CBT and CFT for Chronic Pain

Pain management in hidradenitis suppurativa

Pain is the most impactful symptom in hidradenitis suppurativa (HS), contributing to physical limitations, worsened mental health, and impaired social relationships. Some HS-directed therapies ameliorate HS pain; however, these medications provide insufficient relief for many people living with HS. This article reviews what is currently known about HS pain phenotypes and pathophysiology, the effectiveness of HS treatments for pain, and practical suggestions for dermatologists to help patients manage the symptoms of acute and chronic HS pain.

The Relationship Between Pain Acceptance and Acceptance of Illness in Individuals with Rheumatoid Arthritis

Objective

Managing treatment and symptoms of chronic diseases without accepting the illness is challenging. This study aimed to determine the relationship between pain acceptance and the acceptance of illness in individuals with rheumatoid arthritis (RA).

Methods

In this descriptive study of 123 people diagnosed with rheumatoid arthritis (RA), data were collected through a questionnaire. The questionnaire included a Patient Information Form, Visual Analog Scale (VAS), Health Assessment Questionnaire (HAQ), Disease Activity Score 28 (DAS28), Chronic Pain Acceptance Questionnaire (CPAQ), and Acceptance of Illness Scale (AIS).

Results

The mean chronic pain acceptance score of individuals with RA was 55.32 ± 12.96, and the mean acceptance of illness score was 25.00 ± 8.02. A statistically significant relationship existed between levels of pain measured by VAS and CPAQ (r=-0.184, P=.042). A statistically significant correlation existed between AIS and CPAQ total score (r=0.284, P=.001).

Conclusion

As the levels of pain acceptance increased in RA patients, the levels of pain decreased, and the levels of acceptance of the illness increased. Patients must first acknowledge and accept their illness to follow their treatment plan effectively. Considering that the pain acceptance of individuals diagnosed with RA affects the level of acceptance of illness, it is essential to evaluate patients' pain and disease acceptance processes and support patients to increase treatment success.

Effectiveness of Non-Pharmacological Interventions in the Management of Pediatric Chronic Pain: A Systematic Review

(1) Background: Chronic pain in children remains an under-researched area, especially compared to acute pain. This systematic review aims to evaluate the effectiveness of non-pharmacological interventions in the management of pediatric chronic pain and their impact on the well-being of both children and their families. Given the growing interest in integrative treatments to reduce reliance on pharmacological solutions, this review addresses the need for alternative therapeutic approaches. (2) Methods: A systematic review was conducted following the PRISMA guidelines, covering studies published between 2019 and 2024 from PubMed, Cochrane Library, Web of Science, and Scopus. Eligible studies included children aged 2 to 18 years with chronic pain who received non-pharmacological interventions. Data were extracted on intervention types, participant characteristics, and outcomes. The risk of bias was assessed using RoB2 for randomized trials and ROBINS-I for non-randomized studies. (3) Results: A total of 11 studies involving 1739 children were included, assessing interventions such as cognitive behavioral therapy, personalized psychosocial follow-up programs, hypnotherapy, music therapy, and digital tools. The results demonstrated significant reductions in pain severity, improvements in emotional and physical well-being, and high patient satisfaction. However, the generalizability of findings was limited by the small sample sizes and variability in study designs. (4) Conclusions: Non-pharmacological interventions appear effective in managing pediatric chronic pain, offering improvements in pain reduction and quality of life. Further research is needed to optimize these approaches and confirm their long-term benefits across diverse populations. These interventions represent promising alternatives or complements to pharmacological treatments in pediatric pain management.

The effectiveness of cognitive functional therapy on patients with chronic neck pain: A systematic literature review

OBJECTIVE

Recently, psychological, and behavioral interventions such as cognitive functional therapy (CFT) has gained significant attention in musculoskeletal rehabilitation. We aimed to compare interventions with a CFT component in adults (>18 years old) suffering from chronic neck pain (CNP) or chronic whiplash associated disorders (>3 months) with another intervention or no intervention, in pain, disability, kinesiophobia, or any other reported outcome measure.

RESULTS

One case-study and three randomized controlled trials met the eligibility criteria. Statistically and clinically significant improvement in pain was found in favour of CFT combined with scapular exercise compared to exercise alone (MD = -19.91; 95%CI: -24.18 to -15.64) and controls (MD = -48.91; 95%CI: -53.88 to -43.94) at the very-short term follow-up. A significant difference in kinesiophobia was found at the short-term follow-up in favour of CFT and exercise compared to exercise alone (MD = -13.23; 95%CI-16.94 to -9.52) and controls (MD = -40.81 95%CI: -44.55 to -37.07). Finally, statistically and clinically significant improvement was found in favour of CFT compared to controls at the short-term follow-up in stress (MD = -36.62, 95%CI: 43.47 to -29.77), fear avoidance (MD = -35.44; 95%CI: 42.57 to -28.31), anxiety (MD = -34.43; 95%CI: 41.90 to -26.96), pain catastrophizing (MD = -25.19; 95%CI: 32.49 to -17.89), depression (MD = -30.72; 95%CI: 38.37 to -23.07), but a significant and clinically difference in favour of the control group at self-efficacy (MD = 29.56; 95%CI20.70 to 38.42).

CONCLUSIONS

Very low certainty evidence suggests that CFT alone or in combination with exercise may produce better outcomes than no treatment or exercise alone. The results should be interpreted with caution, given that the number of studies assessing CFT in CNP is limited.

Cognitive functional therapy for lower back pain: A meta-analytical assessment of pain and disability outcomes in randomized controlled trials

BACKGROUND

Cognitive functional therapy (CFT) aims to address low back pain (LBP) comprehensively by considering physical, psychological, and social factors.

OBJECTIVE

The objective was to evaluate the effectiveness of CFT in reducing pain and disability in individuals with LBP over various time intervals.

METHOD

A comprehensive literature search was conducted to identify relevant randomized controlled trials (RCTs) assessing the effects of CFT on LBP.

RESULTS

In this study, 1510 records were initially identified, and 7 studies were included in the analysis. Disability scores were significantly reduced after CFT had been applied for 6 to 8 weeks (SMD =-0.46, 95% CI [-0.74, -0.19]), 12 weeks to 3 months (SMD =-0.54, 95% CI [-0.72, -0.36]), 6 months (MD =-5.82, 95% CI [-9.82, -1.82]), and 12 months (SMD =-0.4, 95% CI [-0.55, -0.26]). There were also significant reductions in pain scores observed after 12 weeks to 3 months (SMD =-0.49, 95% CI [-0.68, -0.3]), 6 months (MD =-0.75, 95% CI [-1.5, -0.0001]), and 12 months (SMD =-0.27, 95% CI [-0.42, -0.12]).

CONCLUSION

CFT showed potential for improving disability scores for individuals with LBP across various time intervals. However, its impacts on pain scores varied.

Pain Comorbidities with Attention Deficit: A Narrative Review of Clinical and Preclinical Research

A negative correlation exists between attention and pain. The cognitive impairments linked to pain can significantly impede a patient's healing process and everyday tasks, particularly for individuals experiencing persistent pain. Furthermore, it has been demonstrated that diversion can effectively decrease pain levels in individuals. The focus of this review is to analyze clinical trials and fundamental investigations regarding alterations in focus and persistent discomfort. Moreover, we investigated the common neuroanatomy associated with attention and pain. Furthermore, we examined the impact of various neuromodulators on the transmission of pain and processes related to attention, while also considering the potential neural mechanisms that contribute to the co-occurrence of pain and attention deficits. Further investigation in this field will enhance our comprehension of patient symptoms and the underlying pathophysiology, ultimately resulting in more objective approaches to treatment.

Efficacy of cognitive functional therapy in patients with low back pain: A systematic review and meta-analysis

BACKGROUND

Low back pain is a major public health problem worldwide, and there exists evidence that cognitive functional therapy may help improve patients' health condition. However, the utilization of cognitive functional therapy for low back pain is limited, and its clinical efficacy remains unclear.

OBJECTIVES

To determine the efficacy of cognitive functional therapy in the management of disability, pain intensity, and fear-avoidance beliefs in low back pain patients.

DESIGN

Systematic review and meta-analysis.

METHOD

A comprehensive study search of Pubmed, Web of Science, Medline, CINAHL, Embase, PsycINFO, and the Cochrane Library databases was conducted from their inception to August 14th, 2023. Two researchers independently conducted the literature search and data extraction. All statistical analysis was performed using Stata Version 17.0.

RESULTS

A total of eight randomized controlled trials were included. In the short-term, cognitive functional therapy significantly improved disability (7 studies, SMD = -1.05, 95 % CI = -1.74 to -0.35, I2 = 95.37 %, GRADE = very low), pain intensity (7 studies, SMD = -1.02, 95 % CI = -1.89 to -0.15, I2 = 97.21 %, GRADE = very low), and fear-avoidance beliefs (4 studies, SMD = -0.89, 95 % CI = -1.30 to -0.47, I2 = 82.49 %, GRADE = very low). In the medium-term, cognitive functional therapy also significantly improved disability (3 studies, SMD = -0.48, 95 % CI = -0.82 to -0.14, I2 = 77.97 %, GRADE = very low), pain intensity (3 studies, SMD = -0.34, 95 % CI = -0.58 to -0.10, I2 = 55.55 %, GRADE = very low), and fear-avoidance beliefs (2 studies, SMD = -0.62, 95 % CI = -1.19 to -0.04, I2 = 88.24 %, GRADE = very low). In the long-term, cognitive functional therapy significantly improved disability (4 studies, SMD = -0.54, 95 % CI = -0.95 to -0.13, I2 = 85.87 %, GRADE = very low) and fear-avoidance beliefs (3 studies, SMD = -0.76, 95 % CI = -1.17 to -0.34, I2 = 80.34 %, GRADE = very low).

CONCLUSION

Cognitive functional therapy might be effective in reducing disability and fear-avoidance beliefs at any of short-, medium- and long-term follow-ups, and reducing pain at short- and medium-term follow-ups. No definitive conclusions can be drawn about the impact of cognitive functional therapy on low back pain patients due to the very low certainty evidence base. Additional rigorous randomized controlled trials are needed to further confirm these findings.

REGISTRATION NUMBER

CRD42022287123 (PROSPERO).

Effectiveness of Cognitive Functional Therapy for Reducing Pain and Disability in Chronic Low Back Pain: A Systematic Review and Meta-analysis

OBJECTIVE: We aimed to evaluate whether cognitive functional therapy (CFT) is an effective treatment for adults with chronic low back pain (LBP). DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched 4 electronic databases (CENTRAL, CINAHL, MEDLINE, and Embase) and 2 clinical trial registers (ClinicalTrials. gov and the EU Clinical Trials Register) from inception up to March 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials evaluating CFT for adults with LBP. DATA SYNTHESIS: The primary outcomes were pain intensity and disability. Secondary outcomes were psychological status, patient satisfaction, global improvement, and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman adjustment was used to estimate pooled effects. RESULTS: Fifteen trials were included (9 ongoing and 1 terminated), of which 5 provided data (n = 507; n = 262 CFT, and n = 245 control). There was very low certainty for the effectiveness of CFT compared to manual therapy plus core exercises (2 studies, n = 265) for reducing pain intensity (mean difference: -1.02/10, 95% confidence interval: -14.75, 12.70) and disability (mean difference: -6.95/100, 95% confidence interval: -58.58, 44.68). Narrative synthesis showed mixed results for pain intensity, disability, and secondary outcomes. No adverse events were reported. All studies were judged to be at high risk of bias. CONCLUSION: Cognitive functional therapy may not be more effective than other common interventions for reducing pain and disability in adults with chronic LBP. The effectiveness of CFT is very uncertain and will remain so until higher-quality studies are available. J Orthop Sports Phys Ther 2023;53(5):1-42. Epub: 23 February 2023. doi:10.2519/jospt.2023.11447.

Microneedle-mediated delivery of Ziconotide-loaded liposomes fused with exosomes for analgesia

Ziconotide (ZIC) is an N-type calcium channel antagonist for treating severe chronic pain that is intolerable, or responds poorly to the administration of other drugs, such as intrathecal morphine and systemic analgesics. As it can only work in the brain and cerebrospinal fluid, intrathecal injection is the only administration route for ZIC. In this study, borneol (BOR)-modified liposomes (LIPs) were fused with exosomes from mesenchymal stem cells (MSCs) and loaded with ZIC to prepare microneedles (MNs) to improve the efficiency of ZIC across the blood-brain barrier. To evaluate local analgesic effects of MNs, the sensitivity of behavioral pain to thermal and mechanical stimuli was tested in animal models of peripheral nerve injury, diabetes-induced neuropathy pain, chemotherapy-induced pain, and ultraviolet-B (UV-B) radiation-induced neurogenic inflammatory pain. BOR-modified LIPs loaded with ZIC were spherical or nearly spherical, with a particle size of about 95 nm and a Zeta potential of -7.8 mV. After fusion with MSC exosomes, the particle sizes of LIPs increased to 175 nm, and their Zeta potential increased to -3.8 mV. The nano-MNs constructed based on BOR-modified LIPs had good mechanical properties and could effectively penetrate the skin to release drugs. The results of analgesic experiments showed that ZIC had a significant analgesic effect in different pain models. In conclusion, the BOR-modified LIP membrane-fused exosome MNs constructed in this study for delivering ZIC provide a safe and effective administration for chronic pain treatment, as well as great potential for clinical application of ZIC.

The effect of perioperative psychological interventions on persistent pain, disability, and quality of life in patients undergoing spinal fusion: a systematic review

PURPOSE

Patients undergoing spinal fusion are prone to develop persisting spinal pain that may be related to pre-existent psychological factors. The aim of this review was to summarize the existing evidence about perioperative psychological interventions and to analyze their effect on postoperative pain, disability, and quality of life in adult patients undergoing complex surgery for spinal disorders. Studies investigating any kind of psychological intervention explicitly targeting patients undergoing a surgical fusion on the spine were included.

METHODS

We included articles that analyzed the effects of perioperative psychological interventions on either pain, disability, and/or quality of life in adult patients with a primary diagnosis of degenerative or neoplastic spinal disease, undergoing surgical fusion of the spine. We focused on interventions that had a clearly defined psychological component. Two independent reviewers used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to perform a systematic review on different databases. Risk of bias was evaluated using the Downs and Black checklist. Given study differences in outcome measures and interventions administered, a meta-analysis was not performed. Instead, a qualitative synthesis of main results of included papers was obtained.

RESULTS

Thirteen studies, conducted between 2004 and 2017, were included. The majority were randomized-controlled trials (85%) and most patients underwent lumbar fusion (92%). Cognitive behavioral therapy (CBT) was used in nine studies (69%). CBT in the perioperative period may lead to a postoperative reduction in pain and disability in the short-term follow-up compared to care as usual. There was less evidence for an additional effect of CBT at intermediate and long-term follow-up.

CONCLUSION

The existing evidence suggests that a reduction in pain and disability in the short-term, starting from immediately after surgery to 3 months, is likely to be obtained when a CBT approach is used. However, there is inconclusive evidence regarding the long-term effect of a perioperative psychological intervention after spinal fusion surgery. Further research is necessary to better define the frequency, intensity, and timing of such an approach in relation to the surgical intervention, to be able to maximize its effect and be beneficial to patients.