorded, transcribed verbatim, and analyzed using the General Inductive Approach.Results: There were two over-arching key themes: firstly, 'Participants' Perspectives' of the session generated four themes: Improved understanding of 'the whole'; Mindful self-awareness; Taking charge; "The pain is still there". Their understanding of pain was reconceptualised, evident by their ability to describe the role of neurophysiological mechanisms, stress and general well-being towards their pain. The second over-arching key theme, 'Participants' Recommendations', had two themes: Integrating neuroscience with pathoanatomical knowledge and Educating other health professionals. Pain levels decreased post-pain education compared to pre-pain education.Conclusions: Following the pain education session, participants had greater understanding of factors influencing their shoulder pain. Pain education, in addition to pathoanatomical information may be useful as part of treatment for persistent rotator cuff-related pain.
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Affiliation(s)
- Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Aleksandra K Mącznik
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Daniel Cury Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Craig A Wassinger
- Department of Physical Therapy, East Tennessee State University, Johnson City, USA
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326
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Wideman TH, Miller J, Bostick G, Thomas A, Bussières A, Wickens RH. The current state of pain education within Canadian physiotherapy programs: a national survey of pain educators. Disabil Rehabil 2019; 42:1332-1338. [PMID: 30620223 DOI: 10.1080/09638288.2018.1519044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To determine the current state of pain education across physiotherapy programs in Canada.Materials and methods: Educators that were responsible for teaching pain-related content at each of the 14 Canadian physiotherapy programs were invited to complete a cross-sectional survey. The online survey evaluated total time spent on pain education and the integration of content from international guidelines on pain education curricula.Results and conclusions: Complete data were obtained from all Canadian physiotherapy programs. The total median time spent on pain education was 18 h, ranging from 8 to 65 h. Across all programs, only 38.6% of the recommended pain curriculum themes were fully integrated within physiotherapy programs. Most of the curriculum themes were partially addressed (median: 52.6%) and a small minority were not addressed (median: 10.5%). There was an overall trend in which greater time spent on pain education corresponded to a higher proportion of pain curriculum themes that were fully integrated. This is the first national survey of pain education that has included all physiotherapy programs across Canada. These data provide a foundation for understanding the current resources and content dedicated to pain education and are an essential step in benchmarking and potentially improving pain education for physiotherapists.Implications for rehabilitationIntegrating pain education within entry-level physiotherapy programs is a foundational step in translating pain research into effective physiotherapy pain management.This survey of all entry-level physiotherapy programs across Canada shows considerable variability in the time and scope of pain education and that, on average, less than 40% of recommended pain education curriculum content is adequately addressed.This work highlights the need for national reference standards in pain education to help improve consistency across training programs.
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Affiliation(s)
- Timothy H Wideman
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research of Greater Montreal, Montreal, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Geoff Bostick
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Aliki Thomas
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research of Greater Montreal, Montreal, Canada.,Centre for Medical Education, McGill University, Montreal, Canada
| | - André Bussières
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research of Greater Montreal, Montreal, Canada
| | - Rebekah H Wickens
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada
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De Groef A, Devoogdt N, Van der Gucht E, Dams L, Bernar K, Godderis L, Morlion B, Moloney N, Smeets A, Van Wilgen P, Meeus M. EduCan trial: study protocol for a randomised controlled trial on the effectiveness of pain neuroscience education after breast cancer surgery on pain, physical, emotional and work-related functioning. BMJ Open 2019; 9:e025742. [PMID: 30612114 PMCID: PMC6326297 DOI: 10.1136/bmjopen-2018-025742] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Over the past decades, awareness on the importance of educational interventions in cancer pain management has increased. However, education is often restricted to biomedical pain management instructions. A more modern educational approach, also known as pain neuroscience education (PNE), explains pain from a biopsychosocial perspective. We hypothesise that this more comprehensive educational approach in the early treatment phase of breast cancer will lead to more beneficial effects for cancer pain management. Therefore, the aim of the present study is to investigate the effectiveness of this PNE intervention, in addition to best evidence physical therapy modalities for treatment and prevention of pain, physical, emotional and work-related functioning after breast cancer surgery, compared with a traditional biomedical educational intervention. METHODS A double-blinded randomised controlled trial has been started in November 2017 at the University Hospitals of Leuven. Immediately after breast cancer surgery, all participants (n=184) receive a 12-week intensive standard physical therapy programme. They receive three additional refresher sessions at 6, 8 and 12 months postsurgery. In addition, participants receive three educational sessions during the first-month postsurgery and three 'booster sessions' at 6, 8 and 12 months postsurgery. In the intervention group, the content of the education sessions is based on the modern PNE approach. Whereas in the control group, the education is based on the traditional biomedical approach. The primary outcome parameter is pain-related disability 1 year after surgery. Secondary outcomes related to other dimensions of pain, physical, emotional and work-related functioning at 1-week, 4, 6, 8, 12 and 18 months postsurgery. ETHICS AND DISSEMINATION The study will be conducted in accordance with the Declaration of Helsinki. This protocol has been approved by the ethical committee of the University Hospitals of Leuven. Results will be disseminated via peer-reviewed scientific journals and presentations at congresses. TRIAL REGISTRATION NUMBER NCT03351075.
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Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Elien Van der Gucht
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Koen Bernar
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Lode Godderis
- Centre for Environment and Health of KU Leuven, Leuven, Belgium
- IDEWE, External Service for Prevention and Protection at Work, Leuven, Belgium
| | - Bart Morlion
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Section Anaesthesiology and Algology, KU Leuven – University of Leuven, Leuven, Belgium
| | - Niamh Moloney
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Thrive Physiotherapy, Guernsey, UK
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Paul Van Wilgen
- Pain in Motion research group (www.paininmotion.be)
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Transcare, Transdisciplinary Pain Management Centre, Groningen, The Netherlands
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Pain in Motion research group (www.paininmotion.be)
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328
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Shepherd M, Louw A, Podolak J. The clinical application of pain neuroscience, graded motor imagery, and graded activity with complex regional pain syndrome-A case report. Physiother Theory Pract 2018; 36:1043-1055. [PMID: 30499359 DOI: 10.1080/09593985.2018.1548047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic Regional Pain Syndrome (CRPS) is a condition that physical therapists may encounter in an outpatient orthopedic setting. In physical therapy (PT) treatment of CRPS addresses pain and the changes observed in the brain through the use of graded motor imagery (GMI). CASE DESCRIPTION A 57-year-old female presented to an outpatient PT clinic with CRPS type 1. Complicating psychosocial factors such as kinesiophobia and catastrophization were present. The patient engaged in a treatment plan including GMI: pain neuroscience education (PNE), laterality training, motor imagery, and mirror training. As symptoms improved, graded functional exposure and functional restoration occurred. OUTCOMES The patient was seen for a total of 26 visits over a 9-month period. FAAM measures exceeded reported clinically important change that was sustained at two-year follow-up. Long term outcomes showed no functional deficits related to her foot or ankle and minimal to no catastrophizing and fear avoidance behaviors. DISCUSSION This case report showcases the use of GMI with a patient with CRPS type 1 in an outpatient orthopedic clinic. Clinicians may consider the use of GMI to progress a patient toward maximal functional gains.
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Affiliation(s)
- Mark Shepherd
- Department of Physical Therapy, South College , Knoxville, TN, USA.,Evidence in Motion Institute of Health Professions , Louisville, KY, USA
| | - Adriaan Louw
- International Spine and Pain Institute , Louisville, KY, USA
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329
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Venturine JS, Pires GMT, Pereira ML, Monteiro MGM, Meziat-Filho N, Nogueira LC, Reis FJJ. Overview of Curricula About Pain in Physical Therapist Education Programs in Brazil: A Faculty Survey. Phys Ther 2018; 98:918-924. [PMID: 30085225 DOI: 10.1093/ptj/pzy091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/08/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Educating health professionals about pain (pain education) during undergraduate studies may be an important step in changing ineffective pain management practices. OBJECTIVE The objective of this study was to assess the extent of pain education in current accredited physical therapist education programs in Brazil. DESIGN This study was designed as a cross-sectional survey study. METHODS Brazilian physical therapist education programs accredited by the Ministry of Education participated in this study. The main outcome measures were frequency of a specific curriculum about pain (pain curriculum) in physical therapist education programs and content analysis according to discipline-specific pain curriculum recommendations developed by the International Association for the Study of Pain. RESULTS A total of 811 physical therapist education programs in Brazil were identified. After duplicates and universities no longer offering a physical therapist education program were removed, a total of 566 physical therapist education programs were left; 399 of the 566 (70.5%) provided information about the curriculum on their websites. Among the identified physical therapist education programs with available curricula, 26 (6.5%) had a specific course about pain (pain course), covering a mean of 44.3 hours. LIMITATIONS Limitations included the inability to cover all the physical therapist education programs in Brazil and the inability to identify whether pain content is distributed in other disciplines such as pediatrics, geriatrics, and neurological and orthopedic physical therapy. CONCLUSIONS Most Brazilian physical therapist education programs do not offer a specific pain course. When a pain course is presented in the curriculum, some content recommended for physical therapist education programs by the International Association for the Study of Pain is not covered. The absence of a pain course in physical therapist education programs may have implications for pain management. To the best of our knowledge, this is the first study about pain education in physical therapist education programs in Brazil.
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Affiliation(s)
- Jéssica S Venturine
- Physical Therapy, Instituto Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Ney Meziat-Filho
- Rehabilitation Sciences, Centro Universitário Augusto Motta, Rio de Janeiro, Brazil
| | | | - Felipe J J Reis
- Physical Therapy, Instituto Federal do Rio de Janeiro, Campus Realengo, Rua Carlos Wenceslau 343, Realengo, CEP 21715-000, Rio de Janeiro, Brazil
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330
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Efectividad de la educación basada en neurociencias en pacientes con dolor lumbar crónico: revisión sistemática con metaanálisis. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.ft.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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331
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Pan F, Jones G. Clinical Perspective on Pain and Pain Phenotypes in Osteoarthritis. Curr Rheumatol Rep 2018; 20:79. [DOI: 10.1007/s11926-018-0796-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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332
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Wood L, Hendrick PA. A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability. Eur J Pain 2018; 23:234-249. [DOI: 10.1002/ejp.1314] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 08/22/2018] [Accepted: 08/29/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Lianne Wood
- Centre for Spinal Studies and Surgery; Nottingham University Hospitals NHS Trust; Nottingham UK
- Research Institute for Primary Care and Health Sciences; Keele University; Staffordshire, ST5 5PB
| | - Paul A. Hendrick
- Division of Physiotherapy and Rehabilitation Sciences; School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus); Nottingham UK
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333
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King R, Robinson V, Elliott-Button HL, Watson JA, Ryan CG, Martin DJ. Pain Reconceptualisation after Pain Neurophysiology Education in Adults with Chronic Low Back Pain: A Qualitative Study. Pain Res Manag 2018; 2018:3745651. [PMID: 30275918 PMCID: PMC6157134 DOI: 10.1155/2018/3745651] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/03/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022]
Abstract
Pain neurophysiology education (PNE) is an educational intervention for patients with chronic pain. PNE purports to assist patients to reconceptualise their pain away from the biomedical model towards a more biopsychosocial understanding by explaining pain biology. This study aimed to explore the extent, and nature, of patients' reconceptualisation of their chronic low back pain (CLBP) following PNE. Eleven adults with CLBP underwent semistructured interviews before and three weeks after receiving PNE. Interviews were transcribed verbatim and thematically analysed in a framework approach using four a priori themes identified from our previous research: (1) degrees of reconceptualisation, (2) personal relevance, (3) importance of prior beliefs, and (4) perceived benefit of PNE. We observed varying degrees of reconceptualisation from zero to almost complete, with most participants showing partial reconceptualisation. Personal relevance of the information to participants and their prior beliefs were associated with the degree of benefit they perceived from PNE. Where benefits were found, they manifested as improved understanding, coping, and function. Findings map closely to our previous studies in more disparate chronic pain groups. The phenomenon of reconceptualisation is applicable to CLBP and the sufficiency of the themes from our previous studies increases confidence in the certainty of the findings.
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Affiliation(s)
- Richard King
- The Pain Clinic, South Tees Hospitals NHS Foundation Trust, Middlesbrough TS3 4BW, UK
| | - Victoria Robinson
- The Pain Clinic, South Tees Hospitals NHS Foundation Trust, Middlesbrough TS3 4BW, UK
| | | | - James A. Watson
- Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK
| | - Cormac G. Ryan
- Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK
| | - Denis J. Martin
- Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK
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334
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Abstract
Persistent pain is common in elite athletes. The current review arose from a consensus initiative by the International Olympic Committee to advance the development of a standardized, scientific, and evidence-informed approach to management. We suggest that optimal management of persistent pain in elite athletes requires an understanding of contemporary pain science, including the rationale behind and implementation of a biopsychosocial approach to care. We argue that athletes and clinicians need to understand the biopsychosocial model because it applies to both pain and the impact of pain with special reference to the sport setting. Management relies on thorough and precise assessment that considers contributing factors across nociceptive, inflammatory, neuropathic, and centrally acting domains; these can include contextual and psychosocial factors. Pain management seeks to remove contributing factors wherever possible through targeted education; adjustment of mechanical loading, training, and performance schedules; psychological therapies; and management of inflammation.
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335
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McClinton S, Heiderscheit B, McPoil TG, Flynn TW. Physical therapist decision-making in managing plantar heel pain: cases from a pragmatic randomized clinical trial. Physiother Theory Pract 2018; 36:638-662. [PMID: 29979912 DOI: 10.1080/09593985.2018.1490941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Plantar heel pain (PHP) is a common condition managed by physical therapists that can, at times, be difficult to treat. Management of PHP is complicated by a variety of pathoanatomic features associated with PHP in addition to several treatment approaches with varying efficacy. Although clinical guidelines and clinical trial data support a general approach to management, the current literature is limited in case-specific descriptions of PHP management that addresses unique combinations of pathoanatomical, physical, and psychosocial factors that are associated with PHP. Purpose: The purpose of this case series is to describe physical therapist decision-making of individualized multimodal treatment for PHP cases presenting with varied clinical presentations. Treatment incorporated clinical guidelines and recent evidence including a combination of manual therapy, patient education, stretching, resistance training, and neurodynamic interventions. A common clinical decision-making framework was used to progress individualized treatment from a focus on symptom modulation initially to increased load tolerance of involved tissues and graded activity. In each case, patients met their individual goals and demonstrated clinically meaningful improvements in pain, function, and global rating of change that were maintained at the 1-2-year follow-up. Implications: This case series provides details of physical therapist management of a variety of PHP clinical presentations that can be used to complement clinical practice guidelines in the management of PHP.
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Affiliation(s)
- Shane McClinton
- Doctor of Physical Therapy Program, Des Moines University , Des Moines, IA, USA
| | - Bryan Heiderscheit
- Departments of Orthopedics & Rehabilitation and Biomedical Engineering, and Doctor of Physical Therapy Program, University of Wisconsin-Madison , Madison, WI, USA
| | - Thomas G McPoil
- School of Physical Therapy, Regis University , Denver, CO, USA
| | - Timothy W Flynn
- School of Physical Therapy, South College , Knoxville, TN, USA
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336
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Moseley GL. Whole of community pain education for back pain. Why does first-line care get almost no attention and what exactly are we waiting for? Br J Sports Med 2018; 53:588-589. [PMID: 29982226 DOI: 10.1136/bjsports-2018-099567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 11/03/2022]
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337
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Abstract
PURPOSE To explore the views of adolescents with chronic idiopathic neck pain toward an intervention consisting of pain neuroscience education and exercise administered in the school setting. METHODS Four focus group interviews were conducted with 21 adolescents with chronic idiopathic neck pain who participated in a 4-week intervention consisting of pain neuroscience education and exercise. The interviews were transcribed verbatim and analyzed using content analysis. RESULTS Two main themes emerged: the perceived relevance of acquired knowledge and the perceived adequacy of the intervention. CONCLUSION An intervention consisting of pain neuroscience education and exercise administered in the school setting is well accepted and considered relevant and appropriate by adolescents with chronic idiopathic neck pain.
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338
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López-de-Uralde-Villanueva I, Beltran-Alacreu H, Fernández-Carnero J, La Touche R. Pain management using a multimodal physiotherapy program including a biobehavioral approach for chronic nonspecific neck pain: a randomized controlled trial. Physiother Theory Pract 2018; 36:45-62. [PMID: 29889599 DOI: 10.1080/09593985.2018.1480678] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective: To determine the effectiveness of a therapeutic patient education (TPE) intervention based on a biobehavioral approach combined with manual therapy (MT) to reduce pain in patients with chronic nonspecific neck pain (CNSNP). In addition, this study intended to assess the effectiveness of a multimodal physiotherapy program including TPE to reduce pain in patients with CNSNP. Design: Single-blind randomized controlled trial. Interventions: A total of 47 patients with CNSNP were randomized into three groups: (1) MT (control group); (2) MT plus TPE based on a biobehavioral approach (Exp1); and (3) MT plus TPE based on a biobehavioral approach, and therapeutic exercise (Exp2). Main Outcome Measurements: The clinical outcomes were recorded at baseline and at 1 and 4 months after the initiation of treatment. The primary outcome was pain intensity (Visual Analog Scale), and the secondary outcomes were pain catastrophizing (Pain Catastrophizing Scale), illness severity and global improvement (Clinical Global Impression Scale), and mechanosensitivity of the median nerve (Upper Limb Neural Test) and the cervical region (Modified Passive Neck Flexion Test). Results: Statistically significant differences in pain intensity were found when Exp2 was compared with Exp1 and the control group at 4 months (p = 0.015 and p = 0.001, respectively), but no difference was found between Exp1 and the control group at the same follow-up period (p = 0.86). Exp2 showed statistically significant differences in all of the secondary outcomes except for pain catastrophizing when compared with the control group at 4 months. Conclusions: The Exp2 group was more effective than Exp1 and the control group in terms of reducing pain intensity at 4 months; at post-treatment, only Exp2 was more effective than the control group.
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Affiliation(s)
- Ibai López-de-Uralde-Villanueva
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Hector Beltran-Alacreu
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Roy La Touche
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
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339
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A systematic review and meta-analysis of the reliability and validity of sensorimotor measurement instruments in people with chronic low back pain. Musculoskelet Sci Pract 2018; 35:73-83. [PMID: 29549815 DOI: 10.1016/j.msksp.2018.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Deficits in the sensorimotor system and its peripheral and central processing of the affected body part might be a contributing factor to chronic low back pain (CLBP). Hence, sensorimotor assessment is important. Valid and reliable sensorimotor measurement instruments are needed. OBJECTIVE To investigate the reliability and validity of sensorimotor measurement instruments for people with chronic low back pain (CLBP). DESIGN Systematic review and meta-analysis. METHODS The review was undertaken using the COSMIN guidelines. Databases were searched for studies investigating the clinimetric properties of sensorimotor tests in people with CLBP. The methodological study quality was rated by two independent reviewers using the COSMIN 4-point rating checklist. RESULTS Ten studies were included covering six sensorimotor measurement instruments with findings for reliability/measurement error, known-groups validity and convergent validity. The methodological quality ranged from poor to good, with only one study rated as good. There was insufficient evidence of enough quality to assess reliability/measurement error or convergent validity. Two-point discrimination, laterality judgement and movement control tests had moderate evidence supporting their ability to distinguish between healthy people and those with CLBP. CONCLUSIONS Two-point discrimination, laterality judgment and movement control tests demonstrate the greatest level of known-groups validity for people with CLBP. However, as the reliability of these measurement tools has yet to be established, this validity data should be interpreted cautiously. Further research is warranted to investigate the clinimetric properties of these sensorimotor techniques.
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340
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Holliday S, Hayes C, Jones L, Gordon J, Harris N, Nicholas M. Prescribing wellness: comprehensive pain management outside specialist services. Aust Prescr 2018; 41:86-91. [PMID: 29922004 PMCID: PMC6003009 DOI: 10.18773/austprescr.2018.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
| | - Chris Hayes
- Hunter Integrated Pain Service, John Hunter Hospital, Newcastle, NSW
| | - Lester Jones
- Discipline of Physiotherapy, Judith Lumley Centre, La Trobe University, Melbourne
| | | | - Newman Harris
- Pain Education Unit, Pain Management Research Institute, Northern Clinical School, University of Sydney
| | - Michael Nicholas
- Pain Education Unit, Pain Management Research Institute, Northern Clinical School, University of Sydney
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341
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Pas R, Meeus M, Malfliet A, Baert I, Oosterwijck SV, Leysen L, Nijs J, Ickmans K. Development and feasibility testing of a Pain Neuroscience Education program for children with chronic pain: treatment protocol. Braz J Phys Ther 2018; 22:248-253. [PMID: 29550259 PMCID: PMC5993952 DOI: 10.1016/j.bjpt.2018.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/09/2018] [Accepted: 02/20/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Current treatment for adults with chronic pain often includes Pain Neuroscience Education (PNE) to make people understand the nature underlying their pain and thus provides a clear rational for a biopsychosocial approach. Despite recommendations to use Pain Neuroscience Education as well in children with chronic pain, a specific program, tailored to children aged 6-12 years is lacking. OBJECTIVES The aim of this study was to develop a Pain Neuroscience Education program for children with chronic pain and test its feasibility. METHODS First the internet and scientific literature was searched for sources (e.g., books, videos, etc.) that might be supportive in teaching children about the neurophysiology of pain. Based on this content, we developed a Pain Neuroscience Education program for children, 'PNE4Kids', which was tested for feasibility in three groups of healthy children (n=18; 9 girls and 9 boys) aged between 6 and 12 years old. RESULTS AND CONCLUSIONS This paper provides both scientists and clinicians with a specific program to explain the neurophysiology of pain to children with chronic pain, since it is past high time to use a modern neuroscience approach in this vulnerable population. Further research should examine the effectiveness of this developed PNE4Kids program on pain-related outcomes in children with chronic pain. Registration number: NCT02880332 (https://clinicaltrials.gov/ct2/show/NCT02880332).
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Affiliation(s)
- Roselien Pas
- Pain in Motion International Research Group(d); Vrije Universiteit Brussel (VUB), Faculty of Physical Education & Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Brussels, Belgium.
| | - Mira Meeus
- Pain in Motion International Research Group(d); University of Antwerp (UA), Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Wilrijk, Belgium
| | - Anneleen Malfliet
- Pain in Motion International Research Group(d); Vrije Universiteit Brussel (VUB), Faculty of Physical Education & Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Brussels, Belgium
| | - Isabel Baert
- Pain in Motion International Research Group(d); University of Antwerp (UA), Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Wilrijk, Belgium
| | - Sophie Van Oosterwijck
- University of Antwerp (UA), Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Wilrijk, Belgium
| | - Laurence Leysen
- Pain in Motion International Research Group(d); Vrije Universiteit Brussel (VUB), Faculty of Physical Education & Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Brussels, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group(d); Vrije Universiteit Brussel (VUB), Faculty of Physical Education & Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Brussels, Belgium
| | - Kelly Ickmans
- Pain in Motion International Research Group(d); Vrije Universiteit Brussel (VUB), Faculty of Physical Education & Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Brussels, Belgium
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342
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Abstract
An estimated 116 million Americans suffer from chronic pain, at a cost of over $600 billion per year, or roughly $2000 per person per year. In this Viewpoint, the authors highlight the challenges of the current opioid epidemic and outline strategies that the physical therapy profession may adopt to be part of the solution. These strategies include facilitating and providing patient education, early access to physical therapy services, and the promotion of health, wellness, and prevention. J Orthop Sports Phys Ther 2018;48(5):349-353. doi:10.2519/jospt.2018.0606.
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343
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Rizzo RRN, Medeiros FC, Pires LG, Pimenta RM, McAuley JH, Jensen MP, Costa LOP. Hypnosis Enhances the Effects of Pain Education in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial. THE JOURNAL OF PAIN 2018; 19:1103.e1-1103.e9. [PMID: 29654980 DOI: 10.1016/j.jpain.2018.03.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/06/2018] [Accepted: 03/15/2018] [Indexed: 01/03/2023]
Abstract
The potential benefits of combining pain education (PE) with clinical hypnosis (CH) has not yet been investigated in individuals with chronic pain. A total of 100 patients with chronic nonspecific low back pain were randomized to receive either: 1) PE alone, or 2) PE with CH. Outcomes were collected by a blinded assessor at 2 weeks and 3 months after randomization. The primary outcomes were average pain intensity, worst pain intensity (both assessed with 11-point numeric rating scales), and disability (24-item Roland Morris Disability Questionnaire) at 2 weeks. At 2 weeks, participants who received PE with CH reported lower worst pain intensity (mean difference = 1.35 points, 95% confidence interval [CI] = .32-2.37) and disability (mean difference = 2.34 points, 95% CI = .06-4.61), but not average pain intensity (mean difference = .67 point, 95% CI = -.27 to 1.62), relative to participants who received PE alone. PE with CH participants also reported more global perceived benefits at 2 weeks (mean difference = -1.98 points, 95% CI = -3.21 to -.75). At 3 months, participants who received PE with CH reported lower worst pain intensity (mean difference = 1.32 points, 95% CI = .29-2.34) and catastrophizing (mean difference = 5.30 points, 95% CI = 1.20-9.41). No adverse effects in either treatment condition were reported. To our knowledge, this is the first trial showing that additional use of hypnosis with PE results in improved outcomes over PE alone in patients with chronic nonspecific low back pain. PERSPECTIVE This study provides evidence supporting the efficacy of another treatment option for teaching patients to self-manage chronic low back pain that has a relatively low cost and that can be offered in groups.
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Affiliation(s)
- Rodrigo R N Rizzo
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
| | - Flavia C Medeiros
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Leandro G Pires
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Rafael M Pimenta
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - James H McAuley
- Neuroscience Research Australia (NeuRA), Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Leonardo O P Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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344
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Thalhamer C. „Schmerzen verstehen“ ist ein wichtiger Eckpfeiler in der Schmerztherapie. MANUELLE MEDIZIN 2018. [DOI: 10.1007/s00337-018-0374-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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345
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Rufa A, Beissner K, Dolphin M. The use of pain neuroscience education in older adults with chronic back and/or lower extremity pain. Physiother Theory Pract 2018; 35:603-613. [DOI: 10.1080/09593985.2018.1456586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Adam Rufa
- Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Katherine Beissner
- Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Michelle Dolphin
- Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, Syracuse, NY, USA
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346
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Louw A, Zimney K, Reed J, Landers M, Puentedura EJ. Immediate preoperative outcomes of pain neuroscience education for patients undergoing total knee arthroplasty: A case series. Physiother Theory Pract 2018; 35:543-553. [PMID: 29589782 DOI: 10.1080/09593985.2018.1455120] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Standard preoperative education for total knee arthroplasty (TKA) has been shown to have no effect on postoperative outcomes. This may be because such education programs fail to educate patients about pain. Pain neuroscience education (PNE) focuses on teaching people more about pain from a neurobiological and neurophysiological perspective. DESIGN AND SETTING Case Series. AIM To determine the immediate effects, if any, of providing PNE before TKA surgery on patient self-report measures. PARTICIPANTS Twelve patients (female = 10) prior to TKA for knee osteoarthritis (OA). INTERVENTION Preoperative educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet. MAIN OUTCOME MEASURES Comparison of pre- and post-PNE self-report measures on knee pain (NPRS), Pain Catastrophization Scale (PCS), fear of movement (TSK), and beliefs about TKA; as well as three physical performance measures - knee flexion active range of motion, 40 m self-paced walk, and pressure pain threshold (PPT). RESULTS Immediately following the PNE, patients had statistically significant lower TSK scores, increased PPT, and improved beliefs about their upcoming surgery. There were no significant changes in knee pain, function, or flexion active range of motion. CONCLUSIONS Results appear to suggest that immediately after PNE, patients scheduled for TKA had statistically significant changes in fear of movement, decreased sensitivity to pain and positive shifts in their beliefs about their future knee surgery. Larger trials with control/comparison groups are warranted to determine the true effects of preoperative PNE for patients about to undergo TKA.
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Affiliation(s)
- Adriaan Louw
- a International Spine and Pain Institute , Story City , IA , USA
| | - Kory Zimney
- b Department of Physical Therapy, School of Health Sciences , University of South Dakota , Vermillion , SD , USA
| | - Jordan Reed
- c Rehabilitation Services , Spencer Hospital , Spencer , IA , USA
| | - Merrill Landers
- d Department of Physical Therapy, School of Allied Health Sciences , University of Nevada Las Vegas , Las Vegas , NV , USA
| | - Emilio J Puentedura
- d Department of Physical Therapy, School of Allied Health Sciences , University of Nevada Las Vegas , Las Vegas , NV , USA
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347
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Exploring effect of pain education on chronic pain patients’ expectation of recovery and pain intensity. Scand J Pain 2018; 18:211-219. [DOI: 10.1515/sjpain-2018-0023] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/24/2018] [Indexed: 12/31/2022]
Abstract
Abstract
Background and aims:
Chronic pain affects an estimated 1 in 10 adults globally regardless of age, gender, ethnicity, income or geography. Chronic pain, a multifactorial problem requires multiple interventions. One intervention which demonstrates promising results to patient reported outcomes is pain education. However, patient perspective on pain education and its impact remains fairly unknown. A cross-sectional study involving individuals with chronic pain examined their perspectives on pain education; did it change their understanding about their pain and self-management and did it have any impact on their perceived pain intensity and recovery.
Methods:
The study complied with CHERRIES guidelines and the protocol was locked prior to data collection. Primary outcomes were pain intensity and participants’ expectation of recovery. Univariate and multiple logistic regressions were used to analyze the data.
Results:
Five hundred and seventy three people participated; full data sets were available for 465. Participants who observed changes in their pain cognition and self-management following pain education reported lower pain intensity and greater expectation of recovery than participants who did not observe changes to cognition and management.
Conclusions:
The results suggest that individuals who observed changes to pain cognition and self-management on receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts who did not perceive any changes to pain cognition and self-management.
Implications:
Pain intensity and expectations about recovery are primary considerations for people in pain. What influences these factors is not fully understood, but education about pain is potentially important. The results suggest that individuals who observed changes to pain cognition and self-management on receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts who did not perceive any changes to pain cognition and self-management. The results from this study highlight the importance of effective pain education focused on reconceptualization of pain and its management.
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348
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Gil-Martínez A, Paris-Alemany A, López-de-Uralde-Villanueva I, La Touche R. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res 2018; 11:571-587. [PMID: 29588615 PMCID: PMC5859913 DOI: 10.2147/jpr.s127950] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Thanks to advances in neuroscience, biopsychosocial models for diagnostics and treatment (including physical, psychological, and pharmacological therapies) currently have more clinical support and scientific growth. At present, a conservative treatment approach prevails over surgery, given it is less aggressive and usually results in satisfactory clinical outcomes in mild–moderate temporomandibular disorder (TMD). The aim of this review is to evaluate the recent evidence, identify challenges, and propose solutions from a clinical point of view for patients with craniofacial pain and TMD. The treatment we propose is structured in a multi-modal approach based on a biobehavioral approach that includes medical, physiotherapeutic, psychological, and dental treatments. We also propose a new biobehavioral model regarding pain perception and motor behavior for the diagnosis and treatment of patients with painful TMD.
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Affiliation(s)
- Alfonso Gil-Martínez
- Department of Physiotherapy.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid.,Hospital La Paz Institute for Health Research, IdiPAZ
| | - Alba Paris-Alemany
- Department of Physiotherapy.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid.,Hospital La Paz Institute for Health Research, IdiPAZ.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Physiotherapy.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid.,Hospital La Paz Institute for Health Research, IdiPAZ
| | - Roy La Touche
- Department of Physiotherapy.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid.,Hospital La Paz Institute for Health Research, IdiPAZ.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
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349
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Response to the Letter to the Editor on "The Effectiveness of Technology-Supported Exercise Therapy for Low Back Pain: A Systematic Review". Am J Phys Med Rehabil 2018. [PMID: 29543599 DOI: 10.1097/phm.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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350
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Use of Pain Neuroscience Education, Tactile Discrimination, and Graded Motor Imagery in an Individual With Frozen Shoulder. J Orthop Sports Phys Ther 2018; 48:174-184. [PMID: 29257926 DOI: 10.2519/jospt.2018.7716] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Case report. Background Aggressive physical therapy in the freezing stage of frozen shoulder may prolong the course of recovery. Central sensitization may play a role in the early stages of frozen shoulder. Pain neuroscience education, tactile discrimination, and graded motor imagery have been used in a number of conditions with central sensitization. The purpose of this case report was to describe the examination and treatment of a patient in the freezing stage of frozen shoulder using pain neuroscience education, tactile discrimination, and graded motor imagery. Case Description A 54-year-old woman with a diagnosis of frozen shoulder was referred by an orthopaedic surgeon following lack of progress after 4 weeks of intensive daily physical therapy. Pain at rest was 7/10, and her Shoulder Pain and Disability Index score was 64%. She had painful and limited active range of motion and elevated fear-avoidance beliefs. Tactile discrimination and limb laterality were impaired, with signs of central sensitization. A "top-down" approach using pain neuroscience education, tactile discrimination, and graded motor imagery was used for the first 6 weeks, followed by a "bottom-up" impairment-based approach. Outcomes The patient was seen for 20 sessions over 12 weeks. At discharge, her Shoulder Pain and Disability Index score was 22%, resting pain was 0/10, and fear-avoidance beliefs improved. Improvements in active range of motion, laterality, and tactile discrimination were also noted. Discussion Intensive physical therapy in the freezing stage of frozen shoulder may be detrimental to long-term outcomes. This case report suggests that a top-down approach may allow a quicker transition through the freezing stage of frozen shoulder. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2018;48(3):174-184. Epub 19 Dec 2017. doi:10.2519/jospt.2018.7716.
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