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Yarns BC, Jackson NJ, Alas A, Melrose RJ, Lumley MA, Sultzer DL. Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2415842. [PMID: 38869899 DOI: 10.1001/jamanetworkopen.2024.15842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
Importance Chronic pain is common and disabling in older adults, and psychological interventions are indicated. However, the gold standard approach, cognitive-behavioral therapy (CBT), produces only modest benefits, and more powerful options are needed. Objectives To evaluate whether emotional awareness and expression therapy (EAET) is superior to CBT for treatment of chronic pain among predominantly male older veterans and whether higher baseline depression, anxiety, or posttraumatic stress disorder (PTSD) symptoms-key targets of EAET-moderate treatment response. Design, Setting, and Participants This 2-arm randomized clinical trial was conducted from May 16, 2019, to September 14, 2023, in the US Department of Veterans Affairs Greater Los Angeles Healthcare System. The trial included a racially and ethnically diverse group of veterans aged 60 to 95 years with at least 3 months of musculoskeletal pain. Interventions Emotional awareness and expression therapy or CBT, conducted concurrently, each presented as one 90-minute individual session followed by eight 90-minute group sessions. Main Outcomes and Measures The primary outcome was Brief Pain Inventory pain severity (range, 0 to 10) from baseline to posttreatment (week 10, primary end point) and 6-month follow-up. Secondary outcomes included Patient Reported Outcomes Institute Measurement System Anxiety, Depression, Fatigue, General Life Satisfaction (NIH Toolbox), Pain Interference, and Sleep Disturbance Short Forms, Patient Global Impression of Change (PGIC), and Satisfaction with Therapy and Therapist Scale-Revised. A subset of participants completed the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). All analyses were for the intention-to-treat population and included all randomized participants. Results Among 126 randomized participants (66 in the EAET group and 60 in the CBT group; mean [SD] age, 71.9 [5.9] years; 116 [92%] male), 111 (88%) completed posttreatment, and 104 (82%) completed the 6-month follow-up. The EAET was superior to CBT for the primary outcome of reduction in pain severity at posttreatment (estimate, -1.59 [95% CI, -2.35 to -0.83]; P < .001) and follow-up (estimate, -1.01 [95% CI, -1.78 to -0.24]; P = .01). A greater percentage of participants in EAET vs CBT had clinically significant (at least 30%) pain reduction (63% vs 17%; odds ratio, 21.54 [95% CI, 4.66-99.56]; P < .001) at posttreatment. In addition, EAET was superior to CBT on 50% pain reduction (35% vs 7%; odds ratio, 11.77 [95% CI, 2.38-58.25]; P = .002), anxiety (estimate, -2.49 [95% CI, -4.30 to -0.68]; P = .006), depression (estimate, -3.06 [95% CI, -5.88 to -0.25]; P = .03), general life satisfaction (estimate, 1.23 [95% CI, 0.36-2.10]; P = .005), PTSD symptoms (estimate, -4.39 [95% CI, -8.44 to -0.34]; P = .03), PGIC score (estimate, 1.46 [95% CI, 0.77-2.15]; P < .001), and global treatment satisfaction (estimate, 0.28 [95% CI, 0.12-0.45]; P < .001) at posttreatment. Higher baseline depression (estimate, -1.55 [95% CI, -0.37 to 2.73]; P < .001), anxiety (estimate, -1.53 [95% CI, -2.19 to -0.88]; P < .001), and PTSD symptoms (estimate, -1.69 [95% CI, -2.96 to -0.42]; P = .009) moderated greater reduction in pain severity after EAET but not CBT. Conclusions and Relevance The results of this randomized clinical trial suggest that EAET may be a preferred intervention for medically and psychiatrically complex patients with pain. The societal burden of chronic pain could be improved by further incorporating the principles of EAET into mainstream clinical pain medicine. Trial Registration ClinicalTrials.gov Identifier: NCT03918642.
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Affiliation(s)
- Brandon C Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
| | - Nicholas J Jackson
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Alexander Alas
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
| | - Rebecca J Melrose
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - David L Sultzer
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Human Behavior, University of California, Irvine School of Medicine, Irvine
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Rai V, Munazzam SW, Wazir NU, Javaid I. Revolutionizing bone tumor management: cutting-edge breakthroughs in limb-saving treatments. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1741-1748. [PMID: 38461457 DOI: 10.1007/s00590-024-03876-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
Limb salvage surgery has revolutionized the approach to bone tumors in orthopedic oncology, steering away from historical amputations toward preserving limb function and enhancing patient quality of life. This transformative shift underscores the delicate balance between tumor eradication and optimal postoperative function. Primary and metastatic bone tumors present challenges in early detection, differentiation between benign and malignant tumors, preservation of function, and the risk of local recurrence. Conventional methods, including surgery, radiation therapy, chemotherapy, and targeted therapies, have evolved with a heightened focus on personalized medicine. A groundbreaking development in limb salvage surgery is the advent of 3D-printed patient-specific implants, which significantly enhance anatomical precision, stability, and fixation. These implants reduce soft tissue disruption and the associated risks, fostering improved osseointegration and correction of deformities for a more natural and functional postoperative outcome. Biological and molecular research has reshaped the understanding of bone tumors, guiding surgical interventions with advancements such as genomic profiling, targeted intraoperative imaging, precision targeting of molecular pathways, and immunotherapy tailored to individual tumor characteristics. In the realm of imaging technologies, MRI, CT scans, and intraoperative navigation systems have redefined preoperative planning, minimizing collateral damage and optimizing outcomes through accurate resections. Postoperative rehabilitation plays a crucial role in restoring function and improving the quality of life. Emphasizing early mobilization, effective pain management, and a multidisciplinary approach, rehabilitation addresses the physical, psychological, and social aspects of recovery. Looking ahead, future developments may encompass advanced biomaterials, smart implants, AI algorithms, robotics, and regenerative medicine. Challenges lie in standardization, cost-effectiveness, accessibility, long-term outcome assessment, mental health support, and fostering global collaboration. As research progresses, limb salvage surgery emerges not just as a preservation tool but as a transformative approach, restoring functionality, resilience, and hope in the recovery journey. This review summarizes the recent advances in limb salvage therapy for bone tumors over the past decade.
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Affiliation(s)
- Vikramaditya Rai
- Department of Orthopedics, Dr. Rajendra Prasad Government Medical College and Hospital, Himachal Pradesh, Tanda at Kangra, India.
| | | | | | - Irum Javaid
- Khyber Medical College, Hayatabad, Peshawar, Pakistan
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Georgopoulos V, McWilliams DF, Hendrick P, Walsh DA. Influence of central aspects of pain on self-management in people with chronic low back pain. PATIENT EDUCATION AND COUNSELING 2024; 121:108109. [PMID: 38114407 DOI: 10.1016/j.pec.2023.108109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE This observational study investigated whether central aspects of pain are associated with self-management domains in individuals with chronic low back pain (CLBP) undertaking a pain management program. METHODS Individuals with CLBP provided pain sensitivity and self-management data at baseline (n = 97) and 3-months (n = 87). Pressure pain detection threshold (PPT) at the forearm, temporal summation (TS) and conditioned pain modulation (CPM), Widespread Pain Index (WPI), and a Central Aspects of Pain factor (CAPf) were considered as central aspects of pain. Self-management was measured using the 8 domains of the Health Education Impact Questionnaire, as well as Pain Self Efficacy and Health Care Utilisation questionnaires. RESULTS PPT, CPM, WPI and CAPf predicted worse performance in several self-management domains at 3-months (r = 0.21 to 0.54, p < 0.05 overall). In multivariable regression models (adjusted for baseline scores of self-management, depression, catastrophization, pain and fatigue) low PPT, high TS, and high CAPf at baseline predicted poorer self-management at 3 months (R2 =0.14 to 0.52, β = -0.37 to 0.35, p < 0.05). CONCLUSIONS Central aspects of pain are associated with impaired self-management, over and above effects of pain intensity, fatigue, depression and catastrophizing. PRACTICE IMPLICATIONS Treatments that target central aspects of pain might help improve self-management in people with CLBP.
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Affiliation(s)
| | - Daniel F McWilliams
- Department of Academic Rheumatology, School of Medicine, University of Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, UK
| | - David A Walsh
- Department of Academic Rheumatology, School of Medicine, University of Nottingham, UK
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Mattenklodt P, Ingenhorst A, Flatau B, Becker K, Grießinger N. [Interdisciplinary pain therapy in the elderly]. Schmerz 2024; 38:89-98. [PMID: 37266908 DOI: 10.1007/s00482-023-00721-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 06/03/2023]
Abstract
Chronic pain in the elderly is becoming increasingly important and is associated with serious health impacts. Therefore, international guidelines demand that pain therapy for the elderly preferably be a multimodal therapy based on a bio-psycho-social pain model. Specific psychometric tests and interview guidelines are available for the interdisciplinary pain assessment. Evidence for the effectiveness of multimodal pain therapy in the elderly remains limited. However, controlled clinical trials have shown that these patients benefit-especially if the intervention is adapted to their specific needs. The focus of movement therapy is not only muscle strengthening but also coordination exercises. In individual physical therapy and occupational therapy, everyday solutions can be developed for individual physical limitations that are more frequent in old age. In psychological training, pain acceptance, balancing rest and activity, social integration and dealing with aging are particularly important topics. Relaxation and mindfulness techniques can also favorably affect pain and function. Thus, these are popular with patients and are often adopted in everyday pain management. Pain education is considered useful as an adjunctive measure and can also be increasingly supported by digital media in the elderly. Complementary therapy components include confrontational treatment of fear-avoidance beliefs (the German AMIKA scale, Ältere Menschen in körperlicher Aktion, "older people in physical action") and naturopathic applications as an active self-help strategy. Since it is unclear how long the achieved therapeutic effects last, follow-up care is of particular importance in therapy for older patients.
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Affiliation(s)
- Peter Mattenklodt
- Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - Anne Ingenhorst
- Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - Brigitta Flatau
- medi train - Bewegungstherapie Physiotherapie, Erlangen, Deutschland
| | - Kristina Becker
- medi train - Bewegungstherapie Physiotherapie, Erlangen, Deutschland
| | - Norbert Grießinger
- Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
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5
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Gungormus DB, Garcia-Moreno FM, Bermudez-Edo M, Sánchez-Bermejo L, Garrido JL, Rodríguez-Fórtiz MJ, Pérez-Mármol JM. A semi-automatic mHealth system using wearable devices for identifying pain-related parameters in elderly individuals. Int J Med Inform 2024; 184:105371. [PMID: 38335744 DOI: 10.1016/j.ijmedinf.2024.105371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/28/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Mobile health systems integrating wearable devices are emerging as promising tools for registering pain-related factors. However, their application in populations with chronic conditions has been underexplored. OBJECTIVE To design a semi-automatic mobile health system with wearable devices for evaluating the potential predictive relationship of pain qualities and thresholds with heart rate variability, skin conductance, perceived stress, and stress vulnerability in individuals with preclinical chronic pain conditions such as suspected rheumatic disease. METHODS A multicenter, observational, cross-sectional study was conducted with 67 elderly participants. Predicted variables were pain qualities and pain thresholds, assessed with the McGill Pain Questionnaire and a pressure algometer, respectively. Predictor variables were heart rate variability, skin conductance, perceived stress, and stress vulnerability. Multiple linear regression analyses were conducted to examine the influence of the predictor variables on the pain dimensions. RESULTS The multiple linear regression analysis revealed that the predictor variables significantly accounted for 27% of the variability in the affective domain, 14% in the miscellaneous domain, 15% in the total pain rating index, 10% in the number of words chosen, 14% in the present pain intensity, and 16% in the Visual Analog Scale scores. CONCLUSION The study found significant predictive values of heart rate variability, skin conductance, perceived stress, and stress vulnerability in relation to pain qualities and thresholds in the elderly population with suspected rheumatic disease. The comprehensive integration of physiological and psychological stress measures into pain assessment of elderly individuals with preclinical chronic pain conditions could be promising for developing new preventive strategies.
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Affiliation(s)
- Dogukan Baran Gungormus
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Francisco M Garcia-Moreno
- Department of Software Engineering, Computer Science School, University of Granada, Granada, Spain; Research Centre for Information and Communication Technologies (CITIC-UGR), University of Granada, Granada, Spain
| | - Maria Bermudez-Edo
- Department of Software Engineering, Computer Science School, University of Granada, Granada, Spain; Research Centre for Information and Communication Technologies (CITIC-UGR), University of Granada, Granada, Spain.
| | - Laura Sánchez-Bermejo
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - José Luis Garrido
- Department of Software Engineering, Computer Science School, University of Granada, Granada, Spain; Research Centre for Information and Communication Technologies (CITIC-UGR), University of Granada, Granada, Spain
| | - María José Rodríguez-Fórtiz
- Department of Software Engineering, Computer Science School, University of Granada, Granada, Spain; Research Centre for Information and Communication Technologies (CITIC-UGR), University of Granada, Granada, Spain
| | - José Manuel Pérez-Mármol
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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6
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Mattenklodt P, Ingenhorst A, Flatau B, Becker K, Grießinger N. [Interdisciplinary pain therapy in the elderly]. DIE ANAESTHESIOLOGIE 2024; 73:147-155. [PMID: 38376754 DOI: 10.1007/s00101-024-01392-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Chronic pain in the elderly is becoming increasingly important and is associated with serious health impacts. Therefore, international guidelines demand that pain therapy for the elderly preferably be a multimodal therapy based on a bio-psycho-social pain model. Specific psychometric tests and interview guidelines are available for the interdisciplinary pain assessment. Evidence for the effectiveness of multimodal pain therapy in the elderly remains limited. However, controlled clinical trials have shown that these patients benefit-especially if the intervention is adapted to their specific needs. The focus of movement therapy is not only muscle strengthening but also coordination exercises. In individual physical therapy and occupational therapy, everyday solutions can be developed for individual physical limitations that are more frequent in old age. In psychological training, pain acceptance, balancing rest and activity, social integration and dealing with aging are particularly important topics. Relaxation and mindfulness techniques can also favorably affect pain and function. Thus, these are popular with patients and are often adopted in everyday pain management. Pain education is considered useful as an adjunctive measure and can also be increasingly supported by digital media in the elderly. Complementary therapy components include confrontational treatment of fear-avoidance beliefs (the German AMIKA scale, Ältere Menschen in körperlicher Aktion, "older people in physical action") and naturopathic applications as an active self-help strategy. Since it is unclear how long the achieved therapeutic effects last, follow-up care is of particular importance in therapy for older patients.
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Affiliation(s)
- Peter Mattenklodt
- Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - Anne Ingenhorst
- Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - Brigitta Flatau
- medi train - Bewegungstherapie Physiotherapie, Erlangen, Deutschland
| | - Kristina Becker
- medi train - Bewegungstherapie Physiotherapie, Erlangen, Deutschland
| | - Norbert Grießinger
- Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
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Moore E, Paré C, Carde E, Pagé MG. Virtual group psychotherapy for chronic pain: exploring the impact of the virtual medium on participants' experiences. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:131-138. [PMID: 37738606 DOI: 10.1093/pm/pnad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Virtual psychotherapy for chronic pain (CP) has been shown to be feasible, efficacious, and acceptable; however, little is known about how virtual delivery of group psychotherapy affects participants' experiences. This study aimed to explore the impact of a virtual medium during the coronavirus disease 2019 (COVID-19) pandemic on social interactions and therapeutic processes in the context of group psychotherapy for CP management. METHODS This qualitative, interview-based study collected data on 18 individuals who participated in virtual group psychotherapy in a tertiary care pain management unit. RESULTS Results of the thematic analysis showed 4 themes. First, the ability to participate and connect was modified by not meeting in person. Connections also occurred differently as the usual patterns of interactions changed. Participants described important shifts in how emotions are communicated and subsequent experience of empathy. Finally, the commonality of chronic pain experience was identified as a central driver of connection between participants. CONCLUSIONS Mixed impacts of the virtual medium on group psychotherapy dynamics and processes were found. Future research could explore ways to mitigate the negative impacts.
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Affiliation(s)
- Emily Moore
- Alan Edwards Pain Management Unit, Montreal General Hospital, Montreal, QC H3G 1A4, Canada
| | - Catherine Paré
- Alan Edwards Pain Management Unit, Montreal General Hospital, Montreal, QC H3G 1A4, Canada
| | - Estelle Carde
- CREMIS (Centre de Recherche de Montréal sur les Inégalités Sociales, les Discriminations et les Pratiques Alternatives de Citoyenneté), Montreal, QC H2X 1K6, Canada
- Department of Sociology, Faculty of Arts and Sciences, Université de Montréal, Montreal, QC H3T 1N8, Canada
| | - M Gabrielle Pagé
- Alan Edwards Pain Management Unit, Montreal General Hospital, Montreal, QC H3G 1A4, Canada
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- D epartment of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montreal, QC H2V 2S9, Canada
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Lam N, Green J, Hallas S, Forster A, Crocker TF, Andre D, Ellwood A, Clegg A, Brown L. Mapping review of pain management programmes and psychological therapies for community-dwelling older people living with pain. Eur Geriatr Med 2024; 15:33-45. [PMID: 37853269 PMCID: PMC10876761 DOI: 10.1007/s41999-023-00871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Persistent pain is common in older people and people living with frailty. Pain or the impact of pain on everyday life is potentially modifiable. We sought to map research evidence and information from randomised controlled trials (RCTs) of pain management programmes and psychological therapies targeting community-dwelling older people, and explore appropriate strategies and interventions for managing or reducing the negative impact of pain for older people, particularly those with frailty. METHOD A mapping review of pain management programmes and psychological therapies for community-dwelling older people living with chronic pain. We searched for systematic reviews of randomised controlled trials and for individual randomised controlled trials and extracted data from eligible studies. RESULTS Searches resulted in 3419 systematic review records and 746 RCT records from which there were 33 eligible interventions identified in 31 eligible RCTs (48 reports). Broad aims of the interventions were to: improve physical, psychological, or social functioning; adjust the effects or sensation of pain psychologically; enhance self-care with self-management skills or knowledge. Common mechanisms of change proposed were self-efficacy enhanced by self-management tasks and skills, using positive psychological skills or refocusing attention to improve responses to pain, and practising physical exercises to improve physiological well-being and reduce restrictions from pain. Content of interventions included: skills training and activity management, education, and physical exercise. Interventions were delivered in person or remotely to individuals or in groups, typically in 1-2 sessions weekly over 5-12 weeks. CONCLUSION All the evaluated interventions appeared to show potential to provide some benefits to older people. None of the included studies assessed frailty. However, some of the included interventions appear appropriate for community-dwelling older people living with both frailty and pain.
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Affiliation(s)
- Natalie Lam
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- Department of Health Sciences, University of York, York, UK
| | - John Green
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Sarah Hallas
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- University of Leeds, Leeds, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK.
- University of Leeds, Leeds, UK.
| | | | - Alison Ellwood
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- University of Leeds, Leeds, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
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Holmes A, Chang YP. Non-pharmacological management of neuropathic pain in older adults: a systematic review. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:47-56. [PMID: 37607003 DOI: 10.1093/pm/pnad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Neuropathic pain encompasses multiple diagnoses with detrimental impacts on quality of life and overall health. In older adults, pharmacological management is limited by adverse effects and drug interactions, while surgical management involves perioperative risk. Prior reviews addressing non-pharmacological interventions for neuropathic pain have not focused on this demographic. Therefore, this systematic review synthesizes the evidence regarding the effectiveness of non-pharmacological interventions in reducing neuropathic pain severity in older adults. METHODS PubMed, CINAHL, Web of Science, and PsycInfo were searched using key terms, with inclusion criteria of age ≥ 65, neuropathic pain, non-pharmacological intervention, pain severity measurement, English language, peer-reviewed, and either randomized controlled trial (RCT) or quasi-experimental design. In total, 2759 records were identified, with an additional 28 records identified by review of reference lists. After removal of duplicates, 2288 records were screened by title and abstract, 404 full-text articles were assessed, and 19 articles were critically reviewed and synthesized. RESULTS Of the 14 RCTs and 5 quasi-experimental studies included in the review, the most common intervention was electric and/or magnetic therapy, followed by acupuncture, mindfulness meditation, exercise, and light therapy. Several studies revealed both statistical and clinical significance, but conclusions were limited by small sample sizes and methodological shortcomings. The interventions were generally safe and acceptable. CONCLUSIONS Results should be interpreted with consideration of clinical vs statistical significance, mediators of pain severity, and individual variations in effectiveness. Further research should address multimodal and novel interventions, newer models of care, and technology-based interventions.
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Affiliation(s)
- Ashleigh Holmes
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY 14214-3079, United States
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY 14214-3079, United States
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Curatolo M. Central Sensitization and Pain: Pathophysiologic and Clinical Insights. Curr Neuropharmacol 2024; 22:15-22. [PMID: 36237158 DOI: 10.2174/1570159x20666221012112725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 11/22/2022] Open
Abstract
Central sensitization is an increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input. AIM To explain how the notion of central sensitization has changed our understanding of pain conditions, discuss how this knowledge can be used to improve the management of pain, and highlight knowledge gaps that future research needs to address. METHODS Overview of definitions, assessment methods, and clinical implications. RESULTS Human pain models, and functional and molecular imaging have provided converging evidence that central sensitization occurs and is clinically relevant. Measures to assess central sensitization in patients are available; however, their ability to discriminate sensitization of central from peripheral neurons is unclear. Treatments that attenuate central sensitization are available, but the limited understanding of molecular and functional mechanisms hampers the development of target-specific treatments. The origin of central sensitization in human pain conditions that are not associated with tissue damage remains unclear. CONCLUSION The knowledge of central sensitization has revolutionized our neurobiological understanding of pain. Despite the limitations of clinical assessment in identifying central sensitization, it is appropriate to use the available tools to guide clinical decisions towards treatments that attenuate central sensitization. Future research that elucidates the causes, molecular and functional mechanisms of central sensitization would provide crucial progress towards the development of treatments that target specific mechanisms of central sensitization.
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Affiliation(s)
- Michele Curatolo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
- The University of Washington Clinical Learning, Evidence and Research (CLEAR), University of Washington, WAI, USA
- Center for Sensory-Motor Interaction, University of Aalborg, Aalborg, Denmark
- Center for Musculoskeletal Disorders, Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
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Yarns BC, Molaie AM, Lumley MA, Zhu TA, Jazi AN, Ganz DA, Melrose RJ. Video telehealth emotional awareness and expression therapy for older U.S. military veterans with chronic pain: A pilot study. Clin Gerontol 2024; 47:136-148. [PMID: 36541672 DOI: 10.1080/07317115.2022.2159909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Emotional Awareness and Expression Therapy (EAET) targets trauma and emotional conflict to reduce or eliminate chronic pain, but video telehealth administration is untested. This uncontrolled pilot assessed acceptability, feasibility, and preliminary efficacy of group-based video telehealth EAET (vEAET) for older veterans with chronic musculoskeletal pain. METHODS Twenty veterans were screened, and 16 initiated vEAET, delivered as one 60-minute individual session and eight 90-minute group sessions. Veterans completed posttreatment satisfaction ratings and pain severity (primary outcome), pain interference, anxiety, depression, functioning, social connectedness, shame, and anger questionnaires at baseline, posttreatment, and 2-month follow-up. RESULTS Satisfaction was high, and veterans attended 7.4 (SD = 0.6) of 8 group sessions; none discontinued treatment. Veterans attained significant, large reductions in pain severity from baseline to posttreatment (p < .001, Hedges' g = -1.54) and follow-up (p < .001, g = -1.20); 14 of 16 achieved clinically significant (≥ 30%) pain reduction, and 3 achieved 90-100% pain reduction. Secondary outcomes demonstrated significant, medium-to-large improvements. CONCLUSIONS In this small sample, vEAET produced better attendance, similar benefits, and fewer dropouts than in-person EAET in prior studies. Larger, controlled trials are needed. CLINICAL IMPLICATIONS Group vEAET appears feasible and highly effective for older veterans with chronic pain.
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Affiliation(s)
- Brandon C Yarns
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Ali M Molaie
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Tongtong A Zhu
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Ali Najafian Jazi
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - David A Ganz
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Rebecca J Melrose
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
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McDermott K, Levey N, Brewer J, Ehmann M, Hooker JE, Pasinski R, Yousif N, Raju V, Gholston M, Greenberg J, Ritchie CS, Vranceanu AM. Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic. JMIR Res Protoc 2023; 12:e52117. [PMID: 38157234 PMCID: PMC10787331 DOI: 10.2196/52117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). OBJECTIVE We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. METHODS We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function-self-reported, performance based (6-minute walk test), and objective (step count)-and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). RESULTS We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. CONCLUSIONS We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52117.
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Affiliation(s)
- Katherine McDermott
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Nadine Levey
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julie Brewer
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Madison Ehmann
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julia E Hooker
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Roger Pasinski
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Neda Yousif
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Vidya Raju
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Milton Gholston
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Christine S Ritchie
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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13
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Reid MC, Pillemer K. Introduction to Special Issue: Translational Research on Pain and Pain Management in Later Life. Innov Aging 2023; 7:igad119. [PMID: 38094939 PMCID: PMC10714899 DOI: 10.1093/geroni/igad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- M Cary Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Karl Pillemer
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
- College of Human Ecology, Cornell University, Ithaca, New York, USA
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Maharjan S, Kertesz SG, Bhattacharya K, Markland A, McGwin G, Yang Y, Bentley JP, Ramachandran S. Coprescribing of opioids and psychotropic medications among Medicare-enrolled older adults on long-term opioid therapy. J Am Pharm Assoc (2003) 2023; 63:1753-1760.e5. [PMID: 37633452 DOI: 10.1016/j.japh.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Pressures to reduce opioid prescribing have potential to incentivize coprescribing of opioids (at lower dose) with psychotropic medications. Evidence concerning the extent of the problem is lacking. This study assessed trends in coprescribing and characterized coprescribing patterns among Medicare-enrolled older adults with chronic noncancer pain (CNCP) receiving long-term opioid therapy (LTOT). METHODS A cohort study was conducted using 2012-2018 5% National Medicare claims data. Eligible beneficiaries were continuously enrolled and had no claims for cancer diagnoses or hospice use, and ≥ 2 claims with diagnoses for CNCP conditions within a 30-day period in the 12 months before the index date (LTOT initiation). Coprescribing was defined as an overlap between opioids and any class of psychotropic medication (antidepressants, benzodiazepines, antipsychotics, anticonvulsants, muscle relaxants, and nonbenzodiazepine hypnotics) based on their prescription fill dates and days of supply in a given year. The occurrence of coprescribing, coprescribing intensity, and number of days of overlap with psychotropic medications were calculated for each calendar year. RESULTS The eligible study population of individuals on LTOT ranged from 2038 in 2013 to 1751 in 2018. The occurrence of coprescribing among eligible beneficiaries decreased from 73.41% in 2013 to 70.81% in 2015 and then increased slightly to 71.22% in 2018. Among eligible beneficiaries with at least one overlap day, the coprescribing intensity with any class of psychotropic medications showed minimal variation throughout the study period: 74.73% in 2013 and 72.67% in 2018. Across all the years, the coprescribing intensity was found to be highest with antidepressants (2013, 49.90%; 2018, 50.33%) followed by benzodiazepines (2013, 25.42%; 2018, 19.95%). CONCLUSION Coprescribing was common among older adults with CNCP who initiated LTOT but did not rise substantially in the period studied. Future research should investigate drivers behind coprescribing and safety of various patterns of use.
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15
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Franqueiro AR, Yoon J, Crago MA, Curiel M, Wilson JM. The Interconnection Between Social Support and Emotional Distress Among Individuals with Chronic Pain: A Narrative Review. Psychol Res Behav Manag 2023; 16:4389-4399. [PMID: 37915959 PMCID: PMC10617401 DOI: 10.2147/prbm.s410606] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023] Open
Abstract
Chronic pain is a public health concern affecting over 100 million U.S. adults. Because chronic pain is multifactorial, it requires a biopsychosocial approach to understand how biological, psychological, and social factors contribute to both the development and maintenance of pain. On average, individuals with chronic pain report higher levels of emotional distress compared to pain-free individuals. Research has demonstrated that social support is associated with better pain outcomes and less emotional distress. It has been proposed that social support may improve pain outcomes by reducing the influence of stressors. However, the majority of research exploring the relationships between social support and pain-related outcomes has focused on the direct relationship between these variables, largely overlooking the process by which social support has a positive influence on pain. This narrative review synthesizes research on how chronic pain, emotional distress, and social support are highly interconnected, yet research investigating chronic pain and emotional distress within a social context is limited. We then highlight disparities in chronic pain, such that the burden of chronic pain is unequal between demographic groups. Next, we discuss existing evidence for the use of group-based interventions to address pain-related outcomes. Lastly, we summarize limitations of prior research studies and highlight gaps in the current literature. Overall, longitudinal research comprehensively investigating the distinct nuances in the measurement of social support and how these nuances relate to emotional distress and pain outcomes is needed and may provide insight into the unique needs of individuals or subgroups. Further, demographically diverse randomized controlled trials are needed to identify the process by which group-based interventions improve pain outcomes and whether these interventions are more effective for particular groups in order to personalize treatment approaches and address inequities in pain care.
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Affiliation(s)
- Angelina R Franqueiro
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - JiHee Yoon
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - Madelyn A Crago
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - Marie Curiel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - Jenna M Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
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16
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Fuller-Thomson E, Dolhai H, MacNeil A, Li G, Jiang Y, De Groh M. Depression during the COVID-19 pandemic among older Canadians with peptic ulcer disease: Analysis of the Canadian Longitudinal Study on Aging. PLoS One 2023; 18:e0289932. [PMID: 37851639 PMCID: PMC10584121 DOI: 10.1371/journal.pone.0289932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 07/29/2023] [Indexed: 10/20/2023] Open
Abstract
The COVID-19 pandemic and associated public health measures have exacerbated many known risk factors for depression that may be particularly concerning for individuals with chronic health conditions, such as peptic ulcer disease (PUD). In a large longitudinal sample of older adults with PUD, the current study examined the incidence of depression during the pandemic among those without a pre-pandemic history of depression (n = 689) and the recurrence of depression among those with a history of depression (n = 451). Data came from four waves of the Canadian Longitudinal Study on Aging (CLSA). Multivariate logistic regression analyses were conducted to identify factors associated with incident and recurrent depression. Among older adults with PUD and without a history of depression, approximately 1 in 8 (13.0%) developed depression for the first time during the COVID-19 pandemic. Among those with a history of depression, approximately 1 in 2 (46.6%) experienced depression during the pandemic. The risk of incident depression and recurrent depression was higher among those who were lonely, those with functional limitations, and those who experienced an increase in family conflict during the pandemic. The risk of incident depression only was higher among women, individuals whose income did not satisfy their basic needs, those who were themselves ill and/or those whose loved ones were ill or died during the pandemic, and those who had disruptions to healthcare access during the pandemic. The risk of recurrent depression only was higher among those with chronic pain and those who had difficulty accessing medication during the pandemic. Implications for interventions are discussed.
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Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - Hannah Dolhai
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - Grace Li
- Department of Sociology, University of Victoria, Victoria, British Columbia, Canada
| | - Ying Jiang
- Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Margaret De Groh
- Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
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17
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Blasco-Belled A, Tejada-Gallardo C, Alsinet C. Positive psychology interventions can improve mental health for chronic pain patients: a systematic review and meta-analysis. Psychol Health 2023:1-17. [PMID: 37644768 DOI: 10.1080/08870446.2023.2250382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/06/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE This study examines the efficacy of positive psychology interventions (PPIs) for patients with chronic pain through a systematic review and meta-analysis. PPIs are defined as strategies that involve focusing on positive emotions, thoughts, and behaviors that improve mental health by increasing mental well-being and reducing psychological distress. DESIGN The search was conducted using the PubMed, Scopus, PsycINFO, and Cochrane Library databases. MAIN OUTCOME MEASURES Subjective, psychological, and social well-being were used as indicators of mental well-being, and depression, anxiety, and stress symptoms were used as indicators of psychological distress. Results: Nine studies were included. Eight studies evaluated subjective well-being, seven evaluated depression, and three evaluated anxiety symptoms. No studies examined psychological well-being, social well-being, or stress. PPIs were found to be effective in promoting subjective well-being post-treatment (Hedges' g = 0.40; 95% CI [0.06, 0.73]) and reducing anxiety (Hedges' g = -0.32, 95% CI [-0.59, -0.06]), but no significant results were found for depression (Hedges' g = -0.23, 95% CI [-0.50, 0.04]). CONCLUSION The included investigations, while limited, suggest the utility of PPIs in mitigating the psychological consequences of chronic pain. Researchers and practitioners are encouraged to implement PPI practices.
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Affiliation(s)
| | | | - Carles Alsinet
- University of Lleida, Avinguda de l'Estudi General 4, Lleida, Spain
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18
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Adogwa O, Reid MC, Chilakapati S, Makris UE. Clin-STAR corner: 2021 update in musculoskeletal pain in older adults with a focus on osteoarthritis-related pain. J Am Geriatr Soc 2023; 71:2373-2380. [PMID: 37186060 PMCID: PMC10524733 DOI: 10.1111/jgs.18369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Chronic musculoskeletal (MSK) pain remains a leading cause of disability and functional impairment among older adults and is associated with substantial societal and personal costs. Chronic pain is particularly challenging to manage in older adults because of multimorbidity, concerns about treatment-related harm, as well as older adults' beliefs about pain and its management. This narrative review presents data on nine high-quality, peer-reviewed clinical trials published primarily over the past two years that focus on MSK pain management in older adults, of which four were comprehensively reviewed. These studies address contributors to knee osteoarthritis (OA) pain (insomnia), provide evidence for digital delivery or artificial intelligence driven behavioral interventions and potentially more efficient/equally effective modes of delivering glucocorticoids for OA; each of the selected studies have potential for scalability and meaningful impact in the care of older adults.
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Affiliation(s)
- Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati School of Medicine, Cincinnati, OH
| | - M. Cary Reid
- Division of Geriatrics and Palliative Medicine, Weil Cornell Medicine, NY, NY
| | - Sai Chilakapati
- Department of Neurological Surgery, UT Southwestern School of Medicine, Dallas, TX
| | - Una E. Makris
- Department of Internal Medicine, UT Southwestern School of Medicine, Dallas, TX
- Medical Service, Veterans Administration North Texas Health Care System, Dallas, TX
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19
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O'Connor V, Rowland JA, Naylor JC, Magnante AT, Craig KM, Miskey HM, Martindale SL. Time doesn't heal all: PTSD symptoms exacerbate the relationship between age and pain intensity. Front Psychiatry 2023; 14:1221762. [PMID: 37575582 PMCID: PMC10415104 DOI: 10.3389/fpsyt.2023.1221762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Objective Posttraumatic stress disorder (PTSD) symptoms and pain interfere with daily functioning and quality of life for many combat Veterans. As individuals age, pain symptoms tend to increase whereas PTSD symptoms tend to decrease. PTSD symptoms exacerbate pain, but the nature of this relationship across the aging process is unclear. The purpose of this study was to determine how PTSD symptoms affect the association between age and pain intensity. Methods Participants in this cross-sectional study included 450 Veterans (80% male) who served after September 11, 2001. PTSD and pain intensity ratings were assessed by the PTSD Checklist for DSM-5 (PCL-5) and the Brief Pain Inventory (BPI), respectively. Hierarchical multiple linear regression evaluated main and interaction effects between age, PTSD symptoms, and pain intensity. Results Age (B = 0.04, p < 0.001) and PTSD symptoms (B = 0.05, p < 0.001) were positively associated with pain intensity. Age and PTSD symptoms were inversely correlated (r = -0.16, p < 0.001). PTSD symptoms exacerbated the relationship between age and pain intensity (ΔR2 = 0.01, p = 0.036). Specifically, when greater PTSD symptoms were reported at older ages, pain intensity was significantly higher. Conclusion Results of these analyses suggests that age is important when considering the effects of PTSD symptoms on pain intensity ratings. Specifically, pain intensity ratings are higher in older Veterans with PTSD symptoms. These findings underscore the importance for clinical providers to evaluate trauma history and PTSD symptoms in older Veterans reporting pain symptoms.
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Affiliation(s)
- Victoria O'Connor
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jared A Rowland
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jennifer C Naylor
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Anna T Magnante
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Katherine M Craig
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
| | - Holly M Miskey
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Sarah L Martindale
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Wake Forest School of Medicine, Winston-Salem, NC, United States
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20
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Hu JH, Shi HJ, Han ZY, Liu H, Ji FH, Peng K. Protocol for Development and Validation of Multivariable Prediction Models for Chronic Postsurgical Pain Following Video-Assisted Thoracic Surgery. J Pain Res 2023; 16:2251-2256. [PMID: 37425224 PMCID: PMC10328098 DOI: 10.2147/jpr.s416450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Chronic postsurgical pain (CPSP) is a common complication after thoracic surgery and associated with long-term adverse outcomes. This study aims to develop two prediction models for CPSP after video-assisted thoracic surgery (VATS). Methods and Analysis This single-center prospective cohort study will include a total of 500 adult patients undergoing VATS lung resection (n = 350 for development and n = 150 for external validation). Patients will be enrolled continuously at The First Affiliated Hospital of Soochow University in Suzhou, China. The cohort for external validation will be recruited in another time period. The outcome is CPSP, which is defined as pain with the numerical rating scale score of 1 or higher 3 months after VATS. Univariate and multivariable logistic regression analyses will be performed to develop two CPSP prediction models based on patients' data of postoperative day 1 and day 14, respectively. For internal validation, we will use the bootstrapping validation technique. For external validation, the discrimination capability of the models will be assessed using the area under the receiver operating characteristic curve, and the calibration will be evaluated using the calibration curve and Hosmer-Lemeshow goodness-of-fit statistic. The results will be presented in model formulas and nomograms. Conclusion Based on the development and validation of the prediction models, our results contribute to early prediction and treatment of CPSP after VATS. Trial Registration Chinese Clinical Trial Register (ChiCTR2200066122).
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Affiliation(s)
- Jing-Hui Hu
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hai-Jing Shi
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Zhen-Yu Han
- Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Fu-Hai Ji
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Ke Peng
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
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21
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French O, Mattacola E. How has the COVID-19 pandemic affected patients' experience of pain management therapy? Br J Pain 2023; 17:46-57. [PMID: 36820057 PMCID: PMC9703013 DOI: 10.1177/20494637221121703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives The current service evaluation aimed to explore the impact of COVID-19 on patients' experiences of pain management therapy. The study examined the barriers and benefits of the move from face-to-face to eHealth methods of delivery. Design A service evaluation was conducted in an outpatient pain clinic in an NHS Trust in the East of England. A qualitative approach was taken using semi-structured interviews. Methods Participants were recruited through a health psychology service operating as part of a multidisciplinary pain management clinic. Six patients, aged 39-67, were interviewed one-to-one using the online platform ZoomTM. During COVID-19, participants had individual or group pain management therapy via telephone or video conferencing. All interviews were transcribed using Otter.aiTM and thematic analysis was performed. The study was approved by internal clinical governance for service evaluations and the authors adhered to the BPS Code of Human Research Ethics. Results Three key themes emerged from the analysis; Benefits Aside From Pain Relief, Limited Their Experience, and COVID- 19: A D ouble-Edged Sword. Conclusion Findings suggested patients were able to benefit from pain management therapy despite the impact of COVID-19 on daily routines and pain experience. Adopting eHealth methods during the pandemic was an effective means of accessing pain management therapy. These methods allowed patients to continue to benefit from peer support and learn about skills and resources regarding self-management, whilst also improving accessibility for those with chronic pain. Yet, these methods are not without their limitations. Technical issues and difficulties creating therapeutic connections with psychologists limited patients' experience of pain management therapy.
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Affiliation(s)
- Olivia French
- School of Psychology, University of Buckingham, Buckingham, UK
- Olivia French, School of Psychology, University of Buckingham, Hunter Street, Buckingham MK18 1EG, UK.
| | - Emily Mattacola
- School of Psychology, University of Buckingham, Buckingham, UK
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22
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Singh SP, Guindon J, Mody PH, Ashworth G, Kopel J, Chilakapati S, Adogwa O, Neugebauer V, Burton MD. Pain and aging: A unique challenge in neuroinflammation and behavior. Mol Pain 2023; 19:17448069231203090. [PMID: 37684099 PMCID: PMC10552461 DOI: 10.1177/17448069231203090] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Chronic pain is one of the most common, costly, and potentially debilitating health issues facing older adults, with attributable costs exceeding $600 billion annually. The prevalence of pain in humans increases with advancing age. Yet, the contributions of sex differences, age-related chronic inflammation, and changes in neuroplasticity to the overall experience of pain are less clear, given that opposing processes in aging interact. This review article examines and summarizes pre-clinical research and clinical data on chronic pain among older adults to identify knowledge gaps and provide the base for future research and clinical practice. We provide evidence to suggest that neurodegenerative conditions engender a loss of neural plasticity involved in pain response, whereas low-grade inflammation in aging increases CNS sensitization but decreases PNS sensitivity. Insights from preclinical studies are needed to answer mechanistic questions. However, the selection of appropriate aging models presents a challenge that has resulted in conflicting data regarding pain processing and behavioral outcomes that are difficult to translate to humans.
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Affiliation(s)
- Shishu Pal Singh
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Josee Guindon
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Prapti H Mody
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Gabriela Ashworth
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jonathan Kopel
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sai Chilakapati
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Volker Neugebauer
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Michael D Burton
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
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23
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Cardle P, Kumar S, Leach M, McEvoy M, Veziari Y. Mindfulness and Chronic Musculoskeletal Pain: An Umbrella Review. J Multidiscip Healthc 2023; 16:515-533. [PMID: 36879651 PMCID: PMC9985422 DOI: 10.2147/jmdh.s392375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/23/2022] [Indexed: 03/04/2023] Open
Abstract
Background Chronic musculoskeletal pain (CMSP) disorders are a leading cause of disability globally, affecting up to one in three people. Mindfulness-based interventions (MBI) have become a popular treatment for CMSP. The aim of this umbrella review was to synthesise the best available research evidence for the effectiveness of MBI for adults with CMSP. Methods Eight databases were searched from inception to 30th June 2021 for systematic reviews that examined the use of MBI in CMSP (pain experienced >3 months) in adult populations. Two reviewers independently conducted screening and selection, data extraction, and assessment of methodological quality using The Assessing the Methodological Quality of Systematic Reviews tool (AMSTAR 2). Outcomes examined were pain, sleep quality, depression, quality of life, physical functioning, and mindfulness. Furthermore, definitions of mindfulness, and intervention parameters (mindfulness practices used, length, frequency of sessions, duration) were also reported. Results Nineteen systematic reviews (n = 1 rated high quality, n = 1 moderate quality, n = 2 low quality and n = 15 critically low quality) examining 194 primary studies met the review criteria. Although some promising evidence was identified for the use of MBI in CMSP, the general low quality and widespread heterogeneity of included SRs and made it difficult to reach a definitive conclusion. Differences in results and outcomes amongst systematic reviews that, in many cases, had a high overlap of included RCTs, suggests fundamental differences in critical design elements that make data difficult to compare. Conclusion This umbrella review found mixed results on the effectiveness of MBI for the management of CMSP across a range of outcomes (pain, sleep quality, depression, quality of life, physical functioning, mindfulness). Definitions of MBI varied as did parameters, which may have contributed to these mixed results. More rigorous research with stringent MBI protocols is required.
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Affiliation(s)
- Paul Cardle
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| | - Saravana Kumar
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| | - Matthew Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia
| | - Maureen McEvoy
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| | - Yasamin Veziari
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
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24
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Montag LT, Salomons TV, Wilson R, Duggan S, Bisson EJ. Examining the roles of depression, pain catastrophizing, and self-efficacy in quality of life changes following chronic pain treatment. Can J Pain 2023; 7:2156330. [PMID: 36874232 PMCID: PMC9980521 DOI: 10.1080/24740527.2022.2156330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Adults with chronic pain have a lower quality of life (QOL) compared to the general population. Chronic pain requires specialized treatment to address the multitude of factors that contribute to an individual's pain experience, and effectively managing pain requires a biopsychosocial approach to improve patients' QOL. Aim This study examined adults with chronic pain after a year of specialized treatment to determine the role of cognitive markers (i.e., pain catastrophizing, depression, pain self-efficacy) in predicting changes in QOL. Methods Patients in an interdisciplinary chronic pain clinic (N = 197) completed measures of pain catastrophizing, depression, pain self-efficacy, and QOL at baseline and 1 year later. Correlations and a moderated mediation were completed to understand the relationships between the variables. Results Higher baseline pain catastrophizing was significantly associated with increased mental QOL (b = 0.39, 95% confidence interval [CI] 0.141; 0.648) and decreased depression (b = -0.18, 95% CI -0.306; -0.052) over a year. Furthermore, the relationship between baseline pain catastrophizing and the change in depression was moderated by the change in pain self-efficacy (b = -0.10, 95% CI -0.145; -0.043) over a year. Patients with high baseline pain catastrophizing reported decreased depression after a year of treatment, which was associated with greater QOL improvements but only in patients with unchanged or improved pain self-efficacy. Conclusions Our findings highlight the roles of cognitive and affective factors and their impact on QOL in adults with chronic pain. Understanding the psychological factors that predict increased mental QOL is clinically useful, because medical teams can optimize these positive changes in QOL through psychosocial interventions aimed at improving patients' pain self-efficacy.
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Affiliation(s)
- Landon T Montag
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Tim V Salomons
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.,Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Rosemary Wilson
- School of Nursing, Queen's University, Kingston, Ontario, Canada.,Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Scott Duggan
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Etienne J Bisson
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.,Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.,School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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25
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Porter LS, Weiner DK, Ramos K, Barnes DE, Schmader KE, Gwyther L, Ritchie CS, Keefe FJ. Partnering to cope with pain: A pilot study of a caregiver-assisted pain coping skills intervention for patients with cognitive impairment and dementia. Palliat Support Care 2022; 20:785-793. [PMID: 36942584 PMCID: PMC10032330 DOI: 10.1017/s1478951521001747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop a new caregiver-assisted pain coping skills training protocol specifically tailored for community-dwelling persons with cognitive impairment and pain, and assess its feasibility and acceptability. METHOD In Phase I, we conducted interviews with 10 patient-caregiver dyads to gather feedback about intervention content and delivery. Phase II was a single-arm pilot test to evaluate the intervention's feasibility and acceptability. Dyads in the pilot study (n = 11) completed baseline surveys, received five intervention sessions, and then completed post-intervention surveys. Analyses focused on feasibility and acceptability. RESULTS Dyads responded positively to the pain coping skills presented in the interviews; their feedback was used to refine the intervention. Findings from the pilot study suggested that the intervention was feasible and acceptable. 69% of eligible dyads consented, 82% completed all five intervention sessions, and 100% completed the post-treatment assessment. Caregivers reported high satisfaction ratings. They also reported using the pain coping skills on a regular basis, and that they found most of the skills helpful and easy to use. SIGNIFICANCE OF RESULTS These preliminary findings suggest that a caregiver-assisted pain coping skills intervention is feasible and acceptable, and that it may be a promising approach to managing pain in patients with cognitive impairment.
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Affiliation(s)
- Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Debra K Weiner
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Katherine Ramos
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Deborah E Barnes
- University of San Francisco, UCSF Weill Institute for Neurosciences, San Francisco, CA
| | - Kenneth E Schmader
- Department of Medicine, Duke University School of Medicine and GRECC, Durham VA Medical Center, Durham, NC
| | - Lisa Gwyther
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Christine S Ritchie
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Francis J Keefe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
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26
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Yarns BC, Zhu TA, Najafian Jazi A. Chronic Pain in Older Adults: A Neuroscience-Based Psychological Assessment and Treatment Approach. Am J Geriatr Psychiatry 2022; 30:1342-1350. [PMID: 35999127 DOI: 10.1016/j.jagp.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
Chronic pain remains a serious healthcare challenge, particularly for older adults who suffer substantial disability and are susceptible to serious risks from pain medications and invasive procedures. Psychotherapy is a promising option for older adults with chronic pain, since it does not contribute to medical or surgical risks. However, standard psychotherapies for chronic pain, including cognitive-behavioral therapy (CBT), acceptance and commitment therapy, and mindfulness-based interventions, produce only modest and time-limited benefits for older adults. In this article, we describe a novel, evidence-based psychological assessment and treatment approach for older adults with chronic pain, including a detailed case example. The approach begins with reviewing patients' pain, psychosocial, and medical histories to elicit evidence of a subtype of chronic pain called centralized (primary, nociplastic, or psychophysiologic) pain, which is highly influenced and may even be caused by life stress, emotions, and alterations in brain function. Patients then undertake a novel psychotherapy approach called emotional awareness and expression therapy (EAET) that aims to reduce or eliminate centralized pain by resolving trauma and emotional conflicts and learning healthy communication of adaptive emotions. Our published preliminary clinical trial (n = 53) indicated that EAET produced statistically significant and large effect size advantages over CBT in pain reduction and marginally greater improvements in pain interference than CBT for older adults with chronic musculoskeletal pain. Geriatric mental healthcare providers may learn this assessment and treatment approach to benefit many of their patients with chronic pain.
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Affiliation(s)
- Brandon C Yarns
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA.
| | - Tongtong A Zhu
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Ali Najafian Jazi
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA
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27
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Schmiesing A, Liang Y, Turner BJ. Association of nonpharmacologic chronic pain management with function in a low-income population: Evidence from a survey of a sample of Latinos from five states. PM R 2022; 14:1343-1350. [PMID: 34464031 DOI: 10.1002/pmrj.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Low-income minority populations often confront barriers to professional nonpharmacologic management of chronic pain and, without this care, may have poorer daily function. OBJECTIVE To examine the association of professional nonpharmacologic chronic pain management in the past year categorized as physical interventions or mind-body interventions with current functional status. DESIGN Online, population-based survey. SETTING Community-dwelling Latinos from five southwestern states (California, Texas, Arizona, Nevada, and New Mexico). PARTICIPANTS The survey was offered to all Latino online panel members aged 35 to 75 years in 5 states (N = 1007). With weights, this sample represented 11,016,135 persons. Of 516 respondents (51%), 486 (94%) had valid surveys and, of these, 102 members (21%) had chronic noncancer pain. With weights, they represented 1,140,170 persons with chronic pain. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Daily impairment in mobility and in activities of daily living (ADLs). RESULTS Of the weighted sample, 37.2% reported daily impairment in mobility and 29.4% in ADLs. Professional physical interventions for chronic pain were received by 41.2% and mind-body interventions received by 33.4% but usually with physical interventions. Adjusted odds ratios (AOR) of daily mobility impairment for respondents who used physical interventions with mind-body interventions or alone were both less than 0.10 (p < .01) versus none. Only professional physical intervention was associated with decreased odds for daily impairment in ADLs (AOR = 0.07; 95% confidence interval = 0.01 to 0.94; p = .045). CONCLUSIONS In a weighted sample of Latinos with chronic pain, professional physical interventions reduced the likelihood of daily impairment in mobility and ADLs.
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Affiliation(s)
- Allie Schmiesing
- Department of Rehabilitation, Stanford Healthcare, Stanford, California, USA
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Barbara J Turner
- Department of Medicine, Keck Medical Center of University of Southern California, Los Angeles, California, USA
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28
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Patterns of patient outcomes following specialist pain management in Australasia: a latent class analysis using the ePPOC database. Pain 2022; 164:967-976. [PMID: 36448970 DOI: 10.1097/j.pain.0000000000002799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/23/2022] [Indexed: 12/05/2022]
Abstract
ABSTRACT The increasing demand for pain management and limited resources available highlight the need to measure treatment effectiveness. We analysed data collected at 75 specialist persistent pain services located in Australia and New Zealand to calculate overall treatment outcome for patients receiving care during 2014-2020. Socio-demographic and clinical information was provided for 23,915 patients, along with patient-reported measures assessing pain, pain interference, depression, anxiety, stress, pain catastrophizing and pain self-efficacy. Latent Class Analysis identified four distinct outcomes based on patients' pattern of responses across the assessment tools at treatment end. Group 1 (n=8,369, 35%) reported low/mild severity across all clinical domains at the end of care, while Group 4 (n= 7,081, 30%) were more likely to report moderate/high severity on all domains. Group 2 (n=1,991, 8%) reported low/mild pain with moderate/high psychological distress at treatment end, and Group 3 (n=6,474, 27%) reported moderate/high pain with low/mild psychological distress. Multi-variable logistic regression identified those factors associated with the different groups. In particular, factors most predictive of a poor (Group 4) vs. good outcome (Group 1) were unemployment (due to pain or other reasons), requiring an interpreter, widespread pain, pain of longer duration and attributing the pain to an injury at work. The results may allow identification of those most likely to benefit from the services currently provided, and inform development of alternative or enhanced services for those at risk of a poor outcome.
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29
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Wu XD, Zeng FF, Yu XX, Yang PP, Wu JP, Xv P, Wang HT, Pei YM. Development and Validation of a Prediction Model for Chronic Post-Surgical Pain After Thoracic Surgery in Elderly Patients: A Retrospective Cohort Study. J Pain Res 2022; 15:3079-3091. [PMID: 36203786 PMCID: PMC9530220 DOI: 10.2147/jpr.s368295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Chronic post-surgical pain (CPSP) is one of the adverse outcomes after surgery, especially in thoracotomy. However, the prevalence of CPSP in elderly adults (≥65 years), is still limited. Therefore, the present study was undertaken to establish and validate the prediction model of CPSP in those patients after thoracic surgery, including thoracotomy and video-assisted thoracoscopic surgery. Patients and Methods This retrospective, observational single-center cohort study was conducted in Nanfang Hospital, Southern Medical University, which randomly and consecutively collected 577 elderly patients who underwent thoracic surgery between January 1, 2017, and December 31, 2020. According to the Akaike information criterion, the prediction model was built based on all the data and was validated by calibration with 500 bootstrap samples. Results The mean age of participants was 69.09±3.80 years old, and 63.1% were male. The prevalence of CPSP was 26.9%. Age more than 75 years, BMI, blood loss, longer length of hospital stays, and higher pre-operative neutrophil count were associated with CPSP. Except for these factors, we incorporated history of drinking to build up the prediction model. The areas under the curve (AUCs) of the prediction models were 0.66 (95% CI, 0.61–0.71) and 0.64 (95% CI, 0.59–0.69) in the observational and validation cohorts, respectively. And the calibration curve of the predictive model showed a good fit between the predicted risk of CPSP and observed outcomes in elderly patients. Conclusion The present developed model may help clinicians to find high-risk elderly patients with CPSP after thoracic surgery and take corresponding measures in advance to reduce the incidence of CPSP and improve their life quality.
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Affiliation(s)
- Xiao-Dan Wu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Fan-Fang Zeng
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Xiao-Xuan Yu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Pan-Pan Yang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Jun-Peng Wu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Ping Xv
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, 510280, People’s Republic of China
| | - Hai-Tang Wang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
- Correspondence: Hai-Tang Wang; You-Ming Pei, Department of Anesthesiology, Nanfang Hospital, Southern medical university, 1838 Guangzhou North Road, Guangzhou, Guangdong, 510515, People’s Republic of China, Tel +86-18718911653; +86-15889942610, Fax +86 20-62787271; +86 20-62787271, Email ;
| | - You-Ming Pei
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
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30
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Herbert MS, Tynan M, Lang AJ, Backhaus A, Casmar P, Golshan S, Afari N. An integrated mindfulness meditation and acceptance and commitment therapy intervention for chronic pain: Rationale, design, and methodology of a pilot randomized controlled trial of Acting with Mindfulness for Pain (AMP). Contemp Clin Trials 2022; 119:106809. [PMID: 35636734 DOI: 10.1016/j.cct.2022.106809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 12/29/2022]
Abstract
Acceptance and commitment therapy (ACT) is an evidence-based psychosocial intervention for chronic pain; however, in its present form ACT produces modest improvements in function and is no more effective than cognitive behavioral therapy (CBT), the current gold standard. This protocol paper describes the Acting with Mindfulness for Pain (AMP) protocol, which emphasizes and integrates formal mindfulness meditation practice within an ACT-based approach. This paper presents the rationale, design and methodology of an ongoing pilot randomized controlled trial (RCT) comparing AMP to CBT among Veterans with chronic pain (N = 86). Specifically, we argue that formal meditation practice is a necessary treatment component that directly targets key ACT processes which will help facilitate large treatment effects on function (e.g., general activity, social relationships, life enjoyment) among individuals with chronic pain. This study will be the first to consider formal mindfulness meditation practice as a principal treatment ingredient in the context of ACT for chronic pain. The purpose of this trial is to evaluate the feasibility of recruitment and collection of measures, and to examine preliminary treatment effects to determine the appropriateness of a subsequent full-scale RCT. This study will also explore within and between group change on primary and secondary outcomes including pain interference, pain acceptance, trait mindfulness, pain catastrophizing, values-based living, quality of life, practice adherence, and objective measures of physical activity. This study will help delineate the role of formal mindfulness practice within an ACT-based approach for chronic pain and provide preliminary data for a future fully powered RCT.
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Affiliation(s)
- Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.
| | - Mara Tynan
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Ariel J Lang
- Department of Psychiatry, University of California, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | - Autumn Backhaus
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Pollyanna Casmar
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Shahrokh Golshan
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
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Salari S, Shaygan M, Setoodeh G. The mediating role of maladaptive cognitive schemas regarding the relationship between parenting styles and chronic pain in adolescents: a structural equation modelling approach. Child Adolesc Psychiatry Ment Health 2022; 16:60. [PMID: 35879725 PMCID: PMC9316414 DOI: 10.1186/s13034-022-00496-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although there is a growing body of evidence linking parenting styles to health outcomes, little emphasis has been dedicated to how parenting styles affect chronic pain in adolescents. Given the high prevalence of chronic pain in adolescents and taking into consideration the complexity of chronic pain and the factors affecting it, further research is needed to better understand the processes through which parenting styles affect adolescents' pain. The purpose of the present study was to explore the mediating role of maladaptive schemas in the association between different parenting styles and chronic pain. METHOD 1302 adolescents aged 12 to 21 in Shiraz, Iran, were randomly selected to participate in this study. To identify adolescents with chronic pain, screening questions based on the 11th revision of the International Classification of Diseases were used. Buri's Parental Authority Questionnaire (PAQ), and Young's Schema Questionnaire-Short Form (YSQ-SF) were used to assess the parenting styles and maladaptive cognitive schemas, respectively. The structural equation modeling approach was carried out to evaluate the direct, indirect, and total effects of different parenting styles on chronic pain. RESULTS The results in the SEM models revealed that disconnection/ rejection (β = - 0.043, 95%CI = - 0.07 to - 0.02), impaired autonomy/ performance (β = - 0.01, 95%CI = - 0.02 to -0.003), over-vigilance/inhibition (β = - 0.007, 95%CI = - 0.01 to - 0.008), and impaired limits schemas (β = - 0.004, 95%CI = - 0.006 to - 0.002) significantly mediated the protective effects of the authoritative parenting style on chronic pain. It was also found that the mediating effects of disconnection/ rejection (β = 0.01, 95%CI = 0.01 to 0.02), and over-vigilance/ inhibition (β = 0.002, 95%CI = 0.001 to 0.02) existed in the relationship between the authoritarian style and chronic pain. The permissive style may also affect chronic pain through disconnection/ rejection (β = 0.004, 95%CI = 0.001 to 0.01), other-directedness (β = 0.01, 95%CI = 0.005 to 0.015), and impaired limits schemas (β = 0.05, 95%CI = 0.04 to 0.06). DISCUSSION The findings of the present study showed that maladaptive cognitive schemas play a mediating role in the relationship between parenting styles and chronic pain in adolescents. It seems that the interventions that target the effective communication between the parents and the adolescents can be considered as an important part in the chronic pain management in adolescents.
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Affiliation(s)
- Saghar Salari
- grid.412571.40000 0000 8819 4698Student Research Committee, Department of Psychiatric Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Shaygan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, P.O. Box 713451359, Shiraz, Iran.
| | - Giti Setoodeh
- grid.412571.40000 0000 8819 4698Department of Psychiatric Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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MacPherson M, Bakker AM, Anderson K, Holtzman S. Do pain management apps use evidence-based psychological components? A systematic review of app content and quality. Can J Pain 2022; 6:33-44. [PMID: 35694141 PMCID: PMC9176230 DOI: 10.1080/24740527.2022.2030212] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background With hundreds of pain management apps on the Canadian marketplace, it can be challenging for patients and clinicians to select effective and evidence-based mobile health (mHealth) apps that address pain from a biopsychosocial perspective. Aims The aim of this study is to identify pain management apps within the Canadian app marketplaces to aid clinicians in recommending apps. Methods The iOS and Android marketplaces were systematically searched to identify pain management apps that included at least one core component of cognitive behavioral therapy (CBT) or mindfulness- and acceptance-based therapies. Selected apps were assessed using a researcher developed psychological components checklist, and the Mobile App Rating Scale (MARS). These two measures provided a robust assessment of the apps' technical abilities and psychological principles being implemented. Results Five hundred eight pain management apps were identified, yet only 12 included a psychological component and were available for evaluation. On average, apps contained 8.10 out of 18 psychological components (SD = 2.77) with a MARS quality rating of 4.02 out of 5 (SD = 0.32). The most common psychological components were grounded in CBT, including psychoeducation, sleep hygiene, behavioral activation, coping skills training, and social support. Among the least commonly included components were goal setting, values, and culture/diversity. Two-thirds of the apps involved health care practitioners in their development, but independent scientific review of apps was scarce. Conclusion The highest scoring apps (Curable, Pathways, Vivify) are highlighted for health care practitioners who may wish to recommend mHealth technologies to their patients for pain management. Future directions for research and app development are discussed.
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Affiliation(s)
- Megan MacPherson
- School of Health and Exercise Sciences, University of British Columbia,Okanagan Campus; 3333 University Way, Kelowna, BC, V1V 1V, Canada,CONTACT Megan MacPherson School of Health and Exercise Sciences; University of British Columbia, Okanagan Campus; 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - A. Myfanwy Bakker
- Department of Psychology, Universiy of British Columbia, Kelowna, British Columbia, Canada
| | - Koby Anderson
- Department of Psychology, Universiy of British Columbia, Kelowna, British Columbia, Canada
| | - Susan Holtzman
- Department of Psychology, Universiy of British Columbia, Kelowna, British Columbia, Canada
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Li WS, Cai YF, Cong L. The Effect of Vertebral Augmentation Procedure on Painful OVCFs: A Meta-Analysis of Randomized Controlled Trials. Global Spine J 2022; 12:515-525. [PMID: 33706568 PMCID: PMC9121160 DOI: 10.1177/2192568221999369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE To systematically compare the effectiveness and safety of vertebral augmentation procedure (VAP) with non-surgical management (NSM) for the treatment of osteoporotic vertebrate compression fractures (OVCFs). METHODS Systematic reviews and meta-analyses with the comparison between VAP and NSM were identified to extract randomized controlled trials from electronic database. Additionally, recently published RCTs were identified. Two researchers independently extracted the data. The primary outcome of this meta-analysis was pain relief evaluated by visual analogue scale (VAS). RESULTS Twenty RCTs involving 2566 patients with painful OVCFs were included. Significant differences were found between percutaneous vertebroplasty (PVP) and conservative treatment (CT) in VAS at each time point during follow-up period. The differences of VAS were not significant between PVP and sham procedure at most time points during follow-up period. In subgroup analysis based on fracture type and fracture location, significant differences of VAS were found between PVP and CT and were not found between PVP and sham procedure. In subgroup analysis of duration of back pain, significant differences were found between PVP and CT in VAS at 1 week, 3 month and 1 year. And the differences of VAS were not significant between PVP and CT at 1 month and 6 month. CONCLUSION BKP is considered sufficient to achieve good clinical outcomes. PVP is associated with on beneficial effect on treatment of painful OVCFs compared with sham procedure. The indication and timing of VAP need further research. More independently high-quality RCTs with sufficiently large sample sizes reporting cost-effectiveness are needed.
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Affiliation(s)
- Wei-Shang Li
- Department of Orthopedic Surgery, The First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Yun-Fei Cai
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Lin Cong
- Department of Orthopedic Surgery, The First Hospital of China Medical University, Shenyang, People’s Republic of China,Lin Cong, Department of Orthopedic Surgery, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang City, Liaoning Province, 110001, People’s Republic of China.
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Peat G, Jordan KP, Wilkie R, Corp N, van der Windt DA, Yu D, Narle G, Ali N. Do recommended interventions widen or narrow inequalities in musculoskeletal health? An equity-focussed systematic review of differential effectiveness. J Public Health (Oxf) 2022; 44:e376-e387. [PMID: 35257184 PMCID: PMC9424108 DOI: 10.1093/pubmed/fdac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 05/10/2021] [Indexed: 11/15/2022] Open
Abstract
Background It is unclear whether seven interventions recommended by Public Health England for preventing and managing common musculoskeletal conditions reduce or widen health inequalities in adults with musculoskeletal conditions. Methods We used citation searches of Web of Science (date of ‘parent publication’ for each intervention to April 2021) to identify original research articles reporting subgroup or moderator analyses of intervention effects by social stratifiers defined using the PROGRESS-Plus frameworks. Randomized controlled trials, controlled before-after studies, interrupted time series, systematic reviews presenting subgroup/stratified analyses or meta-regressions, individual participant data meta-analyses and modelling studies were eligible. Two reviewers independently assessed the credibility of effect moderation claims using Instrument to assess the Credibility of Effect Moderation Analyses. A narrative approach to synthesis was used (PROSPERO registration number: CRD42019140018). Results Of 1480 potentially relevant studies, seven eligible analyses of single trials and five meta-analyses were included. Among these, we found eight claims of potential differential effectiveness according to social characteristics, but none that were judged to have high credibility. Conclusions In the absence of highly credible evidence of differential effectiveness in different social groups, and given ongoing national implementation, equity concerns may be best served by investing in monitoring and action aimed at ensuring fair access to these interventions.
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Affiliation(s)
- G Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - K P Jordan
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - R Wilkie
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - N Corp
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - D A van der Windt
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - D Yu
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - G Narle
- Public Health England, London, SE1 8UG, UK.,Versus Arthritis, Chesterfield, S41 7TD, UK
| | - N Ali
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, SW1H 0EU, UK
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Honda H, Ashizawa R, Kiriyama K, Take K, Hirase T, Arizono S, Yoshimoto Y. Chronic pain in the frail elderly mediates sleep disorders and influences falls. Arch Gerontol Geriatr 2022; 99:104582. [DOI: 10.1016/j.archger.2021.104582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/04/2021] [Accepted: 11/13/2021] [Indexed: 11/29/2022]
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. A Standardized Assessment of Movement-evoked Pain Ratings Is Associated With Functional Outcomes in Older Adults With Chronic Low Back Pain. Clin J Pain 2021; 38:241-249. [PMID: 34954729 PMCID: PMC8917081 DOI: 10.1097/ajp.0000000000001016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/06/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Despite high prevalence estimates, chronic low back pain (CLBP) remains poorly understood among older adults. Movement-evoked pain (MeP) is an understudied factor in this population that may importantly contribute to disability. This study investigated whether a novel MeP paradigm contributed to self-reported and performance-based function in older adults with CLBP. MATERIALS AND METHODS This secondary analysis includes baseline data from 230 older adults with CLBP in the context of a prospective cohort study. The Repeated Chair Rise Test, Six Minute Walk Test, and Stair Climbing Test were used to elicit pain posttest LBP ratings were aggregated to yield the MeP variable. Self-reported and performance-based function were measured by the Late Life Function and Disability Index (LLFDI) scaled function score and Timed Up-and-Go Test (TUG), respectively. Robust regression with HC3 standard errors was used to model adjusted associations between MeP and both functional outcomes; age, sex, body mass index, and pain characteristics (ie, intensity, quality, and duration) were utilized as covariates. RESULTS MeP was present in 81.3% of participants, with an average rating of 5.09 (SD=5.4). Greater aggregated posttest MeP was associated with decreased LLFDI scores (b=-0.30, t=-2.81, P=0.005) and poorer TUG performance (b=0.081, t=2.35, P=0.020), independent of covariates. LBP intensity, quality and duration were not associated with the LLFDI or TUG, (all P>0.05). DISCUSSION Aggregated posttest MeP independently contributed to worse self-reported and performance-based function among older adults with CLBP. To understand long-term consequences of MeP, future studies should examine longitudinal associations between MeP and function in this population.
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Affiliation(s)
- Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Ryan T. Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE
- Biostatistics Core, University of Delaware, Newark, DE
| | | | - Peter C. Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Jaclyn M. Sions
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
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Kechichian A, Lafrance S, Matifat E, Dubé F, Lussier D, Benhaim P, Perreault K, Filiatrault J, Rainville P, Higgins J, Rousseau J, Masse J, Desmeules F. Multimodal Interventions Including Rehabilitation Exercise for Older Adults With Chronic Musculoskeletal Pain: A Systematic Review and Meta-analyses of Randomized Controlled Trials. J Geriatr Phys Ther 2021; 45:34-49. [PMID: 34928239 DOI: 10.1519/jpt.0000000000000279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Musculoskeletal disorders (MSKDs) are the most common causes of disabilities for older adults. The aim of this systematic review and meta-analysis is to assess the effectiveness of multimodal interventions including exercise rehabilitation for older adults with chronic MSKDs. METHODS A literature search was conducted up to February 2019 in 5 bibliographical databases to identify randomized controlled trials (RCTs) that compared multimodal interventions including exercise rehabilitation with usual medical care or no intervention. Randomized controlled trials were assessed with the Cochrane risk-of-bias tool. Meta-analyses were performed and pooled mean differences (MDs) or standardized mean differences (SMDs) were calculated. RESULTS Sixteen RCTs (n = 2322 participants) were included. One RCT was considered at low risk of bias, 8 had some concerns of bias, and 7 had a high risk of bias. Participants suffered from hip or knee osteoarthritis (OA) (n = 12 RCTs), low back pain (LBP) (n = 2 RCTs) and generalized chronic pain (GCP) (n = 2 RCTs). Multimodal interventions were significantly more effective than usual care to decrease pain (visual analog scale, out of 10 points) in the short term, MD: -0.71 (95% confidence interval [CI] -1.08 to -0.34, n = 900), and in the long term: MD: -0.52 (95% CI -0.98 to -0.05, n = 575), but these differences are not considered clinically important. In terms of disabilities, multimodal interventions were also significantly more effective than usual care. The SMDs were -0.47 (95% CI -0.61 to -0.34, n = 903) and -0.29 (95% CI -0.46 to -0.13, n = 568) for OA trials in the short and long terms, respectively, and -0.47 (95% CI -0.81 to -0.12, n = 211) for LBP and GCP trials in the short term. The magnitude of these effects may be considered as small to moderate. CONCLUSION Multimodal intervention including exercise rehabilitation combined with usual medical care is an efficacious therapeutic option to reduce disabilities in older adults with chronic MSKDs. A significant but not clinically important effect was observed for pain. The most beneficial component of the multimodal interventions in terms of education, exercises, or medication remains to be determined.
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Affiliation(s)
- Amélie Kechichian
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.,Pierre and Marie Curie University, Sorbonne University, Paris, France
| | - Simon Lafrance
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Eveline Matifat
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
| | - François Dubé
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - David Lussier
- Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Patrick Benhaim
- Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, University of Laval, Quebec, Canada
| | - Johanne Filiatrault
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Pierre Rainville
- Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.,Departement of Stomatology, Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Johanne Higgins
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
| | - Jacqueline Rousseau
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Julie Masse
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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Donison V, Chesney TR, Wills A, Santos B, McLean B, Alqurini N, Hossain N, Durbano S, Lemonde M, Alibhai SMH, Puts M. Self-management interventions for issues identified in a geriatric assessment: A systematic review. J Am Geriatr Soc 2021; 70:1268-1279. [PMID: 34902156 DOI: 10.1111/jgs.17601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND With the development of electronic geriatric assessment (GA), recommendations for self-management can be provided to patients without the presence of health care providers. Our research question was to identify what self-management interventions can be used by patients to address issues identified in GA and to determine their effect on patient-centered outcomes such as quality of life, health, mood, cognition, and functional status. METHODS Searches were conducted on July 13, 2021, by a health sciences librarian in Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library. A combination of database-specific subject headings and text word searches was used such as self-management, a key word for each of the geriatric assessment domains and older adults. Two independent reviewers reviewed abstracts and full texts for inclusion and abstracted data. Narrative synthesis was used to summarize findings. RESULTS Among 28,520 abstracts reviewed, 34 randomized controlled trials were included. The most frequently studied geriatric domains were mood (n = 13 studies), mobility/falls (n = 12), quality of life (n = 11), and functional status (n = 7). The majority of studies demonstrated positive effects on mobility/falls (9 of 12), pain (3 of 5), comorbidity (4 of 4), and medication management (4 of 4). Most studies were of low to moderate quality. All geriatric domains were targeted in at least one study. CONCLUSIONS Low- to moderate-quality studies show a variety of effective self-efficacy-targeted interventions exist for older adults to improve several important geriatric domains and related outcomes. However, long-term effects, validation, and scalability of these interventions remain largely unknown.
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Affiliation(s)
- Valentina Donison
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tyler R Chesney
- Department of Surgery, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Brenda Santos
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Bianca McLean
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Naser Alqurini
- Central Department of Primary Health Care, Ministry of Health, Kuwait City, Kuwait
| | - Nazia Hossain
- Postgraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada.,Department of Medicine, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Lee YC, Fox RS, Kwakkenbos L, Levis B, Carrier ME, Welling J, Sauvé M, Mouthon L, Benedetti A, Bartlett SJ, Varga J, Thombs BD. Pain levels and associated factors in the Scleroderma Patient-centered Intervention Network (SPIN) cohort: a multicentre cross-sectional study. THE LANCET. RHEUMATOLOGY 2021; 3:e844-e854. [PMID: 38287631 DOI: 10.1016/s2665-9913(21)00318-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pain is an important and detrimental feature of systemic sclerosis but is often overlooked or deprioritised in research and clinical care. Raynaud's phenomenon, arthritis, and cutaneous ulcers are among the commonly reported disease manifestations of systemic sclerosis that could be associated with pain. We aimed to assess levels of pain intensity and interference and to evaluate disease factors associated with pain intensity and interference. METHODS In this multicentre cross-sectional study, participants from the Scleroderma Patient-centered Intervention Network cohort who completed pain intensity and interference measures (Patient Reported Outcomes Information System-29 profile, version 2·0) as part of baseline assessments were included. Patients were recruited from 46 centres in Australia, Canada, France, Mexico, Spain, the UK, and the USA between April 15, 2014, and Jan 7, 2020. Eligible patients included those aged 18 years or older who met the criteria for systemic sclerosis devised by the American College of Rheumatology and the European League Against Rheumatism. Associations of pain intensity and pain interference with systemic sclerosis-related variables and overlap syndromes, controlling for sociodemographic variables, were assessed with multiple linear regression. Continuous independent variables were standardised. FINDINGS Among 2157 participants with systemic sclerosis (268 [12%] males and 1889 [88%] females), 1870 (87%) reported mild, moderate, or severe pain (defined as ≥1 on a 0 to 10 scale), and 815 (38%) reported moderate or severe pain (defined as ≥5). Moreover, 757 (35%) participants reported moderate or severe pain interference. Greater pain intensity was independently associated with female sex (0·58 points [95% CI 0·26-0·90]), non-White race or ethnicity (0·50 points [0·21-0·79]), fewer years in formal education (0·30 points per SD [0·19-0·41]), country (reference: USA; Canada: 0·29 points [0·01-0·57] and UK: 0·58 points [0·21-0·95]), greater body-mass index (0·35 points per SD [0·24-0·45]); joint contractures (0·67 points [0·39-0·94]), digital ulcers (0·33 points [0·10-0·55]), gastrointestinal involvement (0·66 points [0·33-0·98]), skin involvement (measured using modified Rodnan skin score; 0·22 points per SD [0·10-0·35]), rheumatoid arthritis (0·96 points [0·50-1·43]), and Sjögren's syndrome (0·42 points [0·01-0·83]). Pain interference results were similar. INTERPRETATION Pain is common among people with systemic sclerosis. Controlling for sociodemographic variables, greater pain was associated with multiple systemic sclerosis-related manifestations, including joint contractures, digital ulcers, gastrointestinal involvement, skin involvement, and the presence of overlap syndromes. Health-care providers should work with patients to address pain, including identifying and addressing systemic sclerosis manifestations associated with their pain, and supporting behavioural approaches to minimise impact on function and quality of life. FUNDING Canadian Institutes of Health Research, Arthritis Society, The Lady Davis Institute for Medical Research of the Jewish General Hospital, Jewish General Hospital Foundation, McGill University, Scleroderma Society of Ontario, Scleroderma Canada, Sclérodermie Québec, Scleroderma Manitoba, Scleroderma Atlantic, Scleroderma Association of BC, Scleroderma SASK, Scleroderma Australia, Scleroderma New South Wales, Scleroderma Victoria, and Scleroderma Queensland.
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Affiliation(s)
- Yvonne C Lee
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda Kwakkenbos
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands; Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Brooke Levis
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Joep Welling
- Dutch patient organization for systemic autoimmune diseases, Utrecht, Netherlands; Federation of European Scleroderma Associations, Brussels, Belgium
| | - Maureen Sauvé
- Scleroderma Society of Ontario and Scleroderma Canada, Hamilton, ON, Canada
| | - Luc Mouthon
- Service de Medecine Interne, Centre de Reference Maladies Autoimmunes et Systemiques Rares d'Ile de France, Hopital Cochin, Assistance-Publique Hopitaux de Paris, Centre, Universite de Paris, Paris, France
| | - Andrea Benedetti
- Department of Medicine, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada
| | - John Varga
- University of Michigan, Ann Arbor, MI, USA
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada; Department of Psychology, McGill University, Montreal, QC, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada; Biomedical Ethics Unit, McGill University, Montreal, QC, Canada
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Kohlert A, Wick K, Rosendahl J. Autogenic Training for Reducing Chronic Pain: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Int J Behav Med 2021; 29:531-542. [PMID: 34705227 PMCID: PMC8548271 DOI: 10.1007/s12529-021-10038-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 12/17/2022]
Abstract
Background Autogenic training (AT) is frequently used as therapeutic approach in multimodal pain therapy. The aim of this systematic review and meta-analysis is to investigate the efficacy of AT in individuals suffering from chronic pain in comparison to passive and active control groups. Methods A comprehensive literature search in Medline, Web of Science, PsycInfo, and PubPsych and manual searches (last search April 7, 2021) were conducted to locate randomized controlled trials (RCTs). Treatment guidelines and references of relevant articles and previous reviews were checked. ProQuest Dissertations and Theses Full Text database, DART-Europe E-theses Portal, Networked Digital Library of Theses and Dissertations (NDLTD), and the Theses Database of the German National Library were screened to identify any unpublished material. Results A total of 13 eligible studies (k = 15 comparisons) including 576 participants were identified. Random-effects meta-analyses revealed a significantly positive, moderate effect of AT on the primary outcome pain compared to passive control groups (g = 0.58, 95% CI [0.36; 0.79], k = 9, I2 = 0%). In comparison with other psychological interventions, no difference was found (g = − 0.05, 95% CI [− 0.30; 0.20], k = 6, I2 = 0%). Sensitivity analyses proved the robustness of findings. Overall risk-of-bias judgment was ‘some concerns’ in the majority of studies. Conclusions Beneficial effects of AT on pain reduction were demonstrated, but findings are prone to bias. Furthermore, high methodological quality RCTs are needed to strengthen the promising evidence of AT for individuals with chronic pain. Supplementary Information The online version contains supplementary material available at 10.1007/s12529-021-10038-6.
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Affiliation(s)
- Antonia Kohlert
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Stoystr. 3, 07743, Jena, Germany
| | | | - Jenny Rosendahl
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Stoystr. 3, 07743, Jena, Germany.
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Lysne PE, Palit S, Morais CA, DeMonte LC, Lakdawala M, Sibille KT, Bartley EJ. Adaptability and Resilience in Aging Adults (ARIAA): protocol for a pilot and feasibility study in chronic low back pain. Pilot Feasibility Stud 2021; 7:188. [PMID: 34666839 PMCID: PMC8525058 DOI: 10.1186/s40814-021-00923-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/06/2021] [Indexed: 01/02/2023] Open
Abstract
Background Chronic low back pain (cLBP) is the leading cause of disability among older adults and one of the top reasons for seeking healthcare, resulting in significant decrements in physical functioning. Because older adults are among the fastest growing cohorts in the USA, both the incidence and burden of cLBP are expected to increase considerably, rendering geriatric pain management a top health priority. Resilience is defined as a process allowing individuals to adapt and recover from adverse and stressful conditions, and it has been highlighted as a crucial factor in positive health-related functioning. While a growing body of literature supports the use of resilience-based interventions in chronic pain, research examining their effectiveness in older adults with cLBP remains limited. The primary aims of the study are to assess the feasibility and acceptability of a psychologically oriented resilience intervention among aging adults with cLBP. Methods In this article, we describe the rationale and design of the Adaptability and Resilience in Aging Adults (ARIAA) study, a single-arm intervention in which 60 participants (ages ≥ 60 years) with cLBP will be recruited to participate in a 7-week group-based program aimed at enhancing psychological resilience. Intervention sessions will target positive psychology concepts (e.g., positive affect, pain acceptance, hopeful thinking, pain self-efficacy) and cognitive behavioral techniques that have established benefits in pain management. Primary study outcomes include intervention feasibility and acceptability as measured by treatment engagement, intervention credibility and satisfaction, ability to meet recruitment and retention metrics, and the feasibility of questionnaire and home activity completion. Outcomes will be assessed at baseline, immediately at posttreatment, and at the 3-month follow-up period. Discussion This study will establish the feasibility and acceptability of a novel intervention aimed at enhancing positive, psychological functioning, and resilience in older adults with cLBP. Achievement of these aims will provide a rich platform for future intervention research targeting improvements in pain and disability among geriatric populations and will serve as a foundation for a fully powered trial to examine treatment efficacy of the proposed intervention. Trial registration Clinicaltrials.gov, identifier NCT04068922. Registered 28 August 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00923-y.
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Affiliation(s)
- Paige E Lysne
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Shreela Palit
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Calia A Morais
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Lucas C DeMonte
- Department of Counseling and Higher Education, Northern Illinois University, DeKalb, IL, USA
| | - Maria Lakdawala
- Department of Microbiology and Cell Science, University of Florida, Gainesville, FL, USA
| | - Kimberly T Sibille
- Department of Aging and Geriatric Research, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Emily J Bartley
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.
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Chadwick A, Frazier A, Khan TW, Young E. Understanding the Psychological, Physiological, and Genetic Factors Affecting Precision Pain Medicine: A Narrative Review. J Pain Res 2021; 14:3145-3161. [PMID: 34675643 PMCID: PMC8517910 DOI: 10.2147/jpr.s320863] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Precision pain medicine focuses on employing methods to assess each patient individually, identify their risk profile for disproportionate pain and/or the development of chronic pain, and optimize therapeutic strategies to target specific pathological processes underlying chronic pain. This review aims to provide a concise summary of the current body of knowledge regarding psychological, physiological, and genetic determinants of chronic pain related to precision pain medicine. METHODS Following the Scale for the Assessment of Narrative Review Articles (SANRA) criteria, we employed PubMed/Medline to identify relevant articles using primary database search terms to query articles such as: precision medicine, non-modifiable factors, pain, anesthesiology, quantitative sensory testing, genetics, pain medicine, and psychological. RESULTS Precision pain medicine provides an opportunity to identify populations at risk, develop personalized treatment strategies, and reduce side effects and cost through elimination of ineffective treatment strategies. As in other complex chronic health conditions, there are two broad categories that contribute to chronic pain risk: modifiable and non-modifiable patient factors. This review focuses on three primary determinants of health, representing both modifiable and non-modifiable factors, that may contribute to a patient's profile for risk of developing pain and most effective management strategies: psychological, physiological, and genetic factors. CONCLUSION Consideration of these three domains is already being integrated into patient care in other specialties, but by understanding the role they play in development and maintenance of chronic pain, we can begin to implement both precision and personalized treatment regimens.
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Affiliation(s)
- Andrea Chadwick
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andrew Frazier
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Talal W Khan
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Erin Young
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
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Honda H, Ashizawa R, Kiriyama K, Take K, Yoshimoto Y. Depression Is Associated with Chronic Pain in Disabled Older Adults. Exp Aging Res 2021; 48:287-294. [PMID: 34545772 DOI: 10.1080/0361073x.2021.1979346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The association between depression and chronic pain has been clearly demonstrated in healthy older adults, but not in older adults with disabilities. This study thus aimed to clarify the association between depression and chronic pain in older adults with disabilities. METHODS In total, 92 older adults aged 65 years or older subscribed to Japanese long-term care insurance services were included in this study. Depression was assessed using the Geriatric Depression Scale-Short Version-Japanese (GDS-S-J) and was diagnosed among respondents who scored 6 or more points. Chronic pain was assessed using a questionnaire and defined as a "pain that persists in the present and has lasted for more than three months." RESULTS Chronic pain was associated with depression in older adults with disabilities (odds ratio: 3,355, 95% confidence interval: 1,232-9,135, p = 0,018). There was a strong association between severe chronic pain and depression (odds ratio: 3,699, 95% confidence interval: 1,345-10,173, p = 0,011). CONCLUSION Our findings suggest that it is necessary to focus on intensity of chronic pain to improve depression in older adults with disabilities who are more difficult to treat than healthy older adults.
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Affiliation(s)
- Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu-City, Japan
| | - Ryota Ashizawa
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu-City, Japan
| | - Kazuya Kiriyama
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu-City, Japan
| | - Koki Take
- Visiting Nurse Station Takaoka, Seirei Care Center Takaoka, Hamamatsu-City, Japan
| | - Yoshinobu Yoshimoto
- Division of Rehabilitation, Seirei Christopher University, Hamamtsu-City, Japan
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Psychological Predictors of Perceived Age and Chronic Pain Impact in Individuals With and Without Knee Osteoarthritis. Clin J Pain 2021; 36:569-577. [PMID: 32398442 DOI: 10.1097/ajp.0000000000000842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Chronological age is a risk factor in chronic pain; however, aging research supports the premise that physical and psychological health may better predict perceived age. Given the lack of evidence on perceived age in the context of chronic pain, the current study presents novel findings about the relationship between perceived age, chronic pain impact, and psychological function in adults with and without knee osteoarthritis. METHODS This secondary analysis was part of an ongoing multisite observational cohort study to understand the progression of knee pain and disability. Community-dwelling adults (N=227) ages 45+ completed measures of trait resilience, trait positive and negative affect, pain catastrophizing, subjective perceptions of age, and the Graded Chronic Pain Scale. RESULTS On average, participants reported feeling 10 years younger than their chronological age; however, this effect was attenuated in individuals reporting high-impact pain. Lower perceived age was associated with lower pain impact (low pain/low disability), while higher perceived age correlated with higher pain impact (high pain/high disability) and more adverse psychological effects. Using hierarchical linear regression, high-impact pain and positive affect emerged as statistically significant predictors of perceived age, whereas no differences were observed among trait resilience, negative affect, or pain catastrophizing. DISCUSSION These findings highlight the importance of a biopsychosocial approach in understanding the intersection between psychological and physical factors associated with chronic pain. Addressing negative self-perceptions of aging, while simultaneously augmenting positive affect, through psychological therapies may mitigate pain and disability.
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Cheng DK, Lai KSP, Pico-Espinosa OJ, Rice DB, Chung C, Modarresi G, Sud A. Interventions for Depressive Symptoms in People Living with Chronic Pain: A Systematic Review of Meta-Analyses. PAIN MEDICINE 2021; 23:934-954. [PMID: 34373915 PMCID: PMC9071227 DOI: 10.1093/pm/pnab248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This review investigated the effectiveness of clinical interventions on depressive symptoms in people with all types of chronic pain. METHODS We searched seven electronic databases and reference lists on September 15, 2020, and included English-language, systematic reviews and meta-analyses of trials that examined the effects of clinical interventions on depressive outcomes in chronic pain. Two independent reviewers screened, extracted, and assessed the risk of bias. PROSPERO registration: CRD42019131871. RESULTS Eighty-three reviews were selected and included 182 meta-analyses. Data were summarized visually and narratively using standardized mean differences with 95% confidence intervals as the primary outcome of interest. A large proportion of meta-analyses investigated fibromyalgia or mixed chronic pain, and psychological interventions were most commonly evaluated. Acceptance and commitment therapy for general chronic pain, and fluoxetine and web-based psychotherapy for fibromyalgia showed the most robust effects and can be prioritized for implementation in clinical practice. Exercise for arthritis, pharmacotherapy for neuropathic pain, self-regulatory psychotherapy for axial pain, and music therapy for general chronic pain showed large, significant effects, but estimates were derived from low- or critically low-quality reviews. CONCLUSIONS No single intervention type demonstrated substantial superiority across multiple pain populations. Other dimensions beyond efficacy, such as accessibility, safety, cost, patient preference, and efficacy for non-depressive outcomes should also be weighed when considering treatment options. Further effectiveness research is required for common pain types such as arthritis and axial pain, and common interventions such as opioids, anti-inflammatories and acupuncture.
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Affiliation(s)
- Darren K Cheng
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health
| | | | | | | | | | - Golale Modarresi
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health
| | - Abhimanyu Sud
- Department of Family and Community Medicine, University of Toronto
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Minhas S, Lim RQH, Chandan JS. Central sensitisation: causes, therapies, and terminology. THE LANCET. RHEUMATOLOGY 2021; 3:e546. [PMID: 38287617 DOI: 10.1016/s2665-9913(21)00178-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/19/2021] [Indexed: 01/31/2024]
Affiliation(s)
- Sonica Minhas
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rachel Qian Hui Lim
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
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Jensen MP, Hakimian S, Ehde DM, Day MA, Pettet MW, Yoshino A, Ciol MA. Pain-related beliefs, cognitive processes, and electroencephalography band power as predictors and mediators of the effects of psychological chronic pain interventions. Pain 2021; 162:2036-2050. [PMID: 33470745 PMCID: PMC8205936 DOI: 10.1097/j.pain.0000000000002201] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/11/2021] [Indexed: 01/04/2023]
Abstract
ABSTRACT The current study used data from a clinical trial to identify variables that are associated with and/or mediate the beneficial effects of 4 psychological chronic pain treatments: one teaching patients self-hypnosis to reduce pain intensity (HYP), one teaching self-hypnosis to change thoughts about pain (hypnotic cognitive therapy [HYP-CT]), one teaching cognitive restructuring skills to change thoughts about pain (cognitive therapy [CT]), and one providing education about pain (ED; included as an active control condition). Of 17 possible mechanism variables examined, and with alpha not corrected for multiple comparisons, significant between-group differences were observed for 3. Two of these (changes in beliefs about control over pain and number of days of skill practice) were supported as mediators of the beneficial effects of HYP, CT, or HYP-CT, relative to ED. Six mechanism variables evidenced significant pretreatment to post-treatment changes in the sample as a whole, without showing significant between-group differences. Pretreatment to post-treatment changes in all 6 were associated with improvements in pain interference, pain intensity, or both. In addition, participant ratings of therapeutic alliance at post-treatment were associated significantly with improvements in both pain intensity and pain interference in the sample as a whole. Thus, of the 17 possible mediators examined, there were relatively few that served as mediators for the beneficial effects of specific treatments; a larger number of variables predicted treatment outcome overall. The extent to which these variables are treatment mediators (ie, are responsible for, rather than merely associated with, treatment-related improvements) will require further research.
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Affiliation(s)
- Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Shahin Hakimian
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Melissa A Day
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Mark W Pettet
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Atsuo Yoshino
- Department of Psychiatry and Neurosciences, Hiroshima University, Higashihiroshima, Japan
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
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Mindfulness-Based Analgesia or Placebo Effect? The Development and Evaluation of a Sham Mindfulness Intervention for Acute Experimental Pain. Psychosom Med 2021; 83:557-565. [PMID: 33165219 DOI: 10.1097/psy.0000000000000886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Meta-analyses indicate that mindfulness meditation is efficacious for chronic and acute pain, but most available studies lack active control comparisons. This raises the possibility that placebo-related processes may account, at least in part, for mindfulness effects. The objective of this study was to develop a closely matched sham mindfulness condition to establish whether placebo effects contribute to mindfulness-based interventions for pain. METHODS We developed and validated a closely matched sham mindfulness intervention then compared it with 6 × 20-minute sessions of focused-attention mindfulness and a no-treatment condition in 93 healthy volunteers undergoing acute experimental heat pain. RESULTS The sham mindfulness intervention produced equivalent credibility ratings and expectations of improvement as the mindfulness intervention but did not influence mindfulness-related processes. In contrast, mindfulness increased "observing" relative to no treatment but not sham. Mindfulness (F(1,88) = 7.06, p = .009, ηp2 = 0.07) and sham (F(1,88) = 6.47, p = .012, ηp2 = 0.07) moderately increased pain tolerance relative to no treatment, with no difference between mindfulness and sham (F(1,88) = 0.01, p = .92, ηp2 < 0.001). No differences were found for pain threshold. Similarly, neither mindfulness nor sham reduced pain intensity or unpleasantness relative to no treatment, although mindfulness reduced pain unpleasantness relative to sham (F(1,88) = 5.03, p = .027, ηp2 = 0.05). CONCLUSIONS These results suggest that placebo effects contribute to changes in pain tolerance after mindfulness training, with limited evidence of specific effects of mindfulness training on pain unpleasantness relative to sham, but not no treatment. To disentangle the specific analgesic effects of mindfulness from placebo-related processes, future research should prioritize developing and incorporating closely matched sham conditions.Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12618001175268).
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The Relationship between Higher Chronic Opioid Therapy Dose and Specific Personality Traits in Individuals with Chronic Pain. Pain Res Manag 2021; 2021:9946067. [PMID: 34257765 PMCID: PMC8261182 DOI: 10.1155/2021/9946067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/17/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the relationship between opioid use and specific personality traits among individuals with chronic pain stratified by morphine equivalent doses (MEQ). Design Observational cohort study. Setting. Chronic pain outpatient clinic in Canada (2017-2019). Patients. Participants were included if they (1) were at least 18 years old, (2) had been diagnosed with chronic pain (pain >3 months), and (3) were able to read and write in English. Interventions. None. Main Outcome Measures. Completion of the following outcome measures: Acceptance and Action Questionnaire, Anxiety Sensitivity Index, Brief-Coping with Problems Experience 28-item, Brief Pain Inventory Short Form, CAGE-AID substance misuse screening tool, EuroQol-5D, Generalized Anxiety Disorder 7-item, and Patient Health Questionnaire 9-item. One-way analysis of variance compared outcomes between MEQ groups. Results 215 individuals (64.2% female) were included with a mean age of 52.7 ± 11.7 years and time since pain onset of 14.1 ± 10.2 years (range 1-45). There were no significant differences between MEQ groups with respect to sociodemographic and clinical health variables except for gender and employment status and time since pain onset. After controlling for gender, time since pain onset, and average pain severity, patients with MEQ 90+ mg had significantly higher scores for experiential avoidance and anxiety sensitivity in addition to increased pain interference, greater depressive and anxiety symptoms, more dysfunctional coping, and poorer QoL than those with MEQ 1-89 mg or MEQ 0 mg. Conclusions Compared to individuals using no or lower-dose opioids to treat chronic pain, those using high-dose opioids had higher scores on two maladaptive personality traits (i.e., anxiety sensitivity and experiential avoidance) which was associated with poorer mood, greater pain interference, lower quality of life, and dysfunctional coping. These maladaptive personality traits may help to explain how individuals with chronic pain utilize higher doses of opioid analgesics.
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Sheikhzadeh A, Wertli MM, Weiner SS, Rasmussen-Barr E, Weiser S. Do psychological factors affect outcomes in musculoskeletal shoulder disorders? A systematic review. BMC Musculoskelet Disord 2021; 22:560. [PMID: 34147071 PMCID: PMC8214793 DOI: 10.1186/s12891-021-04359-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/12/2021] [Indexed: 01/28/2023] Open
Abstract
Background Psychological factors may impact recovery in patients undergoing treatment for shoulder complaints. The aim of this review is to systematically analyse the evidence for the effect of modifiable psychological factors (MPF) on outcome, for patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment. MPF refers to factors that may change with intervention. Methods This is a systematic literature review. Five databases searched (MEDLINE, CINAHL, Cochrane Library, Embase and PsycInfo), for longitudinal studies investigating the influence of MPF on prognosis of patients with shoulder disorders, all diagnoses, undergoing clinical interventions (conservative or surgical). Level of evidence was determined using Scottish Intercollegiate Guidelines Network (SIGN) methodology. Moderate and high quality evidence was included. We extracted all MPF, categorized constructs into the following domains: beliefs (self-efficacy, expectation of recovery), coping (catastrophizing, avoidant coping), and affect (depression, anxiety). We evaluated constructs for its predictive value of at least one outcome. Outcomes were informed by this review. Evidence was classified into three categories: evidence for, inconclusive evidence, and evidence against. Results Of 1170 references, 40 distinct publications based on 35 datasets were included (intervention type: 20 surgical; 20 conservative). Overall, 22 studies (20 cohort studies and 2 RCTs) were classified as high quality and 18 studies (16 cohort studies, 2 RCTs) were classified as moderate quality. Outcomes reported included pain, disability/function, perceived recovery, physical and mental health, and work status. Based on the review, of the psychological constructs explored, these data would suggest that expectation of recovery, catastrophizing, avoidant coping, depression, and anxiety may predict outcome for patients managed surgically. In patients undergoing conservative intervention the evidence was either against (catastrophizing, depression, anxiety) or inconclusive (self-efficacy, expectation of recovery, avoidant coping) for the predictive value of psychological factors on outcome. Conclusions Five constructs were predictive of outcome for surgically managed patients. This suggests that implementing the biopsychosocial approach (i.e., preoperative screening, intervention by a trained clinician) may be advantageous for patients recommended for shoulder surgery,,. The same is not indicated for conservatively managed patients as no conclusive association of MPF with outcomes was noted. The importance of other MPF on outcome requires further investigation.
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Affiliation(s)
- Ali Sheikhzadeh
- Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center (OIOC), NYU Langone Orthopedic Hospital, 63 Downing Street, New York, NY, 10014, USA. .,Graduate Program in Ergonomics and Biomechanics (ERBI), Graduate School of Arts and Sciences, New York University, New York, USA.
| | - Maria M Wertli
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.,Horten Centre for Patient Oriented Research and Knowledge Transfer, University Hospital Zurich, Pestalozzistrasse, Zurich, Switzerland
| | - Shira Schecter Weiner
- Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center (OIOC), NYU Langone Orthopedic Hospital, 63 Downing Street, New York, NY, 10014, USA.,Graduate Program in Ergonomics and Biomechanics (ERBI), Graduate School of Arts and Sciences, New York University, New York, USA.,School of Health Sciences, Touro College, New York, NY, USA
| | - Eva Rasmussen-Barr
- Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
| | - Sherri Weiser
- Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center (OIOC), NYU Langone Orthopedic Hospital, 63 Downing Street, New York, NY, 10014, USA.,Graduate Program in Ergonomics and Biomechanics (ERBI), Graduate School of Arts and Sciences, New York University, New York, USA
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