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Window P, McGrath M, Harvie DS, Smits E, Johnston V, Murdoch M, Russell T. Pain Education and Virtual Reality Improves Pain, Pain-related Fear of Movement, and Trunk Kinematics in Individuals With Persistent Low Back Pain. Clin J Pain 2024; 40:478-489. [PMID: 38708788 DOI: 10.1097/ajp.0000000000001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/16/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES To evaluate the effect of combining pain education and virtual reality (VR) exposure therapy using a cognitive-behavioral therapy-informed approach (virtual reality-based cognitive behavioral therapy [VR-CBT]) on pain intensity, fear of movement, and trunk movement in individuals with persistent low back pain. MATERIALS AND METHODS Thirty-seven participants were recruited in a single cohort repeated measures study, attending 3 sessions 1 week apart. The VR-CBT intervention included standardized pain education (session 1) and virtual reality-based exposure therapy (VRET; session 2) incorporating gameplay with mixed reality video capture and reflective feedback of performance. Outcome measures (pain intensity, pain-related fear of movement (Tampa Scale of Kinesiophobia), and trunk kinematics during functional movements (maximum amplitude and peak velocity) were collected at baseline (session 1) and 1 week after education (session 2) and VRET (session 3). One-way repeated measures analysis of variances evaluated change in outcomes from baseline to completion. Post hoc contrasts evaluated effect sizes for the education and VR components of VR-CBT. RESULTS Thirty-four participants completed all sessions. Significant ( P < 0.001) reductions were observed in mean (SD) pain (baseline 5.9 [1.5]; completion 4.3 [2.1]) and fear of movement (baseline 42.6 [6.4]; completion 34.3 [7.4]). Large effect sizes (Cohen d ) were observed for education (pain intensity: 0.85; fear of movement: 1.28), whereas the addition of VRET demonstrated very small insignificant effect sizes (pain intensity: 0.10; fear of movement: 0.18). Peak trunk velocity, but not amplitude, increased significantly ( P < 0.05) across trunk movement tasks. CONCLUSION A VR-CBT intervention improved pain, pain-related fear of movement, and trunk kinematics. Further research should explore increased VR-CBT dosage and mechanisms underlying improvement.
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Affiliation(s)
- Peter Window
- Department of Physiotherapy, Royal Brisbane and Women's Hospital
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane
| | - Michelle McGrath
- Department of Physiotherapy, Royal Brisbane and Women's Hospital
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane
| | - Daniel S Harvie
- School of Allied Health and Human Performance, University of South Australia, Adelaide
| | - Esther Smits
- RECOVER Injury Research Centre, University of Queensland
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich
- Centre for Health Research, University of Sothern Queensland, Australia
| | - Megan Murdoch
- Department of Physiotherapy, Royal Brisbane and Women's Hospital
- Tess Cramond Pain and Research Centre, Surgical Treatment and Rehabilitation Service, Herston
| | - Trevor Russell
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane
- RECOVER Injury Research Centre, University of Queensland
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Salazar-Méndez J, Cuyul-Vásquez I, Ponce-Fuentes F, Núñez-Cortés R, Mendez-Rebolledo G, Fuentes J. Effectiveness of in-group versus individually administered pain neuroscience education on clinical and psychosocial outcomes in patients with chronic low back pain: randomized controlled study protocol. PeerJ 2024; 12:e17507. [PMID: 38832030 PMCID: PMC11146333 DOI: 10.7717/peerj.17507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
Objective (1) This trial will compare the clinical and psychosocial effectiveness of in-group and individually pain neuroscience education (PNE) in patients with chronic low back pain (CLBP). In addition, (2) the influence of social determinants of health on post-treatment results will be analyzed. Methods A three-arm randomized controlled trial will be conducted. Sixty-nine participants with CLBP will be recruited in a 1:1:1 ratio. Participants, assessor, and statistician will be blinded to group assignment. The PNE intervention will be adapted to the context of the participants. An experimental group (n = 33) will receive PNE in an in-group modality, the other experimental group (n = 33) will receive PNE in an individually modality and the control group (n = 33) will continue with usual care. Additionally, participants will be encouraged to stay active by walking for 20-30 min 3-5 times per week and will be taught an exercise to improve transversus abdominis activation (bracing or abdominal following). The outcome measures will be fear avoidance and beliefs, pressure pain threshold, pain self-efficacy, catastrophizing, pain intensity, and treatment expectation. Outcome measures will be collected at one-week before intervention, immediately post-intervention, and four-weeks post-intervention. Conclusion The innovative approach of PNE oriented to fear beliefs proposed in this study could broaden the application strategies of this educational therapeutic modality. Impact. Contextualized PNE delivered by physical therapist could be essential to achieve a good cost-effectiveness ratio of this intervention to improve the clinical condition of people with CLBP.
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Affiliation(s)
- Joaquín Salazar-Méndez
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Iván Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
| | | | - Rodrigo Núñez-Cortés
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Guillermo Mendez-Rebolledo
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Jorge Fuentes
- Clinical Research Lab, Department of Physical Therapy, Catholic University of Maule, Talca, Chile
- Faculty of Rehab Medicine, University of Alberta, Edmonton, Canada
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Simic K, Savic B, Knezevic NN. Pain Catastrophizing: How Far Have We Come. Neurol Int 2024; 16:483-501. [PMID: 38804476 PMCID: PMC11130925 DOI: 10.3390/neurolint16030036] [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: 03/13/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
The perception of pain is strongly influenced by various social, emotional, and cognitive factors. A psychological variable which has consistently been shown to exert its influence on pain is a cognitive process referred to as pain catastrophizing. Numerous studies have found it to be a strong predictor of pain intensity and disability across different clinical populations. It signifies a maladaptive response to pain marked by an exaggerated negative assessment, magnification of symptoms related to pain, and, in general, a tendency to experience marked pain-related worry, as well as experiencing feelings of helplessness when it comes to dealing with pain. Pain catastrophizing has been correlated to many adverse pain-related outcomes, including poor treatment response, unsatisfactory quality of life, and high disability related to both acute and chronic pain. Furthermore, there has been consistent evidence in support of a correlation between pain catastrophizing and mental health disorders, such as anxiety and depression. In this review, we aim to provide a comprehensive overview of the current state of knowledge regarding pain catastrophizing, with special emphasis on its clinical significance, and emerging treatment modalities which target it.
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Affiliation(s)
- Katarina Simic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA; (K.S.); (B.S.)
| | - Boris Savic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA; (K.S.); (B.S.)
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA; (K.S.); (B.S.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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Ehrström J, Pöyhiä R, Kettunen J, Pyörälä E. What do Finnish physiotherapists and physiotherapy students know about the neurophysiology of pain? The Finnish version of the revised Neurophysiology of Pain Questionnaire. Physiother Theory Pract 2024; 40:828-842. [PMID: 36475565 DOI: 10.1080/09593985.2022.2154626] [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: 05/25/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Understanding the concept of pain and its underlying biological mechanisms is an essential part of physiotherapists' professional knowledge. OBJECTIVES The first aim of the study was to translate and cross-culturally adapt the revised Neurophysiology of Pain Questionnaire into Finnish (RNPQ-FI) and to evaluate its reliability (internal consistency and test-retest reliability) in a sample of Finnish physiotherapists and physiotherapy students. The second aim was to compare the knowledge of pain neurophysiology between these two groups. METHODS Translation and cross-cultural adaptation followed the COSMIN Study Design checklist. Participants (202 physiotherapists and 97 physiotherapy students) completed an online survey containing RNPQ-FI. Internal consistency was assessed with Cronbach's alpha and test-retest reliability using Intraclass correlation coefficient (ICC3,1). RESULTS Cronbach's alpha was 0.44 and ICC was 0.70 (p < .001). The mean percentage of correct responses was 61.4% for physiotherapists and 62.1% for students. Forty-seven percent of the physiotherapists and 35.1% of the students reported difficulties in understanding the items. A higher amount of pain education was associated with higher RNPQ-FI scores. CONCLUSIONS The RNPQ-FI showed low internal consistency and moderate test-retest reliability among Finnish physiotherapists and physiotherapy students. Physiotherapists and students had equal amount of pain neurophysiology knowledge. Pain education is encouraged.
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Affiliation(s)
- Jolanda Ehrström
- Doctoral Programme in Clinical Research, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Reino Pöyhiä
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jyrki Kettunen
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland
| | - Eeva Pyörälä
- Centre for University Teaching and Learning, Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
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Di Bonaventura S, Fernández Carnero J, Ferrer-Peña R. Can a specific biobehavioral-based therapeutic education program lead to changes in pain perception and brain plasticity biomarkers in chronic pain patients? A study protocol for a randomized clinical trial. PLoS One 2024; 19:e0289430. [PMID: 38241249 PMCID: PMC10798500 DOI: 10.1371/journal.pone.0289430] [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: 07/27/2023] [Accepted: 12/01/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Chronic pain conditions are complex multifactorial disorders with physical, psychological, and environmental factors contributing to their onset and persistence. Among these conditions, the role of brain-derived neurotrophic factor (BDNF) and the impact of a specific therapeutic education (TE) on pain management have emerged as important areas of research. OBJECTIVE This study aims to investigate the effects of a specific type of therapeutic education on pain levels and BDNF concentrations. METHODS In this single-blind, randomized clinical trial, patients will be randomly assigned to one of two groups: one will receive exercise with TE and the other without TE. Assessments will be made at baseline, mid-treatment, post-intervention, and at one and eight months. OUTCOMES This study will shed light on the effectiveness of a therapeutic education (TE) program in pain management. Additionally, it will provide information on its effects on BDNF levels, a biomarker of brain plasticity, as well as on various psychosocial variables that can influence pain experience. CONCLUSION By comprehensively addressing the need to quantify brain changes more precisely in individuals with chronic pain during interventions like TE and recognizing the importance of establishing a more structured and comprehensive protocol, this study lays a solid and replicable foundation for future evidence-based treatment developments.
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Affiliation(s)
- Silvia Di Bonaventura
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Josué Fernández Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain
| | - Raúl Ferrer-Peña
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, CSEU La Salle, Universidad Autonóma de Madrid, Madrid, Spain
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Machado PM, Carmo ACN, Leal LBLG, de Souza RP, Rocha PRS, Funez MI. A systematic review of the added value of perioperative pain neuroscience education. PATIENT EDUCATION AND COUNSELING 2023; 117:107984. [PMID: 37742593 DOI: 10.1016/j.pec.2023.107984] [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: 05/11/2023] [Revised: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To identify and summarize evidence about the benefits of perioperative pain neuroscience education (PNE) on pain-related and psychosocial outcomes. METHODS Included were reports written in English that carried out PNE or its synonyms; perioperative period; aged ≥ 18 years; interventional studies and observational studies. Secondary studies, conference abstracts, and editorials were excluded. There was no time limitation. INFORMATION SOURCES PubMed, Virtual Health Library, Cochrane Library, and Science Direct. Search: June 20th 2023. The risk of bias was assessed using the Joanna Briggs Institute checklists, and synthesis followed the recommendations of the Synthesis Without Meta-analysis (SWiM) guideline. Register: Center for Open Science website (10.17605/OSF.IO/ZTNEJ). RESULTS The sample consisted of 18 reports. For pain outcomes, it was not possible to attribute PNE benefits because ten reports found improvements in both intervention and control groups. For psychosocial outcomes, fourteen reports found benefits for PNE groups. All the analyzed reports showed low risk of bias. CONCLUSION PNE had additional benefits beyond those obtained with conventional treatment for psychosocial outcomes. PRACTICAL IMPLICATIONS Due to the lack of evidence, it was not possible to indicate the clinical use of PNE. It is suggested that further studies are needed aimed at clarifying the possible benefits.
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Affiliation(s)
- Paula Muniz Machado
- University of Brasilia, School of Ceilândia, Graduate Program in Health Sciences and Technology, Federal District, Brasilia, Brazil.
| | - Anne Caroline Nunes Carmo
- University of Brasilia, School of Ceilândia, Collegiate of the Nursing Course, Federal District, Brasilia, Brazil.
| | | | - Raquel Pereira de Souza
- University of Brasilia, School of Ceilândia, Graduate Program in Health Sciences and Technology, Federal District, Brasilia, Brazil.
| | | | - Mani Indiana Funez
- University of Brasilia, School of Ceilândia, Graduate Program in Health Sciences and Technology and Collegiate of the Nursing Course, Federal District, Brasilia, Brazil.
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Sanal-Hayes NEM, Mclaughlin M, Hayes LD, Mair JL, Ormerod J, Carless D, Hilliard N, Meach R, Ingram J, Sculthorpe NF. A scoping review of 'Pacing' for management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): lessons learned for the long COVID pandemic. J Transl Med 2023; 21:720. [PMID: 37838675 PMCID: PMC10576275 DOI: 10.1186/s12967-023-04587-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Controversy over treatment for people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a barrier to appropriate treatment. Energy management or pacing is a prominent coping strategy for people with ME/CFS. Whilst a definitive definition of pacing is not unanimous within the literature or healthcare providers, it typically comprises regulating activity to avoid post exertional malaise (PEM), the worsening of symptoms after an activity. Until now, characteristics of pacing, and the effects on patients' symptoms had not been systematically reviewed. This is problematic as the most common approach to pacing, pacing prescription, and the pooled efficacy of pacing was unknown. Collating evidence may help advise those suffering with similar symptoms, including long COVID, as practitioners would be better informed on methodological approaches to adopt, pacing implementation, and expected outcomes. OBJECTIVES In this scoping review of the literature, we aggregated type of, and outcomes of, pacing in people with ME/CFS. ELIGIBILITY CRITERIA Original investigations concerning pacing were considered in participants with ME/CFS. SOURCES OF EVIDENCE Six electronic databases (PubMed, Scholar, ScienceDirect, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials [CENTRAL]) were searched; and websites MEPedia, Action for ME, and ME Action were also searched for grey literature, to fully capture patient surveys not published in academic journals. METHODS A scoping review was conducted. Review selection and characterisation was performed by two independent reviewers using pretested forms. RESULTS Authors reviewed 177 titles and abstracts, resulting in 17 included studies: three randomised control trials (RCTs); one uncontrolled trial; one interventional case series; one retrospective observational study; two prospective observational studies; four cross-sectional observational studies; and five cross-sectional analytical studies. Studies included variable designs, durations, and outcome measures. In terms of pacing administration, studies used educational sessions and diaries for activity monitoring. Eleven studies reported benefits of pacing, four studies reported no effect, and two studies reported a detrimental effect in comparison to the control group. CONCLUSIONS Highly variable study designs and outcome measures, allied to poor to fair methodological quality resulted in heterogenous findings and highlights the requirement for more research examining pacing. Looking to the long COVID pandemic, our results suggest future studies should be RCTs utilising objectively quantified digitised pacing, over a longer duration of examination (i.e. longitudinal studies), using the core outcome set for patient reported outcome measures. Until these are completed, the literature base is insufficient to inform treatment practises for people with ME/CFS and long COVID.
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Affiliation(s)
- Nilihan E M Sanal-Hayes
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK
- School of Health and Society, University of Salford, Salford, UK
| | - Marie Mclaughlin
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK
- School of Sport, Exercise & Rehabilitation Sciences, University of Hull, Hull, UK
| | - Lawrence D Hayes
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK
| | - Jacqueline L Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Jane Ormerod
- Long COVID Scotland, 12 Kemnay Place, Aberdeen, UK
| | - David Carless
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK
| | | | - Rachel Meach
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK
| | - Joanne Ingram
- School of Education and Social Sciences, University of the West of Scotland, Glasgow, UK
| | - Nicholas F Sculthorpe
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK
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Murillo C, Galán-Martín MÁ, Montero-Cuadrado F, Lluch E, Meeus M, Loh WW. Reductions in kinesiophobia and distress after pain neuroscience education and exercise lead to favourable outcomes: a secondary mediation analysis of a randomized controlled trial in primary care. Pain 2023; 164:2296-2305. [PMID: 37289577 DOI: 10.1097/j.pain.0000000000002929] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/02/2023] [Indexed: 06/10/2023]
Abstract
ABSTRACT Pain neuroscience education combined with exercise (PNE + exercise) is an effective treatment for patients with chronic spinal pain. Yet, however, little is known about its underlying therapeutic mechanisms. Thus, this study aimed to provide the first insights by performing a novel mediation analysis approach in a published randomized controlled trial in primary care where PNE + exercise was compared with standard physiotherapy. Four mediators (catastrophizing, kinesiophobia, central sensitization-related distress, and pain intensity) measured at postintervention and 3 outcomes (disability, health-related quality of life, and pain medication intake) measured at 6-month follow-up were included into the analysis. The postintervention measure of each outcome was also introduced as a competing candidate mediator in each respective model. In addition, we repeated the analysis by including all pairwise mediator-mediator interactions to allow the effect of each mediator to differ based on the other mediators' values. Postintervention improvements in disability, medication intake, and health-related quality of life strongly mediated PNE + exercise effects on each of these outcomes at 6-month follow-up, respectively. Reductions in disability and medication intake were also mediated by reductions in kinesiophobia and central sensitization-related distress. Reductions in kinesiophobia also mediated gains in the quality of life. Changes in catastrophizing and pain intensity did not mediate improvements in any outcome. The mediation analyses with mediator-mediator interactions suggested a potential effect modification rather than causal independence among the mediators. The current results, therefore, support the PNE framework to some extent as well as highlight the need for implementing the recent approaches for mediation analysis to accommodate dependencies among the mediators.
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Affiliation(s)
- Carlos Murillo
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Miguel Ángel Galán-Martín
- Unit for Active Coping Strategies for Pain in Primary Care, East-Valladolid Primary Care Management, Castilla and León Public Health System (Sacyl), Valladolid, Spain
| | - Federico Montero-Cuadrado
- Unit for Active Coping Strategies for Pain in Primary Care, East-Valladolid Primary Care Management, Castilla and León Public Health System (Sacyl), Valladolid, Spain
| | - Enrique Lluch
- Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Mira Meeus
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Wen Wei Loh
- Department of Data Analysis, Ghent University, Ghent, Belgium
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Salazar-Méndez J, Núñez-Cortés R, Suso-Martí L, Ribeiro IL, Garrido-Castillo M, Gacitúa J, Mendez-Rebolledo G, Cruz-Montecinos C, López-Bueno R, Calatayud J. Dosage matters: Uncovering the optimal duration of pain neuroscience education to improve psychosocial variables in chronic musculoskeletal pain. A systematic review and meta-analysis with moderator analysis. Neurosci Biobehav Rev 2023; 153:105328. [PMID: 37516218 DOI: 10.1016/j.neubiorev.2023.105328] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
The aim was to examine the moderator effect of duration of PNE (total minutes) on changes in psychosocial variables after treatment in people with chronic musculoskeletal pain. PubMed/MEDLINE, Embase, Web of Science, Scopus and CINHAL databases were systematically searched from inception to 6 February 2023. A mixed-effects meta-regression was performed to determine the moderator effect of PNE duration. Twenty-three studies involving 2352 patients were included. Meta-analysis revealed a statistically significant effect in favour of PNE on pain neurophysiology knowledge, anxiety symptoms, catastrophizing and kinesiophobia. The total duration of PNE ranged from 40 to 720 min. A linear relationship was observed between longer duration of PNE (total minutes) and changes of psychosocial variables. In addition, a dose of 100, 200 and 400 min of PNE was estimated to exceed the minimum clinically important difference described in the literature for kinesiophobia (mean difference = -8.53 points), anxiety symptoms (mean difference = -1.88 points) and catastrophizing (mean difference = -7.17 points). Clinicians should provide a more tailored PNE to address psychosocial variables.
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Affiliation(s)
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department Cf Physiotherapy, University of Valencia, Spain
| | - Ivana Leão Ribeiro
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | | | - José Gacitúa
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Guillermo Mendez-Rebolledo
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile; Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Carlos Cruz-Montecinos
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department Cf Physiotherapy, University of Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department Cf Physiotherapy, University of Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark
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Díaz-Fernández Á, Ortega-Martínez AR, Cortés-Pérez I, Ibáñez-Vera AJ, Obrero-Gaitán E, Lomas-Vega R. Transcultural Adaptation and Psychometric Validation of the Spanish Version of the Pain Attitudes and Beliefs Scale for Physiotherapists. J Clin Med 2023; 12:6045. [PMID: 37762985 PMCID: PMC10531514 DOI: 10.3390/jcm12186045] [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: 08/24/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Low back pain (LBP) is one of the main musculoskeletal pain conditions, and it affects 23-28% of the global population. Strong evidence supports the absence of a direct relationship between the intensity of pain and tissue damage, with psychosocial factors also playing a crucial role. In this context, the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) is a useful tool for evaluating physiotherapists' treatment orientations and beliefs regarding the management of low back pain (LBP). It helps identify practitioners who may benefit from additional education in modern pain neuroscience. However, there is not a Spanish validation of this scale for physiotherapists. Thus, the aims of this study were to translate and culturally adapt the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) into Spanish and to evaluate its psychometric properties. This validation study used three convenience samples of physiotherapists (PTs) (n = 22 for the pilot study, n = 529 for the validity study and n = 53 for assessing the instrument's responsiveness). The process of translating and adapting the PABS-PT into Spanish followed international guidelines and produced a satisfactory pre-final version of the questionnaire. Factor analysis confirmed the two-factor structure of the original version, with the biomedical (BM) factor explaining 39.4% of the variance and the biopsychosocial (BPS) factor explaining 13.8% of the variance. Cronbach's alpha values were excellent for the BM factor (0.86) and good for the BPS factor (0.77), indicating good internal consistency. Test-retest reliability was excellent for both factors, with intraclass correlation coefficients (ICCs) of 0.84 for BM and 0.82 for BPS. The standard error of measurement (SEM) was acceptable for both factors (3.9 points for BM and 2.4 points for BPS). Concurrent validity was moderate and in the expected direction and had significant correlations with the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and Revised Neurophysiology Pain Questionnaire (R-NPQ). Sensitivity to change was demonstrated by significant improvements in both factors after an educational intervention, with medium-to-large effect sizes. The PABS-PT also showed good discriminative ability, as it was able to distinguish between physiotherapists with and without pain education. Cut-off values for the BM and BPS factors were determined. In conclusion, the translated and adapted Spanish version of the PABS-PT demonstrated good psychometric properties and can be reliably used to assess the attitudes and beliefs of Spanish-speaking physiotherapists regarding LBP. The questionnaire is recommended for use in clinical and educational research in the Spanish language context.
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Affiliation(s)
- Ángeles Díaz-Fernández
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
| | - Ana Raquel Ortega-Martínez
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
- Department of Psychology, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain
| | - Irene Cortés-Pérez
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
| | | | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
| | - Rafael Lomas-Vega
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
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11
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Menés Fernández L, Salvat I, Adillón C. Expressed Beliefs about the Cause of Pain in a Pediatric Population: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1007. [PMID: 37371238 DOI: 10.3390/children10061007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
(1) Background: The aims of this study are to explore what beliefs children and adolescents manifest about the cause of the pain they describe, to compare whether there are differences between beliefs by age and the persistence of pain, and to relate the explanations of the cause of pain with current scientific evidence. (2) Methods: a cross-sectional qualitative study was used. The primary endpoint of the study was obtaining explanations of the cause of pain recorded by means of an open-ended question. The participants were school-age children attending a charted school in the province of Barcelona. (3) Results: The children and adolescents proposed a diverse range of explanations for the cause of pain that they reported in their responses. The most frequent explanation for the cause of pain were pathologies and injuries (45.95%), ergonomic issues (22.60%) and psychological issues (15.95%). (4) Conclusions: There is a lot of variety in the explanations that young people give about the cause of their pain in schoolchildren aged between 10 and 16 years old. There exists a high prevalence of explanations non-associated with tissue damage (ENAD) concerning the causes of pain described. It is necessary that future health prevention programs dedicated to early ages consider which beliefs about the cause of pain are the most frequent in the pediatric population.
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Affiliation(s)
- Laura Menés Fernández
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Isabel Salvat
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Cristina Adillón
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
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12
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Louw A, Louw C, Podalak J, Zimney K, DeLorenzo J, Maiers N, Puentedura EJ, Mintken P. Pain Neuroscience Education in Elementary and Middle Schools. Pediatr Phys Ther 2023:00001577-990000000-00059. [PMID: 37171390 DOI: 10.1097/pep.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE The purpose of this study was to deliver pain neuroscience education (PNE) to participants in grades 3 to 8 to determine whether participants in these grades had positive shifts in pain knowledge and beliefs. METHODS Three hundred twenty participants, grades 3 to 8, received a 1-time, 30-minute PNE lecture. The Neurophysiology of Pain Questionnaire and the Health Care Provider's Pain and Impairment Relationship Scale were administered before and after the PNE lecture. RESULTS All grades improved in pain knowledge and beliefs. Higher-grade school participants (sixth to eighth grades) experienced larger shifts in pain knowledge and attitudes and beliefs than lower-grade (third to fifth grades) participants. CONCLUSION PNE results in changes in pain knowledge and beliefs in school participants in grades 3 to 8.
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Affiliation(s)
- Adriaan Louw
- Evidence in Motion (Dr Louw), Story City, Iowa; Ortho Spine and Pain Clinic (Ms Louw), Story City, Iowa; Phileo Health (Dr Podalak), Eau Claire, Wisconsin; Department of Physical Therapy (Dr Zimney), School of Health Sciences, University of South Dakota, Vermillion, South Dakota; Doctor of Physical Therapy Program (Dr Mintken), College of Health and Society, Hawai'i Pacific University, Honolulu, Hawaii; DeLorenzo Therapy and Wellness (Ms DeLorenzo), Alexandria, Virginia; Physical Therapy Education (Dr Maiers), Des Moines University, Des Moines, Iowa; Department of Physical Therapy (Puentedura), Baylor University, Waco, Texas
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Supe HM, Mungikar SS, Katage GA, Garg KA, Wani SK. Effect of Pain Neuroscience Education with Conventional Physiotherapy via Telerehabilitation on Pain Catastrophizing and Function in Patients with Osteoarthritis Knee: A Randomized Controlled Trial. J Midlife Health 2023; 14:123-129. [PMID: 38029040 PMCID: PMC10664057 DOI: 10.4103/jmh.jmh_33_23] [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: 02/14/2023] [Accepted: 05/04/2023] [Indexed: 12/01/2023] Open
Abstract
Aim By explaining to the patient the biological processes underneath their pain condition, pain neuroscience education (PNE) is a form of educational intervention that aims to relieve pain and impairment. Materials and Methods Patients with knee osteoarthritis (OA) referred to outpatient physiotherapy clinic in India during August 2021 to June 2022 were asked to participate. Out of the eligible patients, 35 were randomly assigned to PNE group and 35 to the control group. Self-reports of Pain Catastrophizing Scale (PCS), Patient Specific Function Scale (PSFS), and Numerical Pain Rating Scale (NPRS) were recorded at baseline (T1) and at 2 weeks (T2). Results After 2 weeks of follow-up, all the three outcome measures were found to be significant in the PNE group. The results of the unpaired t-test revealed statistically significant result posttest for PCS (mean difference 11.4) and NPRS (mean difference 1.20). There was no mean difference found in the patient function (PSFS) between groups. Conclusion The results suggest that adding a program of PNE to conventional physiotherapy exercises led to a greater reduction in pain catastrophization, patient-specific function, and pain intensity rather than conventional physiotherapy alone in patients with knee OA at 2 weeks' follow-up.
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Affiliation(s)
- Hiral Manohar Supe
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Sanket S. Mungikar
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Goutami A. Katage
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Kapil A. Garg
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Surendra Kiran Wani
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
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14
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Chan SY, Lu LY, Lin SY, Ma KSK. Pain neuroscience education for fibromyalgia. Int J Rheum Dis 2023. [PMID: 36889746 DOI: 10.1111/1756-185x.14604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 03/10/2023]
Affiliation(s)
- Shu-Yen Chan
- School of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Internal Medicine, University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | - Li-Yu Lu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Sheng-Yi Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Massachusetts, Boston, USA.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kevin Sheng-Kai Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Massachusetts, Boston, USA.,Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia, USA.,Department of Dermatology, Massachusetts General Hospital, Massachusetts, Boston, USA.,Department of Orthodontics and Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Massachusetts, Boston, USA
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15
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Lepri B, Romani D, Storari L, Barbari V. Effectiveness of Pain Neuroscience Education in Patients with Chronic Musculoskeletal Pain and Central Sensitization: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054098. [PMID: 36901108 PMCID: PMC10001851 DOI: 10.3390/ijerph20054098] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/08/2023] [Accepted: 02/18/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To collect the available evidence about the effectiveness of pain neuroscience education (PNE) on pain, disability, and psychosocial factors in patients with chronic musculoskeletal (MSK) pain and central sensitization (CS). METHODS A systematic review was conducted. Searches were performed on Pubmed, PEDro, and CINAHL, and only randomized controlled trials (RCTs) enrolling patients ≥18 years of age with chronic MSK pain due to CS were included. No meta-analysis was conducted, and qualitative analysis was realized. RESULTS 15 RCTs were included. Findings were divided for diagnostic criteria (fibromyalgia-FM, chronic fatigue syndrome-CFS, low back pain-LBP, chronic spinal pain-CSP). PNE has been proposed as a single intervention or associated with other approaches, and different measures were used for the main outcomes considered. Conclusions, practice implication: PNE is effective in improving pain, disability, and psychosocial factors in patients with fibromyalgia, chronic low back pain (CLBP)-especially if associated with other therapeutic approaches-and also in patients with CFS and CSP. Overall, PNE seems to be more effective when proposed in one-to-one oral sessions and associated with reinforcement elements. However, specific eligibility criteria for chronic MSK pain due to CS are still lacking in most RCTs; therefore, for future research, it is mandatory to specify such criteria in primary studies.
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Affiliation(s)
| | - Daniele Romani
- Department of Biomedical and Neuromotor Science, Bologna Campus, University of Bologna, 40138 Bologna, Italy
- AUSL della Romagna, Ospedale Infermi di Rimini, Viale Luigi Settembrini, 2, 47923 Rimini, Italy
| | - Lorenzo Storari
- Department of Human Neurosciences, University of Roma “La Sapienza”, 00185 Rome, Italy
| | - Valerio Barbari
- Department of Human Neurosciences, University of Roma “La Sapienza”, 00185 Rome, Italy
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Chandan JS, Brown KR, Simms-Williams N, Bashir NZ, Camaradou J, Heining D, Turner GM, Rivera SC, Hotham R, Minhas S, Nirantharakumar K, Sivan M, Khunti K, Raindi D, Marwaha S, Hughes SE, McMullan C, Marshall T, Calvert MJ, Haroon S, Aiyegbusi OL. Non-Pharmacological Therapies for Post-Viral Syndromes, Including Long COVID: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3477. [PMID: 36834176 PMCID: PMC9967466 DOI: 10.3390/ijerph20043477] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Post-viral syndromes (PVS), including Long COVID, are symptoms sustained from weeks to years following an acute viral infection. Non-pharmacological treatments for these symptoms are poorly understood. This review summarises the evidence for the effectiveness of non-pharmacological treatments for PVS. METHODS We conducted a systematic review to evaluate the effectiveness of non-pharmacological interventions for PVS, as compared to either standard care, alternative non-pharmacological therapy, or placebo. The outcomes of interest were changes in symptoms, exercise capacity, quality of life (including mental health and wellbeing), and work capability. We searched five databases (Embase, MEDLINE, PsycINFO, CINAHL, MedRxiv) for randomised controlled trials (RCTs) published between 1 January 2001 to 29 October 2021. The relevant outcome data were extracted, the study quality was appraised using the Cochrane risk-of-bias tool, and the findings were synthesised narratively. FINDINGS Overall, five studies of five different interventions (Pilates, music therapy, telerehabilitation, resistance exercise, neuromodulation) met the inclusion criteria. Aside from music-based intervention, all other selected interventions demonstrated some support in the management of PVS in some patients. INTERPRETATION In this study, we observed a lack of robust evidence evaluating the non-pharmacological treatments for PVS, including Long COVID. Considering the prevalence of prolonged symptoms following acute viral infections, there is an urgent need for clinical trials evaluating the effectiveness and cost-effectiveness of non-pharmacological treatments for patients with PVS. REGISTRATION The study protocol was registered with PROSPERO [CRD42021282074] in October 2021 and published in BMJ Open in 2022.
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Affiliation(s)
- Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Kirsty R. Brown
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Nikita Simms-Williams
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Nasir Z. Bashir
- School of Oral and Dental Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Jenny Camaradou
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - Dominic Heining
- Department of Microbiology, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Grace M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Samantha Cruz Rivera
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
| | - Richard Hotham
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Sonica Minhas
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Midlands Health Data Research UK, Birmingham B15 2TT, UK
| | - Manoj Sivan
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
| | - Devan Raindi
- School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham B5 7EG, UK
| | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham and Solihull Mental Health NHS Foundation Trust, Unit 1, B1, 50 Summer Hill Road, Birmingham B1 3RB, UK
| | - Sarah E. Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration, Birmingham B15 2TT, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Melanie J. Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration, Birmingham B15 2TT, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham B15 2TT, UK
- Health Data Research UK, London WC1E 6BT, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration, Birmingham B15 2TT, UK
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Aguiar ADS, Moseley GL, Bataglion C, Azevedo B, Chaves TC. Education-Enhanced Conventional Care versus Conventional Care Alone for Temporomandibular Disorders: A Randomized Controlled Trial. THE JOURNAL OF PAIN 2023; 24:251-263. [PMID: 36220481 DOI: 10.1016/j.jpain.2022.09.012] [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: 06/09/2022] [Revised: 08/29/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022]
Abstract
The objective of this study was to determine the effect of enhancing conventional care for people with chronic painful temporomandibular disorders (TMD) with an individualised contemporary pain science education (PSE) intervention. In this randomized controlled trial, a consecutive sample of 148 participants (18-55 years of age) was randomized into 2 groups: PSE-enhanced conventional care or Conventional care alone. Conventional care involved a 6-week, 12-session manual therapy and exercise program. The PSE enhancement involved 2 sessions of modern PSE, undertaken in the first 2 treatment sessions. Primary outcomes were pain intensity, assessed with a numeric pain rating scale, and disability, assessed with the craniofacial pain and disability inventory, post-treatment. Linear mixed model analyses were used to investigate between-group differences over time. There was a statistically and clinically meaningful effect of PSE enhancement on disability (Mean Difference = 6.1, 95% CI: 3.3-8.8), but not on pain intensity, post-treatment. Secondary analyses suggested clinically meaningful benefit of PSE enhancement on pain and disability ratings at 10-week and 18-week follow-ups, raising the possibility that preceding conventional care with a PSE intervention may result in long-term benefits. PERSPECTIVE: The addition of modern Pain Science Education (PSE) intervention improved disability for people with chronic TMD receiving manual therapy and exercise, but not pain. A mean difference in pain and disability favoring the PSE group at the 10- and 18-week follow-ups, respectively, suggests that PSE addition resulted in longer-lasting effects. Trial registration: NCT03926767. Registered on April 29, 2019. https://clinicaltrials.gov/ct2/show/NCT03926767.
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Affiliation(s)
- Aroldo D S Aguiar
- Ph.D. in Musculoskeletal Rehabilitation, Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - G Lorimer Moseley
- DSc Ph.D, Bradley Distinguished Professor, IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Cesar Bataglion
- Ph.D in Dental Sciences, Professor and Researcher from the Department of Restorative Dentistry at Ribeirão Preto Dental School (FORP), University of São Paulo-USP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Beatriz Azevedo
- Master's Degree in Progress in Musculoskeletal Rehabilitation, Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Thaís C Chaves
- Ph.D, Adjunct Professor and Researcher from the Department of Physical Therapy, University Federal of São Carlos, UFSCar, São Carlos, Brazil; Researcher from the Graduate Program on Rehabilitation and Functional Performance, Laboratory of Research on Movement and Pain (LabMovePain), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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18
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Pate JW, Harrison LE, Hess CW, Moseley GL, Rush G, Heathcote LC, Simons LE. Targeting Pain Science Education in Youth With Chronic Pain: What Are the Sticking Points for Youth and Their Parents? Clin J Pain 2023; 39:60-67. [PMID: 36453624 DOI: 10.1097/ajp.0000000000001088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/12/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES An important part of providing pain science education is to first assess baseline knowledge and beliefs about pain, thereby identifying misconceptions and establishing individually-tailored learning objectives. The Concept of Pain Inventory (COPI) was developed to support this need. This study aimed to characterize the concept of pain in care-seeking youth and their parents, to examine its clinical and demographic correlates, and to identify conceptual gaps. MATERIALS AND METHODS Following an initial interdisciplinary evaluation, a cohort of 127 youth aged 8 to 18 years, and their parents, completed a series of questionnaires. RESULTS Parents had slightly higher COPI scores than youth did, reflecting parents' greater alignment with contemporary pain science. The moderate positive association with older age among youth ( r =.32) suggests that COPI is sensitive to cognitive development and life experiences. Youth and parent COPI responses were weakly associated ( r =0.24), highlighting the importance of targeting the concept of pain in both groups. For both parents and youth, 'Learning about pain can help you feel less pain' was the least endorsed concept. This conceptual 'gap' is a key point of intervention that could potentially lead to greater engagement with multidisciplinary pain treatment. DISCUSSION The COPI appears useful for identifying conceptual gaps or 'sticking points'; this may be an important step to pre-emptively address misconceptions about pain through pain science education. Future research should determine the utility of COPI in assessing and treating youth seeking care for pain. The COPI may be a useful tool for tailoring pain science education to youth and their parents.
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Affiliation(s)
- Joshua W Pate
- Graduate School of Health, University of Technology Sydney, Sydney, NSW
| | - Lauren E Harrison
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - Courtney W Hess
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - G Lorimer Moseley
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gillian Rush
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Laura E Simons
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
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Salazar-Méndez J, Leão Ribeiro I, Garrido-Castillo M, Gacitúa J. Effects of pain neuroscience education on psycho-emotional and cognitive variables in individuals with chronic musculoskeletal pain: a systematic review of randomised clinical trials. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2023. [DOI: 10.1080/21679169.2022.2162962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | - Ivana Leão Ribeiro
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Bogota, Chile
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | | | - José Gacitúa
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Bogota, Chile
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20
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Are Improvements in Pain Neurophysiology Knowledge Following Pain Science Education Associated With Improved Outcomes in People With Chronic Pain?: A Systematic Review and Meta-analysis. Clin J Pain 2023; 39:41-52. [PMID: 36524771 DOI: 10.1097/ajp.0000000000001086] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to determine the association between changes in patients' pain knowledge after pain science education (PSE) with treatment outcomes in people with chronic pain. METHODS Six electronic databases and 2 clinical trial registries were searched from inception to September 15, 2021 for studies where participants received PSE and had their pain knowledge and clinical outcomes assessed before and after PSE. Meta-analyses were performed for pain intensity, kinesiophobia, and pain catastrophizing. Physical function and quality of life outcomes were synthesized narratively. Risk of bias was assessed using the Cochrane tool for nonrandomized studies and the quality of evidence was assessed using GRADE. RESULTS Fourteen studies (n=1500 participants) were included. Meta-analyses revealed no significant associations between short-term (<12 wk) changes in pain neurophysiology knowledge with changes in pain intensity (n=1075, r=-0.01, 95% CI =-0.14 to 0.13, very low certainty), kinesiophobia (n=152, r=0.02, 95% CI =-0.27 to 0.24, very low certainty) and pain catastrophizing (n=976, r=-0.03, 95% CI=-0.18 to 0.11, low certainty). No significant associations were found between short-term changes in pain neurophysiology knowledge and physical function or quality of life either. DISCUSSION These findings do not support a short-term association between improvements in pain neurophysiology knowledge and better treatment outcomes in people with chronic pain. Increased understanding of how PSE works, as well as better ways to measure it, may help clinicians deliver more targeted education to help patients reconceptualize pain and promote engagement in active treatment strategies (eg, exercise).
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21
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Poulin PA, Shergill Y, Grebowicz A, Almeida I, Cantave R, MacLeod B, Larocque T, Garstin D, Fitzgerald SF, Rash JA. Extension for Community Healthcare Outcomes (ECHO) Chronic Pain & Opioid Stewardship in Northwestern Ontario: A Thematic Analysis of Patient Cases. Can J Pain 2022; 6:211-224. [DOI: 10.1080/24740527.2022.2126754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Patricia A. Poulin
- St Joseph’s Care Group, Project ECHO Chronic Pain & Opioid Stewardship, Thunder Bay, ON, Canada
- Department of Psychology, Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Yaadwinder Shergill
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Adrian Grebowicz
- St Joseph’s Care Group, Project ECHO Chronic Pain & Opioid Stewardship, Thunder Bay, ON, Canada
- Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON, Canada
| | - Inês Almeida
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Psychology, ISCTE – Instituto Universitário de Lisboa, Lisbon, Portugal
| | - Rosemee Cantave
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Bryan MacLeod
- St Joseph’s Care Group, Project ECHO Chronic Pain & Opioid Stewardship, Thunder Bay, ON, Canada
- St. Joseph’s Care Group, Chronic Pain Management Program, Thunder Bay, ON, Canada
| | - Tim Larocque
- St Joseph’s Care Group, Project ECHO Chronic Pain & Opioid Stewardship, Thunder Bay, ON, Canada
| | - Donna Garstin
- St Joseph’s Care Group, Project ECHO Chronic Pain & Opioid Stewardship, Thunder Bay, ON, Canada
| | - Sarah F. Fitzgerald
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Joshua A. Rash
- School of Social Sciences, Memorial University of Newfoundland, St. John’s, NL, Canada
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22
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Trouvin AP, Carvès S, Rouquette A, Coste J, Meyer S, Colin F, Deleens R, Medkour T, Collet MP, Perrot S, Laroche F. "FastSchool": A single session of an interprofessional pain management program for chronic pain patients inspired by cognitive behavioral therapy. PATIENT EDUCATION AND COUNSELING 2022; 105:3509-3514. [PMID: 36115735 DOI: 10.1016/j.pec.2022.09.007] [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: 04/30/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Multidisciplinary approaches to treating chronic pain have been proven effective. Currently, chronic pain patients face lengthy waitlists in pain medicine departments. To overcome this problem, we developed the "FastSchool" program to educate patients about pain management and treatment. In this study, we evaluated the benefit of a "FastSchool" session on pain and catastrophizing in chronic pain patients. METHODS Included patients had chronic non-cancer pain, no more than 2 visits to a pain medicine department. Patients attended a single 3-hour session, conducted by an interprofessional team. Four topics were addressed: chronic pain mechanisms, pharmacological therapies, physical activity, and the management of analgesics. Patients completed questionnaires at baseline and at 3 months post-session to assess pain interference, pain intensity, and catastrophizing. RESULTS The study population included 88 patients; 71 completed the follow-up questionnaires. Pain interference (p = 0.002), average pain intensity (p = 0.013), and catastrophizing (p < 0.001) decreased 3 months after FastSchool. At M3, 35 % of patients felt their pain had improved based on the Patient Global Impression of Change. CONCLUSION FastSchool, an innovative short-term educational program inspired by cognitive behavioral therapy, showed positive results in reducing pain impact. PRACTICE IMPLICATIONS Implementation of FastSchool in pain medicine departments would reduce waitlist times for non-pharmacological treatment.
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Affiliation(s)
| | | | - Alexandra Rouquette
- Department of Epidemiology and Public Health, Bicêtre Universitary Hospital, Le Kremlin-Bicêtre, France
| | - Joël Coste
- Pain Department, GHU Paris Centre-Cochin, Paris, France; Biostatistics and Epidemiology Unit, GHU Paris Centre-Cochin, Paris, France
| | - Sinja Meyer
- Pain Department, Saint-Antoine Sorbonne University Hospital, APHP, Paris, France
| | - Faustine Colin
- Pain Department, Saint-Antoine Sorbonne University Hospital, APHP, Paris, France
| | | | | | | | - Serge Perrot
- Pain Department, GHU Paris Centre-Cochin, Paris, France
| | - Françoise Laroche
- Pain Department, Saint-Antoine Sorbonne University Hospital, APHP, Paris, France
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23
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Alcon CA, Wang-Price S. Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: Evidence and future directions. FRONTIERS IN PAIN RESEARCH 2022; 3:959609. [PMID: 36438443 PMCID: PMC9686004 DOI: 10.3389/fpain.2022.959609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic low back pain (CLBP) is among the leading causes of disability worldwide. Beyond the physical and functional limitations, people's beliefs, cognitions, and perceptions of their pain can negatively influence their prognosis. Altered cognitive and affective behaviors, such as pain catastrophizing and kinesiophobia, are correlated with changes in the brain and share a dynamic and bidirectional relationship. Similarly, in the presence of persistent pain, attentional control mechanisms, which serve to organize relevant task information are impaired. These deficits demonstrate that pain may be a predominant focus of attentional resources, leaving limited reserve for other cognitively demanding tasks. Cognitive dysfunction may limit one's capacity to evaluate, interpret, and revise the maladaptive thoughts and behaviors associated with catastrophizing and fear. As such, interventions targeting the brain and resultant behaviors are compelling. Pain neuroscience education (PNE), a cognitive intervention used to reconceptualize a person's pain experiences, has been shown to reduce the effects of pain catastrophizing and kinesiophobia. However, cognitive deficits associated with chronic pain may impact the efficacy of such interventions. Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective in the treatment of anxiety, depression, and pain. In addition, as with the treatment of most physical and psychological diagnoses, an active multimodal approach is considered to be optimal. Therefore, combining the neuromodulatory effects of NIBS with a cognitive intervention such as PNE could be promising. This review highlights the cognitive-affective deficits associated with CLBP while focusing on current evidence for cognition-based therapies and NIBS.
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Affiliation(s)
- Cory A. Alcon
- Department of Physical Therapy, High Point University, High Point, NC, United States
- School of Physical Therapy, Texas Woman’s University, Dallas, TX, United States
- Correspondence: Cory A. Alcon
| | - Sharon Wang-Price
- School of Physical Therapy, Texas Woman’s University, Dallas, TX, United States
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24
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Loría-Rebolledo LE, Ryan M, Bond C, Porteous T, Murchie P, Adam R. Using a discrete choice experiment to develop a decision aid tool to inform the management of persistent pain in pharmacy: a protocol for a randomised feasibility study. BMJ Open 2022; 12:e066379. [PMID: 36137622 PMCID: PMC9511577 DOI: 10.1136/bmjopen-2022-066379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In an era of personalised healthcare, it has become increasingly important to elicit individual-level preferences. While discrete choice experiments (DCEs) are widely used to measure patient preferences in the delivery of healthcare, the focus has been sample-level analysis. Using the DCE methodology, this project has designed a digital decision aid tool (DAT) with the potential to estimate individual preferences in real time to inform clinical consultation decisions in persistent pain management. METHODS Using a feasibility randomised control trial, this study aims to assess the feasibility of using this Understanding Persistent Pain (UPP) DAT in a pharmacy-based clinical setting and to test processes for a future definite randomised trial. Community and practice-based pharmacists (up to 10) will be recruited in The National Health Service (NHS) Grampian and trained in the use of the digital UPP DAT. Pharmacists will recruit up to 60 patients who are living with persistent pain. Patients will be randomised to one of two groups: using the UPP DAT or usual care. Pharmacists will follow-up patients as needed according to clinical need and following standard practice. DCE response data collected by the UPP DAT will be analysed using the penalised logit model, allowing estimation of individual preferences in real time. We will follow-up pharmacists and patients who use the UPP DAT to gather feedback on their experiences. ETHICS AND DISSEMINATION This study received ethical approval from the North of Scotland Research Ethics Committee (21/NS/0059) and received Research & Development Management Permission to proceed from NHS Grampian (2021UA003E). The study has been registered in the ClinicalTrials.gov database. Findings will be disseminated in peer-reviewed publications, presentations and newsletters and made available in the University of Aberdeen and Pharmacy Research UK websites. Participants gave informed consent to participate in the study before taking part. TRIAL REGISTRATION NUMBER NCT05102578; clinicaltrials.gov.
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Affiliation(s)
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Terry Porteous
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Rosalind Adam
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
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25
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Kanaan SF, Alhendi ZM, Almhdawi KA, Aldahamsheh Z, Ismail N, Khalil H. Evaluating the effectiveness of a comprehensive education on low back pain treatment outcomes: A controlled clinical study. Clin Rehabil 2022; 37:98-108. [PMID: 36071623 DOI: 10.1177/02692155221122661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the effect of integrating an individualized, evidence-based low back pain comprehensive education package on low back pain treatment outcomes. DESIGN Single-blind, controlled clinical study using the alternate allocation of patients. SETTING Outpatient clinic. SUBJECTS In total, 54 participants with chronic low back pain (46.75 ± 11.11 years, 80% females) were randomized to intervention (n = 27) or a control group (n = 27). INTERVENTION The intervention group received additional four one-hour low back pain-related education sessions to eight 45 minutesstandard physical therapy sessions over 4 weeks. OUTCOME MEASURES Assessed at baseline, post-intervention, and 3 months. Outcome measures included pain intensity (Visual Analogue Scale), knowledge (Low Back Pain Knowledge Questionnaire), attitude (the Back Pain Attitudes Questionnaire), disability (the Oswestry Disability Index), mental health symptoms (Depression Anxiety Stress Scale, DASS-21 scale), and fear-avoidance (Fear-Avoidance Beliefs Questionnaire). RESULTS The intervention group showed significantly lower pain intensity ((4 weeks (3.58 ± 1.50 vs. 5.54 ± 1.92), 3 months (3.21 ± 1.74 vs. 5.69 ± 2.51)), higher knowledge ((4 weeks (21.67 ± 2.12 vs. 11.62 ± 3.47), three months (22.08 ± 3.40 vs. 12.23 ± 3.24)), lower negative attitudes ((4 weeks (99.29 ± 11.02 vs. 134.31 ± 12.97), 3 months (102.92 ± 15.58 vs. 132.42 ± 17.79)), lower disability ((4 weeks (26.30 ± 11.37 vs. 45.14 ± 18.67), 3 months (22.83 ± 16.06 vs. 44.13 ± 15.02)), lower stress score ((4 weeks (3.54 ± 3.01 vs. 8.81 ± 5.19), 3 months (3.21 ± 3.22 vs. 7.21 ± 4.36)), lower anxiety ((4 weeks (2.63 ± 3.16 vs. 6.42 ± 4.75), three months (2.63 ± 3.80 vs. 5.73 ± 4.44)), lower depression ((4 weeks (2.42 ± 2.15 vs. 6.42 ± 3.68), three months (2.63 ± 4.18 vs. 7.08 ± 4.41)), and lower fear-avoidance ((4 weeks (13.88 ± 12.32 vs. 50.88 ± 23.25), three months (15.50 ± 16.75 vs. 54.65 ± 31.81)). CONCLUSION Integrating low back pain comprehensive education into standard physical therapy might optimize the treatment outcomes of low back pain.
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Affiliation(s)
- Saddam F Kanaan
- Department of Rehabilitation Sciences, 37251Jordan University of Science and Technology, Jordan.,Department of Physical Therapy and Rehabilitation Science, 61780Qatar University, Qatar
| | - Zainab M Alhendi
- Department of Rehabilitation Sciences, 37251Jordan University of Science and Technology, Jordan
| | - Khader A Almhdawi
- Department of Rehabilitation Sciences, 37251Jordan University of Science and Technology, Jordan
| | - Zaid Aldahamsheh
- Department of Physical Medicine and Rehabilitation, 155132Royal Medical Services, Jordan
| | - Noor Ismail
- Department of Rehabilitation Sciences, 37251Jordan University of Science and Technology, Jordan
| | - Hanan Khalil
- Department of Physical Therapy and Rehabilitation Science, 61780Qatar University, Qatar
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26
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Pinkston MM, Busch AM, Stein M, Baker J, Caviness C, Herman D, Weisberg R, Abrantes AM, Uebelacker LA. Improving functioning in HIV+ patients with chronic pain and comorbid depression: Protocol for a randomized clinical trial testing a collaborative behavioral health intervention based on behavioral activation. Contemp Clin Trials 2022; 119:106842. [PMID: 35777696 PMCID: PMC10739651 DOI: 10.1016/j.cct.2022.106842] [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: 12/23/2021] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Persons living with HIV (PWH) experience a disproportionate level of comorbid chronic pain and depression compared to individuals who do not have a diagnosis of HIV. Many PWH report pain that impairs daily function, is severe, and requires medical management. Depression alone is associated with HIV disease progression, medication non-adherence, and increased mortality. Given that numerous studies show that PWHs have chronic pain and depression despite pharmacologic treatment, there is a clear need for additional treatment modalities to address these conditions. DESIGN In this paper, we describe our protocol for a multisite, randomized controlled trial of the effectiveness of a collaborative behavioral intervention, called HIV-Pain and Sadness Support (HIVPASS), designed for PWH who endorse chronic pain and depressive symptoms, as compared to an attention matched Health Education (HE) condition. The HIVPASS intervention is based on Behavioral Activation and designed to target both pain and depression using an integrated model that promotes collaboration between HIV medical and psychological providers. SETTING AND METHODS We plan to (1) recruit PWH who endorse chronic pain and depression in three sites located in New England and the Midwestern United States and (2) compare our HIVPASS intervention to a full attention matched HE intervention with the primary outcome of pain interference, and secondary outcomes of depression, physical activity, HIV medication adherence, and health-related quality of life. Follow-up assessments will occur monthly for three months during the intervention phase and then during the post-intervention phase at months four, six, nine and twelve. CONCLUSIONS We provide descriptions of our protocol and interventions of our randomized controlled trial for comorbid chronic pain and depression in PWH. TRIAL REGISTRATION http://ClinicalTrials.govNCT02766751 https://clinicaltrials.gov/ct2/show/NCT02766751?term=stein%2C+michael&draw=2&rank=5.
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Affiliation(s)
- Megan M Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Lifespan Physicians Group, The Miriam Hospital, Providence, RI, USA.
| | - Andrew M Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Department of Medicine, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Michael Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Jason Baker
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Department of Medicine, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Celeste Caviness
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Debra Herman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Risa Weisberg
- VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Lisa A Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research, Butler Hospital, Providence, RI, USA
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27
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Rheel E, Heathcote LC, van der Werff Ten Bosch J, Schulte F, Pate JW. Pain science education for children living with and beyond cancer: Challenges and research agenda. Pediatr Blood Cancer 2022; 69:e29783. [PMID: 35593047 DOI: 10.1002/pbc.29783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/05/2022]
Abstract
Pain in children living with and beyond cancer is understudied and undertreated. Pain science education (PSE) is a conceptual change strategy facilitating patients' understanding of the biopsychosocial aspects of pain. Preliminary studies on the adaptation of PSE interventions to adults with and beyond cancer provide a foundation for pediatric research. PSE could help childhood cancer survivors experiencing persistent pain and pain-related worry after active treatment. PSE may also help children receiving cancer treatment, providing them with a foundation of adaptive pain beliefs and cognitions, and preparing them for procedural and treatment-related pain. We direct this paper toward pediatric oncology clinicians, policy makers, and researchers working with children living with and beyond cancer. We aim to (a) identify challenges in adapting PSE for children living with and beyond cancer, (b) offer possible solutions, and (c) propose research questions to guide the implementation of PSE for children living with and beyond cancer.
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Affiliation(s)
- Emma Rheel
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joshua W Pate
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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28
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Soleiman F, Kouhzad Mohamadi H, Saadat M, Derisfard F, Nassadj G. A protocol for a randomized trial on pain neuroscience education vs. routine physical therapy in people with chronic neck pain. Eur J Transl Myol 2022; 32. [PMID: 35833895 PMCID: PMC9580528 DOI: 10.4081/ejtm.2022.10674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of this study is to investigate the effects of combining routine physical therapy with pain neuroscience education (PNE) on psychosocial factors, physical performance, and the experienced pain in patients with chronic neck pain (CNP). This study is a double-blind randomized clinical trial in which patients will be randomly allocated to two groups, routine physical therapy with and without PNE. Patients will be assessed at the baseline, post intervention, and three months later. The results of this research will be used to establish effectiveness of treatment strategies for CNP. Due to the rigorous scientific methods used in this research, the suggested interventions would be clinically applicable in the health care systems.
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Affiliation(s)
- Farzaneh Soleiman
- Musculoskeletal Rehabilitation Research Center Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz.
| | - Hosein Kouhzad Mohamadi
- Musculoskeletal Rehabilitation Research Center Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz.
| | - Maryam Saadat
- Musculoskeletal Rehabilitation Research Center Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz.
| | - Fateme Derisfard
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz.
| | - Gholamhossein Nassadj
- Musculoskeletal Rehabilitation Research Center Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz.
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29
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Rheel E, Ickmans K, Wauters A, Van Ryckeghem DML, Barbé K, Malfliet A, Vervoort T. The Effect of a Pain Educational Video Upon Child Pain-Related Memory and the Moderating Role of Parental Pain- and Non-Pain-Attending Verbalizations: An Experimental Lab-Based Study. J Pediatr Psychol 2022; 47:1057-1070. [PMID: 35640009 DOI: 10.1093/jpepsy/jsac044] [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: 01/27/2022] [Revised: 03/28/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Early memories of pain contribute to fear and may underlie the maintenance and development of chronic pain into adulthood. Accordingly, understanding determinants that may impact children's pain memory development is key. This study examined (a) the effect of a brief engaging pain educational video in healthy children before undergoing an experimental pain task upon children's recalled pain intensity and pain-related fear and (b) the moderating role of parental pain- and non-pain-attending verbalizations before and after the pain task. METHODS Seventy-seven children (8-15 years old) participated in an experimental heat pain task, including actual heat pain stimuli delivered through a thermode on their forearm. Children were randomized to the experimental group (i.e., watching a pain educational video) or the control group (i.e., no video). Children's recalled pain intensity and pain-related fear were elicited 2 weeks later. RESULTS Findings showed that recalled pain intensity (but not recalled pain-related fear) of children who watched the pain educational video was significantly lower compared to the control group (p = .028). Further, parental pain-attending verbalizations before the pain task moderated the impact of the video upon children's recalled pain intensity (p = .038). Specifically, children in the control group, but not the experimental group, whose parents used less pain-attending verbalizations recalled higher pain intensity, whereas children whose parents used more pain-attending verbalizations recalled lower pain intensity. CONCLUSIONS As children's pain memories have important implications for pain assessment, treatment, and health across the lifespan, these findings might have important implications for the prevention of development or maintenance of maladaptive pain-related outcomes.
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Affiliation(s)
- Emma Rheel
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Movement & Nutrition for Health & Performance research group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Aline Wauters
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Dimitri M L Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Section Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Institute for Health and Behavior, INSIDE, University of Luxembourg, Luxembourg City, Luxembourg
| | - Kurt Barbé
- Interfaculty Center for Date-processing and Statistics (ICDS), Vrije Universiteit Brussel, Brussels, Belgium
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Tine Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
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30
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Lane E, Magel JS, Thackeray A, Greene T, Fino NF, Puentedura EJ, Louw A, Maddox D, Fritz JM. Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a cluster-randomized trial. Pain 2022; 163:852-860. [PMID: 34354017 PMCID: PMC8816964 DOI: 10.1097/j.pain.0000000000002436] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic spinal pain poses complex challenges for health care around the world and is in need of effective interventions. Pain neuroscience education (PNE) is a promising intervention hypothesized to improve pain and disability by changing individuals' beliefs, perceptions, and expectations about pain. Pain neuroscience education has shown promise in small, controlled trials when implemented in tightly controlled situations. Exploration of promising interventions through more pragmatic methodologies is a crucial but understudied step towards improving outcomes in routine clinical care. The purpose was to examine the impact of pragmatic PNE training on clinical outcomes in patients with chronic spine pain. The cluster-randomized clinical trial took place in 45 outpatient physical therapist (PT) clinics. Participants included 108 physical therapists (45 clinics and 16 clusters) and 319 patients. Clusters of PT clinics were randomly assigned to either receive training in PNE or no intervention and continue with usual care (UC). We found no significant differences between groups for our primary outcome at 12 weeks, Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test {mean difference = 1.05 (95% confidence interval [CI]: -0.73 to 2.83), P = 0.25}. The PNE group demonstrated significant greater improvements in pain self-efficacy at 12 and 2 weeks compared with no intervention (mean difference = 3.65 [95% CI: 0.00-7.29], P = 0.049 and = 3.08 [95% CI: 0.07 to -6.09], P = 0.045, respectively). However, a similar percentage of participants in both control (41.1%) and treatment (44.4%) groups reported having received the treatment per fidelity question (yes or no to pain discussed as a perceived threat) at 2 weeks. Pragmatic PT PNE training and delivery failed to produce significant functional changes in patients with chronic spinal pain but did produce significant improvement in pain self-efficacy over UC PT.
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Affiliation(s)
- Elizabeth Lane
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - John S. Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Tom Greene
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
- Population Health, Research Study Design and Biostatistics Center, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Nora F. Fino
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | | | - Adriaan Louw
- Department of Physical Therapy, Evidence in Motion, San Antonio, TX, United States
| | - Daniel Maddox
- Department of Physical Therapy, Brenau University, Gainesville, GA, United States
| | - Julie M. Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
- College of Health, University of Utah, Salt Lake City, UT, United States
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Amigos de Fibro (Fibro Friends): Validation of an Educational Program to Promote Health in Fibromyalgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095297. [PMID: 35564691 PMCID: PMC9102409 DOI: 10.3390/ijerph19095297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/19/2022] [Accepted: 04/24/2022] [Indexed: 02/04/2023]
Abstract
Health education is one of the main items to enable the promotion of health for individuals with fibromyalgia (FM) in Primary Health Care (PHC) in Brazil. The purpose of this study was to validate a multidisciplinary educational health promotion program called Amigos de Fibro (Fibro Friends) for individuals with FM. Methodological research involving 23 health professionals (expert judges) and 45 individuals with FM (target audience) used an instrument to assess the objectives, proposed themes and initiatives, relevance, writing style, and structure of the program through the Delphi technique. The content validity index (CVI) ≥ 0.78 and coefficient kappa ≥ 0.61 were used for data analysis. All 25 items evaluated in both groups presented considerable minimum CVI by CVI and the kappa coefficient. In the global evaluation of Amigos de Fibro, the CVI of the specialist judges was 0.90, while the values of the target audience judges were 0.95. The kappa coefficient of the expert judges was 0.90 and that of the target audience judges was 0.85. Amigos de Fibro, a light technology in health, was considered with adequate content validity and internal consistency and is, therefore, valid in the use by health professionals with the target audience in PHC, making it possible for them to act as health-promoting agents.
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Cooper C, Green S, Hartstein A, Fergus A. The impact of pain neuroscience education in a Hispanic-American population: A mixed-methods exploratory study. Physiother Theory Pract 2022:1-14. [PMID: 35383528 DOI: 10.1080/09593985.2022.2060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic pain and pain catastrophization are growing problems across the United States, within the Hispanic-American population. Pain neuroscience education (PNE) changes pain knowledge and beliefs in many populations, but its impact on reconceptualization in people of Hispanic-American origin is unknown. PURPOSE Explore the changes in pain knowledge in Hispanic-American individuals and the process involved in reconceptualization following a PNE lecture. METHODS Eight Hispanic-American adults participated in a mixed-methods exploratory study. The Revised Neurophysiology of Pain Questionnaire (R-NPQ) was completed before, immediately after, and eight months after an adapted PNE lecture. A focus group involving four participants discussed the impact of PNE. Transcripts were translated and theme coded, and a concept map was developed by consensus. RESULTS R-NPQ scores improved from 25.3% to 43.5% post-lecture, and the number of unsure responses decreased from 41.5% to 18.4%. At eight months, R-NPQ scores remained stable (44.2%) but unsure responses increased (28.9%). Themes that contributed to the process of change included cognitive dissonance, relevance of instruction, idea exchange through peer interaction, reflection, confidence, changed behaviors, and educational utility. CONCLUSION While small improvements in knowledge and perception of pain appeared to occur with the PNE, knowledge remained low. Consideration of adult learning principles such as applicability, peer-interaction, the confrontation of beliefs, and reflection throughout PNE may enhance its impact. Future investigation should explore the efficacy of this intervention, when compared or combined with other techniques in the treatment of Hispanic-Americans experiencing persistent pain.
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Affiliation(s)
- Christine Cooper
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
| | - Savannah Green
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
| | - Aaron Hartstein
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
| | - Andrea Fergus
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
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Khosrokiani Z, Letafatkar A, Hadadnezhad M, Sokhanguei Y. Comparison the Effect of Pain Neuroscience and Pain Biomechanics Education on Neck Pain and Fear of Movement in Patients with Chronic Nonspecific Neck Pain During the COVID-19 Pandemic. Pain Ther 2022; 11:601-611. [PMID: 35312949 PMCID: PMC8935612 DOI: 10.1007/s40122-022-00371-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Self-management education is the basis of any intervention for persons with chronic musculoskeletal pain. Given the biopsychosocial nature of chronic musculoskeletal pain, an educational approach based on the biopsychosocial model would seem to be an appropriate educational model for the treatment of these people during coronavirus disease 2019 (COVID-19). The aim of this study was to compare the effect of pain neuroscience education (PNE) and pain biomechanics education, using online and face-to-face sessions on pain and fear of movement, in people with chronic nonspecific neck pain during COVID-19. Methods In this multicenter assessor-blinded randomized controlled trial, 80 patients (both male and female) with chronic nonspecific neck pain (based on the inclusion criteria of the study) participated in educational sessions (face-to-face and online) from the beginning September until the end of October 2021. The participants were randomly divided into two groups (through the selection of numbers from 1 to 80, hidden in a box), with one group receiving PNE (treatment group) and the other group receiving pain biomechanics education (control group). Pain and fear of movement before and after the intervention were measured on the Numerical Pain Rating Scale and the Tampa Scale of Kinesiophobia, respectively. A 2 × 2 variance analysis (treatment group × time) with a mixed-model design was applied to statistically analyze the data. Results No significant change in pain (P = 0.23) was observed between the two groups (P = 0.24, Cohen's d = 0.17, 95% confidence interval [CI] − 0.21 to 0.35), while changes in the fear of movement variable were reported to be significant (P = 0.04, Cohen's d = 0.34, 95% CI 0.11–0.51), in favor of PNE. Intra-group change was seen only in the PNE group for the fear of movement variable (P = 0.04; 14.28%↓). Conclusion In our study population PNE did not affect the pain index, leading to the conclusion that PNE should not be used as the only treatment, but possibly in combination with other active/passive therapy to enhance the results for patients with nonspecific chronic neck pain. Moreover, online treatment may help clinicians to increase their interaction with patients during COVID-19 lockdown.
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Affiliation(s)
- Zohre Khosrokiani
- Biomechanics and Corrective Exercises Laboratory, Faculty of Physical Education and Sports Sciences, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, Iran
| | - Amir Letafatkar
- Biomechanics and Corrective Exercises Laboratory, Faculty of Physical Education and Sports Sciences, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, Iran.
| | - Malihe Hadadnezhad
- Biomechanics and Corrective Exercises Laboratory, Faculty of Physical Education and Sports Sciences, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, Iran
| | - Yahya Sokhanguei
- Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Kujawski S, Słomko J, Newton JL, Eaton-Fitch N, Staines DR, Marshall-Gradisnik S, Zalewski P. Network Analysis of Symptoms Co-Occurrence in Chronic Fatigue Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010736. [PMID: 34682478 PMCID: PMC8535251 DOI: 10.3390/ijerph182010736] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022]
Abstract
Chronic fatigue syndrome (CFS) is a heterogenous disorder of multiple disabling symptoms with complex manifestations. Network analysis is a statistical and interrogative methodology to investigate the prevalence of symptoms (nodes) and their inter-dependent (inter-nodal) relationships. In the present study, we explored the co-occurrence of symptoms in a cohort of Polish CFS patients using network analysis. A total of 110 patients with CFS were examined (75 females). The mean age of the total sample was 37.93 (8.5) years old while the mean duration of symptoms in years was 4.4 (4). Post-exertional malaise (PEM) was present in 75.45% of patients, unrefreshing sleep was noted in 89.09% and impaired memory or concentration was observed in 87.27% of patients. The least prevalent symptom was tender cervical or axillary lymph nodes, noted in 34.55% of the total sample. Three of the most densely connected nodes were the total number of symptoms, sore throat and PEM. PEM was positively related with impairment in memory or concentration. Both PEM and impairment in memory or concentration presence are related to more severe fatigue measured by CFQ and FIS. PEM presence was positively related with the presence of multi-joint pain and negatively with tender lymph nodes and muscle pain. Sore throat was related with objective and subjective autonomic nervous system impairment. This study helps define symptom presentation of CFS with the pathophysiology of specific systems and links with multidisciplinary contemporary molecular pathology, including comparative MRI.
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Affiliation(s)
- Sławomir Kujawski
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland; (J.S.); (P.Z.)
- Correspondence:
| | - Joanna Słomko
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland; (J.S.); (P.Z.)
| | - Julia L. Newton
- Population Health Sciences Institute, The Medical School, Newcastle University, Newcastle-upon-Tyne NE2 4HH, UK;
| | - Natalie Eaton-Fitch
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute of Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia; (N.E.-F.); (D.R.S.); (S.M.-G.)
- Consortium Health International for Myalgic Encephalomyelitis, Menzies Health Institute Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia
| | - Donald R. Staines
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute of Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia; (N.E.-F.); (D.R.S.); (S.M.-G.)
- Consortium Health International for Myalgic Encephalomyelitis, Menzies Health Institute Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia
| | - Sonya Marshall-Gradisnik
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute of Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia; (N.E.-F.); (D.R.S.); (S.M.-G.)
- Consortium Health International for Myalgic Encephalomyelitis, Menzies Health Institute Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia
| | - Paweł Zalewski
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland; (J.S.); (P.Z.)
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute of Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia; (N.E.-F.); (D.R.S.); (S.M.-G.)
- Consortium Health International for Myalgic Encephalomyelitis, Menzies Health Institute Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia
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Pate JW, Simons LE, Rush G, Hancock MJ, Hush JM, Verhagen A, Pacey V. The Concept of Pain Inventory for Adults (COPI-Adult): Assessing Knowledge and Beliefs Regarding Pain Science Education. Clin J Pain 2021; 38:32-40. [PMID: 34636751 DOI: 10.1097/ajp.0000000000000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Assessing knowledge and beliefs regarding pain science can identify gaps and misconceptions. The Concept of Pain Inventory (COPI) was recently developed in children with the intent to guide targeted pain science education. We utilized the original COPI item pool to (1) develop a tool to assess an adult's concept of pain in a cohort who had not received pain science education, (2) evaluate its psychometric properties, (3) examine distribution of scores in a cohort of adults who had received pain science education, and (4) examine associations between scores and clinical variables. MATERIALS AND METHODS A total cohort of 627 adults were recruited through social media for an online survey. Initial development was conducted on those who had not received prior pain science education (n=125), then the COPI-Adult tool was tested in those who had received prior pain science education (n=502). RESULTS The resulting unidimensional 13-item COPI-Adult had acceptable internal consistency (α=0.78) and good test-retest reliability at 1 week (Intraclass Correlation Coefficient3,1=0.84 (95% confidence interval: 0.71-0.91). Higher COPI-Adult scores reflect greater alignment with contemporary pain science. COPI-Adult scores were correlated with revised Neurophysiology of Pain Questionnaire (rNPQ) scores and inversely correlated with average and current pain intensity, and pain interference. Adults who reported having received pain science education had significantly higher mean COPI-Adult scores than those who had not, and this difference exceeded the smallest detectable change. DISCUSSION The COPI-Adult is a brief questionnaire with promising psychometric properties to identify conceptual gaps or misconceptions to inform individualized pain science education.
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Affiliation(s)
- Joshua W Pate
- Graduate School of Health, University of Technology Sydney
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Gillian Rush
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, NSW, Australia
| | - Julia M Hush
- Department of Health Professions, Macquarie University, Sydney, NSW, Australia
| | | | - Verity Pacey
- Department of Health Professions, Macquarie University, Sydney, NSW, Australia
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Saracoglu I, Leblebicier MA, Yaman F, Kavuncu V. Pain neuroscience education combined with usual treatment for fibromyalgia syndrome: A randomized controlled trial. Int J Rheum Dis 2021; 24:1409-1418. [PMID: 34609084 DOI: 10.1111/1756-185x.14223] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/31/2021] [Accepted: 09/26/2021] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to investigate the effectiveness of pain neuroscience education (PNE) in addition to usual treatment in patients with fibromyalgia syndrome. METHODS Forty patients were randomized into 2 groups. The experimental group underwent PNE sessions over 6 weeks in addition to pharmacological treatment, and the control group was given only pharmacological treatment. The primary outcome measure was functional status and the secondary outcome measures were widespread pain pressure threshold and kinesiophobia level. All assessments were conducted before the intervention and at the end of the 6th and 12th weeks by the same blinded researcher. RESULTS The intervention group had significantly greater improvement than the control group in terms of the mean total scores in the Fibromyalgia Impact Questionnaire (P = .001) and the Tampa Scale of Kinesiophobia (P = .001) with large effect sizes. The intervention group also had significantly greater improvement in the pain pressure threshold values of the cervical (P = .040), thoracic (P = .001), lumbar (P < .001), elbow (P = .005) and calf (P = .006) regions with moderate-to-large effect sizes. CONCLUSION This study showed that the addition of 6-week PNE sessions to pharmacological treatment was successful in improving functional status, widespread pain pressure threshold, and level of kinesiophobia in patients with fibromyalgia syndrome during a 12-week follow-up period.
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Affiliation(s)
- Ismail Saracoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
| | - Merve Akdeniz Leblebicier
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Fatima Yaman
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Vural Kavuncu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
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Alhowimel A, Alodiabi F, Alamam D, Alotaibi M, Fritz J. Current Understanding of Pain Neurophysiology among Physiotherapists Practicing in Saudi Arabia. Healthcare (Basel) 2021; 9:healthcare9091242. [PMID: 34575016 PMCID: PMC8469164 DOI: 10.3390/healthcare9091242] [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: 06/16/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022] Open
Abstract
To ensure the effective management of patients’ pain, it is important that physiotherapists have a good understanding of the neuroscience behind pain. A major barrier to adequate pain management is that, for patients, there is limited access to clinicians who are knowledgeable about pain. This study examined the level of knowledge regarding pain neurophysiology among physiotherapists currently practicing in Saudi Arabia. Method: The study was a cross-sectional web-based survey that utilized the 12-item Revised Neurophysiology of Pain Questionnaire. Descriptive and inferential statistics were used to describe levels of knowledge regarding pain neurophysiology and to examine differences in knowledge based on the characteristics of the participating physiotherapists (gender, educational level, experience, practice region, and country where their highest educational level was attained). Results: One hundred and eleven physiotherapists (58.6% male) from various regions and educational backgrounds participated in the study. Out of a maximum Revised Neurophysiology of Pain Questionnaire score of 12, the mean ± standard deviation (SD) was 6.7 ± 2.2; 90% of physiotherapists scored 9 (75%) or less. None of the examined characteristics of the participants were associated with knowledge. Conclusion: Physiotherapists in Saudi Arabia showed limited knowledge of the neurophysiology of pain; however, this was not related to the personal characteristics that were examined. The continuation of education in modern pain science is recommended for physiotherapists, especially those dealing with patients suffering from chronic pain. Clinical Relevance: The physiotherapists who took part in this study displayed limited knowledge of pain neuroscience; this limited knowledge might suggest the need for a more bio-anatomical approach to pain management. There is a need for tailored medical education to address pain neuroscience knowledge in current physiotherapist practitioners.
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Affiliation(s)
- Ahmed Alhowimel
- Department of Health and Rehabilitation Science, Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia;
- Correspondence:
| | - Faris Alodiabi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (D.A.)
| | - Dalyah Alamam
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (D.A.)
| | - Mazyad Alotaibi
- Department of Health and Rehabilitation Science, Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia;
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84112, USA;
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Watson S, Louw A, Wingood M, Rico D, Podolak J, Maiers N, Cox T. Pain Neuroscience Education for Older Adults. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2021.1970692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stacey Watson
- Mary Free Bed Rehabilitation Hospital, Kalamazoo, MI, USA
| | - Adriaan Louw
- Evidence in Motion Pain Science, Story City, IA, USA
| | - Mariana Wingood
- Department of Rehabilitation and Movement Sciences, University of Vermont, Burlington, VT, USA
| | - Debbie Rico
- Physical Therapy, Rockhurst University, Kansas City, MO, USA
| | | | - Nicholas Maiers
- Physical Therapy, College of Health Sciences, Des Moines University, Des Moines, IA, USA
| | - Terry Cox
- Physical Therapy, Southwest Baptist University, Bolivar, MO, USA
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Pain Neuroscience Education Combined with Therapeutic Exercises Provides Added Benefit in the Treatment of Chronic Neck Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168848. [PMID: 34444594 PMCID: PMC8394804 DOI: 10.3390/ijerph18168848] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Chronic neck pain is common in the adult general population. Although the etiology of chronic neck pain is under debate, it is clear that chronic neck pain is multifactorial, with both physical and psychosocial contributors. OBJECTIVE To determine whether adding pain neuroscience education (PNE) to therapeutic exercises improved their pain-disability index, pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy in subjects with chronic nonspecific neck pain. METHODS This study was a three-arm randomized control trial. Seventy-two patients with chronic nonspecific neck pain were allocated to three groups: therapeutic exercises alone (n = 24), combined (therapeutic exercises + PNE; (n = 24), and a control group (n = 24). Each program took place three times a week, lasting for six weeks. The disability index, pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy measured by the Neck Pain and Disability Scale (NPAD), Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ), and Pain Self-Efficacy Questionnaire (PSEQ), respectively. Participants were assessed before and after the six-week intervention, and there was no further follow-up. RESULTS For the outcomes NPAD, PSC, and FABQ, combined intervention demonstrated more significant improvements than therapeutic exercises alone (p ≤ 0.05), whereas no differences were observed between the two intervention groups for PSEQ (p = 0.99). In addition, significant differences were favoring experimental groups versus control for all outcomes (p ≤ 0.001). CONCLUSION Therapeutic exercises combined with pain neuroscience education reduced the pain-disability index, pain catastrophizing, and fear-avoidance beliefs more than therapeutic exercises alone in patients with chronic neck pain. For pain self-efficacy, there was no statistically significant difference between the two intervention groups; however, the combined group had a more significant effect than therapeutic exercises alone. Further studies with longer periods and follow-up are required.
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O'Connor M, Sillevis R, Erickson MR. Pain Neuroscience Education Delivered by a Student Physical Therapist for a Patient with Persistent Musculoskeletal Pain. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932212. [PMID: 34398869 PMCID: PMC8378777 DOI: 10.12659/ajcr.932212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patient: Female, 65-year-old
Final Diagnosis: Fibromyalgia • neck pain radiculopathy • rotator cuff injury bilaterally
Symptoms: Chronic pain
Medication: —
Clinical Procedure: Manual therapy • pain neuroscience education
Specialty: Rehabilitation
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Affiliation(s)
- Michael O'Connor
- Doctor of Physical Therapy Program, Florida Gulf Coast University, Fort Myers, FL, USA.,Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Rob Sillevis
- Doctor of Physical Therapy Program, Florida Gulf Coast University, Fort Myers, FL, USA.,Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Mark R Erickson
- Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
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Barbari V, Storari L, Maselli F, Testa M. Applicability of pain neuroscience education: Where are we now? J Back Musculoskelet Rehabil 2021; 34:511-520. [PMID: 33749636 DOI: 10.3233/bmr-200091] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Explaining pain to patients through pain neuroscience education (PNE) is currently a widespread treatment studied in the musculoskeletal context. Presently, there is sufficient evidence supporting the effectiveness of PNE in patients with chronic musculoskeletal disorders. However, clinicians must pay attention to the actual possibility to transfer research findings in their specific clinical context. OBJECTIVE We analysed the applicability of results of studies focused on PNE, which has not been done previously. METHODS A detailed discussion on PNE applicability is provided, starting from published randomized controlled trials that investigated the effectiveness of PNE. RESULTS This paper markedly points out the awareness of clinicians on the need for an accurate contextualization when choosing PNE as an intervention in clinical practice.
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Minen M, Kaplan K, Akter S, Espinosa-Polanco M, Guiracocha J, Khanns D, Corner S, Roberts T. Neuroscience Education as Therapy for Migraine and Overlapping Pain Conditions: A Scoping Review. PAIN MEDICINE 2021; 22:2366-2383. [PMID: 34270769 DOI: 10.1093/pm/pnab131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuroscience Education Therapy (NET) has been successfully used for numerous overlapping pain conditions, but few studies have investigated NET for migraine. OBJECTIVE We sought to (1) review the literature on NET used for the treatment of various pain conditions to assess how NET has been studied thus far and (2) recommend considerations for future research of NET for the treatment of migraine. DESIGN/METHODS Following the PRISMA guideline for scoping reviews (PRISMA-ScR) Co-author (TR), a Medical Librarian, searched the MEDLINE, PsychInfo, Embase & Cochrane Central Clinical Trials Registry databases for peer-reviewed articles describing NET to treat migraine and other chronic pain conditions. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. RESULTS Overall, a NET curriculum consists of the following topics: pain does not equate to injury, pain is generated in the brain, perception, genetics, reward systems, fear, brain plasticity, and placebo/nocebo effects. Delivered through individual, group, or a combination of individual and group sessions, NET treatments often incorporate exercise programs and/or components of other evidence-based behavioral treatments. NET has significantly reduced catastrophizing, kinesiophobia, pain intensity, and disability in overlapping pain conditions. In migraine-specific studies, when implemented together with traditional pharmacological treatments, NET has emerged as a promising therapy by reducing migraine days, pain intensity and duration, and acute medication intake. CONCLUSION NET is an established treatment for pain conditions, and future research should focus on refining NET for migraine, examining delivery modality, dosage, components of other behavioral therapies to integrate, and migraine-specific NET curricula.
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Affiliation(s)
- Mia Minen
- Department of Neurology, NYU Langone Health, 222 E 41st Street, Floor 9, New York, NY, 10017.,Department of Population Health, NYU Langone Health
| | - Kayla Kaplan
- Department of Biological Sciences, Barnard College, New York, NY
| | - Sangida Akter
- Department of Psychology, The City College of New York, New York, NY
| | | | - Jenny Guiracocha
- Department of Psychology, The City College of New York, New York, NY
| | - Dennique Khanns
- Department of Chemistry and Biochemistry, The City College of New York, New York, NY, USA
| | - Sarah Corner
- Department of Neurology, NYU Langone Health, 222 E 41st Street, Floor 9, New York, NY, 10017
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Development of culturally sensitive pain neuroscience education materials for Hausa-speaking patients with chronic spinal pain: A modified Delphi study. PLoS One 2021; 16:e0253757. [PMID: 34214080 PMCID: PMC8253446 DOI: 10.1371/journal.pone.0253757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/12/2021] [Indexed: 11/19/2022] Open
Abstract
This study aimed to develop culturally sensitive pain neuroscience education (PNE) materials for Hausa speaking patients with chronic spinal pain (CSP). PNE is a program of teaching patients about pain that has gained considerable attention in research and is increasingly used during physical therapy for patients with chronic pain. It helps in decreasing pain, disability, fear-avoidance, pain catastrophization, movement restriction, and health care utilization among patients with chronic pain. However, existing PNE materials and their application are limited to few languages and cultural inclinations. Due to the variations in pain perceptions, beliefs, and related outcomes among different population groups, culture-sensitive PNE materials addressing these outcomes are warranted. A focus-group discussion comprising 4 experts was used to adapt and develop preliminary PNE materials. Thereafter, an internet-based 3-round modified Delphi-study involving 22 experts ensued. Experts’ consensus/recommendations concerning the content were used in modifying the PNE materials. Consensus was predefined as ≥75% level of (dis)agreement. Eighteen experts completed the Delphi rounds. Nineteen, 18 and 18 experts participated in rounds 1, 2 and 3 respectively, representing 86%, 94% and 100% participation rate respectively. Consensus agreement was reached in every round and content of the materials, including drawings, examples, figures and metaphors were adapted following the experts’ suggestions. We therefore concluded that, culture-sensitive PNE materials for Hausa speaking patients with CSP were successfully produced. The present study also provides a direction for further research whereby the effects of culturally-sensitive PNE materials can be piloted among Hausa speaking patients with CSP.
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Rheel E, Ickmans K, Wauters A, Van Ryckeghem DML, Malfliet A, Vervoort T. The effect of a pain educational video intervention upon child pain-related outcomes: A randomized controlled study. Eur J Pain 2021; 25:2094-2111. [PMID: 34155720 DOI: 10.1002/ejp.1822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pain neuroscience education (PNE) has received increasing research attention demonstrating beneficial effects on pain-related outcomes in adults. Conversely, studies on the effectiveness of PNE in children are scarce. METHODS This study investigated the effect of a pain educational video intervention on child pain-related outcomes (i.e. experienced pain intensity, pain-related fear and catastrophic worry about pain, pain threshold and pain knowledge) in healthy children undergoing an experimental pain task. Furthermore, the moderating role of children's demographic (i.e. sex and age) and psychological (i.e. baseline pain knowledge and anticipated pain intensity, pain-related fear and catastrophic worry) characteristics was examined. Participants were 89 children (Mage = 11.85, SD = 1.78), randomly assigned to either a condition whereby they were instructed to watch a brief pain educational video (i.e. experimental group) or to a control condition whereby they did not watch any video. RESULTS Study findings revealed that accurate pain knowledge and pain threshold were higher amongst children in the experimental group compared to the control group. In contrast with expectations, no main effects of the video intervention were observed for experienced pain intensity, pain-related fear and catastrophic worry. Moderation analyses indicated that the video intervention contributed, in comparison with the control condition, to higher levels of pain knowledge amongst younger children only and to higher pain thresholds amongst boys only. CONCLUSIONS Further investigation is needed to optimize pain educational video interventions and to determine whether more beneficial outcomes can be found in clinical (i.e. non-experimental) situations and in children with persistent or recurring pain problems. SIGNIFICANCE Examining the impact of pain educational interventions within a non-clinical setting is deemed particularly important given that adaptive pain coping strategies likely play an important role in preventing the development and maintenance of future maladaptive pain-related behaviour. Further, study findings provide preliminary evidence of baseline and demographic (i.e. age and sex) characteristics explaining differences in the effect of a pain educational video intervention in pain knowledge and pain-related experiences during experimental pain.
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Affiliation(s)
- Emma Rheel
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgium
| | - Kelly Ickmans
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Aline Wauters
- Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgium
| | - Dimitri M L Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgium.,Section Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Institute for Health and Behavior, INSIDE, University of Luxembourg, Luxembourg City, Luxembourg
| | - Anneleen Malfliet
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Tine Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgium
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Silva C, Oliveira D, Pestana-Santos M, Portugal F, Capelo P. Chronic non-cancer pain in adolescents: a narrative review. Braz J Anesthesiol 2021; 72:648-656. [PMID: 34153363 PMCID: PMC9515673 DOI: 10.1016/j.bjane.2021.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction Chronic pain is defined as a pain lasting more than 3–6 months. It is estimated that 25% of the pediatric population may experience some kind of pain in this context. Adolescence, corresponding to a particular period of development, seems to present the ideal territory for the appearance of maladaptive mechanisms that can trigger episodes of persistent or recurrent pain. Methods A narrative review, in the PubMed/Medline database, in order to synthetize the available evidence in the approach to chronic pain in adolescents, highlighting its etiology, pathophysiology, diagnosis, and treatment. Results Pain is seen as a result from the interaction of biological, psychological, individual, social, and environmental factors. Headache, abdominal pain, and musculoskeletal pain are frequent causes of chronic pain in adolescents. Pain not only has implications on adolescents, but also on family, society, and how they interact. It has implications on daily activities, physical capacity, school performance, and sleep, and is associated with psychiatric comorbidities, such as anxiety and depression. The therapeutic approach of pain must be multimodal and multidisciplinary, involving adolescents, their families, and environment, using pharmacological and non-pharmacological strategies. Discussion and conclusion The acknowledgment, prevention, diagnosis, and treatment of chronic pain in adolescent patients seem not to be ideal. The development of evidence-based forms of treatment, and the training of health professionals at all levels of care are essential for the diagnosis, treatment, and early referral of these patients.
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Affiliation(s)
- Carlos Silva
- Centro Hospitalar e Universitário de Coimbra, Serviço de Anestesiologia, Coimbra, Portugal.
| | - Dora Oliveira
- Centro Hospitalar e Universitário de Coimbra, Serviço de Anestesiologia, Departamento de Pediatria, Coimbra, Portugal
| | - Márcia Pestana-Santos
- Centro Hospitalar e Universitário de Coimbra, Departamento de Pediatria, Coimbra, Portugal
| | - Francisco Portugal
- Centro Hospitalar e Universitário de Coimbra, Serviço de Anestesiologia, Coimbra, Portugal
| | - Paula Capelo
- Centro Hospitalar e Universitário de Coimbra, Serviço de Anestesiologia, Departamento de Pediatria, Coimbra, Portugal
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Bacardit Pintó P, Ickmans K, Rheel E, Iwens M, Meeus M, Nijs J, Pas R. Do Parental Pain Knowledge, Catastrophizing, and Hypervigilance Improve Following Pain Neuroscience Education in Healthy Children? CHILDREN-BASEL 2021; 8:children8050420. [PMID: 34065220 PMCID: PMC8161245 DOI: 10.3390/children8050420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
Pediatric chronic pain is a challenging problem for children and their families, although it is still under-recognized and under-treated. The aim of this study was to investigate whether a pain neuroscience education program for children (PNE4Kids) delivered to healthy children aged 8 to 12 years old and attended by their parents would result in improved parental knowledge about pain neurophysiology, decreased parental pain catastrophizing about their own pain and their children's, decreased parental pain vigilance and awareness, and decreased fear of pain in children. Twenty-seven healthy child-parent dyads received a 45 min PNE4Kids session. Demographic data were collected, and the Neurophysiology of Pain Questionnaire (NPQ), Fear of Pain Questionnaire-Parent Proxy Report (FOPQ-P), Pain Catastrophizing Scale (PCS), Pain Catastrophizing Scale for Parents (PCS-P), and the Pain Vigilance and Awareness Questionnaire (PVAQ) were completed by the parents before and after the PNE4Kids session. Twenty-six dyads completed study participation. In response to the PNE4Kids session, significant short-term (1 week) improvements were shown in the NPQ (p < 0.001) and the FOPQ-P (p = 0.002). Parents' level of pain knowledge and children's fear of pain, reported by their parents, improved after a 45 min PNE4Kids session. Thus, PNE4Kids should likewise be further investigated in healthy child-parent dyads as it might be useful to target parental and children's pain cognitions at a young age.
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Affiliation(s)
- Pere Bacardit Pintó
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; (P.B.P.); (E.R.); (M.I.); (J.N.); (R.P.)
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; (P.B.P.); (E.R.); (M.I.); (J.N.); (R.P.)
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussel, Belgium
- Research Foundation—Flanders (FWO), Egmontstraat 5, 1000 Brussel, Belgium
- Correspondence: ; Tel.: +32-(0)2-477-45-03
| | - Emma Rheel
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; (P.B.P.); (E.R.); (M.I.); (J.N.); (R.P.)
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium
| | - Margot Iwens
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; (P.B.P.); (E.R.); (M.I.); (J.N.); (R.P.)
| | - Mira Meeus
- Pain in Motion International Research Group;
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Wilrijk, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Campus UZ, Ghent University, 9000 Ghent, Belgium
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; (P.B.P.); (E.R.); (M.I.); (J.N.); (R.P.)
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussel, Belgium
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Roselien Pas
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; (P.B.P.); (E.R.); (M.I.); (J.N.); (R.P.)
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Wilrijk, Belgium
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Reis F, Palermo TM, Acalantis L, Nogueira LC, Meziat-Filho N, Louw A, Ickmans K. "A journey to learn about pain": the development and validation of a comic book about pain neuroscience education for children. Braz J Phys Ther 2021; 26:100348. [PMID: 34001422 DOI: 10.1016/j.bjpt.2021.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pain education resources for children using appropriate language and illustrations remain scarce. OBJECTIVES We aimed to summarize the development process and testing for face and content validity of a structured comic book about pain education for children. METHODS A first draft of a comic book was developed (Portuguese and English) based on pain education concepts. Experts in pediatric pain from different countries analyzed content, objectives, language, illustrations, layout, motivation, and cultural adjustment. A third draft developed in Portuguese considering experts' suggestions was presented to children and parents in Brazil. The total adequacy score was calculated from the sum of the scores obtained in each domain, divided by the maximum total score. Descriptive analysis is presented. RESULTS The expert panel was composed of 11 (64.7%) physical therapists, and 6 (35.3%) psychologists. The total adequacy score (0-100%) was 87.74%. The third draft version of the comic book was presented to 28 children and the final version was presented to 16 children with a mean age of 9.6 years. Children were totally satisfied (n=4; 26.7%) or satisfied (n=9; 56.2%) with the story of the comic book. The readability of the comic book was considered suitable for grades 4 to 6 educational level. CONCLUSION The comic book "A Journey to Learn about Pain" was validated for face and content validity by the expert panel and the Brazilian target population. This comic book is available in Portuguese and English and can be a potentially useful resource for children.
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Affiliation(s)
- Felipe Reis
- Physical Therapy Department of Instituto Federal do Rio de Janeiro (IFRJ); Pain in Motion research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel.
| | | | - Louise Acalantis
- Physical Therapy Department of Instituto Federal do Rio de Janeiro (IFRJ)
| | - Leandro Calazans Nogueira
- Physical Therapy Department of Instituto Federal do Rio de Janeiro (IFRJ); Postgraduate Program in Rehabilitation Sciences - Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
| | - Ney Meziat-Filho
- Postgraduate Program in Rehabilitation Sciences - Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
| | | | - Kelly Ickmans
- Pain in Motion research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel; Research Foundation - Flanders (FWO), Brussels, Belgium
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Ronald Melzack Award Lecture: Putting the brain to work in cognitive behavioral therapy for chronic pain. Pain 2021; 161 Suppl 1:S27-S35. [PMID: 33090737 DOI: 10.1097/j.pain.0000000000001839] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Development of the Conceptualization of Pain Questionnaire: A Measure to Study How Children Conceptualize Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073821. [PMID: 33917429 PMCID: PMC8038728 DOI: 10.3390/ijerph18073821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/24/2021] [Accepted: 04/02/2021] [Indexed: 11/24/2022]
Abstract
(1) Background: Research has shown that thoughts about pain are important for the management of chronic pain in children. In order to monitor changes in thoughts about pain over time and evaluate the efficacy of treatments, we need valid and reliable measures. The aims of this study were to develop a questionnaire to assess a child’s concept of pain and to evaluate its psychometric properties; (2) Methods: This is a cross-sectional, two-phase, mixed-method study. A total of 324 individuals aged 8 to 17 years old responded to the newly created questionnaire. The Conceptualization of Pain Questionnaire (COPAQ) was calibrated using the Rasch model. The chi-square test was used for the fit statistics. Underfit and overfit of the model were determined and a descriptive analysis of infit and outfit was conducted to identify who responded erratically. Internal consistency was measured using the Person Separation Index (PSI); (3) Results: Fit to the Rasch model was good. Suitable targeting indicated which items were simple to answer; Person Fit identified 9.56% children who responded erratically; PSI = 0.814; (4) Conclusions: The findings suggest that COPAQ is a measure of a child’s concept of pain that is easy to administer and respond to. It has a good fit and a good internal consistency.
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Amer-Cuenca JJ, Pecos-Martín D, Martínez-Merinero P, Lluch Girbés E, Nijs J, Meeus M, Ferrer Peña R, Fernández-Carnero J. How Much Is Needed? Comparison of the Effectiveness of Different Pain Education Dosages in Patients with Fibromyalgia. PAIN MEDICINE 2021; 21:782-793. [PMID: 31216027 DOI: 10.1093/pm/pnz069] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess the effect of different dosages of pain neuroscience education (PNE) programs on central nociceptive processing in patients with fibromyalgia. Second, to compare the effects of different dosages of PNE programs on numerical pain rating scale (NPRS), disability, and psychological variables. DESIGN Single-blind randomized controlled trial. SETTING Three fibromyalgia centers in Spain (Valencia, Alcorcón, Alcalá de Henares). SUBJECTS Seventy-seven patients with fibromyalgia. METHODS Participants were randomized to four groups of PNE: 1) high-dose PNE (N = 20), 2) low-concentrated dose PNE (N = 20), 3) diluted low-dose PNE (N = 20), and (4) control treatment (N = 17), conducted in two 30-50-minute sessions in groups of four to six participants. Conditioned pain modulation (CPM), temporal summation (TS), and pressure pain thresholds (PPTs) were assessed at baseline and at three-month follow-up. Secondary outcome measures were the Fibromyalgia Impact Questionnaire, Pain Catastrophizing Scale, and Pain Anxiety Symptoms Scale. RESULTS There were significant between-group differences for NPRS in favor of the groups receiving high-dose PNE, with a large effect size at three-month follow-up (P < 0.01, η2p = 0.170), but there were no significant differences between groups for the remaining variables (P > 0.05). All groups improved for central nociceptive processing, psychological variables, disability, and pain intensity (NPRS). CONCLUSIONS In patients with fibromyalgia, higher dosages of PNE produced a larger improvement in pain severity at three-month follow-up than other dosages of PNE and biomedical education. However, PNE was not superior to biomedical education in the central nociceptive processing, disability, or psychological variables in patients with fibromyalgia.
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Affiliation(s)
- Juan J Amer-Cuenca
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Daniel Pecos-Martín
- Department of Nursing and Physiotheraphy, Universidad de Alcalá, Alcalá de Henares, Spain
| | | | - Enrique Lluch Girbés
- Department of Physiotherapy, Universitat de València, Valencia, Spain.,Pain in Motion International Research Group, www.paininmotion.be
| | - Jo Nijs
- Pain in Motion International Research Group, www.paininmotion.be.,Department of Physiotherapy, Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group, www.paininmotion.be.,Department Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Raúl Ferrer Peña
- Physical Therapy Department and Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Auta de Madrid, Spain.,Centro de Salud Entrevías. Gerencia de Atenciñn Primaria. Servicio Madrile𭟤e Salud, Madrid, Spain
| | - Josué Fernández-Carnero
- Physical Therapy Department and Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Auta de Madrid, Spain.,Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain.,Foundation for Biomedical Research, La Paz University Hospital, IDIPAZ, Madrid, Spain
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