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Adams H, MacDonald JE, Castillo AN, Pavilanis A, Truchon M, Achille M, Côté P, Sullivan MJL. Qualitative Examination of the Experience of Perceived Injustice Following Disabling Occupational Injury. JOURNAL OF OCCUPATIONAL REHABILITATION 2024; 34:657-668. [PMID: 37996720 DOI: 10.1007/s10926-023-10154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE The primary objective of this study was to explore individuals' perspectives on the factors, situations or events that contributed to their perceptions of injustice following occupational injury. MATERIALS AND METHODS The study sample consisted of 30 participants (18 women, 12 men) who had submitted a time-loss claim for a work-related musculoskeletal injury. Participants with elevated scores on a measure of perceived injustice were interviewed about the factors that contributed to their sense of injustice. A thematic analysis was conducted to identify the broad classes of situations or events that participants experienced as unjust in the weeks following occupational injury. RESULTS Three dominant themes emerged from the interviews: (1) Invalidation, (2) Undeserved suffering and (3) Blame. Inductively derived subthemes reflected specific dimensions of post-injury experiences that contributed to participants' sense of injustice. CONCLUSIONS Given that suffering and invalidating communication are potentially modifiable factors, there are grounds for optimism that intervention approaches can be developed to prevent or reduce perceptions of injustice in the aftermath of debilitating injury. The development of intervention approaches that are effective in preventing or reducing perceptions of injustice holds promise of contributing to more positive recovery outcomes in individuals who have sustained debilitating work injuries.
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Affiliation(s)
- Heather Adams
- School of Social Work, Dalhousie University, Halifax, NS, Canada
| | - Judy E MacDonald
- School of Social Work, Dalhousie University, Halifax, NS, Canada
| | | | | | | | | | | | - Michael J L Sullivan
- Department of Psychology, McGill University, 2001 McGill College Ave, Montreal, QC, H3A 1G1, Canada.
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2
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Castaldo M, Ebbesen BD, Fernández-DE-Las-Peñas C, Arendt-Nielsen L, Giordano R. COVID-19 and musculoskeletal pain: an overview of the current knowledge. Minerva Anestesiol 2023; 89:1134-1142. [PMID: 38019176 DOI: 10.23736/s0375-9393.23.17471-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) has provoked billions of infections worldwide. Several meta-analyses have observed that up to 50% of individuals who had survived to a SARS-CoV-2 acute infection suffer from post-COVID symptoms lasting for weeks or months and up to one year after infection. The prevalence of post-COVID pain ranges between 10% to 20% when assessed with other overall post-COVID symptoms and can reach up to 50% to 60% when investigated specifically. The most common musculoskeletal manifestations of post-COVID-19 condition include fatigue, myalgia, arthralgia or back pain. Despite pain of musculoskeletal origin is one of the most prevalent post-COVID pain symptoms, the exact pathophysiological mechanisms of musculoskeletal post-COVID pain are not completely understood. Studies have reported the complexity of post-COVID pain including immune, biological, and psychological factors, and more recently, they have suggested that genetic and epigenetic factors may also play a potential role, highlighting the need for further investigation into these mechanisms. Its management is still controversial, as no specific guideline for treating musculoskeletal post-COVID pain has been proposed with only general consideration about the relevance of multidisciplinary and multimodal treatment approaches. In this paper we will highlight the clinical features, the mechanism, and the management possibilities of musculoskeletal post-COVID pain.
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Affiliation(s)
- Matteo Castaldo
- School of Medicine, Center for Neuroplasticity and Pain, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark -
| | - Brian D Ebbesen
- School of Medicine, Center for Neuroplasticity and Pain, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - César Fernández-DE-Las-Peñas
- School of Medicine, Center for Neuroplasticity and Pain, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Spain
| | - Lars Arendt-Nielsen
- School of Medicine, Center for Neuroplasticity and Pain, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Rocco Giordano
- School of Medicine, Center for Neuroplasticity and Pain, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
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3
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Montpetit-Tourangeau K, Diaz-Arenales AS, Dyer JO, Rochette A. The Black Box of Patient Education: An Expert Consultation on Patient Education Interventions and Strategies for the Management of Subacromial Pain Syndrome. Physiother Can 2023; 75:215-232. [PMID: 37736407 PMCID: PMC10510546 DOI: 10.3138/ptc-2022-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/25/2023] [Indexed: 09/23/2023]
Abstract
Purpose To identify patient education, interventions, and strategies to optimize the management of subacromial pain syndrome (SAPS) in physical therapy, based on the experiential knowledge of patient-partners and caregivers involved in the rehabilitation of this condition. Method Using a semi-deductive approach building on the evidence extracted from the literature, an expert consultation using focus groups was conducted. The experts were physical therapists (n = 5) and an occupational therapist with extensive clinical experience, as well as a patient-partner. Analysis followed the Framework method. Results Two main themes emerged: (1) interventions directly related to patient education, consisting of nine sub-themes, including symptom self-management and pain phenomenon, and (2) patient education strategies to broadly frame the interventions, consisting of 10 sub-themes, including educational materials and clinical teaching approaches. Conclusion The consultation confirmed and expanded the knowledge from the literature by adding knowledge that emerged from the experts' practical experience. It resulted in the development of preliminary statements on structured patient education interventions and management strategies for SAPS. These emerging statements are, to our knowledge, the first to inform patient education specifically as it relates to the management of SAPS taking into account psychosocial and contextual factors.
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Affiliation(s)
- Katherine Montpetit-Tourangeau
- From the:
School of Rehabilitation, University of Montreal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada
| | | | - Joseph-Omer Dyer
- From the:
School of Rehabilitation, University of Montreal, Montreal, Canada
- Interdisciplinary Research Group in Cognition and Professional Reasoning, Center for Applied Pedagogy in Health Sciences, University of Montreal, Montreal, Canada
| | - Annie Rochette
- From the:
School of Rehabilitation, University of Montreal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada
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Espí-López GV, Pavlu D, Arnal-Gómez A, Muñoz-Gómez E, Martinez-Millana A, Marqués-Sulé E. Short-Term Effects of Manual Therapy on Balance: A Multicenter, Randomized, Double-Blind Controlled Trial. J Manipulative Physiol Ther 2023; 46:162-170. [PMID: 38142378 DOI: 10.1016/j.jmpt.2023.11.003] [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: 05/16/2023] [Revised: 10/18/2023] [Accepted: 11/07/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE The purpose of this study was to analyze short-term changes in dynamic and static balance after a manual therapy protocol in healthy participants and analyze any repercussions on mood and perception of change after applying articulatory techniques. METHODS A single-blind, randomized, multicenter clinical trial was conducted. Participants were allocated to either a manual therapy group (MTG) (n = 101) or a control group (CG) without intervention (n = 99), and measures were taken before treatment, after the intervention, and 1 week after treatment. Assessments included the Star Excursion Balance Test, Unipedal Stance Test (UPST), Profile of Mood States (POMS), and Patient Global Impression of Change (PGIC) scale. RESULTS Two hundred healthy participants completed the study (mean age, 22 [SD = 2.67]). There was a statistically significant interaction between groups and time measurements in the right leg for anterior (P = .003), posteromedial (P < .001), and posterolateral (P = .001) directions in favor of the MTG, as well as in the left leg for anterior (P < .001), posteromedial (P < .001), and posterolateral (P = .012) directions. The analysis failed to show statistically significant interactions between any of the factors for the UPST and POMS (P > .05). The MTG showed a significant improvement compared to the CG after treatment (P = .003) and at 1-week follow-up (P < .001) on the PGIC scale. CONCLUSION The results suggest the MT intervention was effective on dynamic balance in post-intervention in healthy participants, and some of the directions maintained the results at 1-week follow-up. Perception of change in post-treatment and 1-week follow-up also significantly improved. The protocol did not seem to produce changes in static balance and mood states. Positive changes after manual therapy were maintained in the short term.
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Affiliation(s)
- Gemma V Espí-López
- Exercise Intervention for Health (EXINH), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Dagmar Pavlu
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Anna Arnal-Gómez
- Physiotherapy in Motion, Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain.
| | - Elena Muñoz-Gómez
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Elena Marqués-Sulé
- Physiotherapy in Motion, Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
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5
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Wang YT, Lu K, Yao DD, Zhang SX, Chen G. Anti-inflammatory and analgesic effect of Forsythiaside B on complete Freund's adjuvant-induced inflammatory pain in mice. Biochem Biophys Res Commun 2023; 645:55-60. [PMID: 36680937 DOI: 10.1016/j.bbrc.2023.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
Chronic pain is frequently reported in clinical practice. Therefore, it is important to identify effective therapy to relieve pain. In this work, we selected Forsythoside B (FB), a phenylethanoid glycoside isolated from Forsythia suspensa (Thunb.) Vahl, to evaluate its effect in modulating inflammatory pain induced by complete Freund's adjuvant (CFA) and the involved mechanisms. We discovered that FB could attenuate inflammatory pain triggered by CFA injection and exert anti-anxiety effects. In detail, proinflammatory cytokines, consisting of IL-6 and TNF-α, were decreased after FB administration in the CFA-injected mice. Furthermore, the FB application ameliorated the activation of ionized calcium-binding adaptor molecule 1 (Iba-1) and glial fibrillary acidic protein (GFAP), the microglia and astrocytes markers respectively. Therefore, our findings indicate that FB could be a promising treatment for chronic inflammatory pain.
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Affiliation(s)
- Yu-Ting Wang
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kai Lu
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dan-Dan Yao
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shu-Xia Zhang
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Gang Chen
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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6
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Suzuki H, Tahara S, Mitsuda M, Izumi H, Ikeda S, Seki K, Nishida N, Funaba M, Imajo Y, Yukata K, Sakai T. Current Concept of Quantitative Sensory Testing and Pressure Pain Threshold in Neck/Shoulder and Low Back Pain. Healthcare (Basel) 2022; 10:healthcare10081485. [PMID: 36011141 PMCID: PMC9408781 DOI: 10.3390/healthcare10081485] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022] Open
Abstract
In recent years, several published articles have shown that quantitative sensory testing (QST) and pressure pain threshold (PPT) are useful in the analysis of neck/shoulder and low back pain. A valid reference for normal PPT values might be helpful for the clinical diagnosis of abnormal tenderness or muscle pain. However, there have been no reliable references for PPT values of neck/shoulder and back pain because the data vary depending on the devices used, the measurement units, and the area examined. In this article, we review previously published PPT articles on neck/shoulder and low back pain, discuss the measurement properties of PPT, and summarize the current data on PPT values in patients with chronic pain and healthy volunteers. We also reveal previous issues related to PPT evaluation and discuss the future of PPT assessment for widespread use in general clinics. We outline QST and PPT measurements and what kinds of perceptions can be quantified with the PPT. Ninety-seven articles were selected in the present review, in which we focused on the normative values and abnormal values in volunteers/patients with neck/shoulder and low back pain. We conducted our search of articles using PubMed and Medline, a medical database. We used a combination of “Pressure pain threshold” and “Neck shoulder pain” or “Back pain” as search terms and searched articles from 1 January 2000 to 1 June 2022. From the data extracted, we revealed the PPT values in healthy control subjects and patients with neck/shoulder and low back pain. This database could serve as a benchmark for future research with pressure algometers for the wide use of PPT assessment in clinics.
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Affiliation(s)
- Hidenori Suzuki
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
- Correspondence: ; Tel.: +81-836-22-2268
| | - Shu Tahara
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Mao Mitsuda
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Hironori Izumi
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Satoshi Ikeda
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Kazushige Seki
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Norihiro Nishida
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Masahiro Funaba
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
| | - Yasuaki Imajo
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
| | - Kiminori Yukata
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Takashi Sakai
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
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7
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Wu Z, Zhou R, Zhu Y, Zeng Z, Ye Z, Wang Z, Liu W, Xu X. Self-Management for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Res Manag 2022; 2022:2681240. [PMID: 35281344 PMCID: PMC8906975 DOI: 10.1155/2022/2681240] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/24/2022] [Accepted: 02/04/2022] [Indexed: 12/02/2022]
Abstract
Background Knee osteoarthritis (KOA) is a high incidence chronic joint disease that seriously affects patients' quality of life, and current treatment methods have limited efficacy. Self-management may be an effective strategy for KOA, and clinicians have been showing increased interest recently. However, the effectiveness of self-management for KOA remains controversial. Purpose This study aims to systematically evaluate the effectiveness of self-management for KOA. Methods We screened articles published in MEDLINE, Cochrane Library, EMBASE, and Web of Science until September 17, 2021. The main outcomes included pain, knee function, stiffness, WOMAC (total), physical function, arthritis self-efficacy (ASE-pain), arthritis self-efficacy (ASE-other symptoms), mental health, and quality of life. Results Thirteen randomized controlled trials (RCTs) were finally included (n = 1610). Meta-analysis showed differences in pain, knee function, stiffness, ASE-pain, ASE-other symptoms, mental health, and quality of life between the self-management and control groups. Of the nine outcomes evaluated, four were highly heterogeneous, and the quality of evidence ranged from very low to moderate. Conclusion The meta-analysis results showed that self-management might help improve the pain, knee function, stiffness, ASE, mental health, and quality of life in patients with KOA. However, it has no significant effect on WOMAC (total) and physical function. Considering that this study has some limitations, we cannot draw clear conclusions based on the results of this study. Nevertheless, we offer much needed insight and encourage more rigorously designed and implemented RCTs in the future to substantiate our conclusions.
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Affiliation(s)
- Zugui Wu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Rui Zhou
- Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Yue Zhu
- Baishui Health Center, Qujing 655335, China
| | - Ziquan Zeng
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou 510405, China
| | - Zixuan Ye
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zhenbang Wang
- Qujing Hospital of Traditional Chinese Medicine, Qujing 655000, China
| | - Wengang Liu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou 510405, China
| | - Xuemeng Xu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou 510405, China
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Stuhlreyer J, Schwartz M, Friedheim T, Zöllner C, Klinger R. Optimising treatment expectations in chronic lower back pain through observing others: a study protocol for a randomised clinical trial. BMJ Open 2022; 12:e059044. [PMID: 35017258 PMCID: PMC8753422 DOI: 10.1136/bmjopen-2021-059044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Chronic lower back pain (CLBP) is a frequent cause of medical consultations worldwide, and it results in decreased quality of life and disability. Current treatments for CLBP are often not effective, and alternatives are urgently needed. Three promising possibilities have emerged: (1) open-label placebo treatment reduces chronic pain, (2) placebo treatment is as efficacious as opioid treatment with a high correlation between patient expectation and treatment outcome, and (3) observing positive effects in another patient can improve functional capacity. We hypothesise that treatment expectations can be positively influenced through social observation and improve treatment outcome. METHODS AND ANALYSIS In our clinical trial, we will randomise patients with CLBP into five groups. Two groups receive either a 3 week course of treatment with an analgesic (ANA) (metamizole/dipyrone) or with open-label placebos (OLP). For one of each group, we will build treatment expectations through observational learning and assess its impact on the treatment. For this purpose, one group each will watch either a positive or a neutral video. The intervention groups will be compared with a control group that will not be given any medication or observational learning. Participants will be recruited via all institutions in the Hamburg metropolitan area that treat patients with CLBP. Patients are eligible for inclusion if they are at least 18 years or older, have CLBP (of at least 3 months duration), and agree to potentially receive an active ANA or an OLP. Patients with pain-related "red flags" will be excluded. The study requires 150 participants (30 participants per group) to assess the differences in the primary outcome, pain intensity. Secondary outcomes include changes in treatment expectations, anxiety, comorbid depression, stress-related neuroendocrine measures, functional and structural connectivity, functional capacity, and ANA consumption. All outcomes and treatment expectations will be measured before and after the intervention and 3 months post-intervention. ETHICS AND DISSEMINATION Ethical approval was obtained in January 2020 from the Hamburg Medical Ethics Council (ref number PV7067). Outcomes will be disseminated through publications in peer-reviewed journals and presentations at national and international conference meetings. TRIAL REGISTRATION NUMBER The approved trial protocol was registered at the German Clinical Trials Register (DRKS) and can be found at drks.de (Identifier: DRKS00024418).
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Affiliation(s)
- Julia Stuhlreyer
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marie Schwartz
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Friedheim
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zöllner
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Regine Klinger
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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9
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Aasdahl L, Granviken F, Meisingset I, Woodhouse A, Evensen KAI, Vasseljen O. Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. BMC Musculoskelet Disord 2021; 22:455. [PMID: 34011349 PMCID: PMC8132354 DOI: 10.1186/s12891-021-04332-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background There are large variations in symptoms and prognostic factors among patients sharing the same musculoskeletal (MSK) diagnosis, making traditional diagnostic labelling not very helpful in informing treatment or prognosis. Recently, we identified five MSK phenotypes across common MSK pain locations through latent class analysis (LCA). The aim of this study was to explore the one-year recovery trajectories for pain and functional limitations in the phenotypes and describe these in relation to the course of traditional diagnostic MSK groups. Methods We conducted a longitudinal observational study of 147 patients with neck, back, shoulder or complex pain in primary health care physiotherapy. Data on pain intensity and function were collected at baseline (week 0) and 1, 2, 3, 4, 6, 8, 12, 26 and 52 weeks of follow up using web-based questionnaires and mobile text messages. Recovery trajectories were described separately for the traditional diagnostic MSK groups based on pain location and the same patients categorized in phenotype groups based on prognostic factors shared among the MSK diagnostic groups. Results There was a general improvement in function throughout the year of follow-up for the MSK groups, while there was a more modest decrease for pain intensity. The MSK diagnoses were dispersed across all five phenotypes, where the phenotypes showed clearly different trajectories for recovery and course of symptoms over 12 months follow-up. This variation was not captured by the single trajectory for site specific MSK diagnoses. Conclusion Prognostic subgrouping revealed more diverse patterns in pain and function recovery over 1 year than observed in the same patients classified by traditional diagnostic groups and may better reflect the diversity in recovery of common MSK disorders. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04332-3.
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Affiliation(s)
- Lene Aasdahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postboks 8905, MTFS, 7491, Trondheim, Norway. .,Unicare Helsefort Rehabilitation Centre, Rissa, Norway.
| | - Fredrik Granviken
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postboks 8905, MTFS, 7491, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St.Olavs Hospital, Trondheim, Norway
| | - Ingebrigt Meisingset
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postboks 8905, MTFS, 7491, Trondheim, Norway
| | - Astrid Woodhouse
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postboks 8905, MTFS, 7491, Trondheim, Norway
| | - Kari Anne I Evensen
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway.,Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.,Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway
| | - Ottar Vasseljen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postboks 8905, MTFS, 7491, Trondheim, Norway
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10
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Aili K, Campbell P, Michaleff ZA, Strauss VY, Jordan KP, Bremander A, Croft P, Bergman S. Long-term trajectories of chronic musculoskeletal pain: a 21-year prospective cohort latent class analysis. Pain 2021; 162:1511-1520. [PMID: 33230006 PMCID: PMC8054552 DOI: 10.1097/j.pain.0000000000002137] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/13/2020] [Accepted: 10/27/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT Our knowledge of the prevalence, impact, and outcomes of chronic pain in the general population is predominantly based on studies over relatively short periods of time. The aim of this study was to identify and describe trajectories of the chronic pain status over a period of 21 years. Self-reported population data (n = 1858) from 5 timepoints were analyzed. Pain was categorized by: no chronic pain (NCP), chronic regional pain (CRP), and chronic widespread pain (CWP). Latent class growth analysis was performed for identification of trajectories and logistic regression analysis for identification of predictors for pain prognosis. Five trajectories were identified: (1) persistent NCP (57%), (2) migrating from NCP to CRP or CWP (5%), (3) persistent CRP or migration between CRP and NCP (22%), (4) migration from CRP to CWP (10%), and (5) persistent CWP (6%). Age, sleeping problems, poor vitality, and physical function at baseline were associated with pain progression from NCP. Female gender, seeking care for pain, lack of social support, poor physical function, vitality, and mental health predicted poor pain prognosis among those with CRP. In conclusion, chronic pain was common in the population including 6% reporting persistent CWP, although the majority persistently reported NCP. Most people had stable pain status, but some had ongoing change in pain status over time including people who improved from chronic pain. It was possible to identify clinically relevant factors, characterizing trajectories of chronic pain development, that can be useful for identifying individuals at risk and potential targets for intervention.
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Affiliation(s)
- Katarina Aili
- Spenshult Research and Development Center, Halmstad, Sweden
- Halmstad University, School of Health and Welfare, Halmstad, Sweden
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
| | - Paul Campbell
- Keele University, School for Primary, Community and Social Care, Keele, United Kingdom
- Midlands Partnership NHS Foundation Trust, Stafford, United Kingdom
| | - Zoe A. Michaleff
- Keele University, School for Primary, Community and Social Care, Keele, United Kingdom
| | | | - Kelvin P. Jordan
- Keele University, School for Primary, Community and Social Care, Keele, United Kingdom
- Keele University, Centre for Prognosis Research, Keele, United Kingdom
| | - Ann Bremander
- Spenshult Research and Development Center, Halmstad, Sweden
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Peter Croft
- Keele University, School for Primary, Community and Social Care, Keele, United Kingdom
- Keele University, Centre for Prognosis Research, Keele, United Kingdom
| | - Stefan Bergman
- Spenshult Research and Development Center, Halmstad, Sweden
- University of Gothenburg, Institute of Medicine, Gothenburg, Sweden
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11
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Magerl W, Thalacker E, Vogel S, Schleip R, Klein T, Treede RD, Schilder A. Tenderness of the Skin after Chemical Stimulation of Underlying Temporal and Thoracolumbar Fasciae Reveals Somatosensory Crosstalk between Superficial and Deep Tissues. Life (Basel) 2021; 11:life11050370. [PMID: 33919303 PMCID: PMC8143345 DOI: 10.3390/life11050370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/17/2021] [Accepted: 04/17/2021] [Indexed: 01/14/2023] Open
Abstract
Musculoskeletal pain is often associated with pain referred to adjacent areas or skin. So far, no study has analyzed the somatosensory changes of the skin after the stimulation of different underlying fasciae. The current study aimed to investigate heterotopic somatosensory crosstalk between deep tissue (muscle or fascia) and superficial tissue (skin) using two established models of deep tissue pain (namely focal high frequency electrical stimulation (HFS) (100 pulses of constant current electrical stimulation at 10× detection threshold) or the injection of hypertonic saline in stimulus locations as verified using ultrasound). In a methodological pilot experiment in the TLF, different injection volumes of hypertonic saline (50–800 µL) revealed that small injection volumes were most suitable, as they elicited sufficient pain but avoided the complication of the numbing pinprick sensitivity encountered after the injection of a very large volume (800 µL), particularly following muscle injections. The testing of fascia at different body sites revealed that 100 µL of hypertonic saline in the temporal fascia and TLF elicited significant pinprick hyperalgesia in the overlying skin (–26.2% and –23.5% adjusted threshold reduction, p < 0.001 and p < 0.05, respectively), but not the trapezius fascia or iliotibial band. Notably, both estimates of hyperalgesia were significantly correlated (r = 0.61, p < 0.005). Comprehensive somatosensory testing (DFNS standard) revealed that no test parameter was changed significantly following electrical HFS. The experiments demonstrated that fascia stimulation at a sufficient stimulus intensity elicited significant across-tissue facilitation to pinprick stimulation (referred hyperalgesia), a hallmark sign of nociceptive central sensitization.
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Affiliation(s)
- Walter Magerl
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Emanuela Thalacker
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Simon Vogel
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Robert Schleip
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Health Sciences, Technical University of Munich, 80333 Munich, Germany;
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany
| | - Thomas Klein
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Andreas Schilder
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
- Correspondence: ; Tel.: +49-621-383-71400; Fax: +49-621-383-71401
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12
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Takahara-Yamauchi R, Ikemoto H, Okumo T, Sakhri FZ, Horikawa H, Nakamura A, Sakaue S, Kato M, Adachi N, Sunagawa M. Analgesic effect of voluntary exercise in a rat model of persistent pain via suppression of microglial activation in the spinal cord. Biomed Res 2021; 42:67-76. [PMID: 33840672 DOI: 10.2220/biomedres.42.67] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this study, we employed a rodent model for persistent allodynia and hyperalgesia to determine whether voluntary exercise could exert analgesic effects on these pain symptoms. Rats were subcutaneously injected with formalin into the plantar surface of the right hind paw to induce mechanical allodynia and hyperalgesia. We assessed the analgesic effects of a voluntary wheel running (VWR) using the von Frey test and investigated microglial proliferation in the dorsal horn of the spinal cord. We also determined the effect of formalin and VWR on the protein expression levels of brain-derived neurotrophic factor (BDNF), its receptor TrkB, and K+-Cl- cotransporter 2 (KCC2), which play a key role in inducing allodynia and hyperalgesia. Rats with access to the running wheels showed beneficial effects on persistent formalin-induced mechanical allodynia and hyperalgesia. The effects of VWR were elicited through the suppression of formalin-induced microglial proliferation, TrkB up-regulation, and KCC2 down-regulation in the spinal cord. BDNF, however, might not contribute to the beneficial effects of VWR. Our results show an analgesic effect of voluntary physical exercise in a rodent model with persistent pain, possibly through the regulation of microglial proliferation and TrkB and KCC2 expression in the spinal cord.
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Affiliation(s)
- Risa Takahara-Yamauchi
- Department of Physiology, School of Medicine, Showa University.,Faculty of Arts and Sciences at Fujiyoshida, Showa University
| | - Hideshi Ikemoto
- Department of Physiology, School of Medicine, Showa University
| | - Takayuki Okumo
- Department of Physiology, School of Medicine, Showa University
| | | | | | - Akiou Nakamura
- Department of Physiology, School of Medicine, Showa University
| | - Satoshi Sakaue
- Department of Physiology, School of Medicine, Showa University
| | - Mami Kato
- Department of Physiology, School of Medicine, Showa University
| | - Naoki Adachi
- Department of Physiology, School of Medicine, Showa University
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13
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Family history of pain and risk of musculoskeletal pain in children and adolescents: a systematic review and meta-analysis. Pain 2020; 160:2430-2439. [PMID: 31188266 DOI: 10.1097/j.pain.0000000000001639] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Emerging evidence suggests that musculoskeletal (MSK) pain should be viewed from a biopsychosocial perspective and consider the influence of family factors. We conducted a review with meta-analysis to provide summary estimates of effect of family history of pain on childhood MSK pain and explore whether specific family pain factors influence the strength of the association (PROSPERO CRD42018090130). Included studies reported associations between family history of pain and nonspecific MSK pain in children (age <19 years). The outcome of interest was MSK pain in children. We assessed the methodological quality using a modified version of the Quality in Prognosis Studies instrument and quality of evidence for the main analyses using the GRADE criteria. After screening of 7281 titles, 6 longitudinal and 23 cross-sectional studies were included. Moderate quality evidence from 5 longitudinal studies (n = 42,131) showed that children with a family history of MSK pain had 58% increased odds of experiencing MSK pain themselves (odds ratio [OR] 1.58, 95% confidence interval 1.20-2.09). Moderate quality evidence from 18 cross-sectional studies (n = 17,274) supported this finding (OR 2.02, 95% 1.69-2.42). Subgroup analyses showed that the relationship was robust regardless of whether a child's mother, father, or sibling experienced pain. Odds were higher when both parents reported pain compared with one ([mother OR = 1.61; father OR = 1.59]; both parents OR = 2.0). Our findings show moderate quality evidence that children with a family history of pain are at higher risk of experiencing MSK pain. Understanding the mechanism by which this occurs would inform prevention and treatment efforts.
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14
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A capital role for the brain's insula in the diverse fibromyalgia-associated symptoms. Med Hypotheses 2020; 143:110077. [PMID: 32721793 DOI: 10.1016/j.mehy.2020.110077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/04/2023]
Abstract
Unexplained yet persisting general and widespread non-articular musculoskeletal pain and the associated complaints, known as fibromyalgia (FM), is a common disorder with major social and economic impact. We postulate that in FM disturbance of neurotransmitter balances at the brain's insula not only leads to aberrant pain processing but could also govern other associated symptoms. Symptoms might arise from central nervous system dysregulation mediated through an imbalance between the excitatory neurotransmitter glutamate and the inhibitory transmitter gamma-amino butyric acid. The insula could also have a leading role in the dysregulation of heart rate and blood pressure, bladder and bowel symptoms, and anxiety and sleep disturbances which are experienced by many FM patients. The presented hypothesis explains how the diverse FM-associated symptoms could be linked, and puts the brain's insula forward as a possible therapeutic target to be further explored for FM.
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15
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Haglund E, Bremander A, Bergman S. The StarT back screening tool and a pain mannequin improve triage in individuals with low back pain at risk of a worse prognosis - a population based cohort study. BMC Musculoskelet Disord 2019; 20:460. [PMID: 31638972 PMCID: PMC6805365 DOI: 10.1186/s12891-019-2836-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background The STarT Back Screening Tool (SBT) identifies patients with low back pain (LBP) at risk of a worse prognosis of persistent disabling back pain, and thereby facilitates triage to appropriate treatment level. However, the SBT does not consider the pain distribution, which is a known predictor of chronic widespread pain (CWP). The aim of this study was to determine if screening by the SBT and screening of multisite chronic widespread pain (MS-CWP) could identity individuals with a worse prognosis. A secondary aim was to analyze self-reported health in individuals with and without LBP, in relation to the combination of these two screening tools. Methods One hundred and nineteen individuals (aged 40–71 years, mean (SD) 59 (8) years), 52 with LBP and 67 references, answered two screening tools; the SBT and a pain mannequin – as well as a questionnaire addressing self-reported health. The SBT stratifies into low, medium or high risk of a worse prognosis. The pain mannequin stratifies into either presence or absence of CWP in combination with ≥7 painful areas of pain (0–18), here defined as MS-CWP (high risk of worse prognosis). The two screening tools were studied one-by-one, and as a combined screening. For statistical analyses, independent t-tests and Chi-square tests were used. Results Both the SBT and the pain mannequin identified risk of a worse prognosis in individuals with (p = 0.007) or without (p = 0.001) LBP. We found that the screening tools identified partly different individuals at risk. The SBT identified one individual, while the pain mannequin identified 21 (19%). When combining the two screening methods, 21 individuals (17%) were at high risk of a worse prognosis. When analyzing differences between individuals at high risk (combined SBT and MS-CWP) with those at low risk, individuals at high risk reported worse health (p = 0.013 - < 0.001). Conclusions Both screening tools identified individuals at risk, but they captured different aspects, and also different number of individuals at high risk of a worse prognosis. Thus, using a combination may improve early detection and facilitate triage to appropriate treatment level with multimodal approach also in those otherwise missed by the SBT.
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Affiliation(s)
- Emma Haglund
- School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden. .,Spenshult Research and Development Center, Halmstad, Sweden.
| | - Ann Bremander
- Spenshult Research and Development Center, Halmstad, Sweden.,Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Stefan Bergman
- Spenshult Research and Development Center, Halmstad, Sweden.,Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.,Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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16
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Georgopoulos V, Akin-Akinyosoye K, Zhang W, McWilliams DF, Hendrick P, Walsh DA. Quantitative sensory testing and predicting outcomes for musculoskeletal pain, disability, and negative affect: a systematic review and meta-analysis. Pain 2019; 160:1920-1932. [PMID: 31045746 PMCID: PMC6701980 DOI: 10.1097/j.pain.0000000000001590] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hypersensitivity due to central pain mechanisms can influence recovery and lead to worse clinical outcomes, but the ability of quantitative sensory testing (QST), an index of sensitisation, to predict outcomes in chronic musculoskeletal disorders remains unclear. We systematically reviewed the evidence for ability of QST to predict pain, disability, and negative affect using searches of CENTRAL, MEDLINE, EMBASE, AMED, CINAHL, and PubMed databases up to April 2018. Title screening, data extraction, and methodological quality assessments were performed independently by 2 reviewers. Associations were reported between baseline QST and outcomes using adjusted (β) and unadjusted (r) correlations. Of the 37 eligible studies (n = 3860 participants), 32 were prospective cohort studies and 5 randomised controlled trials. Pain was an outcome in 30 studies, disability in 11, and negative affect in 3. Meta-analysis revealed that baseline QST predicted musculoskeletal pain (mean r = 0.31, 95% confidence interval [CI]: 0.23-0.38, n = 1057 participants) and disability (mean r = 0.30, 95% CI: 0.19-0.40, n = 290 participants). Baseline modalities quantifying central mechanisms such as temporal summation and conditioned pain modulation were associated with follow-up pain (temporal summation: mean r = 0.37, 95% CI: 0.17-0.54; conditioned pain modulation: mean r = 0.36, 95% CI: 0.20-0.50), whereas baseline mechanical threshold modalities were predictive of follow-up disability (mean r = 0.25, 95% CI: 0.03-0.45). Quantitative sensory testing indices of pain hypersensitivity might help develop targeted interventions aiming to improve outcomes across a range of musculoskeletal conditions.
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Affiliation(s)
- Vasileios Georgopoulos
- Department of Academic Rheumatology, Faculty of Medicine and Health
Sciences, University of Nottingham
| | - Kehinde Akin-Akinyosoye
- Department of Academic Rheumatology, Faculty of Medicine and Health
Sciences, University of Nottingham
| | - Weiya Zhang
- Department of Academic Rheumatology, Faculty of Medicine and Health
Sciences, University of Nottingham
| | - Daniel F. McWilliams
- Department of Academic Rheumatology, Faculty of Medicine and Health
Sciences, University of Nottingham
| | - Paul Hendrick
- Department of Physiotherapy, Faculty of Medicine and Health
Sciences, University of Nottingham
| | - David A. Walsh
- Department of Academic Rheumatology, Faculty of Medicine and Health
Sciences, University of Nottingham
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17
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Choi HY, Lee CH. Can Beta-Endorphin Be Used as a Biomarker for Chronic Low Back Pain? A Meta-analysis of Randomized Controlled Trials. PAIN MEDICINE 2019; 20:28-36. [PMID: 30256990 DOI: 10.1093/pm/pny186] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Chronic low back pain (CLBP) is usually quantified using the visual analog scale (VAS). However, the VAS is a subjective measure and prone to reporting bias, therefore making it difficult to differentiate patients with true pain from those seeking to obtain secondary gain. This study aimed to evaluate the feasibility of using plasma β-endorphin as an objective biomarker for CLBP. Methods We searched PubMed, Embase, and the Cochrane Library for randomized trials that compared treatment vs sham procedures for patients with CLBP. Changes in VAS and β-endorphin levels between baseline and final evaluations were assessed for the treatment and control groups. A meta-regression model was developed to evaluate the association between the β-endorphin level and VAS. Results We included data from seven trials involving 375 patients. There was no significant difference in VAS scores and β-endorphin levels between both groups at baseline. At final evaluation, the treatment group demonstrated significantly greater improvements in VAS scores and an increased β-endorphin level compared with the control group. The change in the plasma β-endorphin level may be a surrogate marker of treatment response for patients with CLBP (explanatory power: 80%). The plasma β-endorphin level might be rarely affected by sham procedures. For patients with CLBP, the baseline β-endorphin level may reflect the intensity of CLBP (explanatory power: 66%). Conclusions A change in plasma β-endorphin level may be a surrogate marker of the treatment response for patients with CLBP. Advancements in β-endorphin measurements may help us better quantify pain intensity.
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Affiliation(s)
- Ho Yong Choi
- Department of Neurosurgery, Spine Center, Kyung Hee University Hospital at Gangdong, Kyung-Hee University School of Medicine, Seoul, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
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18
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Tassani S, Font-Llagunes JM, González Ballester MÁ, Noailly J. Muscular tension significantly affects stability in standing posture. Gait Posture 2019; 68:220-226. [PMID: 30517907 DOI: 10.1016/j.gaitpost.2018.11.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/06/2018] [Accepted: 11/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Muscular co-contraction is a strategy commonly used by elders with the aim to increase stability. However, co-contraction leads to stiffness which in turns reduces stability. Some literature seems to suggest an opposite approach and to point out relaxation as a way to improve stability. Teaching relaxation is therefore becoming the aim of many studies letting unclear whether tension or relaxation are the most effective muscular strategy to improve stability. Relaxation is a misleading concept in our society. It is often confused with rest, while it should be addressed during stressing tasks, where it should aim to reduce energetic costs and increase stability. The inability to relax can be related to sub-optimal neuro-motor control, which can lead to increased stresses. RESEARCH QUESTION The objective of the study is to investigate the effect of voluntary muscle contraction and relaxation over the stability of human standing posture, answering two specific research questions: (1) Does the muscular tension have an impact on stability of standing posture? (2) Could this impact be estimated by using a minimally invasive procedure? METHODS By using a force plate, we analysed the displacement of the center of pressure of 30 volunteers during state of tension and relaxation in comparison with a control state, and with open and closed eyes. RESULTS We found that tension significantly reduced the stability of subjects (15 out of 16 parameters, p < 0.003). SIGNIFICANCE Our results show that daily situations of stress can lead to decreased stability. Such a loss might actually increase the risk of chronic joint overload or fall. Finally, breathing has direct effect over the management of pain and stress, and the results reported here point out the need to explicitly explore the troubling fact that a large portion of population might not be able to properly breath.
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Affiliation(s)
- Simone Tassani
- Universitat Pompeu Fabra, BCN MedTech, Barcelona, Spain.
| | - Josep M Font-Llagunes
- Universitat Politècnica de Catalunya, Biomechanical Engineering Lab, Department of Mechanical Engineering and Biomedical Engineering Research Centre, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Biomedical Engineering, Esplugues de Llobregat, Spain
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19
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Change in Pain Score after Administration of Analgesics for Lower Extremity Fracture Pain during Hospitalization. Pain Manag Nurs 2018; 20:158-163. [PMID: 30442567 DOI: 10.1016/j.pmn.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/23/2018] [Accepted: 09/02/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Effective acute pain management following injury is critical to improve short-and long-term patient outcomes. Analgesics can effectively reduce pain intensity, yet half of injury patients report moderate to severe pain during hospitalization. PURPOSE The primary aim of this study was to identify the analgesic, different analgesic combinations, or analgesic and adjuvant analgesic combination that generated the largest percent change from pre- to post-analgesic pain score. DESIGN This was a descriptive retrospective cohort study of 129 adults admitted with lower extremity fractures to a trauma center. METHODS Name, dose, and frequency of analgesics and adjuvant analgesics administered from admission to discharge were collected from medical records. Percent change was calculated from pain scores documented on the 0-10 numeric rating scale. RESULTS The analgesic with largest percent change from pre- to post-administration pain score was hydromorphone 2 mg IV (53%) for the emergency department and morphine 4 mg IV (54%) for the in-patient unit. All analgesics administered in the emergency department and ∼50% administered on the in-patient unit produced a minimal (15%) decrease in pain score. CONCLUSIONS This study revealed that few analgesics administered in the emergency department and the in-patient unit to patients with lower extremity fractures provide adequate pain relief. In the emergency department, all analgesics administered resulted in at least minimal improvement of pain. On the in-patient unit 13 analgesic doses resulted at least minimal improvement in pain while nine doses did not even reach 20% change in pain. Findings from this study can be used guide the treatment of fracture pain in the hospital.
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20
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Analgesics Administered for Pain During Hospitalization Following Lower Extremity Fracture: A Review of the Literature. J Trauma Nurs 2018; 25:360-365. [PMID: 30395036 DOI: 10.1097/jtn.0000000000000402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Effective treatment of acute pain during hospitalization following lower extremity fracture is critical to improve short-term patient outcomes including wound healing, stress response, hospital length of stay, and cost as well as minimizing long-term negative patient outcomes such as delayed return to work, disability, and chronic pain. As many patients report moderate to severe pain during hospitalization, identifying the analgesics that most effectively reduces pain is a priority to improve patient outcomes. The purpose of this review was to examine published studies describing patient response to analgesics administered orally (PO) or intravenously (IV) in the immediate hospitalization following lower extremity fracture. PubMed was queried for articles published through May 2017 that included information on type of study, population, fracture site, pain measurement tool, analgesic, and result. Of 514 articles found, eight met the inclusion criteria. Analgesics administered PO or IV were fentanyl, hydromorphone, morphine, remifentanil, diclofenac, ibuprofen, ketorolac, and etoricoxib. Five of the studies focused on comparisons between one or more analgesics and three studies compared an IV analgesic to a regional anesthetic agent. Two studies compared different nonsteroidal anti-inflammatory drugs (NSAIDs). Bupivacaine, lignocaine, and levobupivacaine administered as regional nerve blocks were superior to controlling pain compared with IV fentanyl and IV hydromorphone. IV morphine provided faster and better pain relief compared with IV ibuprofen. Based on the limited data available, regional nerve blocks provided superior pain relief compared with opioids, and opioids provided superior pain relief compared with NSAIDs. Different NSAIDs provided similar pain relief.
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McKinley EC, Richardson EJ, McGwin G, Zhang J. Evaluating the effectiveness of antidepressant therapy adjuvant to gabapentin and pregabalin for treatment of SCI-related neuropathic pain. J Spinal Cord Med 2018; 41:637-644. [PMID: 29319453 PMCID: PMC6217509 DOI: 10.1080/10790268.2017.1415246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To investigate if a combination of anticonvulsant and antidepressant, two primary therapies for neuropathic pain, is associated with improved pain control compared to individual therapy. DESIGN Prospective cohort study Setting: The University of Alabama at Birmingham Rehabilitation Center In-patient Program between 2012 and 2015. PARTICIPANTS Incident SCI cases, 19-65 years of age. OUTCOMES Bryce-Ragnarsson pain classification scheme and the Numerical Rating Scale Results: Twenty-nine eligible patients completed 6-month follow-up; their average age was 36.4 years, 89% were male, and 65% were white. Baseline characteristics were not different by therapy initiated (combination versus single). At 6 months follow-up, therapy initiated at baseline was not associated with level of pain in the past week (p=0.3145) or past 24 hours (p=0.4107). However, patients who remained on the same therapy reported lower levels of pain 30 minutes after waking (p=0.0235). CONCLUSIONS The initiation of a combination of anticonvulsant and antidepressant shortly after SCI was not associated with improved pain control at 6 months compared to individual therapy. Adherent patients reported lower levels of pain; further analysis is warranted to elucidate this association.
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Affiliation(s)
- Emily Carol McKinley
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth J. Richardson
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Jie Zhang
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
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22
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Wahl AK, Opseth G, Nolte S, Osborne RH, Bjørke G, Mengshoel AM. Is regular use of physiotherapy treatment associated with health locus of control and self-management competency? A study of patients with musculoskeletal disorders undergoing physiotherapy in primary health care. Musculoskelet Sci Pract 2018; 36:43-47. [PMID: 29729545 DOI: 10.1016/j.msksp.2018.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/17/2018] [Accepted: 04/26/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate the relationship between regular use of physiotherapy treatment, health locus of control and self-management competency in people with musculoskeletal disorders. METHODS This cross-sectional study included 507 patients between 18 and 70 years of age with musculoskeletal disorders who attended a physiotherapy clinic. The Health Education Impact Questionnaire (heiQ) was used to assess self-management competency; the Health Locus of Control Scale (HLCS) was used to assess health locus of control. Multiple linear regression analyses were performed to estimate the relationships between variables. RESULTS Results showed that patients who attended physiotherapy on a regular basis had lower levels of internal control than those who did not. Furthermore, regular patients reported more health-directed activities and more emotional distress than patients not attending physiotherapy on a regular basis. Finally, internal health locus of control showed statistically significant associations with all heiQ domains, indicating that a stronger internal control is associated with higher levels of self-management competency. CONCLUSION Our findings suggest that attending physiotherapy on a regular basis is related to self-management competency and internal health locus of control. PRACTICAL IMPLICATIONS A treatment aim in primary care for people with long term conditions should include development of self-management capacity.
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Affiliation(s)
- Astrid K Wahl
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Gro Opseth
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway; Hans & Olaf Fysioterapi AS, Oslo, Norway
| | - Sandra Nolte
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Public Health Innovation, School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Richard H Osborne
- Public Health Innovation, School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | | | - Anne Marit Mengshoel
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
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Hernandez NM, Parry JA, Mabry TM, Taunton MJ. Patients at Risk: Preoperative Opioid Use Affects Opioid Prescribing, Refills, and Outcomes After Total Knee Arthroplasty. J Arthroplasty 2018; 33:S142-S146. [PMID: 29402712 DOI: 10.1016/j.arth.2018.01.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/19/2017] [Accepted: 01/04/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of preoperative opioid use on opioid prescriptions, refills, and clinical outcomes after total knee arthroplasty (TKA). METHODS A retrospective review identified 53 patients on preoperative opioids who were matched 1:2 to 106 opioid-naive patients undergoing primary TKA with at least 2-year follow-up. Opioid refills, Knee Society Score (preoperative and follow-up), morphine equivalent dose (MED) prescribed, and persistent opioid use were compared between groups. RESULTS The average total MED prescribed at discharge was 1248 mg, ranging from 0 to 5600 mg. The average daily MED used before discharge was greater in the preoperative opioid group compared to the opioid-naive group (90 ± 75 mg vs 54 ± 42 mg; P = .001). The preoperative opioid group and opioid-naive group differed in terms of refills (1.3 ± 1.6 vs 0.4 ± 0.6; P = .0001), persistent opioid use (21 [39%] vs 5 [4%], P = .0001), postoperative KSS (85 ± 11 vs 90 ± 13; P = .01), and manipulations under anesthesia (4 [8%] vs 1 [1%], P = .03). Preoperative tramadol users had the same risk of refills, persistent opioid use, reduced KSS, and manipulation under anesthesia as those taking other opioids. CONCLUSION Preoperative opioid users were discharged with less opioids, required more refills, were more likely to remain on opioids, and required more manipulations under anesthesia than opioid-naive patients. These risks extended to preoperative tramadol users.
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Affiliation(s)
| | - Joshua A Parry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Tad M Mabry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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24
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Waldheim E, Ajeganova S, Bergman S, Frostegård J, Welin E. Variation in pain related to systemic lupus erythematosus (SLE): a 7-year follow-up study. Clin Rheumatol 2018; 37:1825-1834. [PMID: 29654486 PMCID: PMC6006213 DOI: 10.1007/s10067-018-4079-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/11/2018] [Accepted: 03/23/2018] [Indexed: 12/18/2022]
Abstract
We have previously shown that most patients with systemic lupus erythematosus (SLE) reported low degree of SLE-related pain. However, 24% of the patients reported high degree of SLE-related pain, more fatigue, anxiety and depression, and worse health-related quality of life (HRQoL). To explore SLE-related pain, the presence of long-standing widespread pain, and patient-reported outcomes (PROs) after 7 years. Sixty-four out of 84 patients participated in a 7-year follow-up of the original survey and completed the same questionnaires answered at inclusion: pain (VAS 100 mm), fatigue (MAF), HRQoL (SF-36), anxiety and depression (HADS), and, if appropriate, a pain-drawing. Differences between inclusion and follow-up (change) were calculated. The patients with a low degree of SLE-related pain at inclusion reported no changes at follow-up in pain and PROs except for worsening in physical function in SF-36, median change (IQR) 0 (- 10 to 5), p = 0.024. Half of the patients with high degree of pain at inclusion reported decreased pain at follow-up, median change (IQR) 45 (35 to 65), p = 0.021; fatigue, 8 (8 to 17), p = 0.018; anxiety, 4 (1 to 4), p = 0.035; and depression, 4 (2 to 5), p = 0.018 and improvements in most dimensions of SF-36. The remaining half of the patients reported no changes regarding pain and PROs except for a worsening in vitality in SF-36, 20 (15 to 35), p = 0.0018. All patients with remaining high level of pain indicated long-standing widespread pain. After 7 years, a subgroup of patients with SLE reported remaining high level of SLE-related pain and a high symptom burden, including long-standing widespread pain. Such patients require more observant attention to receive appropriate treatment.
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Affiliation(s)
- Eva Waldheim
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Sofia Ajeganova
- Department of Medicine, Huddinge H7, Unit for Gastroenterology and Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Bergman
- Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Spenshult Research and Development Center, Halmstad, Sweden
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Johan Frostegård
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Welin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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25
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Liu JYW, Leung DYP. Pain Treatments for Nursing Home Residents with Advanced Dementia and Substantial Impaired Communication: A Cross-Sectional Analysis at Baseline of a Cluster Randomized Controlled Trial. PAIN MEDICINE 2018; 18:1649-1657. [PMID: 27688313 DOI: 10.1093/pm/pnw242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives This is a cross-sectional analysis at baseline of a cluster randomized controlled trial to identify factors associated with the use of pharmacological and nonpharmacological pain treatments by nursing home residents with dementia and impaired communication. Methods One hundred thirty-four residents with dementia and impaired communication were recruited. Nine of them were excluded because data on their pain treatments were missing, resulting in 125 for analysis. Hierarchical generalized estimating equations analyses controlling for the clustering effect of nursing homes were used to identify factors associated with the use of pharmacological and nonpharmacological pain treatments. Results Although all participants had a confirmed pain condition, only 23 (18.4%) and 45 (36%) had received pharmacological or nonpharmacological pain treatments, respectively. Participants with a higher ability to communicate ( P = 0.031) and fewer pain locations were found to be more likely to receive pain medications, with the impact of communication ability being greater among participants with better cognitive status than among those with poor cognitive status. Participants who had been living in the home longer and who were more dependent were less likely to receive nonpharmacological treatments. Conclusion Suboptimal pain management was common among this population. Severe impairment in the ability to communicate is a major reason for the underuse of pain medications. Staff may become desensitized and fail to perceive subtle changes in the residents' behavior as indicative of pain, leading to the underadministering of nonpharmacological treatments. To improve this situation, it is suggested that observational pain assessments be systematically carried out in nursing homes.
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Affiliation(s)
- Justina Yat Wa Liu
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Doris Y P Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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26
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Almeida SC, George SZ, Leite RDV, Oliveira AS, Chaves TC. Cluster subgroups based on overall pressure pain sensitivity and psychosocial factors in chronic musculoskeletal pain: Differences in clinical outcomes. Physiother Theory Pract 2018; 35:1218-1232. [PMID: 29771165 DOI: 10.1080/09593985.2018.1474512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: We aimed to empirically derive psychosocial and pain sensitivity subgroups using cluster analysis within a sample of individuals with chronic musculoskeletal pain (CMP) and to investigate derived subgroups for differences in pain and disability outcomes. Methods: Eighty female participants with CMP answered psychosocial and disability scales and were assessed for pressure pain sensitivity. A cluster analysis was used to derive subgroups, and analysis of variance (ANOVA) was used to investigate differences between subgroups. Results: Psychosocial factors (kinesiophobia, pain catastrophizing, anxiety, and depression) and overall pressure pain threshold (PPT) were entered into the cluster analysis. Three subgroups were empirically derived: cluster 1 (high pain sensitivity and high psychosocial distress; n = 12) characterized by low overall PPT and high psychosocial scores; cluster 2 (high pain sensitivity and intermediate psychosocial distress; n = 39) characterized by low overall PPT and intermediate psychosocial scores; and cluster 3 (low pain sensitivity and low psychosocial distress; n = 29) characterized by high overall PPT and low psychosocial scores compared to the other subgroups. Cluster 1 showed higher values for mean pain intensity (F(2,77) = 10.58, p < 0.001) compared with cluster 3, and cluster 1 showed higher values for disability (F(2,77) = 3.81, p = 0.03) compared with both clusters 2 and 3. Conclusions: Only cluster 1 was distinct from cluster 3 according to both pain and disability outcomes. Pain catastrophizing, depression, and anxiety were the psychosocial variables that best differentiated the subgroups. Overall, these results call attention to the importance of considering pain sensitivity and psychosocial variables to obtain a more comprehensive characterization of CMP patients' subtypes.
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Affiliation(s)
- Suzana C Almeida
- Physical Therapy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Steven Z George
- Duke Clinical Research Institute, Duke University, Durham NC, USA.,Department of Orthopaedic Surgery, Duke University, Durham NC, USA
| | - Raquel D V Leite
- Post Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Anamaria S Oliveira
- Post Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.,Department of Biomechanics, Medicine and Rehabilitation of the Musculoskeletal System, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Thais C Chaves
- Post Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.,Department of Neurosciences and Behavioral Sciences Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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27
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Geenen R, Overman CL, Christensen R, Åsenlöf P, Capela S, Huisinga KL, Husebø MEP, Köke AJA, Paskins Z, Pitsillidou IA, Savel C, Austin J, Hassett AL, Severijns G, Stoffer-Marx M, Vlaeyen JWS, Fernández-de-Las-Peñas C, Ryan SJ, Bergman S. EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis 2018; 77:797-807. [PMID: 29724726 DOI: 10.1136/annrheumdis-2017-212662] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/21/2018] [Accepted: 03/28/2018] [Indexed: 01/19/2023]
Abstract
Pain is the predominant symptom for people with inflammatory arthritis (IA) and osteoarthritis (OA) mandating the development of evidence-based recommendations for the health professional's approach to pain management. A multidisciplinary task force including professionals and patient representatives conducted a systematic literature review of systematic reviews to evaluate evidence regarding effects on pain of multiple treatment modalities. Overarching principles and recommendations regarding assessment and pain treatment were specified on the basis of reviewed evidence and expert opinion. From 2914 review studies initially identified, 186 met inclusion criteria. The task force emphasised the importance for the health professional to adopt a patient-centred framework within a biopsychosocial perspective, to have sufficient knowledge of IA and OA pathogenesis, and to be able to differentiate localised and generalised pain. Treatment is guided by scientific evidence and the assessment of patient needs, preferences and priorities; pain characteristics; previous and ongoing pain treatments; inflammation and joint damage; and psychological and other pain-related factors. Pain treatment options typically include education complemented by physical activity and exercise, orthotics, psychological and social interventions, sleep hygiene education, weight management, pharmacological and joint-specific treatment options, or interdisciplinary pain management. Effects on pain were most uniformly positive for physical activity and exercise interventions, and for psychological interventions. Effects on pain for educational interventions, orthotics, weight management and multidisciplinary treatment were shown for particular disease groups. Underpinned by available systematic reviews and meta-analyses, these recommendations enable health professionals to provide knowledgeable pain-management support for people with IA and OA.
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Affiliation(s)
- Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Cécile L Overman
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | - Susana Capela
- Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Lisbon, Portugal.,Rheumatology Research Unit, Faculty of Medicine, Lisbon Academic Medical Centre, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | - Karen L Huisinga
- Department of Rheumatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Mai Elin P Husebø
- Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, NBRR, Diakonhjemmet Hospital, Oslo, Norway
| | - Albère J A Köke
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Zoe Paskins
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Irene A Pitsillidou
- EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus
| | - Carine Savel
- Department of Rheumatology, CHU, Clermont Ferrand, Clermont Ferrand, France
| | - Judith Austin
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Afton L Hassett
- Department of Anesthesiology, Division of Pain Research, Chronic Pain & Fatigue Research Center, University of Michigan Medical School, Ann Harbor, Michigan, USA
| | - Guy Severijns
- EULAR Social Leagues Patients' Representative, Leuven, Belgium
| | - Michaela Stoffer-Marx
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Department of Health Sciences, University of Applied Sciences FH Campus Wien, Vienna, Austria
| | - Johan W S Vlaeyen
- Research group Health Psychology, University of Leuven, Leuven, Belgium.,Behavioral Medicine Research, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - César Fernández-de-Las-Peñas
- Department Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Sarah J Ryan
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Stefan Bergman
- Department of Public Health and Community Medicine, Primary Health Care Unit, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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28
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Griffin D, Wall P, Realpe A, Adams A, Parsons N, Hobson R, Achten J, Fry J, Costa M, Petrou S, Foster N, Donovan J. UK FASHIoN: feasibility study of a randomised controlled trial of arthroscopic surgery for hip impingement compared with best conservative care. Health Technol Assess 2018; 20:1-172. [PMID: 27117505 DOI: 10.3310/hta20320] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a syndrome of hip or groin pain associated with shape abnormalities of the hip joint. Treatments include arthroscopic surgery and conservative care. This study explored the feasibility of a randomised controlled trial to compare these treatments. OBJECTIVES The objectives of this study were to estimate the number of patients available for a full randomised controlled trial (RCT); to explore clinician and patient willingness to participate in such a RCT; to develop consensus on eligibility criteria, surgical and best conservative care protocols; to examine possible outcome measures and estimate the sample size for a full RCT; and to develop trial procedures and estimate recruitment and follow-up rates. METHODS Pre-pilot work: we surveyed all UK NHS hospital trusts (n = 197) to identify all FAI surgeons and to estimate how much arthroscopic FAI surgery they performed. We interviewed a purposive sample of 18 patients, 36 physiotherapists, 18 surgeons and two sports physicians to explore attitudes towards a RCT and used consensus-building methods among them to develop treatment protocols and patient information. Pilot RCT: we performed a pilot RCT in 10 hospital trusts. Patients were randomised to receive either hip arthroscopy or best conservative care and then followed up at 3, 6 and 12 months using patient-reported questionnaires for hip pain and function, activity level, quality of life, and a resource-use questionnaire. Qualitative recruitment intervention: we performed semistructured interviews with all researchers and clinicians involved in the pilot RCT in eight hospital trusts and recorded and analysed diagnostic and recruitment consultations with eligible patients. RESULTS We identified 120 surgeons who reported treating at least 1908 patients with FAI by hip arthroscopy in the NHS in the financial year 2011/12. There were 34 hospital trusts that performed ≥ 20 arthroscopic FAI operations in the year. We found that clinicians were positive about a RCT: only half reported equipoise, but most said that they would be prepared to randomise patients. Patients strongly supported a RCT, but expressed concerns about its design; these were used to develop patient information for the pilot RCT. We developed a surgical protocol and showed that this could be used in a RCT. We developed a physiotherapy-led exercise-based package of best conservative care called 'personalised hip therapy' and showed that this was practicable. In the pilot RCT, we recruited 42 out of 60 eligible patients (70%) across nine sites. The mean duration and recruitment rate across all sites were 4.5 months and one patient per site per month, respectively. The lead site recruited for the longest period (9.3 months) and accrued the largest number of patients (2.1 patients per month). We recorded and analysed 84 diagnostic and recruitment consultations in 60 patients and used these to develop a model for an optimal recruitment consultation. We identified the International Hip Outcome Tool at 12 months as an appropriate outcome measure and estimated the sample size for a full trial as 344 participants: a number that could be recruited in 25 centres over 18 months. CONCLUSION We have demonstrated that it is feasible to perform a RCT to establish the clinical effectiveness of hip arthroscopy compared with best conservative care for FAI. We have designed a full trial and developed and tested procedures for it, including an innovative approach to recruitment. We propose that a full trial be implemented. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Damian Griffin
- Division of Health Sciences, University of Warwick, Warwick, UK
| | - Peter Wall
- Division of Health Sciences, University of Warwick, Warwick, UK
| | - Alba Realpe
- Division of Mental Health and Wellbeing, University of Warwick, Warwick, UK
| | - Ann Adams
- Division of Mental Health and Wellbeing, University of Warwick, Warwick, UK
| | - Nick Parsons
- Department of Statistics and Epidemiology, University of Warwick, Warwick, UK
| | - Rachel Hobson
- Division of Health Sciences, University of Warwick, Warwick, UK
| | - Juul Achten
- Division of Health Sciences, University of Warwick, Warwick, UK
| | | | - Matthew Costa
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Nadine Foster
- Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK
| | - Jenny Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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29
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Ghasemi H, Tamaddonfard E, Soltanalinejad F. Role of thalamic ventral posterolateral nucleus histamine H 2 and opiate receptors in modulation of formalin-induced muscle pain in rats. Pharmacol Rep 2017; 69:1393-1401. [DOI: 10.1016/j.pharep.2017.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/18/2017] [Accepted: 05/05/2017] [Indexed: 02/02/2023]
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Abstract
Supplemental Digital Content is Available in the Text. Patients with chronic widespread pain may regularly consult in primary care for regional pain without being recognized as having a generalized condition. Chronic widespread pain (CWP) is common in the general population. It is unclear how people reporting this problem present in primary care; they may regularly consult for regional pains without being recognized as having a generalized condition. Our objectives were to determine the prevalence of people consulting in primary care for musculoskeletal conditions in different body regions on different occasions (recurrent regional pain consultation), the proportion with diagnosed generalized pain and survey-reported widespread pain, and if they have features characteristic of CWP. Phase 1 used electronic records from 12 general practices in North Staffordshire (Consultations in Primary Care Archive) from 2005 to 2009. Phase 2 used linked self-reported health and primary health care data from 8286 people aged >50 years in 8 general practices (North Staffordshire Osteoarthritis Project) between 2002 and 2005. In Phase 1, 11% of registered patients fulfilled criteria for recurrent regional pain consultation. Three-quarters had no recorded CWP-related generalized pain condition (eg, fibromyalgia). In Phase 2, 53% of recurrent regional pain consulters had survey-reported widespread pain and 88% had consulted for somatic symptoms. Self-reported general health was worse in recurrent regional pain consulters than in single-region consulters and poorest in those who also reported persistent widespread pain. Recurrent regional pain consulters are a heterogeneous group of frequent consulters sharing features with CWP (eg, somatic symptoms) but including those less severely affected. They lie on the spectrum of polysymptomatic distress characteristic of CWP and represent a group whose needs may be better met by earlier diagnosis of multisite pain.
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31
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Makrani AH, Afshari M, Ghajar M, Forooghi Z, Moosazadeh M. Vitamin D and fibromyalgia: a meta-analysis. Korean J Pain 2017; 30:250-257. [PMID: 29123619 PMCID: PMC5665736 DOI: 10.3344/kjp.2017.30.4.250] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 11/06/2022] Open
Abstract
Vitamin D is a cofactor responsible for autoimmune disorders. There is no agreement in the studies investigating the association between vitamin D and fibromyalgia. This study aims to combine the conflicting results of the primary studies which compared these patients with control groups regarding the serum concentration of vitamin D. This meta-analysis has been designed based on PRISMA guidelines. Relevant keywords were searched in PubMed, Science direct, Scopus, Cochrane, and Google scholar and primary studies were selected. After screening the eligible studies according to inclusion/exclusion criteria, we investigated the risk of bias in the selected studies and also the heterogeneity between the primary results using Cochrane (Q) and I-squared (I2) indices. The primary results were combined using inverse variance method and Cohen statistics as well as a random effects model. Publication bias was assessed using Egger test. Sensitivity analysis was applied to investigate the influence of each primary study on the final result of the meta-analysis. Suspected factors in the heterogeneity were assessed using meta-regression models. We entered 12 eligible studies in the meta-analysis including 851 cases compared with 862 controls. The standardized mean difference of Vitamin D between the two groups was −0.56 (95% confidence interval: −1.05, −0.08). Our meta-analysis showed that vitamin D serum levels of patients with fibromyalgia was significantly lower than that of control group.
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Affiliation(s)
| | - Mahdi Afshari
- Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Marayam Ghajar
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Forooghi
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
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32
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Hutting N, Oswald W, Staal JB, Engels JA, Nouwens E, Nijhuis van-der Sanden MW, Heerkens YF. Physical therapists and importance of work participation in patients with musculoskeletal disorders: a focus group study. BMC Musculoskelet Disord 2017; 18:196. [PMID: 28511676 PMCID: PMC5434575 DOI: 10.1186/s12891-017-1546-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders are a major health problem resulting in negative effects on wellbeing and substantial costs to society. Work participation is associated with positive benefits for both mental and physical health. Potentially, generalist physical therapists (GPTs) can play an important role in reducing absenteeism, presenteeism and associated costs in patients with musculoskeletal disorders. However, work participation is often insufficiently addressed within generalist physical therapy practice (GPTP). Therefore, this study evaluates whether GPTs take work participation into account as a determining factor in patients with musculoskeletal disorders, and how this might be improved. METHODS This qualitative study consisted of seven focus groups involving 30 participants: 21 GPTs and 9 occupational physical therapists (OPTs). Based on an interview guide, participants were asked how they integrate work participation within their practice, how they collaborate with other professionals, and how GPTs can improve integration of the patient's work within their practice. RESULTS Although participants recognized the importance of work participation, they mentioned that the integration of this item in their GPTP could be improved. Generally, GPTs place insufficient priority on work participation. Moreover, there is a lack of cooperation between the generalist physical therapist and (other) occupational healthcare providers (including OPTs), and the borderlines/differences between generalist physcial therapy and occupational health physcial therapy were sometimes unclear. GPTs showed a lack of knowledge and a need for additional information about several important work-related factors (e.g. work content, physical and psychosocial working conditions, terms of employment). CONCLUSIONS Although a patient's work is important, GPTs take insufficient account of work participation as a determining factor in the treatment of patients with musculoskeletal disorders. GPTs often lack specific knowledge about work-related factors, and there is insufficient cooperation between OPTs and other occupational healthcare providers. The integration of work participation within GPTP, and the cooperation between GPTs and other occupational healthcare providers, show room for improvement.
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Affiliation(s)
- Nathan Hutting
- Faculty of Health and Social Studies, Research Group Occupation & Health, HAN University of Applied Sciences, P.O. Box 6960, 6503, GL, Nijmegen, Netherlands.
| | - Wiebke Oswald
- Faculty of Health and Social Studies, Research Group Occupation & Health, HAN University of Applied Sciences, P.O. Box 6960, 6503, GL, Nijmegen, Netherlands.,Faculty of Health and Social Studies, Physical Therapy, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - J Bart Staal
- Faculty of Health and Social Studies, Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, Netherlands.,Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Josephine A Engels
- Faculty of Health and Social Studies, Research Group Occupation & Health, HAN University of Applied Sciences, P.O. Box 6960, 6503, GL, Nijmegen, Netherlands
| | - Elvira Nouwens
- Faculty of Health and Social Studies, Physical Therapy, HAN University of Applied Sciences, Nijmegen, Netherlands
| | | | - Yvonne F Heerkens
- Faculty of Health and Social Studies, Research Group Occupation & Health, HAN University of Applied Sciences, P.O. Box 6960, 6503, GL, Nijmegen, Netherlands
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33
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Wall PD, Dickenson EJ, Robinson D, Hughes I, Realpe A, Hobson R, Griffin DR, Foster NE. Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial. Br J Sports Med 2017; 50:1217-23. [PMID: 27629405 PMCID: PMC5036255 DOI: 10.1136/bjsports-2016-096368] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Femoroacetabular impingement (FAI) syndrome is increasingly recognised as a cause of hip pain. As part of the design of a randomised controlled trial (RCT) of arthroscopic surgery for FAI syndrome, we developed a protocol for non-operative care and evaluated its feasibility. METHODS In phase one, we developed a protocol for non-operative care for FAI in the UK National Health Service (NHS), through a process of systematic review and consensus gathering. In phase two, the protocol was tested in an internal pilot RCT for protocol adherence and adverse events. RESULTS The final protocol, called Personalised Hip Therapy (PHT), consists of four core components led by physiotherapists: detailed patient assessment, education and advice, help with pain relief and an exercise-based programme that is individualised, supervised and progressed over time. PHT is delivered over 12-26 weeks in 6-10 physiotherapist-patient contacts, supplemented by a home exercise programme. In the pilot RCT, 42 patients were recruited and 21 randomised to PHT. Review of treatment case report forms, completed by physiotherapists, showed that 13 patients (62%) received treatment that had closely followed the PHT protocol. 13 patients reported some muscle soreness at 6 weeks, but there were no serious adverse events. CONCLUSION PHT provides a structure for the non-operative care of FAI and offers guidance to clinicians and researchers in an evolving area with limited evidence. PHT was deliverable within the National Health Service, is safe, and now forms the comparator to arthroscopic surgery in the UK FASHIoN trial (ISRCTN64081839). TRIAL REGISTRATION NUMBER ISRCTN 09754699.
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Affiliation(s)
- Peter Dh Wall
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - David Robinson
- Southbank Hospital Worcester, Spire Healthcare, Worcester, UK
| | - Ivor Hughes
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Alba Realpe
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Hobson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Damian R Griffin
- University Hospitals of Coventry and Warwickshire NHS Trust and Warwick Medical School, University of Warwick, Coventry, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences NIHR Professor of Musculoskeletal Health in Primary Care, Keele University, Keele, UK
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Hansen CA, Inacio MCS, Pratt NL, Roughead EE, Graves SE. Chronic Use of Opioids Before and After Total Knee Arthroplasty: A Retrospective Cohort Study. J Arthroplasty 2017; 32:811-817.e1. [PMID: 27836577 DOI: 10.1016/j.arth.2016.09.040] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/31/2016] [Accepted: 09/24/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Opioids are commonly used for the management of preoperative and postoperative pain among patients undergoing total knee arthroplasty (TKA). There is limited literature on the chronic use of opioids pre-TKA and post-TKA. The aim of this study was to characterize the use of opioids in TKA patients before and after surgery and identify risk factors of chronic opioid use. METHODS Opioid use among 15,020 patients undergoing TKA (01/01/2001-31/12/2012) was examined. Generalized estimating equations assessed change in total oral morphine equivalents pre-TKA and post-TKA, and logistic regression estimated risk factors of chronic opioid use. RESULTS Of the total sample, 7782 (52.0%) patients had at least 1 opioid (38.6% pre-TKA and 34.4% post-TKA). The most commonly prescribed opioids were oxycodone, codeine + acetaminophen, and tramadol. Pre-TKA, 720 (4.8%) patients were chronic opioid users, of which 241 (33.5%) stopped being chronic users after surgery and 479 (66.5%) continued but had a 16% reduction (incidence rate ratio = 0.84; 95% confidence interval, 0.78-0.90) in total oral morphine equivalents. Of the 5077 (33.8%) occasional opioid user pre-TKA, 2407 (47.4%) stopped after surgery. Compared to nonopioid users, chronic users were younger, were female, had more comorbidity, and had longer hospital stays. Older age was associated with ceasing chronic opioid use post-TKA. CONCLUSION There was a reduction in opioid use following TKA. Almost 50% of occasional users and more than 30% of chronic users pre-TKA ceased opioids postoperatively. There was a reduction in use for those chronic users who continued to take opioids postsurgery.
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Affiliation(s)
- Craig A Hansen
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maria C S Inacio
- Medicine and Devices Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole L Pratt
- Medicine and Devices Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Elizabeth E Roughead
- Medicine and Devices Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Total Joint Replacement Registry, University of Adelaide, Adelaide, South Australia, Australia
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Hutting N, Detaille SI, Heerkens YF, Engels JA, Staal JB, Nijhuis-van der Sanden MWG. Experiences of Participants in a Self-Management Program for Employees with Complaints of the Arm, Neck or Shoulder (CANS): A Mixed Methods Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:35-48. [PMID: 26875155 PMCID: PMC5306216 DOI: 10.1007/s10926-016-9630-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Purpose To investigate the experiences of participants of a self-management program for employees with complaints of the arm, neck or shoulder (CANS). The program consisted of six group sessions combined with an eHealth module. Methods Semi-structured interviews with the first 31 consecutive participants of the intervention group participating in a randomized controlled trial. Participants were interviewed after their last group session. Semi-structured interviews were guided by an interview guide and audio-recorded. Data were analyzed using thematic analysis and the emerging themes were discussed. All participants in the intervention group were asked about their experiences with a questionnaire at three (n = 58) and 12-months (n = 53) follow-up. Results Most participants appreciated the diversity of the program and benefited from the interaction with their peers. The eHealth module, although not used by everyone, was generally experienced as positive, especially the section with the physical exercises. Participants obtained more insight into their complaints and increased awareness, which contributed to the acceptance of and coping with the complaints. There was also criticism about the content of the program and the lack of a follow-up session. Results of the questionnaires showed that participants had a high level of satisfaction. Conclusions In general, the intervention fitted the needs of employees with CANS. Participants obtained more knowledge and insight into their complaints, as well as increased awareness; all this contributed to a behavioral change and improved coping. Many participants made changes at work and during their leisure time, whereas some felt that continuing their 'changed' behavior would be a challenge.
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Affiliation(s)
- Nathan Hutting
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
- Research Group Occupation and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands.
| | - Sarah I Detaille
- Research Group Occupation and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands
- HAN Seneca, Expertise Centre for Sports, Work and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Yvonne F Heerkens
- Research Group Occupation and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands
| | - Josephine A Engels
- Research Group Occupation and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands
| | - J Bart Staal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Group Musculoskeletal Rehabilitation, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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Liu JYW, Lai CKY. Implementation of Observational Pain Management Protocol for Residents With Dementia: A Cluster-RCT. J Am Geriatr Soc 2017; 65:e56-e63. [DOI: 10.1111/jgs.14763] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Justina Y. W. Liu
- Centre for Gerontological Nursing; School of Nursing; The Hong Kong Polytechnic University; Hong Kong
| | - Claudia K. Y. Lai
- Centre for Gerontological Nursing; School of Nursing; The Hong Kong Polytechnic University; Hong Kong
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Cerdá M, Gaidus A, Keyes KM, Ponicki W, Martins S, Galea S, Gruenewald P. Prescription opioid poisoning across urban and rural areas: identifying vulnerable groups and geographic areas. Addiction 2017; 112:103-112. [PMID: 27470224 PMCID: PMC5148642 DOI: 10.1111/add.13543] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/31/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022]
Abstract
AIMS To determine (1) whether prescription opioid poisoning (PO) hospital discharges spread across space over time, (2) the locations of 'hot-spots' of PO-related hospital discharges, (3) how features of the local environment contribute to the growth in PO-related hospital discharges and (4) where each environmental feature makes the strongest contribution. DESIGN Hierarchical Bayesian Poisson space-time analysis to relate annual discharges from community hospitals to postal code characteristics over 10 years. SETTING California, USA. PARTICIPANTS Residents of 18 517 postal codes in California, 2001-11. MEASUREMENTS Annual postal code-level counts of hospital discharges due to PO poisoning were related to postal code pharmacy density, measures of medical need for POs (i.e. rates of cancer and arthritis-related hospital discharges), economic stressors (i.e. median household income, percentage of families in poverty and the unemployment rate) and concentration of manual labor industries. FINDINGS PO-related hospital discharges spread from rural and suburban/exurban 'hot-spots' to urban areas. They increased more in postal codes with greater pharmacy density [rate ratio (RR) = 1.03; 95% credible interval (CI) = 1.01, 1.05], more arthritis-related hospital discharges (RR = 1.08; 95% CI = 1.06, 1.11), lower income (RR = 0.85; 95% CI = 0.83, 0.87) and more manual labor industries (RR = 1.15; 95% CI = 1.10, 1.19 for construction; RR = 1.12; 95% CI = 1.04, 1.20 for manufacturing industries). Changes in pharmacy density primarily affected PO-related discharges in urban areas, while changes in income and manual labor industries especially affected PO-related discharges in suburban/exurban and rural areas. CONCLUSIONS Hospital discharge rates for prescription opioid (PO) poisoning spread from rural and suburban/exurban hot-spots to urban areas, suggesting spatial contagion. The distribution of age-related and work-place-related sources of medical need for POs in rural areas and, to a lesser extent, the availability of POs through pharmacies in urban areas, partly explain the growth of PO poisoning across California, USA.
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Affiliation(s)
- Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA
| | - Andrew Gaidus
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA, USA
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - William Ponicki
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA, USA
| | - Silvia Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA, USA
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Du S, Hu L, Dong J, Xu G, Chen X, Jin S, Zhang H, Yin H. Self-management program for chronic low back pain: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2017; 100:37-49. [PMID: 27554077 DOI: 10.1016/j.pec.2016.07.029] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the effectiveness of self-management programs (SMPs) on chronic low back pain (CLBP). METHODS A search of randomized controlled trials (RCTs) was performed in Pubmed, Cochrane Library, Web of Science, Elsevier, and CINAHL through June, 2015. Two reviewers selected trials, conducted critical appraisal, and extracted data. Meta analyses were performed. RESULTS Thirteen moderate-quality RCTs were included. There were 9 RCTs for immediate post intervention on pain intensity and disability, 5 RCTs for short term, 3 RCTs for intermediate and 4 RCTs for long term. Specifically, the effect sizes (ESs) of SMP on pain intensity were -0.29, -0.20, -0.23, and -0.25 at immediate post-intervention, short-term, intermediate-term, and long-term follow-ups, respectively. The ESs on disability were -0.28, -0.23, -0.19, and -0.19 at immediate post-intervention, short-term, intermediate-term, and long-term follow-ups, respectively. CONCLUSION For CLBP patients, there is moderate-quality evidence that SMP has a moderate effect on pain intensity, and small to moderate effect on disability. PRACTICE IMPLICATIONS SMP can be regarded as an effective approach for CLBP management. In addition to face-to-face mode, internet-based strategy can also be considered as a useful option to deliver SMP. Theoretically driven programs are preferred.
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Affiliation(s)
- Shizheng Du
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China
| | - Lingli Hu
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Jianshu Dong
- Shanghai Health Education Institute, 358 Jiaozhou Road Building B, Jing'an District, Shanghai, 200040, China
| | - Guihua Xu
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China.
| | - Xuan Chen
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China
| | - Shengji Jin
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China
| | - Heng Zhang
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China
| | - Haiyan Yin
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China
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Inacio MCS, Pratt NL, Roughead EE, Paxton EW, Graves SE. Opioid use after total hip arthroplasty surgery is associated with revision surgery. BMC Musculoskelet Disord 2016; 17:122. [PMID: 26965992 PMCID: PMC4785728 DOI: 10.1186/s12891-016-0970-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/01/2016] [Indexed: 12/16/2022] Open
Abstract
Background Pain is an indication for total hip arthroplasty (THA) and it should be resolved post-surgery. Because patients’ pain is typically treated pharmacologically we tested whether opioid use can be used as a surrogate for patient-reported pain and as an indicator for early surgical failure. Specifically, we evaluated whether the amount of opioids taken within the year after THA was associated with one and five years risk of revision surgery. Methods A cohort of 9943 THAs (01/2001-12/2012) was evaluated. Post-operative opioid use was the exposure of interest and cumulative daily oral morphine equivalent (OME) amounts were calculated. Total OMEs/90-day periods were categorised into quartiles. Revisions within one and five years were the outcomes of interest. Results Of the THAs, 2.0 % (N = 200) were revised within one year and 4.2 % (N = 413) within five years. After adjustments for gender, age, surgical indication, co-morbidities, and other analgesics, revision was associated with amount of OMEs in the second quarter after THA (days 91–180 after discharge). Patients on medium-high amounts of OME (400-1119 mg) had higher risk of one (hazard ratio (HR) = 2.22, 95 % CI 1.08-4.56) and five year (HR = 1.66, 95 % CI 1.08-2.56) revision than a patient not taking opioids. During the same period, patients taking the highest amounts of OMEs (≥1120 mg) had a 2.64 (95 % CI 1.03-6.74) times higher risk of one year and a 2.11 (95 % CI 1.13-3.96) times higher risk of five year revision. Conclusions Opioid use 91–180 days post-surgery is associated with higher risk of revision surgery and therefore is an early and useful indicator for surgical failure.
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Affiliation(s)
- Maria C S Inacio
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia, Australia.
| | - Nicole L Pratt
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia, Australia.,Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia, Australia
| | - Elizabeth E Roughead
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia, Australia.,Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia, Australia
| | - Elizabeth W Paxton
- Surgical Outcomes and Analysis, SCPMG Clinical Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA, 92108, USA
| | - Stephen E Graves
- Australian Orthopaedic Association National Total Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Sundstrup E, Jakobsen MD, Brandt M, Jay K, Aagaard P, Andersen LL. Associations between biopsychosocial factors and chronic upper limb pain among slaughterhouse workers: cross sectional study. BMC Musculoskelet Disord 2016; 17:104. [PMID: 26919829 PMCID: PMC4769589 DOI: 10.1186/s12891-016-0953-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 02/17/2016] [Indexed: 01/22/2023] Open
Abstract
Background Knowledge of factors associated with chronic pain is necessary for preventive strategies. The present study investigates biopsychosocial differences, with specific focus on rate of force development (RFD) and work ability, between workers with and without chronic upper limb pain. Methods Eighty-two male slaughterhouse workers, 49 with chronic upper limb pain and 33 pain-free controls participated in the study. Maximal muscle strength, RFD, and muscle activity was determined from fast and forceful maximal voluntary contractions for the shoulder and hand. Participants filled out a questionnaire on work ability (work ability index), work disability (Work module of DASH questionnaire), fear avoidance, and self-rated health. Additionally, pressure pain threshold (PPT) was measured in muscles of the arm, shoulder and lower leg. Results Muscle strength and RFD (determined within time intervals of 30, 50, 100, and 200 ms relative to onset of contraction) was 28 % and 58–78 % lower, respectively, in workers with chronic pain compared with pain-free controls, and paralleled by reduced muscle activity (all p < 0.001). Workers with chronic pain had lower PPT of the arm, shoulder and lower leg (p < 0.01), and reported impaired work ability index score and general health along with higher work disability and fear avoidance compared with controls (all p < 0.0001). No differences were observed between the groups in regard to age, BMI, physical activity level, job position and duration of slaughterhouse work (all p > 0.4). Conclusions Chronic upper limb pain was paralleled by reduced neuromuscular function of the shoulder and hand along with impaired work ability, work disability and general health. Future studies on chronic pain management at the workplace should carefully consider the biopsychosocial nature of pain when designing and implementing preventive strategies.
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Affiliation(s)
- Emil Sundstrup
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark. .,Institute for Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC), University of Southern Denmark, Odense, Denmark.
| | - Markus D Jakobsen
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark.,Institute for Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC), University of Southern Denmark, Odense, Denmark
| | - Mikkel Brandt
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark.,Physical Activity and Human Performance Group, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Kenneth Jay
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark.,Institute for Sport and Clinical Biomechanics, Department of physical activity and health, University of Southern Denmark, Odense, Denmark
| | - Per Aagaard
- Institute for Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC), University of Southern Denmark, Odense, Denmark
| | - Lars L Andersen
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark.,Physical Activity and Human Performance Group, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Favre C, Dériaz O, Hanon R, Luthi F. Care related pain in rehabilitation after orthopedic trauma: An exploratory study with qualitative data. Ann Phys Rehabil Med 2014; 58:132-8. [PMID: 25818069 DOI: 10.1016/j.rehab.2014.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Care related pain (CRP) is generally under-estimated and rarely studied in rehabilitation as well as in general medecine. Beliefs about pain influence psychological distress, adjustment to pain and physical disability. In this sense, perceptions of CRP could limit recovery. This exploratory study aims to understand patients' and caregivers' subjective perceptions and beliefs about CRP. PATIENTS AND METHODS Questionnaires about CRP were submitted to members of the interdisciplinary team of a rehabilitation hospital and to patients with musculoskeletal complaints (cross-sectional design). Twenty patients were also individually interviewed (qualitative data). Four topics were addressed: frequency of CRP, situations and procedures causing CRP, beliefs about CRP and means used to deal with CRP. RESULTS Seventy-five caregivers and 50 patients replied to the questionnaire. CRP is a very common experience in rehabilitation and it is recognized by both groups. Generally, the situations causing CRP reflect the specificity of rehabilitation (mobilization…) and are similarly perceived by patients and caregivers, with patients considering them as more painful. Beliefs about CRP are clearly different from those usually associated with pain. Both groups point out the utilitarian and the inevitable character of CRP. They differ on that, that patients had a more positive view about CRP. They associate it more often with progress and see it as acceptable at least until a certain limit. They are also able to perceive the richness of means used by physiotherapists to help them coping with CRP. CONCLUSION Our data may suggest new keys to motivate patient to be active in rehabilitation for example in choosing carefully arguments or words which may fit theirs' beliefs about CRP, or in using various means to manage CRP. Promoting the use of relational competences with chronic pain patients and of a patient-centred approach may also be a concern in training caregivers.
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Affiliation(s)
- C Favre
- Service de psychosomatique, clinique romande de réadaptation Suvacare, avenue Grand-Champsec 90, 1950 Sion, Switzerland.
| | - O Dériaz
- Institut de recherche en réadaptation-réinsertion, avenue Grand-Champsec 90, 1950 Sion, Switzerland
| | - R Hanon
- Service de physiothérapie, clinique romande de réadaptation Suvacare, avenue Grand-Champsec 90, 1950 Sion, Switzerland
| | - F Luthi
- Service de réadaptation de l'appareil locomoteur, clinique romande de réadaptation Suvacare, avenue Grand-Champsec 90, 1950 Sion, Switzerland; Département de l'appareil locomoteur, service de rhumatologie, centre hospitalier universitaire Vaudois (CHUV), avenue Pierre-Decker 4, 1005 Lausanne, Switzerland
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Herquelot E, Bodin J, Petit A, Ha C, Leclerc A, Goldberg M, Zins M, Roquelaure Y, Descatha A. Long-term persistence of knee pain and occupational exposure in two large prospective cohorts of workers. BMC Musculoskelet Disord 2014; 15:411. [PMID: 25475051 PMCID: PMC4289228 DOI: 10.1186/1471-2474-15-411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 12/02/2014] [Indexed: 12/03/2022] Open
Abstract
Background The persistence of knee pain (KP) and its relationship with occupational factors were investigated in two prospective cohorts of French workers: retirees of the Gazel cohort and workers in the Cosali cohort. Methods KP was defined according to the Nordic questionnaire (>1 day in the last year), and the information was extracted from two questionnaires in 2006 and 2012 for the Gazel cohort, and in 2002–2005 and 2007–2010 for the Cosali cohort. The personal and occupational factors and the severity of KP were measured at baseline. Of the 4590 members of the Gazel cohort with KP at baseline, 4140(90.2%) were followed up, as were 637(63.1%) members of the Cosali cohort. Logistic models were used to evaluate associations (ORs) between occupational exposure and the persistence of KP separately by sex, adjusted on indicators of severity of KP. Results KP was no longer present at follow-up for 38.3% of Gazel men and 46.0% of Cosali men (33.4% of Gazel women and 50.6% of Cosali women). The persistence of KP in men was associated with carrying or handling heavy loads on univariate analyses and with kneeling on multivariate analyses, with ORs of 1.3(1.0-1.6) (Gazel) and 1.6(1.0-2.6) (Cosali). Climbing stairs was not significantly associated with the persistence of knee pain among men. The persistence of KP in women was not significantly associated with such occupational exposure. Conclusions This study highlights the role of occupational factors in the persistence of KP for men, in particular kneeling and handling/carrying loads. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-411) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eléonore Herquelot
- UMS011 Inserm, Université Versailles St-Quentin, Population-Based Epidemiological Cohorts, Hôpital P, Brousse - bat 15/16 RDC Gauche, 16 av Paul Vaillant Couturier, 94807 Villejuif Cedex, France.
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Abstract
An ageing, physically inactive and increasingly obese population, coupled with finite health and social care resources, requires a shift from treating musculoskeletal disease when it arises to a preventive approach promoting lifelong musculoskeletal health. A public health approach to musculoskeletal health ensures that people are able to live not only long, but also well. Supporting self-management, addressing common misconceptions about the inevitability of musculoskeletal conditions, and offering brief interventions to support necessary lifestyle changes are basic public health functions that all health professionals can deliver. More specialist public health skills including needs assessment, data interpretation and service planning are also needed to deliver high quality services. These will require improvements in the data collected about musculoskeletal health nationally. A public health approach would benefit individuals through reduced pain and improved function due to musculoskeletal conditions, and wider society by minimising lost economic productivity and lowering health and social care costs.
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Affiliation(s)
- P M Clark
- London and KSS School of Public Health, London, UK.
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Chopade A, Sayyad F. Antifibromyalgic activity of standardized extracts of Phyllanthus amarus and Phyllanthus fraternus in acidic saline induced chronic muscle pain. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.biomag.2014.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Joshi A, Stagni G, Cleary A, Patel K, Weiss DS, Hagins M. Iontophoresis Successfully Delivers Dexamethasone Sodium Phosphate to Dermis as Measured by Microdialysis. J Pharm Sci 2014; 103:191-6. [DOI: 10.1002/jps.23771] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/29/2013] [Accepted: 10/14/2013] [Indexed: 11/09/2022]
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Effect of brief daily resistance training on occupational neck/shoulder muscle activity in office workers with chronic pain: randomized controlled trial. BIOMED RESEARCH INTERNATIONAL 2013; 2013:262386. [PMID: 24490152 PMCID: PMC3892746 DOI: 10.1155/2013/262386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/19/2013] [Accepted: 12/04/2013] [Indexed: 12/04/2022]
Abstract
Purpose. This study investigates the acute and longitudinal effects of resistance training on occupational muscle activity in office workers with chronic pain. Methods. 30 female office workers with chronic neck and shoulder pain participated for 10 weeks in high-intensity elastic resistance training for 2 minutes per day (n = 15) or in control receiving weekly email-based information on general health (n = 15). Electromyography (EMG) from the splenius and upper trapezius was recorded during a normal workday. Results. Adherence to training and control interventions were 86% and 89%, respectively. Compared with control, training increased isometric muscle strength 6% (P < 0.05) and decreased neck/shoulder pain intensity by 40% (P < 0.01). The frequency of periods with complete motor unit relaxation (EMG gaps) decreased acutely in the hours after training. By contrast, at 10-week follow-up, training increased average duration of EMG gaps by 71%, EMG gap frequency by 296% and percentage time below 0.5%, and 1.0% EMGmax by 578% and 242%, respectively, during the workday in m. splenius. Conclusion. While resistance training acutely generates a more tense muscle activity pattern, the longitudinal changes are beneficial in terms of longer and more frequent periods of complete muscular relaxation and reduced pain.
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Chopade AR, Sayyad F. Antinociceptive effect of Phyllanthus fraternus extract in complete Freund's adjuvant induced chronic pain in mice. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.biomag.2013.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Cheung J, Kajaks T, MacDermid JC. The relationship between neck pain and physical activity. Open Orthop J 2013; 7:521-9. [PMID: 24133553 PMCID: PMC3795407 DOI: 10.2174/1874325001307010521] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/18/2013] [Accepted: 04/18/2013] [Indexed: 11/22/2022] Open
Abstract
Neck pain is a significant societal burden due to its high prevalence and healthcare costs. While physical activity can help to manage other forms of chronic musculoskeletal pain, little data exists on the relationship between physical activity and neck pain. The purpose of this study was to compare physical activity levels between individuals with neck pain and healthy controls, and then to relate disability, fear of movement, and pain sensitivity measures to physical activity levels in each of the two participant groups. 21 participants were recruited for each of the two participant groups (n = 42). Data collection included the use of the Neck Disability Index, the Tampa Scale for Kinesiophobia, electrocutaneous (Neurometer® CPT) and pressure stimulation (JTech algometer) for quantitative sensory testing, and 5 days of subjective (Rapid Assessment of Physical Activity) and objective (BioTrainer II) measurements of physical activity. Analysis of Variance and Pearson's Correlation were used to determine if differences and relationships exist between dependent variables both within and between groups. The results show that individuals with mild neck pain and healthy controls do not differ in subjectively and objectively measured physical activity. While participants with neck pain reported higher neck disability and fear of movement, these factors did not significantly relate to physical activity levels. Perceived activity level was related to pain threshold and tolerance at local neck muscles sites (C2 paraspinal muscle and upper trapezius muscle), whereas measured activity was related to generalized pain sensitivity, as measured at the tibialis anterior muscle site.
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Affiliation(s)
- Janice Cheung
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Tara Kajaks
- Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Joy C. MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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Myhr A, Augestad LB. Chronic Pain Patients—Effects on Mental Health and Pain After a 57-Week Multidisciplinary Rehabilitation Program. Pain Manag Nurs 2013; 14:74-84. [DOI: 10.1016/j.pmn.2010.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 09/30/2010] [Accepted: 09/30/2010] [Indexed: 10/18/2022]
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