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Hearn JH, Martin S, Smith M. Assessment of suitable referral, effectiveness and long-term outcomes of standard vs intensive pain management programmes for people with chronic pain. Br J Pain 2023; 17:71-86. [PMID: 36815071 PMCID: PMC9940255 DOI: 10.1177/20494637221132451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Chronic pain is a leading cause of disability, often requiring multidisciplinary management. 2021 NICE guidance has questioned the quality of the evidence surrounding the efficacy of pain management programmes (PMPs), with only minor benefit demonstrated in psychological and physical outcomes. There is need for further high-quality evidence for the efficacy of PMPs for a range of chronic pain conditions and to identify barriers to successful management of chronic pain. Objective This service evaluation utilised routinely collected outcome data of 508 PMP attendees to investigate change in pain- and patient-related outcomes across two distinct PMPs; a standard and an intensive PMP, and establish their longer-term efficacy and appropriateness for patients with differing degrees of need. Results More people with chronic widespread pain, fibromyalgia, and osteoarthritis were referred to the intensive PMP (reflecting greater disability and distress in these conditions). Those referred to the intensive PMP demonstrated greater distress (such as more severe depression and anxiety), lower pain acceptance and poorer physical function. Improvements were observed in all outcomes across both PMPs (including physical function, pain catastrophising and pain acceptance). Depression and disability demonstrated clinically meaningful improvements in the intensive PMP, and pain severity showed clinically meaningful improvement in both PMPs. However, depression severity, disability, pain severity, and pain interference significantly deteriorated at 6-month follow-up for those on the intensive PMP, with pain severity increasing to a clinically meaningful degree (by more than 10%), though these outcomes remained better than at baseline. Conclusion This evaluation identified that people with chronic pain most at risk of deterioration in physical and psychological wellbeing after completing a PMP require early identification to mitigate such deterioration. Established and emerging PMPs need to be tailored to the needs of this group, particularly at follow-up to reduce risks of pain severity increasing, alongside establishing/reinforcing safeguards against deterioration post-PMP.
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Affiliation(s)
- Jasmine H. Hearn
- The Department of Psychology, Manchester Metropolitan University, UK,Jasmine Heath Hearn, Department of Psychology, Manchester Metropolitan University, Bonsall Street, Manchester, M15 6GX, UK.
| | - Sarah Martin
- The Department of Psychology, Manchester Metropolitan University, UK
| | - Melanie Smith
- Manchester & Salford Pain Centre, Irving Building, Salford Royal NHS Foundation Trust, UK
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Hwang UJ, Kwon OY. Influencing factors of pressure pain hypersensitivity of the upper trapezius in food service workers with nonspecific neck/shoulder myofascial pain: A cross-sectional study. Medicine (Baltimore) 2022; 101:e29696. [PMID: 35945777 PMCID: PMC9351888 DOI: 10.1097/md.0000000000029696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
It is unclear which factors contribute to the developing pressure pain hypersensitivity of the upper trapezius, a type of neurophysiological hyperexcitability. The present study investigated the relationship between physical and psychological factors and pressure pain hypersensitivity of the upper trapezius for each sex. In total, 154 individuals with neck/shoulder myofascial pain participated, among 372 food service workers. Participants completed a questionnaire (Beck Depression Inventory, and Borg Rating of Perceived Exertion scale) and were photographed to measure posture. Pressure pain sensitivity, 2 range of motions (cervical lateral bending and rotation), and 4 muscle strengths (serratus anterior, lower trapezius [LT], biceps, and glenohumeral external rotator) were measured by a pressure algometer, iPhone application, and handheld dynamometer, respectively. For each sex, forward multivariate logistic regression was used to test our a priori hypothesis among selected variables that a combination of psychosocial and physical factors contributed to the risk for pressure pain hypersensitivity. In multivariate analyses, LT strength (odds ratio = 0.94, 95% confidence interval = 0.91-0.97, P = .001) was the only significant influencing factor for pressure pain hypersensitivity in men. Dominant painful ipsilateral cervical rotation range of motion (odds ratio = 0.96, 95% confidence interval = 0.92-0.99, P = .037) was the only influencing factor for pressure pain hypersensitivity in women. LT strength and dominant painful ipsilateral cervical rotation range of motion could serve as guidelines for preventing and managing pressure pain hypersensitivity of the upper trapezius in food service workers with nonspecific neck/shoulder myofascial pain.
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Affiliation(s)
- Ui-Jae Hwang
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Kangwon-Do, South Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, Wonju, Kangwon-Do, South Korea
- *Correspondence: Oh-Yun Kwon, Department of Physical Therapy, Graduate School, Yonsei University, 234 Maeji-ri, Heungeop-Myeon, Wonju, Kangwon-Do, 220-710, Laboratory of Kinetic Ergocise based on Movement Analysis, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea (e-mail: )
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Heymann RE, Paiva ES, Martinez JE, Helfenstein M, Rezende MC, Provenza JR, Ranzolin A, Assis MRD, Feldman DP, Ribeiro LS, Souza EJR. New guidelines for the diagnosis of fibromyalgia. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57 Suppl 2:467-476. [PMID: 28800969 DOI: 10.1016/j.rbre.2017.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To establish guidelines based on scientific evidence for the diagnosis of fibromyalgia. MATERIAL AND METHODS Evidence collection was performed based on 9 questions regarding the diagnosis of fibromyalgia, structured using the Patient, Intervention or Indicator, Comparison and Outcome (P.I.C.O.), with searches in the main, primary databases of scientific information. After defining the potential studies to support the recommendations, they were graded according to evidence and degree of recommendation.
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Affiliation(s)
- Roberto E Heymann
- Sociedade Brasileira de Reumatologia, Brazil; Universidade Federal do Estado de São Paulo, São Paulo, SP, Brazil.
| | - Eduardo S Paiva
- Sociedade Brasileira de Reumatologia, Brazil; Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - José Eduardo Martinez
- Sociedade Brasileira de Reumatologia, Brazil; Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil
| | - Milton Helfenstein
- Sociedade Brasileira de Reumatologia, Brazil; Universidade Federal do Estado de São Paulo, São Paulo, SP, Brazil
| | - Marcelo C Rezende
- Sociedade Brasileira de Reumatologia, Brazil; Santa Casa de Campo Grande, Campo Grande, MS, Brazil
| | - Jose Roberto Provenza
- Sociedade Brasileira de Reumatologia, Brazil; Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
| | - Aline Ranzolin
- Sociedade Brasileira de Reumatologia, Brazil; Hospital das Clínicas de Pernambuco, Recife, PE, Brazil
| | - Marcos Renato de Assis
- Sociedade Brasileira de Reumatologia, Brazil; Faculdade de Medicina de Marília, Marília, SP, Brazil
| | - Daniel P Feldman
- Sociedade Brasileira de Reumatologia, Brazil; Universidade Federal do Estado de São Paulo, São Paulo, SP, Brazil
| | - Luiz Severiano Ribeiro
- Sociedade Brasileira de Reumatologia, Brazil; Hospital do Servidor Público de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Eduardo J R Souza
- Sociedade Brasileira de Reumatologia, Brazil; Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil
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Heymann RE, Paiva ES, Martinez JE, Helfenstein M, Rezende MC, Provenza JR, Ranzolin A, Assis MRD, Feldman DP, Ribeiro LS, Souza EJ. Novas diretrizes para o diagnóstico da fibromialgia. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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López DL, Fernández JMV, Iglesias MEL, Castro CÁ, Lobo CC, Galván JR, de Bengoa Vallejo RB. Influence of depression in a sample of people with hallux valgus. Int J Ment Health Nurs 2016; 25:574-578. [PMID: 26892262 DOI: 10.1111/inm.12196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/06/2015] [Accepted: 10/21/2015] [Indexed: 11/30/2022]
Abstract
Hallux valgus (HV) is a highly-prevalent forefoot deformity associated with progressive subluxation and osteoarthritis of the first metatarsophalangeal joint; it is believed to be associated with depression. The aim of the present study was to determine the association of patients with varying degrees of HV involvement to depression using the Beck Depression Inventory (BDI). The sample consisted of 102 participants (mean age: 45.1 ± 1.6), who attended an outpatient centre where self-report data were recorded. The degree of HV deformity was determined in both feet, and the scores on the BDI were compared. A total of 38.24% of the sample had depression, with an average BDI score of 10.55 ± 12.36 points. There was a statistically-significant association between the degree and presence of HV in both feet (P = 0.0001). People with a greater degree of HV deformity in any foot also have a significant increase in depression based on BDI scores, regardless of sex.
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Kroenke K, Yu Z, Wu J, Kean J, Monahan PO. Operating characteristics of PROMIS four-item depression and anxiety scales in primary care patients with chronic pain. PAIN MEDICINE 2014; 15:1892-901. [PMID: 25138978 DOI: 10.1111/pme.12537] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Depression and anxiety are prevalent in patients with chronic pain and adversely affect pain, quality of life, and treatment response. The purpose of this psychometric study was to determine the reliability and validity of the four-item Patient Reported Outcomes Measurement Information System (PROMIS) depression and anxiety scales in patients with chronic pain. DESIGN Secondary analysis of data from the Stepped Care to Optimize Pain care Effectiveness study, a randomized clinical trial of optimized analgesic therapy. SETTING Five primary care clinics at the Roudebush VA Medical Center (RVAMC) in Indianapolis, Indiana. SUBJECTS Two hundred forty-four primary care patients with chronic musculoskeletal pain. METHODS All patients completed the four-item depression and anxiety scales from the PROMIS 29-item profile, as well as several other validated psychological measures. The minimally important difference (MID) using the standard error of measurement (SEM) was calculated for each scale, and convergent validity was assessed by interscale correlations at baseline and 3 months. Operating characteristics of the PROMIS measures for detecting patients who had probable major depression or were anxiety-disorder screen-positive were calculated. RESULTS The PROMIS scales had good internal reliability, and the MID (as represented by two SEMs) was 2 points for the depression scale and 2.5 points for the anxiety scale. Convergent validity was supported by strong interscale correlations. The optimal screening cutpoint on the 4- to 20-point PROMIS scales appeared to be 8 for both the depression and anxiety scales. CONCLUSIONS The PROMIS four-item depression and anxiety scales are reasonable options as ultra-brief measures for screening in patients with chronic pain.
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Affiliation(s)
- Kurt Kroenke
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, Indiana, USA
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Skolasky RL, Riley LH, Maggard AM, Wegener ST. The relationship between pain and depressive symptoms after lumbar spine surgery. Pain 2012; 153:2092-2096. [DOI: 10.1016/j.pain.2012.06.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 06/20/2012] [Accepted: 06/27/2012] [Indexed: 12/27/2022]
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