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Kardash L, Wall CL, Flack M, Searle A. The role of pain self-efficacy and pain catastrophising in the relationship between chronic pain and depression: A moderated mediation model. PLoS One 2024; 19:e0303775. [PMID: 38781197 PMCID: PMC11115195 DOI: 10.1371/journal.pone.0303775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
Chronic pain is a substantial health problem with a high prevalence of comorbid depression. To understand the link between chronic pain and depression, cognitive factors including pain catastrophising and pain self-efficacy have been theorised as significant contributing variables. There is relatively strong evidence that pain catastrophising mediates the relationship between pain severity and depression symptoms. There is also emerging evidence that the mediation role of pain catastrophising may vary as a function of pain self-efficacy. However, it is unknown whether this model will apply in a tertiary pain clinic sample. Thus, this study aimed to examine the respective moderating and mediating roles of pain self-efficacy and pain catastrophising on the association between pain severity and depressive symptoms in a large clinical sample of Australian adults living with chronic pain. Participants (n = 1195) completed all questionnaire measures prior to their first appointments at one tertiary pain service. As expected, the PROCESS path analysis showed that pain catastrophising mediated the relationship between pain severity and depressive symptoms. Further, there was support for the moderating effect of pain self-efficacy; as pain self-efficacy decreased, the relationship strengthened between both pain severity and pain catastrophising, as well as pain catastrophising and depressive symptoms. These findings may have important clinical implications including how relationships between these factors may be considered in the provision of care for those with chronic pain. Notably, these measures could be used in triaging processes to inform treatment decisions.
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Affiliation(s)
- Lauren Kardash
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Cindy Lee Wall
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Mal Flack
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Amelia Searle
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Pain Management Unit, Flinders Medical Centre, Bedford Park, SA, Australia
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Farragher JB, Pranata A, Williams GP, El-Ansary D, Parry SM, Clark RA, Mentiplay B, Kasza J, Crofts S, Bryant AL. Neuromuscular Control and Resistance Training for People With Chronic Low Back Pain: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2024; 54:350-359. [PMID: 38497906 DOI: 10.2519/jospt.2024.12349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
OBJECTIVE: To determine if adding lumbar neuromuscular control retraining exercises to a 12-week program of strengthening exercises had greater effect for improving disability than 12 weeks of strengthening exercises alone in people with chronic low back pain (LBP). DESIGN: Single-center, participant- and assessor-blinded, comparative effectiveness randomized controlled trial. METHODS: Sixty-nine participants (31 females; 29 males; mean age: 46.5 years) with nonspecific chronic LBP were recruited for a 12-week program involving lumbar extension neuromuscular retraining in addition to resistance exercises (intervention) or 12 weeks of resistance exercises alone (control). The primary outcome measure was the Oswestry Disability Index. Secondary outcome measures included the Numeric Rating Scale, Tampa Scale for Kinesiophobia, Pain Self-Efficacy Questionnaire, and the International Physical Activity Questionnaire. Outcomes were measured at baseline, 6 weeks, and 12 weeks. RESULTS: Forty-three participants (22 control, 21 intervention) completed all outcome measures at 6 and 12 weeks. Fourteen participants were lost to follow-up, and 12 participants discontinued due to COVID-19 restrictions. Both groups demonstrated clinically important changes in disability, pain intensity, and kinesiophobia. The difference between groups with respect to disability was imprecise and not clinically meaningful (mean difference, -4.4; 95% CI: -10.2, 1.4) at 12 weeks. Differences in secondary outcomes at 6 or 12 weeks were also small with wide confidence intervals. CONCLUSIONS: Adding lumbar neuromuscular control retraining to a series of resistance exercises offered no additional benefit over resistance exercises alone over a 12-week period. J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 18 March 2024. doi:10.2519/jospt.2024.12349.
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Ni RJ, Yu Y. Relationship between physical activity and risk of depression in a married group. BMC Public Health 2024; 24:829. [PMID: 38491473 PMCID: PMC10943876 DOI: 10.1186/s12889-024-18339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Currently, there are many different findings on the relationship between physical activity and depression, and there may be differences between genders. This study therefore focused on gender differences to understand the relationship between physical activity behaviour and the risk of depression in married individuals. METHODS 15607 married people in the China Family Panel Studies 2020 (CFPS 2020) were used to understand the relationship between physical activity and depression risk in different populations, and the chi-square test, Mann-Whitney U-test, and binary logistic regression were used to explore the relationship between physical activity and depression risk in the married population. RESULTS 527 (6.64%) women were at high risk of depression and 365 (4.76%) men were at high risk of depression; physical activity was associated with the risk of depression in the married population, but after incorporating demographic and relevant cognitive variables, physical activity was negatively associated with the risk of depression in women (OR = 0.94, P < 0.01) but not statistically significant with the risk of depression in men (OR = 0.96, P > 0.05). CONCLUSION Physical activity was directly related to the risk of depression in married women, but not in married men.
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Affiliation(s)
- Rong Jing Ni
- Physical Education Institute, Liaoning Normal University, Dalian, 116029, China
| | - Ying Yu
- Physical Education Institute, Liaoning Normal University, Dalian, 116029, China.
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McLaughlin KH, Fritz JM, Minick KI, Brennan GP, McGee T, Lane E, Thackeray A, Bardsley T, Wegener ST, Hunter SJ, Skolasky RL. Examining the Relationship Between Individual Patient Factors and Substantial Clinical Benefit From Telerehabilitation Among Patients With Chronic Low Back Pain. Phys Ther 2024; 104:pzad180. [PMID: 38157307 DOI: 10.1093/ptj/pzad180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 08/18/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The coronavirus disease-2019 pandemic has facilitated the emergence of telerehabilitation, but it is unclear which patients are most likely to respond to physical therapy provided this way. The purpose of this study was to examine the relationship between individual patient factors and substantial clinical benefit from telerehabilitation among a cohort of patients with chronic low back pain (LBP). METHODS This is a secondary analysis of data collected during a prospective longitudinal cohort study. Patients with chronic LBP (N = 98) were provided with a standardized physical therapy protocol adapted for telerehabilitation. We examined the relationship between patient factors and substantial clinical benefit with telerehabilitation, defined as a ≥50% improvement in disability at 10 weeks, measured using the Oswestry Disability Index. RESULTS Sixteen (16.3%) patients reported a substantial clinical benefit from telerehabilitation. Patients reporting substantial clinical benefit from telerehabilitation had lower initial pain intensity, lower psychosocial risk per the STarT Back Screening Tool, higher levels of pain self-efficacy, and reported higher therapeutic alliance with their physical therapist compared to other patients. CONCLUSION Patients with lower psychosocial risk and higher pain-self efficacy experienced substantial clinical benefit from telerehabilitation for chronic LBP more often than other patients in our cohort. Therapeutic alliance was higher among patients who experienced a substantial clinical benefit compared to those who did not. IMPACT This study indicates that psychosocial factors play an important role in the outcomes of patients receiving telerehabilitation for chronic LBP. Baseline psychosocial screening may serve as a method for identifying patients likely to benefit from this approach.
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Affiliation(s)
- Kevin H McLaughlin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Kate I Minick
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Gerard P Brennan
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Terrence McGee
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Elizabeth Lane
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Anne Thackeray
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Tyler Bardsley
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephen J Hunter
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Gerdle B, Dragioti E, Rivano Fischer M, Ringqvist Å. Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up: A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Pain Res 2024; 17:83-105. [PMID: 38196970 PMCID: PMC10775695 DOI: 10.2147/jpr.s438260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024] Open
Abstract
Background Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies. Aim This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator. Methods This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008-2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims. Results Changes in acceptance (β:0.424-0.553; all P<0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (β: 0.177-0.233; all P<0.001) and changes in fear-avoidance (β: -0.152- -0.186; all P<0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator. Discussion and Conclusion Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
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Stubbs C, McAuliffe S, Chimenti RL, Coombes BK, Haines T, Heales L, de Vos RJ, Lehman G, Mallows A, Michner LA, Millar NL, O'Neill S, O'Sullivan K, Plinsinga M, Rathleff M, Rio E, Ross M, Roy JS, Silbernagel KG, Thomson A, Trevail T, van den Akker-Scheek I, Vicenzino B, Vlaeyen JWS, Pinto RZ, Malliaras P. Which Psychological and Psychosocial Constructs Are Important to Measure in Future Tendinopathy Clinical Trials? A Modified International Delphi Study With Expert Clinician/Researchers and People With Tendinopathy. J Orthop Sports Phys Ther 2024; 54:14-25. [PMID: 37729020 DOI: 10.2519/jospt.2023.11903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE: To identify which psychological and psychosocial constructs to include in a core outcome set to guide future clinical trials in the tendinopathy field. DESIGN: Modified International Delphi study. METHODS: In 3 online Delphi rounds, we presented 35 psychological and psychosocial constructs to an international panel of 38 clinician/researchers and people with tendinopathy. Using a 9-point Likert scale (1 = not important to include, 9 = critical to include), consensus for construct inclusion required ≥70% of respondents rating "extremely critical to include" (score ≥7) and ≤15% rating "not important to include" (score ≤3). Consensus for exclusion required ≥70% of respondents rating "not important to include" (score ≤3) and ≤15% of rating "critical to include" (score ≥7). RESULTS: Thirty-six participants (95% of 38) completed round 1, 90% (n = 34) completed round 2, and 87% (n = 33) completed round 3. Four constructs were deemed important to include as part of a core outcome set: kinesiophobia (82%, median: 8, interquartile range [IQR]: 1.0), pain beliefs (76%, median: -7, IQR: 1.0), pain-related self-efficacy (71%, median: 7, IQR: 2.0), and fear-avoidance beliefs (73%, median: -7, IQR: 1.0). Six constructs were deemed not important to include: perceived injustice (82%), individual attitudes of family members (74%), social isolation and loneliness (73%), job satisfaction (73%), coping (70%), and educational attainment (70%). Clinician/researchers and people with tendinopathy reached consensus that kinesiophobia, pain beliefs, pain self-efficacy, and fear-avoidance beliefs were important psychological constructs to measure in tendinopathy clinical trials. J Orthop Sports Phys Ther 2024;54(1):1-12. Epub 20 September 2023. doi:10.2519/jospt.2023.11903.
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Waardenburg S, de Meij N, van Kuijk SMJ, Van Zundert J, Brouwer BA. Expectations of treatment outcome in complex cases of patients with chronic pain: A study on the DATAPAIN cohort. Pain Pract 2024; 24:8-17. [PMID: 37477420 DOI: 10.1111/papr.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND A better insight in how the biopsychosocial factors influence patient outcome(s) may provide information that helps selecting the optimal pain management for a specific group. METHODS Categorization was made in the prospective DATAPAIN registry, in which patients with pain severity (Numeric Rating Scale [NRS]: 7-10), depression or anxiety (Hospital Anxiety and Depression Scale: > 10), and pain catastrophizing (Pain Catastrophizing Scale: > 31) were identified as complex cases. Patient outcomes; treatment satisfaction on the Patient Global Impression of Change (PGIC), pain relief (NRS), pain interference on the Brief Pain Inventory (BPI) and quality of life indicator General Perceived Health (GPH) were evaluated. Logistic regression analyzed if belonging to the complex cases showed modification in the outcome of the PGIC and GPH. Linear regression was observed if complex cases differed in average reduction in pain relief and interference compared to non-complex cases. RESULTS 1637 patients were included, of which 345 (21.08%) were considered complex cases. The changes in scores of pain relief and BPI active subscale were not significantly different between groups. The BPI affective subscale had a different change in score (-0.509; p: 0.002). The complex cases had an odds ratio (OR) of 0.59 (95% confidence interval [CI]: 0.36-0.77) on treatment satisfaction compared to non-complex cases, and an OR of 0.28 (95% CI: 0.11-0.56) on the GPH. CONCLUSION When treating patients with complex cases, desired treatment outcome(s) should be recognized by specialists and patients, as these may be less likely to occur.
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Affiliation(s)
- Sophie Waardenburg
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre MUMC+, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre MUMC+, Maastricht, The Netherlands
| | - Nelleke de Meij
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre MUMC+, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre MUMC+, Maastricht, The Netherlands
| | - Jan Van Zundert
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre MUMC+, Maastricht, The Netherlands
- Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost Limburg, Genk/Lanaken, Belgium
| | - Brigitte A Brouwer
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre MUMC+, Maastricht, The Netherlands
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Zager Kocjan G, Avsec A, Kavčič T. Feeling too low to be active: Physical inactivity mediates the relationship between mental and physical health. Soc Sci Med 2024; 341:116546. [PMID: 38169178 DOI: 10.1016/j.socscimed.2023.116546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 08/18/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Physical inactivity is one of the most influential and pervasive risk factors for health problems. Therefore, public health experts call for interventions to promote physical activity across the lifespan. This study aimed to examine the role of mental health in physical inactivity and the subsequent role of physical activity in various aspects of physical health. METHODS Data were collected in the third wave of the European Health Interview Survey (EHIS) in Slovenia. A nationally representative sample of 9,900 people (49.6% male) aged 15 years or more (M = 49.2; SD = 18.9 years) provided self-reports on depression (PHQ-8), subjective well-being (MHC-SF), physical (in)activity, bodily pain, long-standing activity limitations, their general health status, and possible chronic diseases. RESULTS The results of a path analysis showed that depression had a positive effect and well-being had a negative effect on physical inactivity, which in turn contributed to the likelihood of severe bodily pain, activity limitations, poor self-rated health, and multimorbidity. Depression and well-being contributed to health-related outcomes directly and indirectly through physical inactivity. LIMITATIONS Because of the cross-sectional design, this study is limited in its ability to draw causal conclusions. All health data were self-reported. CONCLUSIONS Results suggest that high levels of depression and low levels of subjective well-being may be an early warning sign of physical health problems. Interventions aimed at preventing or reducing mental health problems and promoting positive mental health may benefit not only mental health per se, but also prevent physical inactivity and, consequently, physical health problems.
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Affiliation(s)
| | | | - Tina Kavčič
- Faculty of Health Sciences, University of Ljubljana, Slovenia
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Espejo EP, Sheridan TM, Pino CA, Phillips CR. Mental Health Predictors of Response to Standard Medical Intervention at a Military Pain Specialty Clinic. Mil Med 2023; 188:149-156. [PMID: 37948258 DOI: 10.1093/milmed/usad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/03/2023] [Accepted: 02/15/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Chronic pain among active duty service members can negatively impact operational readiness and contributes to significant health care costs within military treatment facilities. Response to standard medical intervention (SMI) for chronic pain is highly variable. The objective of the current study was to examine whether mental health indicators predict individual variation in response to SMI for chronic pain in a military pain specialty clinic. METHODS This is a retrospective observational study of data previously collected at the Pain Medicine Center at Naval Medical Center San Diego (NMCSD) approved by the NMCSD Institutional Review Board. We included 286 ADSMs who completed the Pain Assessment Screening Tool and Outcomes Registry (PASTOR) at two assessment points (mean = 118.45 days apart, SD = 37.22) as part of standard care. Hierarchical linear regression analyses were conducted to examine whether pretreatment mental health measures predict changes in the pain impact score (PIS)-a composite measure of pain intensity, pain interference, and physical functioning-over the course of treatment. RESULTS After controlling for pretreatment PIS, pretreatment PTSD symptoms, fatigue, and anger were all significant predictors of posttreatment PIS: Higher PTSD symptoms, higher fatigue, and lower anger predicted poorer response to treatment (all Ps < .05). CONCLUSION Higher pretreatment PTSD and fatigue symptoms may portend poorer response to SMI for chronic pain. Poor response to treatment may also be predicted by lower pretreatment anger. Further investigation is warranted to identify the best strategies for treating chronic pain in military treatment facilities when these conditions are identified during initial evaluation.
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Affiliation(s)
- Emmanuel P Espejo
- Pain Medicine Center, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Tara M Sheridan
- Pain Medicine Center, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Carlos A Pino
- Pain Medicine Center, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Christopher R Phillips
- Pain Medicine Center, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
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Dobija L, Pereira B, Cohen-Aknine G, Roren A, Dupeyron A, Coudeyre E. Immediate effect of passive hamstring stretching on flexibility and relationship with psychosocial factors in people with chronic low back pain. Heliyon 2023; 9:e19753. [PMID: 37810115 PMCID: PMC10559058 DOI: 10.1016/j.heliyon.2023.e19753] [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] [Received: 05/16/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Background Hamstring muscle tightness contributes to disability in people with chronic low back pain (CLBP). HM stretching improves flexibility in healthy individuals, but the immediate effect of stretching is unknown in people with CLBP. Moreover, the stretching effect could be influenced by psychosocial factors. Objectives To evaluate the immediate effect of passive HM stretching on flexibility in people with CLBP and the relationships between psychosocial factors and change in hamstring flexibility. Design Non-randomized, pilot trial. Method One minute of passive stretching was performed in 90 people with CLBP. Change in Active Knee Extension and Straight Leg Raise angles (digital inclinometer), and Fingertips-to-Floor distance (measuring tape) were measured before and immediately after stretching. Correlations between change in flexibility and baseline Fear-Avoidance Beliefs Questionnaire (FABQ) and Hospital Anxiety and Depression Scale (HADS) scores were analyzed. Results Hamstring flexibility improved significantly after stretching; Active Knee Extension mean difference was 4° (95% CI, 2.4 to 5.1; p < 0.001, right ES = 0.24, left ES = 0.23); Straight Leg Raise mean difference was 7° (95% CI, 5.5 to 8.6, p < 0.001, right ES = 0.44, left ES = 0.42), Fingertips-to-Floor mean difference was 2 cm (95% CI, 1.7 to 3.0, p < 0.001, ES = 0.20). No correlation was found between improvement in any of the hamstring flexibility measurements and FABQ or HADS scores (p > 0.05). Conclusions Passive hamstring stretching induced an immediate, statistically significantly improvement in hamstring flexibility, but only the change in Straight Leg Raise amplitude was clinically important. Psychosocial factors were not related to improvements in flexibility after hamstring stretching.
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Affiliation(s)
- Lech Dobija
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire (CHU) de Clermont Ferrand, 63000 Clermont-Ferrand, France
- Unité de Nutrition Humaine, INRAE, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et de l’Innovation, Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Gabriel Cohen-Aknine
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire (CHU) de Nîmes, 30900 Nîmes, France
| | - Alexandra Roren
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre-Université de Paris, Hôpital Cochin, Paris, France
| | - Arnaud Dupeyron
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire (CHU) de Nîmes, 30900 Nîmes, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire (CHU) de Clermont Ferrand, 63000 Clermont-Ferrand, France
- Unité de Nutrition Humaine, INRAE, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
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Wang LY, Fu TS, Tsia MC, Hung CI. The associations of depression, anxiety, and insomnia at baseline with disability at a five-year follow-up point among outpatients with chronic low back pain: a prospective cohort study. BMC Musculoskelet Disord 2023; 24:565. [PMID: 37434175 DOI: 10.1186/s12891-023-06682-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/30/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND No previous study has investigated the associations of depression, anxiety, and insomnia at baseline with disability at a five-year follow-up point among outpatients with chronic low back pain (CLBP). The study aimed to simultaneously compare the associations of depression, anxiety, and sleep quality at baseline with disability at a 5-year follow-up point among patients with CLBP. METHODS Two-hundred and twenty-five subjects with CLBP were enrolled at baseline, and 111 subjects participated at the five-year follow-up point. At follow-up, the Oswestry Disability Index (ODI) and total months of disability (TMOD) over the past five years were used as the indices of disability. The depression (HADS-D) and anxiety (HADS-A) subscales of the Hospital Anxiety and Depression Scale and the Insomnia Severity Index (ISI) were used to assess depression, anxiety, and insomnia at baseline and follow-up. Multiple linear regression was employed to test the associations. RESULTS The scores of the HADS-D, HADS-A, and ISI were correlated with the ODI at the same time points (both at baseline and follow-up). A greater severity on the HADS-D, an older age, and associated leg symptoms at baseline were independently associated with a greater ODI at follow-up. A greater severity on the HADS-A and fewer educational years at baseline were independently associated with a longer TMOD. The associations of the HADS-D and HADS-A at baseline with disability at follow-up were greater than that of the ISI at baseline, based on the regression models. CONCLUSION Greater severities of depression and anxiety at baseline were significantly associated with greater disability at the five-year follow-up point. The associations of depression and anxiety at baseline with disability at the long-term follow-up point might be greater than that of insomnia at baseline.
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Affiliation(s)
- Le-Yung Wang
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsai-Sheng Fu
- Department of Orthopedics, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Chu Tsia
- Department of Nursing, Chang Gung Memorial Hospital at Taoyuan and Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Spoonemore SL, McConnell RC, Owen WE, Young JL, Clewley DJ, Rhon DI. The influence of pain-related comorbidities on pain intensity and pain-related psychological distress in patients presenting with musculoskeletal pain. Braz J Phys Ther 2023; 27:100532. [PMID: 37611373 PMCID: PMC10468365 DOI: 10.1016/j.bjpt.2023.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/22/2023] [Accepted: 08/04/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Musculoskeletal pain (MSP) is the largest contributor to chronic pain and frequently occurs alongside other medical comorbidities. OBJECTIVE Explore the relationships between the presence of pain-related comorbidities, pain intensity, and pain-related psychological distress in patients with MSP. METHODS A longitudinal assessment of individuals 18-90 years old in the Midwestern United States beginning a new episode of physical therapy for MSP. Electronic medical records were assessed the full year prior for care-seeking of diagnoses for pain-related comorbidities (anxiety, metabolic disorder, chronic pain, depression, nicotine dependence, post-traumatic stress disorder, sleep apnea, and sleep insomnia). Pain intensity and pain-related psychological distress (Optimal Screening for Prediction of Referral and Outcome - Yellow Flags tool) were captured during the physical therapy evaluation. Generalized linear models were used to assess the association between pain intensity, psychological distress, and pain-related co-morbidities. Models were adjusted for variables shown in the literature to influence pain. RESULTS 532 participants were included in the cohort (56.4% female; median age of 59 years, Interquartile Range [IQR]:47, 69). Comorbid depression (beta coefficient (β) = 0.7; 95%CI: 0.2, 1.2), spine versus lower extremity pain ((β = 0.6; 95%CI: 0.1, 1.1), and prior surgery (β = 0.8, 95%CI: 0.3, 1.4) were associated with higher pain intensity scores. No pain-related comorbidities were associated with pain-related psychological distress (yellow flag count or number of domains). Female sex was associated with less pain-related psychological distress (β = -0.2, 95%CI: -0.3, -0.02). CONCLUSIONS Depression was associated with greater pain intensity. No comorbidities were able to account for the extent of pain-related psychological distress.
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Affiliation(s)
- Steven L Spoonemore
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, United States; U.S. Public Health Service, Intrepid Spirit Center, Fort Carson, CO, United States.
| | - Ryan C McConnell
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, United States; Department of Physical Therapy, Belmont University, Nashville, TN, United States
| | - William E Owen
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, United States
| | - Jodi L Young
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, United States
| | - Derek J Clewley
- Physical Therapy Division, Duke University School of Medicine, Durham, NC, United States
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, United States; Department of Rehabilitation Medicine, School of Medicine, The Uniformed Services University of Health Sciences, Bethesda, MD, United States
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Dunbar MS, Rodriguez A, Edelen MO, Hays RD, Coulter ID, Siconolfi D, Herman PM. Longitudinal Associations of PROMIS-29 Anxiety and Depression Symptoms With Low Back Pain Impact in a Sample of U.S. Military Service Members. Mil Med 2023; 188:e630-e636. [PMID: 34417805 DOI: 10.1093/milmed/usab339] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/22/2021] [Accepted: 08/10/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The Impact Stratification Score (ISS) is a measure of the impact of chronic low back pain (LBP) consisting of nine Patient-Reported Outcomes Measurement Information System (PROMIS-29) items, but no studies have examined the ISS or its association with psychological symptoms in military samples. This study examines longitudinal associations between psychological symptoms and the ISS among military service members. MATERIAL AND METHODS The study involved secondary data analysis of a sample of active duty U.S. military service members aged 18-50 years with LBP (n = 733). Participants completed the PROMIS-29 at three time points during treatment: baseline (time 1, T1), week 6 of treatment (time 2, T2), and week 12 of treatment (time 3, T3). The impact of LBP was quantified using the ISS (ranging from 8 = least impact to 50 = greatest impact). Psychological symptoms were assessed as PROMIS-29 anxiety and depression scores. Separate autoregressive cross-lagged models examined reciprocal associations of ISSs with anxiety, depression, and emotional distress scores from T1 to T3. RESULTS Within each time point, the ISS was significantly and positively correlated with anxiety and depression. In autoregressive cross-lagged models, anxiety and depression predicted the ISS at the next time point and associations were similar in magnitude (e.g., anxiety T2 to ISS T3: β = 0.12, P < .001; depression T2 to ISS T3: β = 0.12, P <.001). The ISS did not predict future depression or emotional distress scores at any time point, but the ISS at T2 was significantly, positively associated with anxiety scores at T3 (β = 0.07, P = .04). CONCLUSION Psychological symptoms consistently and prospectively predict the impact of LBP as measured by the ISS among service members undergoing pain treatment. The ISS may also be associated with future anxiety but not depression. PROMIS-29 anxiety and depression items may be useful adjunctive measures to consider when using the ISS to support LBP treatment planning and monitoring with service members.
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Affiliation(s)
| | | | - Maria O Edelen
- RAND Corporation, Boston, MA 02116, USA
- Department of Surgery, Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, MA 02120, USA
| | - Ron D Hays
- RAND Corporation, Santa Monica, CA 90401, USA
- Department of Medicine, University of California, Los Angeles, CA 90024, USA
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Haider S, Janowski AJ, Lesnak JB, Hayashi K, Dailey DL, Chimenti R, Frey-Law LA, Sluka KA, Berardi G. A comparison of pain, fatigue, and function between post-COVID-19 condition, fibromyalgia, and chronic fatigue syndrome: a survey study. Pain 2023; 164:385-401. [PMID: 36006296 PMCID: PMC9797623 DOI: 10.1097/j.pain.0000000000002711] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/02/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT A growing number of individuals report prolonged symptoms following acute Coronavirus-19 (COVID-19) infection, known as post-COVID-19 condition (post-COVID-19). While studies have emerged investigating the symptom sequelae of post-COVID-19, there has been limited investigation into the characterization of pain, fatigue, and function in these individuals, despite initial reports of a clinical phenotype similar to fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME). This study aimed to characterize multiple symptom domains in individuals reporting post-COVID-19 and compare its clinical phenotype with those with FMS and CFS. A total of 707 individuals with a single or comorbid diagnosis of post-COVID-19, FMS, and/or CFS completed multiple surveys assessing self-reported pain, fatigue, physical and cognitive function, catastrophizing, kinesiophobia, anxiety, depression, dyspnea, and sleep quality. In all 3 diagnoses, elevated pain, fatigue, anxiety, depression, catastrophizing, and kinesiophobia were reported. Physical and cognitive function were similarly impacted among individuals with post-COVID-19, FMS, and CFS; however, individuals with post-COVID-19 reported lower pain and fatigue than FMS and CFS. The comorbid diagnosis of post-COVID-19 with FMS and/or CFS further exacerbated pain, fatigue, and psychological domains when compared with post-COVID-19 alone. In summary, individuals with post-COVID-19 report a symptom phenotype similar to FMS and CFS, negatively impacting cognitive and physical function, but with less severe pain and fatigue overall. These findings may help direct future investigations of the benefit of a biopsychosocial approach to the clinical management of post-COVID-19.
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Affiliation(s)
- Saman Haider
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Adam J. Janowski
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Joseph B. Lesnak
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Kazuhiro Hayashi
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Dana L. Dailey
- Department of Physical Therapy, St. Ambrose University, Davenport, IA 52803
| | - Ruth Chimenti
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Laura A. Frey-Law
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Giovanni Berardi
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
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Heuch I, Heuch I, Hagen K, Storheim K, Zwart JA. Menopausal hormone therapy, oral contraceptives and risk of chronic low back pain: the HUNT Study. BMC Musculoskelet Disord 2023; 24:84. [PMID: 36721124 PMCID: PMC9887847 DOI: 10.1186/s12891-023-06184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are indications that use of menopausal hormone therapy (MHT) and oral contraceptives (OC) increases the risk of low back pain (LBP), with higher oestrogen levels involved in the underlying mechanisms. The purpose of the present study was to investigate associations between use of systemic MHT or OC and risk of chronic LBP in a large population-based data set. METHODS Data were obtained from two surveys in the Trøndelag Health Study in Norway, HUNT2 (1995-1997) and HUNT3 (2006-2008). A cross-sectional study of association between use of systemic MHT and prevalence of chronic LBP comprised 12,974 women aged 40-69 years in HUNT2, with 4007 women reporting chronic LBP. A cohort study involving MHT comprised 6007 women without chronic LBP at baseline in HUNT2, and after 11 years 1245 women reported chronic LBP at follow-up in HUNT3. The cross-sectional study of association with use of OC included 23,593 women aged 20-69 years in HUNT2, with 6085 women reporting chronic LBP. The corresponding cohort study included 10,586 women without chronic LBP at baseline in HUNT2, of whom 2084 women reported chronic LBP in HUNT3. Risk of chronic LBP was examined in both study designs in generalised linear models with adjustment for potential confounders. RESULTS In the cohort study, current users of systemic MHT at baseline showed a greater risk of chronic LBP (relative risk (RR) 1.30; 95% CI: 1.14-1.49; compared with never users). The risk increased according to duration of MHT use (P for linear trend = 0.003). Known users of systemic MHT based exclusively on oestrogen experienced the highest risk (RR 1.49; 95% CI: 1.16-1.91), but an increased risk was also seen among known users of oestrogen-progestin combination MHT (RR 1.35; 95% CI: 1.16-1.57). A slight increase in risk of chronic LBP was found in the cohort study among former users of OC (RR 1.17; 95% CI: 1.06-1.30; compared with never users). CONCLUSIONS Long-lasting use of systemic MHT, in particular therapy based on oestrogen only, is associated with greater risk of chronic LBP. Having been a user of OC most likely entails a minor increase in risk.
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Affiliation(s)
- Ingrid Heuch
- grid.55325.340000 0004 0389 8485Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Nydalen, P.O. Box 4956, N-0424 Oslo, Norway
| | - Ivar Heuch
- grid.7914.b0000 0004 1936 7443Department of Mathematics, University of Bergen, Bergen, Norway
| | - Knut Hagen
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Clinical Research Unit Central Norway, St. Olavs Hospital, Trondheim, Norway
| | - Kjersti Storheim
- grid.55325.340000 0004 0389 8485Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Nydalen, P.O. Box 4956, N-0424 Oslo, Norway ,grid.412414.60000 0000 9151 4445Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - John-Anker Zwart
- grid.55325.340000 0004 0389 8485Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Nydalen, P.O. Box 4956, N-0424 Oslo, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway
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Hayes CJ, Gannon MA, Woodward EN, Long CR, George M, Ray-Griffith S, Tobey LR, Goree J. Implementation and Preliminary Effectiveness of a Multidisciplinary Telemedicine Pilot Initiative for Patients with Chronic Non-Cancer Pain in Rural and Underserved Areas at a Major Academic Medical Center. J Pain Res 2023; 16:55-69. [PMID: 36636266 PMCID: PMC9831086 DOI: 10.2147/jpr.s383212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/24/2022] [Indexed: 01/06/2023] Open
Abstract
Background Arkansas lacks adequate access to high-quality pain care, as evidenced, in part, by it having the second highest opioid prescribing rate in the United States. To improve access to high-quality treatment of chronic pain, we developed the Arkansas Improving Multidisciplinary Pain Care and Treatment (AR-IMPACT) Telemedicine Clinic, a multidisciplinary and interprofessional team of specialists who provide evidence-based pain management for patients with chronic pain. Methods We conducted a single-arm pilot trial of the AR-IMPACT Telemedicine Clinic with rural, university-affiliated primary care clinics. We assessed the AR-IMPACT Telemedicine Clinic using an implementation framework and preliminary effectiveness measures. Specifically, we assessed 5 of the 8 implementation outcomes of the framework (ie, penetration, adoption, acceptability, appropriateness, and feasibility) using a mixed methods approach. To evaluate implementation outcomes, we used surveys, interviews, and administrative data. We used electronic health record data to measure preliminary effectiveness (ie, changes in average morphine milligram equivalents per day and pain and depression scores). Results The AR-IMPACT team saw 23 patients that were referred by 13 primary care physicians from three rural, university-affiliated primary care clinics over one year. Of the 19 patients willing to participate in the pilot study, 12 identified as women, 31.6% identified as Black, and over 50% had less than a bachelor's level education. Patients rated the clinic positively with high overall satisfaction. Referring physicians indicated high levels of appropriateness, acceptability, and feasibility of the program. AR-IMPACT team members identified several barriers and facilitators to the feasibility of implementing the program. No changes in preliminary effectiveness measures were statistically significant. Conclusion Overall, the AR-IMPACT Telemedicine Clinic obtained moderate penetration and adoption, was highly acceptable to patients, was highly acceptable and appropriate to providers, and was moderately feasible to providers and AR-IMPACT team members.
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Affiliation(s)
- Corey J Hayes
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA,Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA,Correspondence: Corey J Hayes, Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 782, Little Rock, AR, 72205, USA, Tel +501 526-8113, Email
| | - Matthew A Gannon
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, 72701, USA
| | - Eva N Woodward
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA,Center for Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Christopher R Long
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, 72701, USA
| | - Masil George
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Shona Ray-Griffith
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA,Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Leah R Tobey
- Center for Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Johnathan Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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Ju P, Zhao D, Zhu C, Zheng Y, Peng S, Wu H, Yang B, Yi Z, Yuan T, Chen J. Deep Transcranial Magnetic Stimulation as a Potential Approach for Digital Pain Management in Patients with Psychotic Disorder. Neurosci Bull 2023; 39:89-93. [PMID: 35836055 PMCID: PMC9849504 DOI: 10.1007/s12264-022-00919-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/14/2022] [Indexed: 01/22/2023] Open
Affiliation(s)
- Peijun Ju
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 201108, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 201108, China
| | - Di Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 201108, China
| | - Cuizhen Zhu
- Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People's Hospital, Hefei, 230022, China
- Anhui Mental Health Center, Hefei, 230022, China
| | - Yongjun Zheng
- Department of Pain Management, HuaDong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Shiyu Peng
- School of Life Sciences, Westlake Institute for Advanced Study, Westlake University, Hangzhou, 310024, China
| | - Haisu Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 201108, China
| | - Beibei Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 201108, China
| | - Zhenghui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 201108, China.
| | - Tifei Yuan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 201108, China.
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226019, China.
| | - Jinghong Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 201108, China.
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18
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Chandrupatla RS, Shahidi B, Bruno K, Chen JL. A Retrospective Study on Patient-Specific Predictors for Non-Response to Sacroiliac Joint Injections. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15519. [PMID: 36497595 PMCID: PMC9739978 DOI: 10.3390/ijerph192315519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 06/17/2023]
Abstract
Intra-articular or peri-articular corticosteroid injections are often used for treatment of sacroiliac joint (SIJ) pain. However, response to these injections is variable and many patients require multiple injections for sustained benefit. In this study, we aim to identify patient-specific predictors of response or non-response to SIJ injections. Identification of these predictors would allow providers to better determine what treatment would be appropriate for a patient with SIJ pain. A retrospective review of 100 consecutive patient charts spanning a 2-year period at an academic multi-specialty pain center was conducted and a multivariate regression analysis was used to identify patient-specific predictors of response to SIJ injections. Our analysis identified that a history of depression and anxiety (OR: 0.233, 95%CI: 0.057-0.954) and increased age (OR: 0.946, 95%CI: 0.910-0.984) significantly reduced the odds of responding to injections. We also found that the associated NPRS score change for SIJ injection responders was less than the minimally clinically significant value of a 2-point differential, suggesting that reported changes in pain scores may not accurately represent a patient's perception of success after SIJ injection. These findings warrant further investigation through a prospective study and can potentially influence clinical decision making and prognosis for patients receiving SIJ injections.
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Affiliation(s)
- Rahul S. Chandrupatla
- School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Bahar Shahidi
- Department of Orthopaedic Surgery, University of California San Diego, 9500 Gilman Drive (MC0863), La Jolla, San Diego, CA 92093, USA
| | - Kelly Bruno
- Department of Anesthesiology, Division of Pain Medicine, University of California San Diego, 9300 Campus Point Drive (MC 7651), La Jolla, CA 92037, USA
| | - Jeffrey L. Chen
- Department of Anesthesiology, Division of Pain Medicine, University of California San Diego, 9300 Campus Point Drive (MC 7651), La Jolla, CA 92037, USA
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Salmasi V, Lii TR, Humphreys K, Reddy V, Mackey SC. A literature review of the impact of exclusion criteria on generalizability of clinical trial findings to patients with chronic pain. Pain Rep 2022; 7:e1050. [PMID: 36398200 PMCID: PMC9663135 DOI: 10.1097/pr9.0000000000001050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
The ability of clinical trials to inform the care of chronic pain may be limited if only an unrepresentative subset of patients are allowed to enroll. We summarize and report new insights on published studies that report on how trial exclusions affect the generalizability of their results. We conducted a PubMed search on the following terms: (("eligibility criteria" AND generalizability) OR ("exclusion criteria" AND generalizability) OR "exclusion criteria"[ti] OR "eligibility criteria"[ti]) AND pain. We only considered studies relevant if they analyzed data on (1) the prevalence and nature of exclusion criteria or (2) the impact of exclusion criteria on sample representativeness or study results. The 4 articles that were identified reported differences in patients who were included and excluded in different clinical trials: excluded patients were older, less likely to have a paid job, had more functional limitations at baseline, and used strong opioids more often. The clinical significance of these differences remains unclear. The pain medicine literature has very few published studies on the prevalence and impact of exclusion criteria, and the outcomes of excluded patients are rarely tracked. The frequent use of psychosocial exclusions is especially compromising to generalizability because chronic pain commonly co-occurs with psychiatric comorbidities. Inclusion of more representative patients in research samples can reduce recruitment barriers and broaden the generalizability of findings in patients with chronic pain. We also call for more studies that examine the use of exclusion criteria in chronic pain trials to better understand their implications.
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Affiliation(s)
- Vafi Salmasi
- Departments of Anesthesiology, Perioperative and Pain Medicine and
| | - Theresa R. Lii
- Departments of Anesthesiology, Perioperative and Pain Medicine and
| | - Keith Humphreys
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Healthcare System, Palo Alto, CA, USA
| | - Vinay Reddy
- Departments of Anesthesiology, Perioperative and Pain Medicine and
| | - Sean C. Mackey
- Departments of Anesthesiology, Perioperative and Pain Medicine and
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Williamson TK, Passfall L, Ihejirika-Lomedico R, Espinosa A, Owusu-Sarpong S, Lanre-Amos T, Schoenfeld AJ, Passias PG. Assessing the influence of modifiable patient-related factors on complication rates after adult spinal deformity surgery. Bone Joint J 2022; 104-B:1249-1255. [DOI: 10.1302/0301-620x.104b11.bjj-2022-0574.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aims Postoperative complication rates remain relatively high after adult spinal deformity (ASD) surgery. The extent to which modifiable patient-related factors influence complication rates in patients with ASD has not been effectively evaluated. The aim of this retrospective cohort study was to evaluate the association between modifiable patient-related factors and complications after corrective surgery for ASD. Methods ASD patients with two-year data were included. Complications were categorized as follows: any complication, major, medical, surgical, major mechanical, major radiological, and reoperation. Modifiable risk factors included smoking, obesity, osteoporosis, alcohol use, depression, psychiatric diagnosis, and hypertension. Patients were stratified by the degree of baseline deformity (low degree of deformity (LowDef)/high degree of deformity (HighDef): below or above 20°) and age (Older/Younger: above or below 65 years). Complication rates were compared for modifiable risk factors in each age/deformity group, using multivariable logistic regression analysis to adjust for confounders. Results A total of 480 ASD patients met the inclusion criteria. By two years, complication rates were 72% ≥ one complication, 28% major, 21% medical, 27% surgical, 11% major radiological, 8% major mechanical, and 22% required reoperation. Younger LowDef patients with osteoporosis were more likely to suffer either a major mechanical (odds ratio (OR) 5.9 (95% confidence interval (CI) 1.1 to 36.9); p = 0.048) or radiological complication (OR 7.0 (95% CI 1.9 to 25.9); p = 0.003). Younger HighDef patients were much more likely to develop complications if obese, especially major mechanical complications (OR 2.8 (95% CI 1.1 to 8.6); p = 0.044). Older HighDef patients developed more complications when diagnosed with depression, including major radiological complications (OR 3.5 (95% CI 1.1 to 10.6); p = 0.033). Overall, a diagnosis of depression proved to be a risk factor for the development of major radiological complications (OR 2.4 (95% CI 1.3 to 4.5); p = 0.005). Conclusion Certain modifiable patient-related factors, especially osteoporosis, obesity, and mental health status, are associated with an increased risk of complications after surgery for spinal deformity. Surgeons should look for these conditions when assessing a patient for surgery, and optimize them to the fullest extent possible before proceeding to surgical correction so as to minimize the prospect of postoperative morbidity. Cite this article: Bone Joint J 2022;104-B(11):1249–1255.
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Affiliation(s)
- Tyler K. Williamson
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
| | - Lara Passfall
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
| | - Rivka Ihejirika-Lomedico
- Department of Orthopaedic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
| | - Annie Espinosa
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
| | - Stephane Owusu-Sarpong
- Department of Orthopaedic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
| | - Tomi Lanre-Amos
- Department of Orthopaedic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
| | - Andrew J. Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Peter G. Passias
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
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Hochheim M, Ramm P, Wunderlich M, Amelung V. Association between chronic low back pain and regular exercise, sedentary behaviour and mental health before and during COVID-19 pandemic: insights from a large-scale cross-sectional study in Germany. BMC Musculoskelet Disord 2022; 23:860. [PMID: 36104661 PMCID: PMC9474280 DOI: 10.1186/s12891-022-05806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nonspecific chronic low back pain (CLBP) is a complex symptom with numerous possible causes and influencing factors. Understanding how modifiable factors affect the course of CLBP is important for preventing progression. As the COVID-19 pandemic has changed the lifestyle of many people, this study paper assessed whether it also changed the influence of modifiable lifestyle factors (regular exercise and sedentary behaviour) and mental health factors (anxiety and depression) on CLBP pain intensity and disability by comparing the strength of these associations before and during the pandemic. We hypothesised that the importance of regular physical activity and good mental health for CLBP patients would increase during the pandemic.
Methods
These questions were investigated in a cross-sectional study of insurance claims data and self-reported data from various questionnaires from 3,478 participants in a German CLBP health intervention (2014–2021) by calculating pre- and intra-pandemic odds ratios (OR) and 95% confidence intervals (CI) for each variable of interest and outcome. Potential confounders were also considered. Pandemic status was treated as an effect modifier. Based on the date of enrolment, participants were classified as “pre-pandemic” or “pandemic”.
Results
Regularly exercising ≥ 4 h/week significantly reduced the odds of high disability for men (OR 0.49, 95% CI 0.31 – 0.79, p = 0.003) and women (OR 0.30, 95% CI 0.14 – 0.563, p = 0.002) and reduced the probability of severe pain in women (OR 0.37, 95% CI 0.21 – 0.65, p < 0.001). Each one-point increase in PHQ-4 score for anxiety and depression increased the OR of high pain intensity by 1.25 points (95% CI 1.18 – 1.34, p < 0.001). A clear impact of COVID-19 lockdowns was observed. In individuals who exercised ≥ 4 h/week the OR of high disability was 0.57 (95% CI 0.36 – 0.92, p = 0.021) in the pre-pandemic group compared to 0.29 (95% CI 0.12 – 0.56, p = 0.002) in the pandemic group. The probability of high disability increased from an OR of 1.42 (95% CI 1.33 – 1.52, p < 0.001) per marginal increase in the PHQ-4 scale before the pandemic, to an OR of 1.73 (95% CI 1.58 – 1.89, p < 0.001) during the pandemic.
Conclusions
The magnitude of association of the factors that influenced high pain intensity and disability increased during the pandemic. On the one hand, the protective effect of regular exercising was greater in participants surveyed during lockdown. On the other hand, a higher risk through anxiety or depression during the lockdown was identified. An additional study with objective measures of sedentary behaviour and physical activity is needed to validate these results. More in-depth investigation of lockdown-induced associations between reduced daily physical activity, increased levels of anxiety and depression, and their effects on CLPB could also be worthwhile.
Trial registration
This study used routinely collected data from a CLBP intervention that was previously evaluated and registered in the German Registry of Clinical Trials under DRKS00015463 (04/09/2018). The original ethics approval, informed consent and self-reported questionnaire have remained unchanged and are still valid.
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22
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Stillianesis G, Cavaleri R, Summers SJ, Tang C. Exploring patient perceptions of repetitive transcranial magnetic stimulation as a treatment for chronic musculoskeletal pain: a qualitative study. BMJ Open 2022; 12:e058928. [PMID: 35918117 PMCID: PMC9351339 DOI: 10.1136/bmjopen-2021-058928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/20/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS), a form of non-invasive brain stimulation, is a novel avenue for the management of chronic musculoskeletal pain. Despite evidence for the effectiveness of rTMS in chronic pain conditions, the clinical uptake of rTMS remains limited and little is known regarding patient perceptions of this therapeutic technique. DESIGN Qualitative study using a phenomenological approach, reported in accordance with the Consolidated criteria for Reporting Qualitative research checklist. SETTING Sydney, Australia. PARTICIPANTS Fifteen participants were recruited from the community and completed the study. All participants had a diagnosis of chronic musculoskeletal pain, a history of seeking treatment and no prior experience with rTMS. METHODS AND ANALYSIS All participants completed a semistructured interview to explore overall knowledge, preconceived concerns and attitudes regarding rTMS as a treatment for chronic musculoskeletal pain. The interviews were transcribed verbatim and analysed thematically. RESULTS The key themes that influenced an individual's hypothetical acceptance of rTMS for chronic pain management were (1) the individual's initial impression of the equipment appearance, (2) the participant's individual history and familiarity with technology, (3) the accessibility and availability of rTMS and (4) knowledge regarding pain physiology and rTMS. CONCLUSIONS This was the first qualitative study to explore the perception of rTMS as a treatment among people with chronic musculoskeletal pain. RTMS appears to be accepted as a treatment option among individuals with chronic musculoskeletal pain. Developing targeted strategies to address accessibility, funding support and medical endorsements may encourage use of rTMS in a clinical chronic pain setting.
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Affiliation(s)
- Georgia Stillianesis
- Physiotherapy, Western Sydney University, Penrith South, New South Wales, Australia
- Brain Stimulation and Rehabilitation Lab, Western Sydney University, Penrith South, New South Wales, Australia
| | - Rocco Cavaleri
- Physiotherapy, Western Sydney University, Penrith South, New South Wales, Australia
- Brain Stimulation and Rehabilitation Lab, Western Sydney University, Penrith South, New South Wales, Australia
| | - Simon J Summers
- Brain Stimulation and Rehabilitation Lab, Western Sydney University, Penrith South, New South Wales, Australia
- School of Biomedical Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Clarice Tang
- Physiotherapy, Western Sydney University, Penrith South, New South Wales, Australia
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23
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Boody BS, Sperry BP, Harper K, Macadaeg K, McCormick ZL. The Relationship Between Patient Demographic and Clinical Characteristics and Successful Treatment Outcomes After Basivertebral Nerve Radiofrequency Ablation: A Pooled Cohort Study of Three Prospective Clinical Trials. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:S2-S13. [PMID: 35856330 PMCID: PMC9297161 DOI: 10.1093/pm/pnac050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Multiple studies have demonstrated the safety and effectiveness of basivertebral nerve radiofrequency ablation (BVN RFA) for improving low back pain related to the vertebral endplate. However, the influence of patient demographic and clinical characteristics on treatment outcome is unknown. DESIGN Pooled cohort study of three clinical trials of patients with vertebral endplate pain identified by Type 1 and/or Type 2 Modic changes and a correlating presentation of anterior spinal element pain. SETTING Thirty-three global study centers. SUBJECTS Patients (n = 296) successfully treated with BVN RFA. METHODS Participant demographic and clinical characteristics were analyzed with stepwise logistic regression to identify predictors of treatment success. Three definitions of treatment success were defined: 1) ≥50% visual analog scale pain improvement, 2) ≥15-point Oswestry Disability Index (ODI) improvement, and 3) ≥50% visual analog scale or ≥15-point ODI improvement from baseline. RESULTS Low back pain of ≥5 years' duration and higher ODI scores at baseline increased the odds of treatment success, whereas baseline opioid use and higher Beck Depression Inventory scores reduced these odds. However, the three regression models demonstrated receiver-operating characteristics of 62-70% areas under the curve, and thus, limited predictive capacity. CONCLUSIONS This analysis identified no demographic or clinical characteristic that meaningfully increased or reduced the odds of treatment success from BVN RFA. On the basis of these findings and the high response rates from the three analyzed trials, we recommend the use of objective imaging biomarkers (Type 1 and/or 2 Modic changes) and a correlating presentation of anterior spinal element pain to determine optimal candidacy for BVN RFA.
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Affiliation(s)
| | - Beau P Sperry
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | - Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
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24
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Patterson T, Beckenkamp P, Ferreira M, Bauman A, Carvalho-E-Silva AP, Ferreira LC, Ferreira P. The impact of different intensities and domains of physical activity on analgesic use and activity limitation in people with low back pain: a prospective cohort study with a one-year follow-up. Eur J Pain 2022; 26:1636-1649. [PMID: 35642334 PMCID: PMC9544541 DOI: 10.1002/ejp.1987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Analgesics are the most common form of managing low back pain (LBP). No previous study has examined which domains and intensities of physical activity are most beneficial in reducing the frequency of analgesic use for LBP, and its related activity limitation. METHODS This cohort study forms part of the AUstralian Twin low BACK pain study, investigating the impact of physical activity on LBP. Information on demographics, LBP and health-related factors, including physical activity were collected at baseline. Data on the total counts of analgesic use and activity limitation for LBP were collected weekly for one-year. Negative binomial regression models were conducted separately for each type of physical activity. Results were presented as Incidence Rate Ratios (IRR) and 95% Confidence Intervals (CI). RESULTS From an initial sample of 366 participants, 86 participants reported counts of analgesic use and 140 recorded counts of activity limitation across the follow up period. The negative binomial regression models for analgesic use counts indicated moderate-vigorous physical activity (IRR 0·97, 95% C.I 0·96-0·99) and physical workload (IRR 1·02, 95% C.I 1·01-1·05) to be significant. For activity limitation counts, significant associations were shown for sedentary time (IRR 1·04, 95% C.I 1·01-1·09) and leisure activity (IRR 0·94, 95% C.I 0·81-0·99). CONCLUSIONS Our findings highlight the potential importance of supporting engagement in moderate-vigorous and leisure physical activity, as well as minimising sedentary time and physical workload to reduce the risk of activity limitation and the need for analgesic use in people with LBP.
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Affiliation(s)
- Thomas Patterson
- The University of Sydney, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Susan Walking Building D18 Western Avenue, Camperdown, NSW, Australia
| | - Paula Beckenkamp
- The University of Sydney, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Susan Walking Building D18 Western Avenue, Camperdown, NSW, Australia
| | - Manuela Ferreira
- The University of Sydney, Sydney Musculoskeletal Health, School of Health Sciences, The Kolling Institute of Medical Research, Faculty of Medicine and Health, Kolling Building, St Leonards, NSW, Australia
| | - Adrian Bauman
- The University of Sydney, Public Health, Sydney School of Public Health, Faculty of Medicine and Health, Edward Ford Building A27 Fisher Rd, Camperdown, NSW, Australia
| | - Ana Paula Carvalho-E-Silva
- The University of Sydney, Public Health, Sydney School of Public Health, Faculty of Medicine and Health, Edward Ford Building A27 Fisher Rd, Camperdown, NSW, Australia
| | - Lucas Calais Ferreira
- The University of Melbourne, Twins Research Australia Unit, School of Population and Global Health, 207 Bouverie St, Carlton, VIC, Australia
| | - Paulo Ferreira
- The University of Sydney, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Susan Walking Building D18 Western Avenue, Camperdown, NSW, Australia
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25
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Wong JJ, Tricco AC, Côté P, Liang CY, Lewis JA, Bouck Z, Rosella LC. Association Between Depressive Symptoms or Depression and Health Outcomes for Low Back Pain: a Systematic Review and Meta-analysis. J Gen Intern Med 2022; 37:1233-1246. [PMID: 34383230 PMCID: PMC8971223 DOI: 10.1007/s11606-021-07079-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Study results vary on whether depressive symptoms are associated with worse prognosis for low back pain (LBP). We assessed the association between depressive symptoms or depression and health outcomes in persons with LBP. METHODS We searched MEDLINE, Embase, CINAHL, and PsycINFO from inception to June 2020. Eligible studies were cohort and case-control studies assessing the association between depressive symptoms (questionnaires) or depression (diagnoses) and health outcomes in persons aged ≥16 years with LBP in the absence of major pathology. Reviewers independently screened articles, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. We classified exploratory versus confirmatory studies based on phases of prognostic factor investigation. We conducted random-effects meta-analyses and descriptive synthesis where appropriate. RESULTS Of 13,221 citations screened, we included 62 studies (63,326 participants; 61 exploratory studies, 1 confirmatory study). For acute LBP, depressive symptoms were associated with self-reported disability (descriptive synthesis: 6 studies), worse recovery (descriptive synthesis: 5 studies), and slower traffic injury-related claim closure (1 study), but not pain or work-related outcomes. Depressive symptoms were associated with greater primary healthcare utilization for acute LBP (1 confirmatory study). For chronic LBP, depressive symptoms were associated with higher pain intensity (descriptive synthesis: 9 studies; meta-analysis: 3 studies, 2902 participants, β=0.11, 95% confidence interval (CI) 0.05-0.17), disability (descriptive synthesis: 6 studies; meta-analysis: 5 studies, 3549 participants, β=0.16, 95% CI 0.04-0.29), and worse recovery (descriptive synthesis: 2 studies; meta-analysis: 2 studies, 13,263 participants, relative risk (RR)=0.91, 95% CI 0.88-0.95), but not incident chronic widespread pain (1 study). DISCUSSION Depressive symptoms may be associated with self-reported disability and worse recovery in persons with acute and chronic LBP, and greater primary healthcare utilization for acute LBP. Our review provides high-quality prognostic factor information for LBP. Healthcare delivery that addresses depressive symptoms may improve disability and recovery in persons with LBP. Confirmatory studies are needed to assess the association between depressive symptoms and health outcomes in persons with LBP. PROTOCOL REGISTRATION PROSPERO database (CRD42019130047).
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Affiliation(s)
- Jessica J Wong
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada. .,Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada.
| | - Andrea C Tricco
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1W8, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, Ontario, M5B 1T8, Canada
| | - Pierre Côté
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada.,Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, Ontario, M5B 1T8, Canada.,Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
| | - Catherine Y Liang
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - Jeremy A Lewis
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - Zachary Bouck
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada.,Centre for Drug Policy and Evaluation, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Laura C Rosella
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada.,ICES, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Stephen Family Chair in Community Health, Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, Ontario, L5B 1B8, Canada
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26
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Bisby MA, Karin E, Scott AJ, Dudeney J, Fisher A, Gandy M, Hathway T, Heriseanu AI, Staples L, Titov N, Dear BF. Examining the psychometric properties of brief screening measures of depression and anxiety in chronic pain: The Patient Health Questionnaire 2-item and Generalized Anxiety Disorder 2-item. Pain Pract 2022; 22:478-486. [PMID: 35258171 PMCID: PMC9311649 DOI: 10.1111/papr.13107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 01/01/2023]
Abstract
Objective Individuals with chronic pain experience anxiety and depressive symptoms at rates higher than the general population. The Patient Health Questionnaire 2‐item (PHQ‐2) and Generalized Anxiety Disorder 2‐item (GAD‐2) are brief screening measures of depression and anxiety, respectively. These brief scales are well‐suited for use in routine care due to their brevity and ease of administration, yet their psychometric properties have not been established in heterogeneous chronic pain samples when administered over the Internet. Materials and Methods Using existing data from randomized controlled trials of an established Internet‐delivered pain management program (n = 1333), we assessed the reliability, validity, diagnostic accuracy, and responsiveness to treatment change in the PHQ‐2 and GAD‐2, as well as the long‐form counterparts. Exploratory analyses were conducted to obtain cutoff scores using those participants with diagnostic data (n = 62). Results The PHQ‐2 and GAD‐2 demonstrated appropriate reliability (eg, Cronbach's α = 0.79–0.84), validity (eg, higher scores in individuals with a diagnosis; p < 0.001), and responsiveness to treatment change (eg, pre‐ to post‐treatment scores, p < 0.001). The psychometric properties of the short forms compared well with the longer forms. Cutoff scores on the short forms were consistent with general population samples, while cutoff scores on the long forms were higher than previously observed using general population samples. All four scales favored specificity over sensitivity. Conclusions The PHQ‐2 and GAD‐2 demonstrated acceptable psychometric properties in the current sample, as did the long forms. Based on our findings, the PHQ‐2 and GAD‐2 can be used as screening tools with chronic pain samples when administered over the Internet.
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Affiliation(s)
- Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Eyal Karin
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Amelia J Scott
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Joanne Dudeney
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Alana Fisher
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Milena Gandy
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Taylor Hathway
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Andreea I Heriseanu
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Lauren Staples
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
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27
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Compton P, St Marie B. Coexisting Substance Use Disorder and Chronic Pain During COVID-19. Pain Manag Nurs 2022; 23:17-25. [PMID: 34620549 PMCID: PMC8418911 DOI: 10.1016/j.pmn.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/29/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Peggy Compton
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, 19104-4217.
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28
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Chen Y, Ju P, Xia Q, Cheng P, Gao J, Zhang L, Gao H, Cheng X, Yu T, Yan J, Wang Q, Zhu C, Zhang X. Potential Role of Pain Catastrophic Thinking in Comorbidity Patients of Depression and Chronic Pain. Front Psychiatry 2022; 13:839173. [PMID: 35898637 PMCID: PMC9309267 DOI: 10.3389/fpsyt.2022.839173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although comorbidity of major depressive disorder (MDD) and chronic pain (CP) has been well-studied, their association with pain catastrophizing is largely elusive. This study aimed to investigate the potential effects of pain catastrophizing in patients with a comorbidity. METHODS In total, 140 participants were included in this study and divided into three groups according to the Diagnostic and Statistical Manual of Mental Disorders and the International Association for the study of pain (i.e., the comorbidity group: patients with depression with chronic pain, n = 45; depression group: patients with depression without chronic pain, n = 47; and healthy controls: n = 48). The Hamilton Depression Rating Scale (HAMD)-24 and Hamilton Anxiety Rating Scale (HAMA)-14 were used by professional psychiatrists to evaluate the severity of depression and anxiety. Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) were conducted by patients' self-report to assess the symptom severity. The pain intensity numerical rating scale (PI-NRS) was used to assess the pain intensity. Pain Catastrophizing Scale (PCS) and Pain Anxiety Symptoms Scale (PASS) were used to estimate pain-related negative thinking. RESULTS The results showed that PASS and PCS scores were significantly different among the three groups. Particularly, the scores in the comorbidity group were the highest. The Pearson correlation analysis revealed a positive correlation between PCS (including the patients' helplessness, magnification, rumination, and total scores) and the severity of depression symptoms, anxiety symptoms, and pain intensity (P < 0.05). A stepwise regression analysis further demonstrated that the total PCS score, high monthly income level, and BDI score had positive impacts on PASS (P < 0.05). We also found that the total BDI score, disease course ≥1 year, and pain intensity had positive effects on PCS (P < 0.05), whereas years of education (≤ 12 years) had a negative effect on PCS (P = 0.012). In all, we have clearly demonstrated that PCS and PASS could serve as potentially predictive factors in patients suffering from comorbidity of MDD and CP. CONCLUSION Our results suggested that the pain-related catastrophic thinking and anxiety were more severe in the comorbidity group than in MDD-only group and healthy group. Pain-related catastrophizing thoughts and anxiety may have potentially effects on the comorbidity of depression and chronic pain.
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Affiliation(s)
- Yuanyuan Chen
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People's Hospital, Hefei, China.,Department of Geriatric Psychology, Anhui Mental Health Center, Hefei, China
| | - Peijun Ju
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Qingrong Xia
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People's Hospital, Hefei, China.,Department of Geriatric Psychology, Anhui Mental Health Center, Hefei, China
| | - Peng Cheng
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People's Hospital, Hefei, China.,Department of Geriatric Psychology, Anhui Mental Health Center, Hefei, China
| | - Jianliang Gao
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People's Hospital, Hefei, China.,Department of Geriatric Psychology, Anhui Mental Health Center, Hefei, China
| | - Loufeng Zhang
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People's Hospital, Hefei, China.,Department of Geriatric Psychology, Anhui Mental Health Center, Hefei, China
| | - Hua Gao
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People's Hospital, Hefei, China.,Department of Geriatric Psychology, Anhui Mental Health Center, Hefei, China
| | - Xialong Cheng
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People's Hospital, Hefei, China.,Department of Geriatric Psychology, Anhui Mental Health Center, Hefei, China
| | - Tao Yu
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People's Hospital, Hefei, China.,Department of Geriatric Psychology, Anhui Mental Health Center, Hefei, China
| | - Junwei Yan
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People's Hospital, Hefei, China.,Department of Geriatric Psychology, Anhui Mental Health Center, Hefei, China
| | - Qiru Wang
- Minhang Branch, Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Cuizhen Zhu
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People's Hospital, Hefei, China.,Department of Geriatric Psychology, Anhui Mental Health Center, Hefei, China
| | - Xulai Zhang
- Anhui Clinical Research Center for Mental Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Clinical Center for Mental and Psychological Diseases, Hefei Fourth People's Hospital, Hefei, China.,Department of Geriatric Psychology, Anhui Mental Health Center, Hefei, China
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29
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Turner HN, Oliver J, Compton P, Matteliano D, Sowicz TJ, Strobbe S, St Marie B, Wilson M. Pain Management and Risks Associated With Substance Use: Practice Recommendations. Pain Manag Nurs 2021; 23:91-108. [PMID: 34965906 DOI: 10.1016/j.pmn.2021.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/13/2021] [Indexed: 01/08/2023]
Abstract
Assessing and managing pain while evaluating risks associated with substance use and substance use disorders continues to be a challenge faced by health care clinicians. The American Society for Pain Management Nursing and the International Nurses Society on Addictions uphold the principle that all persons with co-occurring pain and substance use or substance use disorders have the right to be treated with dignity and respect, and receive evidence-based, high quality assessment, and management for both conditions. The American Society for Pain Management Nursing and International Nurses Society on Addictions have updated their 2012 position statement on this topic supporting an integrated, holistic, multidimensional approach, which includes nonopioid and nonpharmacological modalities. Opioid use disorder is used as an exemplar for substance use disorders and clinical recommendations are included with expanded attention to risk assessment and mitigation with interventions targeted to minimize the risk for relapse or escalation of substance use. Opioids should not be excluded for anyone when indicated for pain management. A team-based approach is critical, promotes the active involvement of the person with pain and their support systems, and includes pain and addiction specialists whenever possible. Health care systems should establish policies and procedures that facilitate and support the principles and recommendations put forth in this article.
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Affiliation(s)
| | - June Oliver
- Swedish Hospital, Northshore University Healthsystem, Chicago, IL.
| | | | | | | | | | - Barbara St Marie
- University of Iowa College of Nursing, Washington State University, College of Nursing
| | - Marian Wilson
- Oregon Health & Science University School of Nursing; Washington State University, College of Nursing
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30
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Moraes ÉBD, Martins Junior FF, Silva LBD, Garcia JBS, Mattos-Pimenta CAD. Self-efficacy and fear of pain to movement in chronic low back pain: an intervention developed by nurses. Rev Gaucha Enferm 2021; 42:e20200180. [PMID: 34878010 DOI: 10.1590/1983-1447.2021.20200180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 05/31/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To test the effect of interventions to chronic low back pain developed by nurses in the Program to Increase Self-efficacy and Reduce the Fear of Pain and Avoidance of Movement. METHOD Clinical trial, with 81 patients, carried out in 2016, at the Pain Outpatient Clinic in São Luís, Maranhão, Brazil. The groups received: A (education and exposure), B (education) and C (control). Chi-square, Fisher's Exact, ANOVA and Kruskal Wallis tests were performed. RESULTS Patients in groups A and B improved self-efficacy, anxiety, depression, and disability, compared to group C. The reduction in fear of pain and avoidance of movement was greater in Group A, which also showed a decrease in current pain and overall scores compared to Group B and C. CONCLUSION Education was effective in increasing the Self-Efficacy Belief. For the Belief of Fear of Pain and Avoidance of Movement and pain intensity, the association with exposure showed better results.
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Affiliation(s)
- Érica Brandão de Moraes
- Universidade Federal Fluminense (UFF), Escola de Enfermagem Aurora de Afonso Costa, Departamento de Fundamentos de Enfermagem e Administração. Niterói, Rio de Janeiro, Brasil
| | | | - Larissa Barros da Silva
- Universidade Federal do Maranhão (UFMA), Programa de Pós-graduação em Ciências da Saúde. São Luís, Maranhão, Brasil
| | - João Batista Santos Garcia
- Universidade Federal do Maranhão (UFMA), Faculdade de Medicina, Departamento de Medicina II. São Luís, Maranhão, Brasil
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Flynn DM, McQuinn H, Burke L, Steffen A, Fairchok A, Snow T, Doorenbos AZ. Use of Complementary and Integrative Health Therapies Prior to Intensive Functional Restoration in Active Duty Service Members with Chronic Pain. PAIN MEDICINE 2021; 23:844-856. [PMID: 34791423 DOI: 10.1093/pm/pnab326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 10/09/2021] [Accepted: 10/24/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Psychosocial factors are known to predict chronic pain, and the use of complementary and integrative health (CIH) therapies to address pain is emerging among military population. However, conflicting results on pain outcomes warrant additional research. This study aimed to (1) evaluate the benefit of adding a CIH pain management program to standard rehabilitative care (SRC), as compared to SRC alone, as precursor to an intensive functional restoration (FR) program; (2) identify factors that predict improvement in pain outcomes following treatment; and (3) determine the proportion of participants who experience clinically meaningful response. DESIGN Pragmatic randomized controlled clinical trial. Participants were randomized to a 3-week course of either SRC alone or SRC+CIH (stage 1), followed by a 3- to 6-week course of FR (stage 2). SETTING AND SUBJECTS Active duty service members with chronic pain. METHODS Participants completed either SRC alone or SRC+CIH (stage 1), followed by a course of FR (stage 2). Patient-reported and provider-determined outcomes were collected at baseline, after stage 1, and after stage 2. A covariance pattern model with unstructured residual covariance matrix was used to compare treatment arms while accounting for dependency due to repeated measurements. RESULTS A total of 210 service members participated. Most were Army (82%) and male (84%). Participants randomized to the SRC+CIH intervention had greater improvement in the pain impact score than those in the SRC alone group. Predictors of outcomes were baseline impact score, anger, depression, and educational status. CONCLUSIONS This study found that military service members with the highest pain impact benefit the most from interdisciplinary pain care.
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Affiliation(s)
| | | | - Larisa Burke
- College of Nursing, University of Illinois, Chicago, USA
| | - Alana Steffen
- College of Nursing, University of Illinois, Chicago, USA
| | | | - Tyler Snow
- Madigan Army Medical Center, Washington, USA
| | - Ardith Z Doorenbos
- College of Nursing, University of Illinois, Chicago, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
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Soleymani A, Masjedi Arani A, Raeissadat SA, Davazdahemami MH. Rumination-Focused Cognitive-Behavioral Therapy for Chronic Low Back Pain: A Randomized Controlled Trial. Galen Med J 2021; 9:e1722. [PMID: 34466577 PMCID: PMC8343985 DOI: 10.31661/gmj.v9i0.1722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/04/2020] [Accepted: 01/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Chronic pain remains or reappears for more than 3 to 6 months, and it is influencing 20% of the global population. The pain catastrophizing affects pain intensity and psychological conditions of patients with chronic pain. Rumination-focused cognitive-behavioral therapy (RFCBT) targets rumination as the key component of pain catastrophizing. The aim of this study was to determine the effectiveness of RFCBT on depression, anxiety, and pain severity of individuals with chronic low back pain (LBP). Materials and Methods: In a randomized controlled trial, 30 patients aged between 20-55 years with diagnosed chronic LBP were chosen by convenience sampling and randomly allocated into intervention and control groups. All patients used their prescribed medications for pain management, but the intervention group received 12 weekly sessions of RFCBT, which was manualized psychotherapy to change unconstructive rumination to constructive rumination. Depression Anxiety and Stress scale-21 and chronic pain grade questionnaire were administered as pre-tests and re-administered after 3 and 6 months as post-test and follow-up assessments, respectively. Results: RFCBT significantly reduced depression (F1=23.01, P=0.001), anxiety (F1=25.7, P=0.001) and pain severity (F1=7.17, P=0.012) in patients with chronic LBP. Conclusion: RFCBT may offer benefits for treating patients with chronic low back pain when added to their usual pharmacological treatment. This benefit may be the result of targeting rumination as the key element of pain catastrophizing.
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Affiliation(s)
- Ali Soleymani
- Department of Clinical Psychology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Masjedi Arani
- Department of Clinical Psychology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Correspondence to: Abbas Masjedi Arani Ph.D., Head of the department of clinical psychology Shahid Beheshti University of Medical Sciences Telephone Number: (+98)-21- 23031548 Email Address:
| | - Seyed Ahmad Raeissadat
- Department of Physical Medicine and Rehabilitation, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Personality Profile and Low Back Pain: Are Clinicians Missing an Important Factor That Influences Pain Perception and Treatment Options? NEUROSCI 2021. [DOI: 10.3390/neurosci2030019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Personality type can influence pain perception and prognosis. Therefore, it is important for clinicians to consider personality factors that may influence outcomes and understand personality inventories to garner a better understanding of how an individual may perceive pain. This paper explores different elements that contribute to low back pain (LBP) and evaluates a personality inventory reported in the medical literature. Understanding how to evaluate personality type as well as how to approach clinical interactions based on personality may help to provide context for the unique needs of individual patients when developing a plan of care to treat LBP.
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Fishman MA, Antony AB, Hunter CW, Pope JE, Staats PS, Agarwal R, Connolly AT, Dalal N, Deer TR. The Cost of Lost Productivity in an Opioid Utilizing Pain Sample. J Pain Res 2021; 14:2347-2357. [PMID: 34377015 PMCID: PMC8349546 DOI: 10.2147/jpr.s309691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aims Chronic pain affects more adults in the United States than any other condition. Opioid medications are widely used in the treatment of chronic pain, but there remains considerable risk and cost associated with their use. This study aims to characterize the effects of opioid prescribing for chronic pain and similar pain conditions on lost productivity in the United States. Methods This was a retrospective, longitudinal, observational study of chronic pain patients in 2011–2014. We identified patients with a diagnosis of musculoskeletal pain receiving index prescription for opioids in administrative claims and studied disability absence in a linked health and productivity management database. Patients were grouped as de novo and continued use opioid users before index, and by opioid dose in the year after index. Days of disability were compared before and after index with bootstrapping. Effect of opioid dose group on disability was evaluated with negative binomial regression. Lost productivity cost was compared before and after index. Results The cohort contained 16,273 de novo and 6604 continued use patients. On average, de novo patients used 24.8 days of disability after index, an increase of 18.3 more days compared to before (p < 0.001). Continued use patients used 30.7 days after index, 9 more days than before (p < 0.001). There was a dose–response relationship between dose group and days of disability in de novo patients (p < 0.001). The weighted-average cost per person of lost productivity was $4344 higher in the year after index compared to the year before. Conclusion Opioid prescriptions for pain patients were associated with significant disability use and lost productivity costs. With the evolution of opioid-prescribing practices, CDC recommendations, and the HHS Pain Management Best Practices, there is opportunity to use alternative pain therapies without the risks of opioid-induced side effects to improve work productivity.
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Affiliation(s)
| | | | - Corey W Hunter
- Ainsworth Institute of Pain Management, New York, NY, USA
| | | | | | | | | | | | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Fadipe B, Oshodi YO, Umeh C, Aikomo K, Ajirotutu OF, Kajero J, Fashanu C, Adeoye AA, Coker AO, Sokunbi M, Nyamali VO, Ajomale T, Gbadebo A, Oni A, Keshinro AO, Ngozi Ejiegbu TA, Bowale A, Akase IE, Mutiu B, Adebayo B, Abdus-Salam I, Bode C, Osibogun A. Psychosocial health effects of Covid-19 infection on persons in treatment centers in Lagos, Nigeria. Brain Behav Immun Health 2021; 16:100284. [PMID: 34151305 PMCID: PMC8205258 DOI: 10.1016/j.bbih.2021.100284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Prior research has highlighted the psychosocial impact of infectious diseases on individuals and the community at large. However, little is known about the psychosocial implications of COVID-19. This study set out to determine the rate as well as correlates of anxiety and depressive symptoms among persons managed as in-patients for COVID-19 in Lagos, Nigeria. Materials and methods We conducted an online survey between April to June ending 2020 using a consecutive sampling technique of persons positive for COVID-19 and who were managed as in-patients across five (5) treatment centres in Lagos, Nigeria. The survey collected information on demographic as well as clinical data including suicidality. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Results There were one hundred and sixty participants in total. The mean age of respondents was 36.4 (±9.7) years with a higher proportion (56.9%) being males. With regards to diagnosis, 28.1% and 27.5% of the respondents were categorised as probable cases of depression and anxiety respectively, while 3.8% respondents reported suicidal ideation. Majority of the respondents (61.9%) reported the fear of infecting their loved ones. The variables that showed association with psychiatric morbidity were a past history of an emotional concern, employment status, guilt about infecting others and boredom. Conclusion This study revealed a high burden of psychological/psychiatric morbidity among persons treated for COVID-19, particularly persons who have had prior emotional concerns. The findings from this study reiterate the need to pay attention to the mental health of people during disease outbreaks and to incorporate psychosocial interventions as part of the management package.
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Affiliation(s)
- Babatunde Fadipe
- Dept of Psychiatry, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | - Yewande O Oshodi
- Dept of Psychiatry, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | - Charles Umeh
- Dept of Psychiatry, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | - Kehinde Aikomo
- Dept of Medical Social Work, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria
| | | | | | | | | | - Ayodele Olurotimi Coker
- Department of Psychiatry, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria
| | | | | | - Tolu Ajomale
- Lagos State Ministry of Health, Ikeja, Lagos, Nigeria
| | | | - Adedapo Oni
- Dept of Psychiatry, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | | | | | | | - Iorhen E Akase
- Infectious Disease Unit, Department of Medicine, Lagos University Teaching Hospital (LUTH), Nigeria
| | - Bamidele Mutiu
- Lagos State Biobank, Mainland Hospital, Yaba, Lagos, Nigeria
| | - Bisola Adebayo
- Department of Community Health and Primary Care, Lagos State University, College of Medicine, Ikeja, Lagos, Nigeria
| | | | - Chris Bode
- Department of Surgery, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria
| | - Akin Osibogun
- Department of Community Health and Primary Care, College of Medicine University of Lagos, Lagos, Nigeria
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Prognostic factors for pain chronicity in low back pain: a systematic review. Pain Rep 2021; 6:e919. [PMID: 33981936 PMCID: PMC8108595 DOI: 10.1097/pr9.0000000000000919] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Several prognostic factors are related to low back pain chronicity, and these should be taken into account when planning more comprehensive models in its prevention. Low back pain is the leading cause for years lived in disability. Most people with acute low back pain improve rapidly, but 4% to 25% of patients become chronic. Since the previous systematic reviews on the subject, a large number of new studies have been conducted. The objective of this article was to review the evidence of the prognostic factors behind nonspecific chronic low back pain. A systematic literature search was performed without date limitation from the MEDLINE, Cochrane library, and Medic databases. Specific inclusion criteria were used, and risk factors before the onset of chronic symptoms were searched. Study quality was assessed by 2 independent reviewers. One hundred eleven full articles were read for potential inclusion, and 25 articles met all the inclusion criteria. One study was rated as good quality, 19 studies were rated as fair quality, and 5 articles were rated as poor quality. Higher pain intensity, higher body weight, carrying heavy loads at work, difficult working positions, and depression were the most frequently observed risk factors for chronic low back pain. Maladaptive behavior strategies, general anxiety, functional limitation during the episode, smoking, and particularly physical work were also explicitly predictive of chronicity. According to this systematic review, several prognostic factors from the biomechanical, psychological and psychosocial point of view are significant for chronicity in low back pain.
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Sturgeon JA, Langford D, Tauben D, Sullivan M. Pain Intensity as a Lagging Indicator of Patient Improvement: Longitudinal Relationships With Sleep, Psychiatric Distress, and Function in Multidisciplinary Care. THE JOURNAL OF PAIN 2021; 22:313-321. [DOI: 10.1016/j.jpain.2020.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/12/2020] [Indexed: 12/21/2022]
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Asrar MM, Ghai B, Pushpendra D, Bansal D. Psychosocial morbidity profile in a community based sample of low back pain patients. Sci Rep 2021; 11:2610. [PMID: 33510413 PMCID: PMC7843973 DOI: 10.1038/s41598-021-82324-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/19/2021] [Indexed: 11/09/2022] Open
Abstract
Low back pain (LBP) is a major health concern and is closely associated with psychosocial morbidity and diminished Health-related quality of life (HRQoL). This is minimally investigated in community-based samples of developing nations like India. This study is aimed to specifically investigate the exposure-outcome associations between LBP and burden of disability (Modified Oswestry questionnaire (MODQ)), psychological morbidities (Depression, Anxiety and Stress Scale (DASS-21)), and HRQoL (Short Form -12 version 2 (SF12V2). A Cross-sectional study using a community-based sample of LBP positive population was conducted. The range of treatment options sought was also collected. Chi-square tests and independent t-test were used to analyze the data. Of 1531 recruited participants, 871(57%) were identified as LBP positive of whom 60% were females. Mean (SD) of age and pain intensity of LBP patients was 33 (11) years and numeric rating scale4.2 (2.6) respectively. Two-third reported minimal/moderate disability. Mean (SD) scores of depression 11.87 (4.05), anxiety (8.32), stress 13.7 (5.98), physical and mental summary scores of SF-12v2 were 47.9 (7.4) and 42.2 (10.4). A multitude of remedial options was sought for the ailment. LBP causes significant disability and psychological morbidity among affected population. This may adversely affect their HRQoL and subsequently productivity. Acupuncture was a preferred treatment sought by Indian LBP patients.
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Affiliation(s)
- Mir Mahmood Asrar
- Clinical Research Unit, Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, SAS Nagar, Mohali, Punjab, 160062, India
| | - Babita Ghai
- Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Dhanuk Pushpendra
- Clinical Research Unit, Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, SAS Nagar, Mohali, Punjab, 160062, India
| | - Dipika Bansal
- Clinical Research Unit, Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, SAS Nagar, Mohali, Punjab, 160062, India.
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Behavioral Symptom Clusters, Inflammation, and Quality of Life in Chronic Low Back Pain. Pain Manag Nurs 2021; 22:361-368. [PMID: 33478899 DOI: 10.1016/j.pmn.2020.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/22/2020] [Accepted: 11/29/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic low back pain is a prevalent condition, often involving an inflammatory process. Behavioral symptoms, including depressed mood, fatigue, and sleep disturbance, intensifies pain and reduces quality of life. AIMS The objectives of this pilot study were to identify behavioral symptom clusters (depressive mood, fatigue, poor sleep) in individuals with chronic low back pain, and to determine whether there are differences in pain, quality of life and inflammation (plasma IL-6) based on cluster membership. DESIGN AND SETTINGS A cross-sectional study was conducted in a pain clinic. PARTICIPANTS/ SUBJECTS Participants between ages 21 to 70 years (N=69) were enrolled if they had chronic low back pain for at least six months. METHODS Participants completed instruments measuring, pain, depressive mood, fatigue, sleep, and demographic form. Blood (10ml) was obtained. Latent class analysis was used to identify clusters. RESULTS AND CONCLUSIONS Findings revealed a two-class model, with Class 1 characterized by more depressive mood, fatigue, and sleep disturbance compared to Class 2. Class 1 participants reported worse quality of life than those in Class 2. Pain severity and pain interference were not significantly different between the classes. Levels of IL-6 were significantly greater in Class 1 participants compared to Class 2 with higher levels of IL-6 correlating with greater pain severity and sleep disturbances. Logistic regression revealed higher levels of IL-6 predicted Class 1 membership. Behavioral symptoms cluster exist in chronic low back pain patients and impact quality of life. Inflammation may contribute to relationship between behavioral symptoms and pain severity.
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Weng LM, Wu B, Chen CC, Wang J, Peng MS, Zhang ZJ, Wang XQ. Association of Chronic Low Back Pain With Personal Space Regulation. Front Psychiatry 2021; 12:719271. [PMID: 34975558 PMCID: PMC8714678 DOI: 10.3389/fpsyt.2021.719271] [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: 06/23/2021] [Accepted: 11/24/2021] [Indexed: 12/19/2022] Open
Abstract
Background: While most previous studies regarding patients with chronic low back pain (CLBP) mainly focused on pain, disability, psychological damage, and intervention measures, the effect of CLBP on personal space remains unclear. The study aimed to assess the personal space of patients with CLBP and healthy controls, explored the differences between the two groups, and examined whether pain, dysfunction, anxiety, and depression affected the personal space regulation. Methods: The cross-sectional study recruited 24 patients with CLBP and 24 healthy controls at Shanghai Shangti Orthopedic Hospital and Shanghai University of Sport, Shanghai, China, from December 2018 to January 2019. A stop-distance paradigm was applied to measure the comfortable and uncomfortable distance under four conditions. A self-rating anxiety scale (SAS) and a self-rating depression scale (SDS) were used to examine the anxiety and depression levels of all participants. The pain intensity and dysfunction in the CLBP group were evaluated by the numeric rating scale and Roland-Morris questionnaire (RMDQ), respectively. Results: When approaching another individual or when being approached, the interpersonal distance under all the conditions in the CLBP group significantly differed from that in the healthy control group with larger space distances (p < 0.01). Gender had a significant main effect on the regulation of personal space in patients with CLBP (p < 0.05). The average pain intensity, scores on RMDQ, SAS, and SDS had a significant positive correlation with the interpersonal distance under the Same or Opposite Gender condition (p < 0.05). Conclusion: People with CLBP show an atypical personal space behavior and indeed have a greater interpersonal distance to strangers. The higher the pain intensity, dysfunction, anxiety, and depression, the greater the interpersonal distance in patients with CLBP. In the future, the effect and underlying neural mechanisms of pain and negative emotions on social withdrawal in patients should be examined.
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Affiliation(s)
- Lin-Man Weng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Bao Wu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Chang-Cheng Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Juan Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Meng-Si Peng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Zhi-Jie Zhang
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.,Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China
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A public health concern: Chronic low back pain and the relationship between pain, quality of life, depression, anxiety, and sleep quality. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.710076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shi S, Zhou Z, Ni HJ, Wang CF, He ZM, Yang YH, Du JH, Wu JS, He SS. Does anxiety influence the prognosis of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation? A preliminary propensity score matching analysis. INTERNATIONAL ORTHOPAEDICS 2020; 44:2357-2363. [PMID: 32529310 DOI: 10.1007/s00264-020-04656-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 06/02/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Previous reports revealed a correlation between psychological problems and spinal surgery. There is a lack of knowledge on the effect of anxiety on the percutaneous transforaminal endoscopic discectomy (PTED) outcome at the two year follow-up. The purpose of this study is to investigate changes in anxiety after PTED among patients with lumbar disc herniation (LDH), to compare the effect of anxiety on the prognosis using propensity score matching analysis, and to identify the related parameters of anxiety. METHODS A total of 145 patients with LDH requiring PTED surgery were included. Twenty-six LDH patients with anxiety were matched with 26 control patients utilizing propensity score matching analysis. The demographic and peri-operative data were collected and analyzed. A correlation analysis was utilized. RESULTS Both groups achieved significant improvements in visual analogue scale (VAS) scores for pain, Japanese Orthopedic Association (JOA) scores for neurological deficit, and 36-item Short-Form Health Survey (SF-36) scores and Oswestry Disability Index (ODI) scores for quality of life. A statistical difference was detected between the pre-operative and the post-operative Zung Self-Rating Anxiety Scale scores in the anxiety cohort. However, the difference between the anxiety group and the control group was statistically significant in the aforementioned parameters. The VAS, JOA, ODI and the SF-36 scores, and the disease duration were associated with pre-operative anxiety. CONCLUSION PTED may provide significant improvements in clinical outcomes and symptoms of anxiety. A negative impact on the patient's prognosis may be caused by the presence of anxiety. Pain severity, neurological deficit, disease duration, and quality of life were associated with anxiety.
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Affiliation(s)
- Sheng Shi
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Zhi Zhou
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Hai-Jian Ni
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Chuan-Feng Wang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Zhi-Min He
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Yue-Hua Yang
- Department of Orthopedics, The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, 510900, People's Republic of China
| | - Jun-Hua Du
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Jun-Song Wu
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Shi-Sheng He
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China. .,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China.
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Onda A, Kimura M. Reduction in anxiety during treatment with exercise and duloxetine is related to improvement of low back pain-related disability in patients with non-specific chronic low back pain. Fukushima J Med Sci 2020; 66:148-155. [PMID: 33298637 PMCID: PMC7790464 DOI: 10.5387/fms.2020-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Non-invasive treatment is generally recommended for patients with non-specific chronic low back pain (CLBP). However, the impact of combination therapy with physical exercise and a serotonin-norepinephrine reuptake inhibitor has not been clarified in patients with non-specific CLBP. This study assessed the efficacy of combination treatment with exercise and duloxetine on non-specific CLBP and aimed to identify factors that contributed to improvement of LBP-induced disability. Methods: This prospective study was conducted on consecutive outpatients with non-specific CLBP. Patients received a supervised home-based exercise program and duloxetine administration for 15 weeks. The Roland-Morris Disability Questionnaire (RDQ), Numerical Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), and Pain Catastrophizing Scale (PCS) were assessed at baseline and 15 weeks. Multiple logistic regression modeling was used to identify factors associated with an improvement in RDQ. Results: Forty-two patients were enrolled. Overall, scores on the RDQ, NRS, and PCS (total score, magnification, helplessness) were significantly reduced at 15 weeks (p < 0.01 for all). An improvement of disability was confirmed in 22 patients (52%). A higher HADS depression score before and after the intervention was significantly associated with a lack of improvement in disability (p < 0.01). Further, a reduction in HADS anxiety score over 15 weeks was a significant factor associated with an improvement in disability (odds ratio: 1.99;95% CI: 1.26-3.65). Conclusions: Supervised exercise plus duloxetine resulted in favorable outcomes and an improvement of LBP-related disability in approximately 50% of patients. A reduction in anxiety over treatment was associated with the improved disability.
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Affiliation(s)
- Akira Onda
- Department of Orthopaedic Surgery, Zenshukai Hospital, Maebashi City
| | - Masashi Kimura
- Department of Orthopaedic Surgery, Zenshukai Hospital, Maebashi City
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Wong JJ, Tricco AC, Côté P, Rosella LC. The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review. Syst Rev 2019; 8:267. [PMID: 31703727 PMCID: PMC6839250 DOI: 10.1186/s13643-019-1192-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 10/09/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND A considerable proportion of adults with low back pain (LBP) suffer from depressive symptoms or depression. Those with depressive symptoms or depression may be at risk of poorer LBP recovery and require more health care. Understanding the role of prognostic factors for LBP is critically important to guide management and health services delivery. Our objective is to conduct a systematic review to assess the association between depressive symptoms or depression and health outcomes in adults with LBP with or without radiculopathy. METHODS Electronic databases including MEDLINE, Embase, CINAHL, and PsycINFO will be searched from inception to April 2019 to identify relevant studies. Additional citations will be identified by searching reference lists of included studies and related systematic reviews. Cohort and case-control studies assessing the association between depressive symptoms/depression and health outcomes in adults aged 16 years and older with LBP with or without radiculopathy will be included. The following will be included: depressive symptoms as measured on standardized questionnaires (e.g., Center for Epidemiologic Studies Depression Scale, Beck Depression Index), and depression as standardized diagnoses (e.g., International Classification of Diseases codes) or self-reported depression diagnosis on standardized questionnaires. Outcomes of interest are standardized measures for pain, disability, overall health status, satisfaction with care, and health care utilization. These are informed by core outcome domains that international expert panels consider important for LBP research. Pairs of reviewers will screen articles retrieved from the search, extract data, and assess risk of bias using the Risk Of Bias In Non-randomized Studies-of Exposures (ROBINS-E) tool. Reviewers will use these criteria to inform their judgment on the internal validity of studies (e.g., low, moderate, or high risk of bias). If studies are deemed homogeneous, a random effects meta-analysis on the association between depressive symptoms and health outcomes will be performed. The results of the included studies will be descriptively outlined if studies are deemed heterogeneous. DISCUSSION The impact of depressive symptoms and depression on health- and health care-related outcomes for LBP with or without radiculopathy will be assessed and quantified. Findings of this systematic review will advance our understanding of LBP prognosis, and guide decision-making and improve quality of care for adults with LBP. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019130047.
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Affiliation(s)
- Jessica J. Wong
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, ON L1H 7K4 Canada
| | - Andrea C. Tricco
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Knowledge Translation Program, 209 Victoria Street, East Building, Room 716, Toronto, ON M5B 1W8 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, ON M5T 3M7 Canada
| | - Pierre Côté
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, ON L1H 7K4 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, ON M5T 3M7 Canada
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1H 7K4 Canada
| | - Laura C. Rosella
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
- ICES, 155 College Street, Toronto, ON M5T 3M7 Canada
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Abstract
STUDY DESIGN Prospective study. OBJECTIVE Determine risk factors and consider impact of low back pain for medical students. SUMMARY OF BACKGROUND DATA Low back pain (LBP) is one of the most prevalent complaints among students. The vulnerability of medical students due to stress and numerous hours of studying and training makes them at risk of LBP. METHODS We submitted an online self-administered modified version of the Standardized Nordic Questionnaire to 1800 medical students from 2nd to 6th year from December 2017 to March 2018. RESULTS A total of 1243/1800 (68.9%) students responded to our survey. Mean age was 23.3 ± 2.9 years ranging from 18 to 44 years. 835 (72.1%) students reported suffering from LBP. In multivariate analysis with logistic regression analysis model, the third year of medical studies (odds ratio [OR]: 0.558, 95% confidence interval [CI] 0.387-0.805; P = 0.002) was identified as an independent prognostic factor of LBP. Moreover, exercising weekly (OR: 1.835, 95% CI 0.933-2.5; P = 0.01) and walking at least 30 minutes a day (OR: 1.458, 95% CI 1.129-1.876; P = 0.01) significantly improve LBP. LBP generate higher monthly consumption of an analgesic (OR: 32.8, 95% CI 4.271-252.2; P < 0.001). Finally, LBP had a severe repercussion on student work (OR: 18.89, 95% CI 10.122-35.253; P < 0.0001), on the quality of sleep (OR: 12.162, 95% CI 6.917-21.386; P < 0.0001) and on their personal life (OR: 12.343, 95% CI 5.681-26.8; P < 0.0001). CONCLUSION Medical students reported high prevalence of LBP with severe consequences. Our educational perspective is to identify the risk factors of LBP, fight them, to improve the medical student' work, and welfare. LEVEL OF EVIDENCE 3.
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Malec M, Levine S. How do I best treat pain in my older patient with cancer? J Geriatr Oncol 2019; 10:841-844. [PMID: 31171495 DOI: 10.1016/j.jgo.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 04/08/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Monica Malec
- University of Chicago, United States of America.
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