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Ma LC, Liu J, Jiao CL, Du SY, Zhang RL, Ding XJ, Shi XY, Wang Y. Exploring the effects of an online learning platform in stage III cardiac rehabilitation for individuals with coronary heart disease: Randomized controlled study. Medicine (Baltimore) 2024; 103:e39497. [PMID: 39287309 PMCID: PMC11404953 DOI: 10.1097/md.0000000000039497] [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: 12/07/2023] [Revised: 07/03/2024] [Accepted: 08/08/2024] [Indexed: 09/19/2024] Open
Abstract
The objective of this study is to assess the influence of blended education methodologies, utilizing an online education platform, among stage III cardiac rehabilitation (CR) patients diagnosed with coronary heart disease (CHD). Between June and August 2021, a cohort of 90 patients diagnosed with CHD, previously discharged from a second-class hospital 1 year earlier, were randomly allocated into 2 groups: the experimental and control groups, with each comprising 45 patients. Patients in the control group received out-of-hospital CR education via WeChat, while those in the experimental group received blended CR education utilizing an online education platform. Following a 24-week period, the self-management behavior and negative emotions of both groups were compared before and after the intervention. The final count of patients in the control and experimental groups was 39 and 37, respectively. Post the intervention, in terms of self-management behavior, the control group achieved an average score of 90.69 ± 7.13, while the experimental group scored 96.11 ± 5.42 (P < .05). Concerning negative emotions, the anxiety scores for the control and experimental groups were 3.03 ± 2.63 and 1.86 ± 1.80, respectively, and the depression scores were 3.00 (3.00) and 2.00 (3.00), respectively (P < .05). The differences in the outcomes mentioned above were statistically significant. The implementation of a blended educational approach utilizing an online platform has resulted in notable improvements in self-management skills and the reduction of negative emotions among patients with CHD. As a result, this educational strategy has demonstrated effectiveness in providing post-discharge CR education for patients with CHD.
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Affiliation(s)
- Li-Chao Ma
- School of Nursing, Hebei University, Baoding, China
- Operating Room, The Fourth Hospital of Hebei Medical University, Shijiazhang, China
| | - Juan Liu
- Department of Rehabilitation Medicine, Affiliated Hospital of Hebei University, Baoding, China
| | - Cui-Liu Jiao
- School of Nursing, Hebei University, Baoding, China
| | - Shao-Ying Du
- School of Nursing, Hebei University, Baoding, China
| | | | | | | | - Yan Wang
- School of Nursing, Hebei University, Baoding, China
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Adenis N, Wieczorek V, Corbinau S, Mortain L, Thevenon A. Pain neuroscience education is not superior to spinal physiology and ergonomics education within a short multidisciplinary rehabilitation program: A randomized controlled trial. Musculoskelet Sci Pract 2024; 74:103176. [PMID: 39260006 DOI: 10.1016/j.msksp.2024.103176] [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] [Received: 04/06/2024] [Revised: 06/25/2024] [Accepted: 09/02/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION There is little evidence to suggest that one educational intervention is superior to another when associated with a rehabilitation program in the management of persistent low back pain. The objective of the present study was to compare pain neuroscience education with spine physiology and ergonomics education as part of a one-week multidisciplinary rehabilitation program. METHOD We conducted a randomized, controlled trial among patients having experienced persistent low back pain for at least 1 year. The patients participated in a one-week multidisciplinary rehabilitation program with an educational component. The members of the experimental and control groups received pain neuroscience education and spine physiology and ergonomics education, respectively. Outcomes were assessed before the program (day 0), immediately afterwards (day 5), and on day 90 after the start of the program. The primary outcome measure was functional disability on day 90. RESULTS A total of 88 patients were randomized. On day 90, a statistically significant mean [95% confidence interval] decrease in the level of disability was observed in the experimental (PNE) group (-3.4 [-5.0 to -1.8]). The mean [95%CI] difference versus the control group (-1.7 [-4.0 to 0.5]) was not statistically significant (p = 0.12). There were no statistically significant intergroup differences in the secondary outcome measures. CONCLUSION There appears to be no advantage in replacing a conventional, non-neuroscientific educational program (based on spinal physiology and ergonomics) with a pain neuroscience education program as part of a one-week multidisciplinary rehabilitation program. Further research is needed to identify patients who will respond better to a pain neuroscience education module as part of a personalized care program.
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Affiliation(s)
- Nicolas Adenis
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, 413 Av. Eugène Avinée, 59120, Loos, France.
| | | | - Sophie Corbinau
- Pôle RRSS, Hôpital Swynghedauw, CHU, F-59000, Lille, France.
| | - Léa Mortain
- Léa Mortain, Biostatistics Department, CHU Lille, F-59000, Lille, France.
| | - André Thevenon
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, 413 Av. Eugène Avinée, 59120, Loos, France.
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Kircali S, Özcan ÖÖ, Karahan M. Pain neuroscience education and motor imagery-based exercise protocol for patients with fibromyalgia: A randomized controlled trial. Brain Behav 2024; 14:e70013. [PMID: 39262170 PMCID: PMC11391019 DOI: 10.1002/brb3.70013] [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: 04/24/2024] [Revised: 07/24/2024] [Accepted: 08/11/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND This study is a randomized controlled, biopsychosocial study investigating the effectiveness of pain neuroscience education (PNE) and motor imagery-based exercise protocol (MIEP) on fibromyalgia pain. METHODS Our study has four groups (MIEP n = 12, PNE n = 12, MIEP + PNE n = 14, Control n = 12) and all participants (n = 50) consist of patients diagnosed with fibromyalgia with chronic back pain. The primary outcome measure was pain intensity, and secondary outcome measures were beliefs, kinesiophobia, anxiety-depression, cognitive-mood, self-esteem, and body awareness. RESULTS A statistically significant decrease in pain intensity was observed in all experimental groups, without any group being superior (Visual Analog Scale [VAS]: MIEP + PNE p = .003, 95% confidence interval [CI], -4.7078 to -0.9922; MIEP p = .003, 95% CI, -5.4806 to -1.0194; PNE p = .002, 95% CI, -3.6139 to -1.5461). There was a significant improvement in organic beliefs in both groups where PNE was applied (MIEP + PNE: p = .017, 95% CI, -7.8211 to -0.3189; PNE: p = .003, 95% CI, -9.7999 to -0.0401). A significant superiority in organic pain beliefs was detected in the MIEP + PNE group compared to the control group (p = .008, 95% CI, 1.7241-9.4959). CONCLUSIONS According to this study, in which MIEP and PNE were combined, there was a decrease in pain intensity when both applications were applied together and when they were applied one by one. MIEP has improved her motor imagery ability, improved pain and increased body awareness. PNE has improved people's organic pain beliefs; removed people from fears, catastrophizing, and negative thoughts about pain; improved easier management of psychological processes and cognitive-emotion regulation ability.
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Affiliation(s)
- Selin Kircali
- Neuroscience, Health Sciences InstituteÜsküdar UniversityIstanbulTurkey
| | - Öznur Özge Özcan
- Electroneurophysiology, Vocational School of Health SciencesÜsküdar UniversityIstanbulTurkey
| | - Mesut Karahan
- Medical Laboratory Techniques, Vocational School of Health SciencesÜsküdar UniversityIstanbulTurkey
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Du S, Hu Y, Zhou Y, Xing W, Zhu Z, Meng A, Zhi X, Dong G, Mao C. The implementation study of nurses' work related low back pain prevention and care guideline: A quasi-experimental study. Appl Nurs Res 2024; 78:151818. [PMID: 39053998 DOI: 10.1016/j.apnr.2024.151818] [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: 06/12/2022] [Revised: 07/15/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
AIM To understand the implementation process and outcomes of nurses' work related low back pain (WLBP) prevention and care guideline. BACKGROUND WLBP is a common occupational injury for clinical nurses. We developed the first evidence-based guideline of nurses' WLBP prevention and care of its kind both at home and abroad, and it is necessary for us to explore its feasibility, appropriateness and effectiveness in practice. METHODS Based on the model of the integrated Promoting Action on Research Implementation in Health Services, we performed a four-phase implementation study in a tertiary hospital. The study was a non-randomized concurrent controlled trial design,and multilevel measures were examined including implementation outcomes and clinical outcomes. RESULTS For the implementation outcomes, the tailored recommendations of the guideline were found to be acceptable, appropriate, feasible, and well adopted both at the unit level and the hospital level. The clinical outcomes indicated that, compared with the control unit, nurses of the treatment unit performed better in awareness, knowledge, practice of WLBP prevention and care. CONCLUSIONS The implementation study supports the successful application of the guideline, which can serve as a valuable evidence-based document to improve back health of nursing personnel.
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Affiliation(s)
- Shizheng Du
- School of Nursing, Nanjing University of Chinese Medicine, #138 Xianlin Avenue, Nanjing 210023, China; School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China
| | - Yan Hu
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China.
| | - Yingfeng Zhou
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China
| | - Weijie Xing
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China
| | - Zheng Zhu
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China
| | - Aifeng Meng
- Jiangsu Cancer Hospital, Jiangsu Cancer Research Institute, Cancer Hospital Affiliated to Nanjing Medical University, #42 Baiziting, Nanjing 210009, China
| | - Xiaoxu Zhi
- Jiangsu Cancer Hospital, Jiangsu Cancer Research Institute, Cancer Hospital Affiliated to Nanjing Medical University, #42 Baiziting, Nanjing 210009, China
| | - Gaoyue Dong
- Jiangsu Cancer Hospital, Jiangsu Cancer Research Institute, Cancer Hospital Affiliated to Nanjing Medical University, #42 Baiziting, Nanjing 210009, China
| | - Changmin Mao
- Jiangsu Cancer Hospital, Jiangsu Cancer Research Institute, Cancer Hospital Affiliated to Nanjing Medical University, #42 Baiziting, Nanjing 210009, China
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Silva de Barros A, Mesquita Magalhães G, Darc de Menezes Braga L, Oliveira Veloso M, Olavo de Paula Lima P, Moreira da Cunha R, Soares Coutinho S, Lira do Nascimento S, Robson Pinheiro Sobreira Bezerra L. Musculoskeletal evaluation of the lower pelvic complex in women with endometriosis: A case-control study. Eur J Obstet Gynecol Reprod Biol 2024; 299:317-321. [PMID: 38959628 DOI: 10.1016/j.ejogrb.2024.04.030] [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: 10/10/2023] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE Use clinical pain measurement tools to investigate and compare the prevalence of pelvic loin disoders in women with and without endometriosis. STUDY DESIGN Chronic pelvic pain (CPP) associated with endometriosis has diverse origins, including musculoskeletal factors. Musculoskeletal dysfunction in the pelvic region is theorized to result from sustained muscular contraction, triggered by altered visceral stimuli and adoption of antalgic postures, causing secondary damage to muscles, ligaments, and joints. CPP significantly impacts quality of life, relationships, sexuality, and mental health. However, limited data exists on musculoskeletal impacts of endometriosis and CPP. It was made a case-control study at Maternidade Escola Assis Chateaubriand from August 2017 to January 2021. Evaluated 71 women: 41 in endometriosis group (EG) and 30 in control group (CG). Data collection included sociodemographic questionnaires, musculoskeletal physiotherapeutic evaluations, pain mapping, pressure pain thresholds, kinesiophobia, and disability measurements. Statistical analysis was performed using Spearman's Rho test to determine correlations. RESULTS Mean age of participants was 31 years. EG exhibited lower pain threshold variations in lumbopelvic trigger points than CG (P < .05). Significant muscle flexibility differences between groups were observed; EG had reduced flexibility (P < .05). Most common pain areas were hypogastrium in EG (48.78 %) and left lumbar in CG (30 %). EG had higher kinesiophobia values (P = .009). There was a weak association between kinesiophobia-pressure threshold association observed in CG's lumbar pelvic region. CONCLUSION Women with Endometriosis and CPP exhibit higher prevalence of musculoskeletal disorder, lower pain thresholds, decreased lumbopelvic muscle range of motion, higher kinesiophobia scores, and increased disability indices with low back pain compared to healthy women.
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Chen L, Li H, Gou X, Dong H, Yang S, Dong F, Wu J. Coping as a mediator of the relationship between kinesiophobia and illness perception in atrial fibrillation patients: A cross-sectional mediation analysis. J Adv Nurs 2024. [PMID: 38924140 DOI: 10.1111/jan.16262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/15/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
AIM(S) To explore the mediating role of coping styles in the association between illness perception and kinesiophobia in atrial fibrillation patients. DESIGN A cross-sectional survey. METHODS Between June 2021 and November 2022, data were collected using a self-designed demographic questionnaire, the Brief Illness Perception Questionnaire (BIPQ), Tampa Scale for Kinesiophobia Heart (TSK-SV Heart) and Medical Coping Modes Questionnaire (MCMQ). The sample comprised 474 atrial fibrillation patients recruited from three hospitals in China. To analyse the data, multiple linear regression models with forced entry were employed, and the mediation Mode 4 of the PROCESS macro in SPSS was implemented. RESULTS In total, 57.8% of patients exhibited a high level of kinesiophobia. Regression analyses uncovered associations between kinesiophobia and various demographic and disease characteristics, as well as assessments of both illness perception and coping styles. Path analysis results indicated that illness perception reduced kinesiophobia through the mediating effect of confrontation, while avoidance and resignation intensified kinesiophobia. The mediating factor of coping styles explained a significant 53% of the overall effect. CONCLUSIONS Coping styles mediate the relationship between illness perception and kinesiophobia, resulting in a shift in coping styles as illness perception decreases and ultimately leading to reduced kinesiophobia. IMPACT Coping styles play a mediating role in the relationship between kinesiophobia and illness perception. The results suggest healthcare providers in identifying high-risk individuals and tailoring interventions to effectively break the vicious cycle of kinesiophobia. Therefore, screening and intervening with patients showcasing heightened illness perception aims to promote a transformation in coping styles, subsequently reducing atrial fibrillation kinesiophobia. REPORTING METHOD The results of the observations were reported in adherence to the STROBE criteria. PATIENT OR PUBLIC CONTRIBUTION No patient and public involvement.
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Affiliation(s)
- Limei Chen
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Husheng Li
- Department of Nursing, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyu Gou
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Dong
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shenglan Yang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fengwei Dong
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jing Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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7
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Núñez-Cortés R, Salazar-Méndez J, Calatayud J, Malfliet A, Lluch E, Mendez-Rebolledo G, Guzmán-Muñoz E, López-Bueno R, Suso-Martí L. The optimal dose of pain neuroscience education added to an exercise programme for patients with chronic spinal pain: a systematic review and dose-response meta-analysis. Pain 2024; 165:1196-1206. [PMID: 38047772 DOI: 10.1097/j.pain.0000000000003126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/10/2023] [Indexed: 12/05/2023]
Abstract
ABSTRACT Pain neuroscience education (PNE) has shown promising results in the management of patients with chronic spinal pain (CSP). However, no previous review has determined the optimal dose of PNE added to an exercise programme to achieve clinically relevant improvements. The aim was to determine the dose-response association between PNE added to an exercise programme and improvements in pain intensity and disability in patients with CSP. A systematic search of PubMed/MEDLINE, Embase, Web of Science, Scopus, and the Cochrane Library was conducted from inception to April 19, 2023. The exposure variable (dosage) was the total minutes of PNE. Outcome measures included pain intensity, disability, quality of life, pressure pain thresholds, and central sensitization inventory. Data extraction, risk-of-bias assessment, and certainty of evidence were performed by 2 independent reviewers. The dose-response relationship was assessed using a restricted cubic spline model. Twenty-six randomised controlled trials with 1852 patients were included. Meta-analysis revealed a statistically significant effect in favour of PNE on pain intensity and disability. In addition, a dose of 200 and 150 minutes of PNE added to an exercise programme was estimated to exceed the minimum clinically important difference described in the literature for pain intensity (-2.61 points, 95% CI = -3.12 to -2.10) and disability (-6.84 points, 95% CI = -7.98 to -5.70), respectively. The pooled effect of the isolated exercise was small. These findings may be useful in optimising the most appropriate PNE dose to achieve clinically relevant improvements in patients with CSP.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Research Foundation, Flanders (FWO), Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Enrique Lluch
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
| | - Guillermo Mendez-Rebolledo
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Eduardo Guzmán-Muñoz
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
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Salazar-Méndez J, Cuyul-Vásquez I, Ponce-Fuentes F, Guzmán-Muñoz E, Núñez-Cortés R, Huysmans E, Lluch-Girbés E, Viscay-Sanhueza N, Fuentes J. Pain neuroscience education for patients with chronic pain: A scoping review from teaching-learning strategies, educational level, and cultural perspective. PATIENT EDUCATION AND COUNSELING 2024; 123:108201. [PMID: 38387389 DOI: 10.1016/j.pec.2024.108201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE (1) To identify the characteristics of PNE programs in terms of teaching-learning strategies, session modality, content delivery format, number of sessions, total minutes and instructional support material used in patients with chronic musculoskeletal pain, (2) to describe PNE adaptations for patients with different educational levels or cultural backgrounds, and (3) to describe the influence of the patient's educational level or cultural background on the effects of PNE. METHODS The PRISMA guideline for scoping reviews was followed. Nine databases were systematically searched up to July 8, 2023. Articles that examined clinical or psychosocial variables in adults with chronic musculoskeletal pain who received PNE were included. RESULTS Seventy-one articles were included. Studies found benefits of PNE through passive/active teaching-learning strategies with group/individual sessions. However, PNE programs presented great heterogeneity and adaptations to PNE were poorly reported. Most studies did not consider educational level and culture in the effects of PNE. CONCLUSIONS Despite the large number of studies on PNE and increased interest in this intervention, the educational level and culture are poorly reported in the studies. PRACTICAL IMPLICATIONS It is recommended to use passive and/or active teaching-learning strategies provided in individual and/or group formats considering the patient's educational level and culture.
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Affiliation(s)
| | - Iván Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Chile; Facultad de las Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
| | - Felipe Ponce-Fuentes
- Escuela de Kinesiología, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Temuco, Chile
| | - Eduardo Guzmán-Muñoz
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile; Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels 1090, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels 1090, Belgium; Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Enrique Lluch-Girbés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels 1090, Belgium
| | | | - Jorge Fuentes
- Clinical Research Lab, Department of Physical Therapy, Catholic University of Maule, Chile; Faculty of Rehab Medicine, University of Alberta, Edmonton, Canada.
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Scholz C, Schmigalle P, Plessen CY, Liegl G, Vajkoczy P, Prasser F, Rose M, Obbarius A. The effect of self-management techniques on relevant outcomes in chronic low back pain: A systematic review and meta-analysis. Eur J Pain 2024; 28:532-550. [PMID: 38071425 DOI: 10.1002/ejp.2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Among many treatment approaches for chronic low back pain (CLBP), self-management techniques are becoming increasingly important. The aim of this paper was to (a) provide an overview of existing digital self-help interventions for CLBP and (b) examine the effect of these interventions in reducing pain intensity, pain catastrophizing and pain disability. DATABASES AND DATA TREATMENT Following the PRISMA guideline, a systematic literature search was conducted in the MEDLINE, EMBASE, PsychInfo, CINAHL and Cochrane databases. We included randomized controlled trials from the last 10 years that examined the impact of digital self-management interventions on at least one of the three outcomes in adult patients with CLBP (duration ≥3 months). The meta-analysis was based on random-effects models. Standardized tools were used to assess the risk of bias (RoB) for each study and the quality of evidence for each outcome. RESULTS We included 12 studies (n = 1545). A small but robust and statistically significant pooled effect was found on pain intensity (g = 0.24; 95% CI [0.09, 0.40], k = 12) and pain disability (g = 0.43; 95% CI [0.27, 0.59], k = 11). The effect on pain catastrophizing was not significant (g = 0.38; 95% CI [-0.31, 1.06], k = 4). The overall effect size including all three outcomes was g = 0.33 (95% CI [0.21, 0.44], k = 27). The RoB of the included studies was mixed. The quality of evidence was moderate or high. CONCLUSION In summary, we were able to substantiate recent evidence that digital self-management interventions are effective in the treatment of CLBP. Given the heterogeneity of interventions, further research should aim to investigate which patients benefit most from which approach. SIGNIFICANCE This meta-analysis examines the effect of digital self-management techniques in patients with CLBP. The results add to the evidence that digital interventions can help patients reduce their pain intensity and disability. A minority of studies point towards the possibility that digital interventions can reduce pain catastrophizing. Future research should further explore which patients benefit most from these kinds of interventions.
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Affiliation(s)
- C Scholz
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - P Schmigalle
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Y Plessen
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - G Liegl
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - P Vajkoczy
- Department for Neurosurgery with Pediatric Neurosurgery, Center for Neurology, Neurosurgery und Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - F Prasser
- Center of Health Data Sciences, Berlin Institut of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Quantitative Health Sciences, Medical School, University of Massachusetts, Boston, Massachusetts, USA
| | - A Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- BIH Charité Digital Clinician Scientist Program, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
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Van Bogaert W, Liew BXW, Fernández-de-Las-Peñas C, Valera-Calero JA, Varol U, Coppieters I, Kregel J, Nijs J, Meeus M, Cagnie B, Danneels L, Malfliet A. Exploring Interactions Between Sex, Pain Characteristics, Disability, and Quality of Life in People With Chronic Spinal Pain: A Structural Equation Model. THE JOURNAL OF PAIN 2024; 25:791-804. [PMID: 37871684 DOI: 10.1016/j.jpain.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023]
Abstract
In people with nonspecific chronic spinal pain (nCSP), disability and quality of life are associated with clinical, cognitive, psychophysical, and demographic variables. However, evidence regarding the interactions between these variables is only limited to this population. Therefore, this study aims to explore path models explaining the multivariate contributions of such variables to disability and quality of life in people with nCSP. This secondary analysis uses baseline data from a randomized controlled trial including 120 participants with nCSP. Structural equation modeling was used to explore path models for the Pain Disability Index (PDI), the Short Form 36-item physical (SF-36 PC), and mental (SF-36 MC) component scores. All models included sex, pain catastrophizing, kinesiophobia, hypervigilance, and pain intensity. Additionally, the PDI and SF-36 PC models included pressure pain thresholds (PPTs) at the dominant pain site (ie, neck or low back). Significant associations were found between sex, pain cognitions, pain intensity, and PPTs. Only pain catastrophizing significantly directly influenced the PDI (P ≤ .001) and SF-36 MC (P = .014), while the direct effects on the SF-36 PC from kinesiophobia (P = .008) and pain intensity (P = .006) were also significant. However, only the combined effect of all pain cognitions on the SF-36 PC was mediated by pain intensity (P = .019). Our findings indicate that patients' pain-related cognitions have an adverse effect on their physical health-related quality of life via a negative influence on their pain intensity in people with nCSP. PERSPECTIVE: This secondary analysis details a network analysis confirming significant interactions between sex, pain cognitions, pain intensity, and PPTs in relation to disability and health-related quality of life in people with chronic spinal pain. Moreover, its findings establish the importance of pain cognitions and pain intensity for these outcomes. TRIALS REGISTRATION: Clinicaltrials.gov (NCT02098005).
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Affiliation(s)
- Wouter Van Bogaert
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Juan A Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain; InPhysio Group, Health Research Institute, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Umut Varol
- International Doctoral School, Rey Juan Carlos University, Alcorcón, Spain
| | - Iris Coppieters
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; The Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Jeroen Kregel
- Breederode Hogeschool, Rotterdam, The Netherlands; Pain in Motion International Research Group
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; Institute of Health and Care Sciences, and the University of Gothenburg Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mira Meeus
- Pain in Motion International Research Group; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
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11
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Lesmond I, Calvache-Mateo A, Heredia-Ciuró A, Martín-Núñez J, Navas-Otero A, López-López L, Valenza MC. Neurophysiological pain education for patients with symptomatic knee osteoarthritis: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2024; 120:108128. [PMID: 38147773 DOI: 10.1016/j.pec.2023.108128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of neurophysiological pain education in patients with symptomatic knee osteoarthritis considering pain-related variables. METHODS A systematic review and meta-analysis was carried out according to the PRISMA guidelines. A search was conducted in PubMed, PEDro Database, Cochrane Library, Scopus, and Web of Science. Only randomized controlled trials enrolling patients ≥ 18 years of age with symptomatic knee osteoarthritis were included. The Downs and Black quality assessment tool was used to assess the quality of the articles, and the risk of bias was evaluated with the Cochrane Risk of Bias Assessment Tool. RESULTS A total of 7 studies were included in the study. Most of the studies were rated as "fair" on the Downs and Black quality assessment tool, and in the category of "some concerns" according to the Cochrane Risk of Bias Assessment Tool. Neurophysiological pain education was conducted alone or combined with exercise, joint mobilizations, or self-management programs. The number of sessions ranged from 1 to 10. The meta-analysis results showed significant differences in favor of the intervention group in pain (MD = -0.49; 95% CI = -0.66; -0.32; p < 0.001) and catastrophization (MD = -1.81; 95% CI = -3.31, -0.3; p = 0.02). CONCLUSION, PRACTICE IMPLICATIONS Neurophysiological pain education interventions in isolation or combined with exercise, joint mobilizations, or self-management programs have proven to significantly improve pain and catastrophization in patients with symptomatic knee osteoarthritis. These findings could provide clinicians with more information regarding the management of patients with symptomatic knee osteoarthritis.
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Affiliation(s)
- Inès Lesmond
- Groupe Hospitalier Nord Essonne, Longjumeau, France
| | - Andrés Calvache-Mateo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Alejandro Heredia-Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Alba Navas-Otero
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Kragting M, Pool-Goudzwaard AL, Coppieters MW, O'Sullivan PB, Voogt L. Illness perceptions in people with chronic and disabling non-specific neck pain seeking primary healthcare: a qualitative study. BMC Musculoskelet Disord 2024; 25:179. [PMID: 38413876 PMCID: PMC10900625 DOI: 10.1186/s12891-024-07302-7] [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: 10/26/2023] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Illness perceptions can affect the way people with musculoskeletal pain emotionally and behaviorally cope with their health condition. Understanding patients illness perceptions may help facilitate patient-centered care. The purpose of this study was to explore illness perceptions and the origin of those perceptions in people with chronic disabling non-specific neck pain seeking primary care. METHODS A qualitative study using a deductive and inductive analytical approach was conducted in 20 people with persistent (> 3 months) and disabling (i.e., Neck Disability Index ≥ 15) neck pain. Using a semi-structured format, participants were interviewed about their illness perceptions according to Leventhal's Common Sense Model. Purposive sampling and member checking were used to secure validity of study results. RESULTS Participants reported multiple symptoms, thoughts and emotions related to their neck pain, which continuously required attention and action. They felt trapped within a complex multifactorial problem. Although some participants had a broader biopsychosocial perspective to understand their symptoms, a biomedical perspective was dominant in the labelling of their condition and their way of coping (e.g., limiting load, building strength and resilience, regaining mobility, keep moving and being meaningful). Their perceptions were strongly influenced by information from clinicians. Several participants indicated that they felt uncertain, because the information they received was contradictory or did not match their own experiences. CONCLUSION Most participants reported that understanding their pain was important to them and influenced how they coped with pain. Addressing this 'sense making process' is a prerequisite for providing patient-centered care.
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Affiliation(s)
- Maaike Kragting
- Department of Physical Therapy, Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam, 3015 EK, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annelies L Pool-Goudzwaard
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Somt University of Physiotherapy, Amersfoort, The Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Peter B O'Sullivan
- School of Allied Health, Curtin University, Bentley, Australia
- Body Logic Physiotherapy Clinic, Shenton Park, Australia
| | - Lennard Voogt
- Department of Physical Therapy, Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam, 3015 EK, The Netherlands.
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
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13
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Lin LH, Lin TY, Chang KV, Wu WT, Özçakar L. Pain neuroscience education for reducing pain and kinesiophobia in patients with chronic neck pain: A systematic review and meta-analysis of randomized controlled trials. Eur J Pain 2024; 28:231-243. [PMID: 37694895 DOI: 10.1002/ejp.2182] [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: 04/01/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Chronic neck pain (CNP) is a common musculoskeletal disorder. Pain neuroscience education (PNE) is a promising nonpharmacological intervention for CNP, however, its effectiveness remains unclear. This systematic review and meta-analysis aimed to evaluate the effectiveness of PNE in treating CNP. METHODS Electronic databases from inception to February 2023 were searched for randomized controlled trials (RCTs) on the effects of PNE on CNP. The primary outcome was the change in pain intensity, and the secondary outcome was improvement in kinesiophobia, standardized using Hedges' g. Two authors independently scrutinized eligible articles, extracted data and assessed quality; a random-effects model was employed for data pooling. RESULTS In total, seven RCTs comprising 479 participants were included and demonstrated that PNE significantly reduced pain intensity (Hedges' g = -0.730, 95% CI = -1.340 to -0.119, p = 0.019, I2 = 89.288%). Subgroup analysis revealed that the adult group experienced significant pain reduction after PNE, whereas the adolescent group did not. PNE also reduced kinesiophobia which was evaluated in four of seven RCTs (Hedges' g = -0.444, 95% CI = -0.735 to -0.154, p = 0.003, I2 = 36.822%). The meta-regression analysis indicated that an increased intervention duration contributed to greater pain reduction. No adverse events were reported following PNE or the control treatment. CONCLUSIONS PNE effectively reduced pain intensity and kinesiophobia in patients with CNP. A longer PNE time leads to greater pain reduction and is more effective in adults than in adolescents. Further studies are required to examine the long-term effects on CNP management. SIGNIFICANCE This is the first meta-analysis evaluating the effectiveness of treating chronic neck pain with pain neuroscience education. Pain neuroscience education is successful in reducing pain and decreasing kinesiophobia in the chronic neck pain population. Longer treatment time leads to greater pain reduction.
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Affiliation(s)
- Long-Huei Lin
- Kaohsiung Rukang Physiotherapy Clinic, Kaohsiung, Taiwan
| | - Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Di Bonaventura S, Fernández Carnero J, Ferrer-Peña R. Can a specific biobehavioral-based therapeutic education program lead to changes in pain perception and brain plasticity biomarkers in chronic pain patients? A study protocol for a randomized clinical trial. PLoS One 2024; 19:e0289430. [PMID: 38241249 PMCID: PMC10798500 DOI: 10.1371/journal.pone.0289430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/01/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Chronic pain conditions are complex multifactorial disorders with physical, psychological, and environmental factors contributing to their onset and persistence. Among these conditions, the role of brain-derived neurotrophic factor (BDNF) and the impact of a specific therapeutic education (TE) on pain management have emerged as important areas of research. OBJECTIVE This study aims to investigate the effects of a specific type of therapeutic education on pain levels and BDNF concentrations. METHODS In this single-blind, randomized clinical trial, patients will be randomly assigned to one of two groups: one will receive exercise with TE and the other without TE. Assessments will be made at baseline, mid-treatment, post-intervention, and at one and eight months. OUTCOMES This study will shed light on the effectiveness of a therapeutic education (TE) program in pain management. Additionally, it will provide information on its effects on BDNF levels, a biomarker of brain plasticity, as well as on various psychosocial variables that can influence pain experience. CONCLUSION By comprehensively addressing the need to quantify brain changes more precisely in individuals with chronic pain during interventions like TE and recognizing the importance of establishing a more structured and comprehensive protocol, this study lays a solid and replicable foundation for future evidence-based treatment developments.
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Affiliation(s)
- Silvia Di Bonaventura
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Josué Fernández Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain
| | - Raúl Ferrer-Peña
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Madrid, Spain
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, CSEU La Salle, Universidad Autonóma de Madrid, Madrid, Spain
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Salazar-Méndez J, Núñez-Cortés R, Suso-Martí L, Ribeiro IL, Garrido-Castillo M, Gacitúa J, Mendez-Rebolledo G, Cruz-Montecinos C, López-Bueno R, Calatayud J. Dosage matters: Uncovering the optimal duration of pain neuroscience education to improve psychosocial variables in chronic musculoskeletal pain. A systematic review and meta-analysis with moderator analysis. Neurosci Biobehav Rev 2023; 153:105328. [PMID: 37516218 DOI: 10.1016/j.neubiorev.2023.105328] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
The aim was to examine the moderator effect of duration of PNE (total minutes) on changes in psychosocial variables after treatment in people with chronic musculoskeletal pain. PubMed/MEDLINE, Embase, Web of Science, Scopus and CINHAL databases were systematically searched from inception to 6 February 2023. A mixed-effects meta-regression was performed to determine the moderator effect of PNE duration. Twenty-three studies involving 2352 patients were included. Meta-analysis revealed a statistically significant effect in favour of PNE on pain neurophysiology knowledge, anxiety symptoms, catastrophizing and kinesiophobia. The total duration of PNE ranged from 40 to 720 min. A linear relationship was observed between longer duration of PNE (total minutes) and changes of psychosocial variables. In addition, a dose of 100, 200 and 400 min of PNE was estimated to exceed the minimum clinically important difference described in the literature for kinesiophobia (mean difference = -8.53 points), anxiety symptoms (mean difference = -1.88 points) and catastrophizing (mean difference = -7.17 points). Clinicians should provide a more tailored PNE to address psychosocial variables.
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Affiliation(s)
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department Cf Physiotherapy, University of Valencia, Spain
| | - Ivana Leão Ribeiro
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | | | - José Gacitúa
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Guillermo Mendez-Rebolledo
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile; Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Carlos Cruz-Montecinos
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department Cf Physiotherapy, University of Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department Cf Physiotherapy, University of Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark
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Escriche-Escuder A, Nijs J, Silbernagel KG, van Wilgen CP, Plinsinga ML, Casaña J, Cuesta-Vargas AI. Pain neuroscience education in persistent painful tendinopathies: A scoping review from the Tendon PNE Network. Phys Ther Sport 2023; 63:38-49. [PMID: 37499463 DOI: 10.1016/j.ptsp.2023.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE to conduct and report a scoping review of the available evidence of the effects and content of pain neuroscience education for patients with persistent painful tendinopathies. METHODS PubMed, Embase, Web of Science, CINAHL, SPORTDiscus, and grey literature databases were searched from database inception to May 2022. Randomised and non-randomised controlled trials, non-controlled clinical trials, cohort studies, case series, case studies including people with persistent painful tendinopathy aged ≥18 years, a pain education intervention, and in English were included. Studies were excluded if they were cross-sectional studies, reviews, editorials, abstracts, or full-text not available or if included heterogeneous study cohorts, patients with tendon rupture, or patients with systemic diseases. RESULTS five studies (n = 164) were included. Pain neuroscience education entailed face-to-face discussion sessions or educational materials including videos, brochures, paper drawings, and review questions. All studies used pain neuroscience education in conjunction with other interventions, obtaining significant benefits in outcomes related to pain, physical performance, or self-reported function, among others. CONCLUSIONS The application of pain neuroscience education in conjunction with other interventions seemed to improve several outcomes. However, considering the current knowledge about tendon pain and the scarcity of well-designed trials studying pain neuroscience education in tendinopathy, additional research is needed.
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Affiliation(s)
- Adrian Escriche-Escuder
- Department of Physiotherapy, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - C Paul van Wilgen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Transcare Transdisciplinary Pain Management Center, Groningen, the Netherlands
| | - Melanie L Plinsinga
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain; School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
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Rabiei P, Sheikhi B, Letafatkar A. Examining the influence of pain neuroscience education followed by a Pilates exercises program in individuals with knee osteoarthritis: a pilot randomized controlled trial. Arthritis Res Ther 2023; 25:94. [PMID: 37280700 DOI: 10.1186/s13075-023-03079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a multifactorial form of rheumatic condition contributing to physical and psychological factors. Treatments have been provided solely and often compared with each other. An alternative view is that combined treatments addressing physical and psychological factors may result in more benefits. This study aimed to investigate the effect of pain neuroscience education (PNE) followed by Pilates exercises (PEs) in participants with knee OA, compared to PE alone. METHODS In this two-arm assessor-blind pilot randomized controlled trial, fifty-four community-dwelling adults with knee OA were randomly assigned to the PNE followed by PEs and PEs groups (27 in each group). The study was conducted between early July 2021 and early March 2022 at the university's health center. Primary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales of pain and physical limitation and secondary outcomes were Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Pain Self-Efficacy Questionnaire, and Timed "Up & Go" test covering function. The primary and secondary outcomes were measured at baseline and eight weeks post-treatment. A general linear mixed model was used for between-group comparison with a statistical significance level of 0.05. RESULTS Significant within-group differences were observed in all outcomes in both groups at post-treatment. There were no statistically between-group differences in pain (adjusted mean difference: -0.8; 95% CI -2.2 to 0.7; p = 0.288), physical limitation (adjusted mean difference: -0.4; 95% CI -4 to 3.1; p = 0.812) and function (adjusted mean difference: -0.8; 95% CI -1.8 to 0.1; p = 0.069) at eight weeks. For pain catastrophizing (adjusted mean difference: -3.9; 95% CI -7.2 to -0.6; p = 0.021), kinesiophobia (adjusted mean difference: -4.2; 95% CI -8.1 to -0.4; p = 0.032), and self-efficacy (adjusted mean difference: 6.1; 95% CI 0.7 to 11.5; p = 0.028) statistically between-group improvements were observed favoring PNE followed by PEs group after the treatment. CONCLUSIONS Combining PNE with PEs could have superior effects on psychological characteristics but not on pain, physical limitation, and function, compared to PEs alone. This pilot study emphasizes the need to investigate the combined effects of different interventions. TRIAL REGISTRATION IRCT20210701051754N1.
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Affiliation(s)
- Pouya Rabiei
- Faculty of Medicine, Université Laval, Quebec City, Canada.
- Centre Interdisciplinaire de Recherche en Réadaptation Et Intégration Sociale (Cirris), 525 Boulevard Hamel, Quebec, QC, G1M 2S8, Canada.
| | - Bahram Sheikhi
- Sports Injury and Corrective Exercises, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
| | - Amir Letafatkar
- Sports Injury and Corrective Exercises, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
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De Baets L, Sergooris A, Neblett R, Matheve T, Mingels S, Van Goethem A, Huybrechts X, Corten K, Gerits D, Vandevoort D, Timmermans A, Janssens L. The development and measurement properties of the Dutch version of the fear-avoidance components scale (FACS-D) in persons with chronic musculoskeletal pain. Scand J Pain 2023; 23:298-307. [PMID: 36513392 DOI: 10.1515/sjpain-2022-0046] [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: 03/14/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument assessing different constructs related to the fear-avoidance model of pain. The aim was to translate the original English FACS into Dutch (FACS-D) and assess its measurement properties in persons with chronic musculoskeletal pain. METHODS The original English FACS (20 item-scale, range: 0-100) was translated in Dutch through standard forward-backward translation methodology. The FACS-D's measurement properties were evaluated in 224 persons with chronic musculoskeletal pain. Internal consistency, test-retest reliability and measurement error were assessed with the Cronbach's alpha coefficient (α), intraclass correlation coefficient (ICC), and standard error of measurement (SEM). Construct validity was assessed through inter-item correlation analyses, exploratory factor analysis, association with other fear-avoidance-related constructs, and hypothesis testing. RESULTS Internal consistency, test-retest reliability and hypotheses testing were good (α=0.92; ICC=0.92, CI 0.80-0.96; 7/8 hypotheses confirmed). Similar to the original FACS and other translated versions, a two-factor model best fit the data. However, the item distribution differed from other versions. One factor represented "pain-related cognitions and emotions" and a second factor represented "avoidance behaviour." In contrast to the original FACS, low inter-item correlations for item 12 were found. The FACS-D was more strongly associated with fear-avoidance-related constructs of pain severity, perceived disability, feelings of injustice, and depressive/anxiety symptoms than the other fear-avoidance-related scales studied here. CONCLUSIONS The FACS-D demonstrated good reliability and construct validity, suggesting that it may be a useful measure for Dutch-speaking healthcare providers. Two clinically relevant factors, with a different item distribution than the original FACS, were identified: one covering items on pain-related cognitions and emotions, and one covering items on avoidance behaviour. The stronger association between FACS-D and fear-avoidance related constructs suggests that the FACS-D may be more effective in evaluating the cognitive, emotional and behavioural constructs of pain-related fear-avoidance than other similar measures.
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Affiliation(s)
- Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Abner Sergooris
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - Thomas Matheve
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Spine, Head and Pain Research Unit Ghent; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Sarah Mingels
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Research Group for Musculoskeletal Rehabilitation, Faculty of Movement and Rehabilitation Sciences, Leuven University, Leuven, Belgium
| | - Ann Van Goethem
- Multidisciplinary Pain Centre, Genk, Belgium
- Physical Medicine and Rehabilitation, Genk, Belgium
- Centre for Translational Psychological Research (TRACE), Hospital ZOL Limburg, Genk, Belgium
| | - Xavier Huybrechts
- Department of Physical and Rehabilitation Medicine, Jessa Hospital, Hasselt, Belgium
| | | | - Dave Gerits
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Dagmar Vandevoort
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Annick Timmermans
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Lotte Janssens
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Supe HM, Mungikar SS, Katage GA, Garg KA, Wani SK. Effect of Pain Neuroscience Education with Conventional Physiotherapy via Telerehabilitation on Pain Catastrophizing and Function in Patients with Osteoarthritis Knee: A Randomized Controlled Trial. J Midlife Health 2023; 14:123-129. [PMID: 38029040 PMCID: PMC10664057 DOI: 10.4103/jmh.jmh_33_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/04/2023] [Indexed: 12/01/2023] Open
Abstract
Aim By explaining to the patient the biological processes underneath their pain condition, pain neuroscience education (PNE) is a form of educational intervention that aims to relieve pain and impairment. Materials and Methods Patients with knee osteoarthritis (OA) referred to outpatient physiotherapy clinic in India during August 2021 to June 2022 were asked to participate. Out of the eligible patients, 35 were randomly assigned to PNE group and 35 to the control group. Self-reports of Pain Catastrophizing Scale (PCS), Patient Specific Function Scale (PSFS), and Numerical Pain Rating Scale (NPRS) were recorded at baseline (T1) and at 2 weeks (T2). Results After 2 weeks of follow-up, all the three outcome measures were found to be significant in the PNE group. The results of the unpaired t-test revealed statistically significant result posttest for PCS (mean difference 11.4) and NPRS (mean difference 1.20). There was no mean difference found in the patient function (PSFS) between groups. Conclusion The results suggest that adding a program of PNE to conventional physiotherapy exercises led to a greater reduction in pain catastrophization, patient-specific function, and pain intensity rather than conventional physiotherapy alone in patients with knee OA at 2 weeks' follow-up.
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Affiliation(s)
- Hiral Manohar Supe
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Sanket S. Mungikar
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Goutami A. Katage
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Kapil A. Garg
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Surendra Kiran Wani
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
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Aguiar ADS, Moseley GL, Bataglion C, Azevedo B, Chaves TC. Education-Enhanced Conventional Care versus Conventional Care Alone for Temporomandibular Disorders: A Randomized Controlled Trial. THE JOURNAL OF PAIN 2023; 24:251-263. [PMID: 36220481 DOI: 10.1016/j.jpain.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/29/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022]
Abstract
The objective of this study was to determine the effect of enhancing conventional care for people with chronic painful temporomandibular disorders (TMD) with an individualised contemporary pain science education (PSE) intervention. In this randomized controlled trial, a consecutive sample of 148 participants (18-55 years of age) was randomized into 2 groups: PSE-enhanced conventional care or Conventional care alone. Conventional care involved a 6-week, 12-session manual therapy and exercise program. The PSE enhancement involved 2 sessions of modern PSE, undertaken in the first 2 treatment sessions. Primary outcomes were pain intensity, assessed with a numeric pain rating scale, and disability, assessed with the craniofacial pain and disability inventory, post-treatment. Linear mixed model analyses were used to investigate between-group differences over time. There was a statistically and clinically meaningful effect of PSE enhancement on disability (Mean Difference = 6.1, 95% CI: 3.3-8.8), but not on pain intensity, post-treatment. Secondary analyses suggested clinically meaningful benefit of PSE enhancement on pain and disability ratings at 10-week and 18-week follow-ups, raising the possibility that preceding conventional care with a PSE intervention may result in long-term benefits. PERSPECTIVE: The addition of modern Pain Science Education (PSE) intervention improved disability for people with chronic TMD receiving manual therapy and exercise, but not pain. A mean difference in pain and disability favoring the PSE group at the 10- and 18-week follow-ups, respectively, suggests that PSE addition resulted in longer-lasting effects. Trial registration: NCT03926767. Registered on April 29, 2019. https://clinicaltrials.gov/ct2/show/NCT03926767.
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Affiliation(s)
- Aroldo D S Aguiar
- Ph.D. in Musculoskeletal Rehabilitation, Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - G Lorimer Moseley
- DSc Ph.D, Bradley Distinguished Professor, IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Cesar Bataglion
- Ph.D in Dental Sciences, Professor and Researcher from the Department of Restorative Dentistry at Ribeirão Preto Dental School (FORP), University of São Paulo-USP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Beatriz Azevedo
- Master's Degree in Progress in Musculoskeletal Rehabilitation, Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Thaís C Chaves
- Ph.D, Adjunct Professor and Researcher from the Department of Physical Therapy, University Federal of São Carlos, UFSCar, São Carlos, Brazil; Researcher from the Graduate Program on Rehabilitation and Functional Performance, Laboratory of Research on Movement and Pain (LabMovePain), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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21
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Khosrokiani Z, Letafatkar A, Hadadnezhad M, Sokhanguei Y. The comparison between the effects of pain education interventions with online and face-to-face exercise and the control group received biomedical education + standardized physical therapy in patients with chronic nonspecific neck pain during COVID-19: protocol for a parallel-group randomized controlled trial. Trials 2022; 23:1031. [PMID: 36539843 PMCID: PMC9763812 DOI: 10.1186/s13063-022-06932-3] [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: 12/08/2021] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Various psychological issues and serious health concerns during the imposed lockdown by coronavirus disease 2019 (COVID-19) have induced many changes in the treatment of patients. More effective self-management strategies through tele-rehabilitation are suggested to be applied for patients with chronic neck pain to reduce referrals to health cares and disability support through COVID-19. Also, the pain neuroscience education (PNE) approach is an educational method used by health professionals to assist patients in understanding the biology, physiology, and psychosocial factors affecting their pain experience and aligning with the cognitions and beliefs associated with pain and recurrent disability. PNE combined with tele-rehabilitation could be a new solution to encourage patients to manage their condition by themselves and increase the continuity of practice instead of face-to-face sessions. OBJECTIVE This randomized control trial (RCT) aims to investigate the effects of PNE with online and face-to-face exercise interventions, and the control group received biomedical education + standardized physical therapy on neck pain and disability, psychological factors, and function in non-traumatic chronic neck pain. METHODS/DESIGN Patients with non-traumatic chronic neck pain (patient-centered care and active involvement of patients and the public) will be recruited via flyers displayed in hospitals and universities to participate in an RCT with two experimental and one control group designed to investigate the effects of PNE with online and face-to-face exercise interventions, and the control group received biomedical education + standardized physical therapy on neck pain and disability, psychological factors, and function in non-traumatic chronic neck pain. The outcomes will be measured at baseline, after PNE, and after 3 months of an exercise intervention. All outcomes are presented as mean ± SD, and statistical significance was set at α level of < 0.05. The normal distribution of the variables was verified by the Kolmogorov-Smirnov test, following a descriptive analysis. DISCUSSION It seems that PNE plus online and face-to-face exercise interventions are appropriate educational models for the treatment of patients with neck pain during COVID-19. Also, online training seems to encourage patients to continue their treatment. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20150503022068N5. Registered on 09 September 2021.
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Affiliation(s)
- Zohre Khosrokiani
- grid.412265.60000 0004 0406 5813Biomechanics and Corrective Exercise Laboratory, Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, 00982122258084 Iran
| | - Amir Letafatkar
- grid.412265.60000 0004 0406 5813Biomechanics and Corrective Exercise Laboratory, Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, 00982122258084 Iran
| | - Malihe Hadadnezhad
- grid.412265.60000 0004 0406 5813Biomechanics and Corrective Exercise Laboratory, Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, 00982122258084 Iran
| | - Yahya Sokhanguei
- grid.472458.80000 0004 0612 774XUniversity of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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22
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Ickmans K, Rheel E, Rezende J, Reis FJJ. Spreading the word: pediatric pain education from treatment to prevention. Arch Physiother 2022; 12:25. [PMID: 36376953 PMCID: PMC9663293 DOI: 10.1186/s40945-022-00151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022] Open
Abstract
Pain affects everyone hence one can argue that it is in each individual’s interest to understand pain in order to hold correct and adaptive beliefs and attitudes about pain. In addition, chronic pain is reaching pandemic proportions and it is now well known that people living with chronic pain have a reduced life expectancy. To address and to prevent the growth of this public health disaster, we must start looking beyond adulthood. How children view pain has an impact on their behavioral coping responses which in turn predict persistent pain early in the lifespan. In addition, children who suffer from chronic pain and who are not (properly) treated for it before adolescence have an increased risk of having chronic pain during their adult life. Explaining pain to children and youth may have a tremendous impact not only on the individual child suffering from chronic pain but also on society, since the key to stop the pain pandemic may well lie in the first two decades of life. In order to facilitate the acquisition of adaptive behavioral coping responses, pain education aims to shift people’s view on pain from being an apparent threat towards being a compelling perceptual experience generated by the brain that will only arise whenever the conceivable proof of danger to the body is greater than the conceivable proof of safety to the body. Nowadays a lot of pain education material is available for adults, but it is not adapted to children’s developmental stage and therefore little or not suitable for them. An overview of the state-of-the-art pain education material for children and youth is provided here, along with its current and future areas of application as well as challenges to its development and delivery. Research on pediatric pain education is still in its infancy and many questions remain to be answered within this emerging field of investigation.
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23
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Alcon CA, Wang-Price S. Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: Evidence and future directions. FRONTIERS IN PAIN RESEARCH 2022; 3:959609. [PMID: 36438443 PMCID: PMC9686004 DOI: 10.3389/fpain.2022.959609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic low back pain (CLBP) is among the leading causes of disability worldwide. Beyond the physical and functional limitations, people's beliefs, cognitions, and perceptions of their pain can negatively influence their prognosis. Altered cognitive and affective behaviors, such as pain catastrophizing and kinesiophobia, are correlated with changes in the brain and share a dynamic and bidirectional relationship. Similarly, in the presence of persistent pain, attentional control mechanisms, which serve to organize relevant task information are impaired. These deficits demonstrate that pain may be a predominant focus of attentional resources, leaving limited reserve for other cognitively demanding tasks. Cognitive dysfunction may limit one's capacity to evaluate, interpret, and revise the maladaptive thoughts and behaviors associated with catastrophizing and fear. As such, interventions targeting the brain and resultant behaviors are compelling. Pain neuroscience education (PNE), a cognitive intervention used to reconceptualize a person's pain experiences, has been shown to reduce the effects of pain catastrophizing and kinesiophobia. However, cognitive deficits associated with chronic pain may impact the efficacy of such interventions. Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective in the treatment of anxiety, depression, and pain. In addition, as with the treatment of most physical and psychological diagnoses, an active multimodal approach is considered to be optimal. Therefore, combining the neuromodulatory effects of NIBS with a cognitive intervention such as PNE could be promising. This review highlights the cognitive-affective deficits associated with CLBP while focusing on current evidence for cognition-based therapies and NIBS.
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Affiliation(s)
- Cory A. Alcon
- Department of Physical Therapy, High Point University, High Point, NC, United States
- School of Physical Therapy, Texas Woman’s University, Dallas, TX, United States
- Correspondence: Cory A. Alcon
| | - Sharon Wang-Price
- School of Physical Therapy, Texas Woman’s University, Dallas, TX, United States
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24
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Mukhtar NB, Meeus M, Gursen C, Mohammed J, De Pauw R, Cagnie B. Pilot study on the effects of a culturally-sensitive and standard pain neuroscience education for Hausa-speaking patients with chronic neck pain. Disabil Rehabil 2022; 44:7226-7236. [PMID: 34663135 DOI: 10.1080/09638288.2021.1988155] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To pilot feasibility and assess preliminary effectiveness of standard and culture-sensitive Pain Neuroscience Education (PNE) among Hausa-speaking patients with Chronic Neck Pain (CNP). METHODS Adverts (online & clinic-based) were used to recruit Hausa-speaking patients with nonspecific CNP in Kano, Nigeria. Selected participants were randomized to culture-sensitive PNE (CSPNE), standard PNE (PNE), or control groups. Each group received bi-weekly sessions of exercise therapy for 6 weeks. Two sessions of PNE plus a home-based session were administered before exercise therapy in the PNE groups. Primary (pain-intensity and disability) and secondary (pain-knowledge, pain catastrophizing, and quality of life) outcomes were measured. The study was pre-registered (PACTR201902788269426). RESULTS Fifty-three (out of 64) participants met the inclusion criteria. The majority of them were recruited through radio adverts (83%). Interventions were successfully administered and data collection was completed for the participants. About 15% and 17% drop-out rate was recorded before intervention (post-randomization) and during follow-up, respectively. Main results indicated that significant within-group improvements in disability and pain knowledge scores were found in favor of the PNE groups. CONCLUSION Culture-sensitive and standard PNE plus exercise therapy are feasible for Hausa patients with CNP, and current findings indicate support for reducing disability and increasing pain knowledge among them.Implications for rehabilitationBoth standard PNE and culture-sensitive PNE are feasible for administration as interventions for Hausa-speaking patients with CNP.Radio adverts may be necessary for patients recruitment in addition to specialists' referrals.Culturally sensitive PNE materials may be more desirable as an intervention option due to the low literacy level among the Hausa population.
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Affiliation(s)
- Naziru Bashir Mukhtar
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Department of Physiotherapy, Bayero University, Kano, Nigeria
| | - Mira Meeus
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group (PiM), Belgium.,Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Ceren Gursen
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Jibril Mohammed
- Department of Physiotherapy, Bayero University, Kano, Nigeria
| | - Robby De Pauw
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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25
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Andias R, Sa-Couto P, Silva AG. Blended-Learning Pain Neuroscience Education and Exercise in High School Students With Chronic Neck Pain: A Randomized Controlled Trial. Phys Ther 2022; 102:6575293. [PMID: 35485186 DOI: 10.1093/ptj/pzac048] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/07/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pain neuroscience education (PNE) and exercise have emerged as potential interventions in adolescents with chronic pain; however, very few studies have explored their effectiveness. Blended-learning approaches combining face-to-face and online educational sessions have also emerged as facilitating methods of health education. This study aimed to compare the effectiveness of exercises and PNE versus exercise alone in adolescents with chronic neck pain (NP). METHODS A randomized controlled trial with 6-month follow-up was conducted in 2 high schools. Over 8 weeks, a total of 127 adolescents with chronic NP were randomly allocated to either (1) perform functional and region-specific exercises, including generalized neuromuscular control, endurance, and strength exercises, as well as exercises targeting the deep neck flexor and extensor muscles and scapular stabilizer muscles; or (2) perform the same exercise-based intervention plus PNE. Pain intensity (primary outcome), disability, sleep, catastrophizing, fear of movement, self-efficacy, and knowledge of pain neuroscience were assessed at baseline, postintervention, and 6-month follow-up. Neck and scapular muscle endurance and pressure pain thresholds were assessed at baseline and postintervention. Patient's Global Impression of Change was assessed postintervention and at 6-month follow-up. RESULTS There was a significant decrease in pain intensity from baseline to postintervention and from baseline to follow-up in both groups, but there were no between-group differences or interactions between time and groups. These results were similar for the secondary outcomes, except for knowledge of pain neuroscience, for which a significant group and time interaction was found. CONCLUSION Exercise and exercise plus PNE were similarly effective in treating adolescents with chronic NP, and the results were maintained for up to 6 months. Further studies are needed to explore the effect of these interventions for longer follow-ups.
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Affiliation(s)
- Rosa Andias
- School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal.,Center for Health Technology and Services Research (CINTESIS), Piso 2, Edifício nascente, Porto, Portugal
| | - Pedro Sa-Couto
- CINTESIS@RISE, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Anabela G Silva
- School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal.,Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, Aveiro, Portugal
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26
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Lane E, Magel JS, Thackeray A, Greene T, Fino NF, Puentedura EJ, Louw A, Maddox D, Fritz JM. Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a cluster-randomized trial. Pain 2022; 163:852-860. [PMID: 34354017 PMCID: PMC8816964 DOI: 10.1097/j.pain.0000000000002436] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic spinal pain poses complex challenges for health care around the world and is in need of effective interventions. Pain neuroscience education (PNE) is a promising intervention hypothesized to improve pain and disability by changing individuals' beliefs, perceptions, and expectations about pain. Pain neuroscience education has shown promise in small, controlled trials when implemented in tightly controlled situations. Exploration of promising interventions through more pragmatic methodologies is a crucial but understudied step towards improving outcomes in routine clinical care. The purpose was to examine the impact of pragmatic PNE training on clinical outcomes in patients with chronic spine pain. The cluster-randomized clinical trial took place in 45 outpatient physical therapist (PT) clinics. Participants included 108 physical therapists (45 clinics and 16 clusters) and 319 patients. Clusters of PT clinics were randomly assigned to either receive training in PNE or no intervention and continue with usual care (UC). We found no significant differences between groups for our primary outcome at 12 weeks, Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test {mean difference = 1.05 (95% confidence interval [CI]: -0.73 to 2.83), P = 0.25}. The PNE group demonstrated significant greater improvements in pain self-efficacy at 12 and 2 weeks compared with no intervention (mean difference = 3.65 [95% CI: 0.00-7.29], P = 0.049 and = 3.08 [95% CI: 0.07 to -6.09], P = 0.045, respectively). However, a similar percentage of participants in both control (41.1%) and treatment (44.4%) groups reported having received the treatment per fidelity question (yes or no to pain discussed as a perceived threat) at 2 weeks. Pragmatic PT PNE training and delivery failed to produce significant functional changes in patients with chronic spinal pain but did produce significant improvement in pain self-efficacy over UC PT.
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Affiliation(s)
- Elizabeth Lane
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - John S. Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Tom Greene
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
- Population Health, Research Study Design and Biostatistics Center, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Nora F. Fino
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | | | - Adriaan Louw
- Department of Physical Therapy, Evidence in Motion, San Antonio, TX, United States
| | - Daniel Maddox
- Department of Physical Therapy, Brenau University, Gainesville, GA, United States
| | - Julie M. Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
- College of Health, University of Utah, Salt Lake City, UT, United States
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27
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Khosrokiani Z, Letafatkar A, Hadadnezhad M, Sokhanguei Y. Comparison the Effect of Pain Neuroscience and Pain Biomechanics Education on Neck Pain and Fear of Movement in Patients with Chronic Nonspecific Neck Pain During the COVID-19 Pandemic. Pain Ther 2022; 11:601-611. [PMID: 35312949 PMCID: PMC8935612 DOI: 10.1007/s40122-022-00371-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Self-management education is the basis of any intervention for persons with chronic musculoskeletal pain. Given the biopsychosocial nature of chronic musculoskeletal pain, an educational approach based on the biopsychosocial model would seem to be an appropriate educational model for the treatment of these people during coronavirus disease 2019 (COVID-19). The aim of this study was to compare the effect of pain neuroscience education (PNE) and pain biomechanics education, using online and face-to-face sessions on pain and fear of movement, in people with chronic nonspecific neck pain during COVID-19. Methods In this multicenter assessor-blinded randomized controlled trial, 80 patients (both male and female) with chronic nonspecific neck pain (based on the inclusion criteria of the study) participated in educational sessions (face-to-face and online) from the beginning September until the end of October 2021. The participants were randomly divided into two groups (through the selection of numbers from 1 to 80, hidden in a box), with one group receiving PNE (treatment group) and the other group receiving pain biomechanics education (control group). Pain and fear of movement before and after the intervention were measured on the Numerical Pain Rating Scale and the Tampa Scale of Kinesiophobia, respectively. A 2 × 2 variance analysis (treatment group × time) with a mixed-model design was applied to statistically analyze the data. Results No significant change in pain (P = 0.23) was observed between the two groups (P = 0.24, Cohen's d = 0.17, 95% confidence interval [CI] − 0.21 to 0.35), while changes in the fear of movement variable were reported to be significant (P = 0.04, Cohen's d = 0.34, 95% CI 0.11–0.51), in favor of PNE. Intra-group change was seen only in the PNE group for the fear of movement variable (P = 0.04; 14.28%↓). Conclusion In our study population PNE did not affect the pain index, leading to the conclusion that PNE should not be used as the only treatment, but possibly in combination with other active/passive therapy to enhance the results for patients with nonspecific chronic neck pain. Moreover, online treatment may help clinicians to increase their interaction with patients during COVID-19 lockdown.
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Affiliation(s)
- Zohre Khosrokiani
- Biomechanics and Corrective Exercises Laboratory, Faculty of Physical Education and Sports Sciences, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, Iran
| | - Amir Letafatkar
- Biomechanics and Corrective Exercises Laboratory, Faculty of Physical Education and Sports Sciences, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, Iran.
| | - Malihe Hadadnezhad
- Biomechanics and Corrective Exercises Laboratory, Faculty of Physical Education and Sports Sciences, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, Iran
| | - Yahya Sokhanguei
- Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Kim KS, An J, Kim JO, Lee MY, Lee BH. Effects of Pain Neuroscience Education Combined with Lumbar Stabilization Exercise on Strength and Pain in Patients with Chronic Low Back Pain: Randomized Controlled Trial. J Pers Med 2022; 12:jpm12020303. [PMID: 35207790 PMCID: PMC8876043 DOI: 10.3390/jpm12020303] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/27/2022] [Accepted: 02/11/2022] [Indexed: 12/02/2022] Open
Abstract
Chronic low back pain that lasts more than 12 weeks causes mental and physical distress. This study investigated the effects of pain neuroscience education combined with lumbar stabilization exercises on strength, pain, flexibility, and activity disorder index in female patients with chronic low back pain. Thirty-five female patients with chronic low back pain were randomly divided into two groups: the pain neuroscience education (PNE) combined with lumbar stabilization exercises (LSEs) group (n = 18, experimental group) and the lumbar stabilization exercises alone group (n = 17, control group). The experimental group underwent PNE combined with LSEs for 30 min per session, twice per week for 8 weeks, and the control group underwent LSEs only. The primary outcomes were strength (sit-up and back-up movements), Numerical Pain Rating Scale (NPRS), Korean Pain Catastrophizing Scale (K-PCS), and Tampa Scale of Kinesio-phobia-11 (TSK-11) for pain. The secondary outcomes were modified–modified Schober’s test (MMST) and finger to floor test (FFT) for flexibility and activity disorder (Roland–Morris Disability Questionnaire index). A significant difference was observed in the primary outcomes after intervention in the abdominal muscle strength (group difference, mean, −7.50; 95% CI, −9.111 to –5.889, F = 9.598; ANCOVA p = 0.005), the back muscle strength (group difference, mean, −9.722; 95% CI, −10.877 to –8.568, F = 7.102; ANCOVA p = 0.014), the NPRS (group difference, mean, 1.89; 95% CI,1.65 to 2.12, F = 24.286; ANCOVA p < 0.001), K-PCS (group difference, mean, 7.89; 95% CI, 7.02 to 8.76, F = 11.558; ANCOVA p = 0.003), and TSK-11 (group difference, mean, 16.79; 95% CI, 13.99 to 19.59, F = 13.179; ANCOVA p = 0.014) for pain. In the secondary outcomes, there was a significant difference in the FFT (group difference, mean, −0.66; 95%CI, −0.99 to −0.33, F = 4.327; ANCOVA p = 0.049), whereas the difference in flexibility (MMST) and activity disorder index of the secondary outcomes did not reach significance. Therefore, this study confirmed that PNE combined with LSEs is an effective intervention compared to LSE alone in improving muscle strength and pain in female patients with chronic low back pain.
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Affiliation(s)
- Ki-Sang Kim
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea; (K.-S.K.); (J.A.); (J.-O.K.)
| | - Jungae An
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea; (K.-S.K.); (J.A.); (J.-O.K.)
| | - Ju-O Kim
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea; (K.-S.K.); (J.A.); (J.-O.K.)
| | - Mi-Young Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
- Correspondence: ; Tel.: +82-2-3399-1634
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Bilterys T, Kregel J, Nijs J, Meeus M, Danneels L, Cagnie B, Van Looveren E, Malfliet A. Influence of education level on the effectiveness of pain neuroscience education: A secondary analysis of a randomized controlled trial. Musculoskelet Sci Pract 2022; 57:102494. [PMID: 34953290 DOI: 10.1016/j.msksp.2021.102494] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Current evidence supports the use of pain neuroscience education (PNE) in several chronic pain populations. However, the effects of PNE at group level are rather small and little is known about the influence of personal factors (e.g. level of education [LoE]). OBJECTIVE To examine whether the effectiveness of PNE differs in chronic spinal pain (CSP) patients with high LOE (at least a Bachelor's degree) versus lower educated patients. METHOD A total of 120 Belgian CSP patients were randomly assigned to the experimental (PNE) or control group (biomedical-focused neck/back school). Participants within each group were further subcategorized based on highest achieved LoE. ANOVA and Bonferroni post-hoc analyses were used to evaluate differences in effectiveness of the interventions between higher and lower educated participants. RESULTS No differences between higher and lower educated participants were identified for pain-related disability. Significant interactions (P < .05) were found for kinesiophobia and several illness perceptions components. Bonferroni post-hoc analysis revealed a significant improvement in kinesiophobia (P < .001 and P < .002, medium effect sizes) and perceived negative consequences (P < .001 and P < .008, small effect sizes) in the PNE groups. Only the higher education PNE group showed a significant improvement in perceived illness cyclicity (P = .003, small effect size). Post-treatment kinesiophobia was significant lower in the higher educated PNE group compared to the higher educated control group (p < .001). CONCLUSION Overall, the exploratory findings suggest no clinical meaningful differences in effectiveness of PNE between higher and lower educated people. PNE is effective in improving kinesiophobia and several aspects of illness perceptions regardless of LoE.
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Affiliation(s)
- Thomas Bilterys
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Jeroen Kregel
- Pain in Motion International Research Group, Belgium(1); Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group, Belgium(1); Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Eveline Van Looveren
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Anneleen Malfliet
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium.
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30
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von Korn K, Weiss T, von Piekartz H. [Effects of preoperative neurobiological education on postoperative outcome : A systematic review]. Schmerz 2022; 36:406-421. [PMID: 34985533 DOI: 10.1007/s00482-021-00608-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/26/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pain may have a crucial impact on human quality of life. An increase in knowledge about neurobiological and neuroscientific processes alone can positively influence the subjective perception of pain as well as psychometric variables. There are different forms of preoperative patient education with the aim to explain postoperative pain. Based on current literature, preoperative biomedical education has a low level of evidence. It can increase the preoperative anxiety and stress level of patients, which has a negative impact on the postoperative outcome. In contrast, the neuroscientific understanding considers postoperative pain from the viewpoints of the plasticity of the nervous system and involves sensitizational processes in the central and peripheral nervous systems. PURPOSE To systematically investigate short- and long-term effects of pain neuroscience education (PNE) in patients before spine surgery. MATERIALS AND METHODS The literature search involved a search of medical databases according to the PI(C)O scheme, and 83 articles were shortlisted. Nine articles that met the inclusion and exclusion criteria were finally included. RESULTS Preoperative pain neuroscience education can positively influence postoperative catastrophizing tendencies as well as postoperative kinesiophobia but has no influence on postoperative pain and function. CONCLUSION Preoperative reduction of anxiety and pain-maintaining factors mainly on the psychological and social level may have a positive effect on postoperative subjective pain evaluation, which is reflected in a reduction of anxiety, catastrophizing tendencies, and a lower utilization of postoperative health care services.
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Affiliation(s)
- Karolin von Korn
- Lubinus Aktiv GmbH, Steenbeker Weg 33, 24106, Kiel, Deutschland.,Fakultät Wirtschafts- und Sozialwissenschaften, Physiotherapie und Rehabilitationswissenschaften, Hochschule Osnabrück, Caprivistr. 30a, 49076, Osnabrück, Deutschland
| | - Thomas Weiss
- Lehrstuhl für Klinische Psychologie, Friedrich-Schiller-Universität Jena, Am Steiger 3, Haus 1, 07743, Jena, Deutschland
| | - Harry von Piekartz
- Fakultät Wirtschafts- und Sozialwissenschaften, Physiotherapie und Rehabilitationswissenschaften, Hochschule Osnabrück, Caprivistr. 30a, 49076, Osnabrück, Deutschland.
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Johnson A, Booker SQ. Population-Focused Approaches for Proactive Chronic Pain Management in Older Adults. Pain Manag Nurs 2021; 22:694-701. [PMID: 33972196 PMCID: PMC11198878 DOI: 10.1016/j.pmn.2021.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/14/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
Chronic pain, and the ethical management thereof, is the single most imperative health issue of this decade. Although a growing majority of individuals with chronic pain are middle-aged, the largest proportion of sufferers are older adults. Shifting tides in practice and research have led to population-focused approaches to pain management; however, the practice of many healthcare providers remains reactive and individualistic, limiting the discovery and implementation of long-term solutions for pain management in older adults. Yet, nurses and other health professionals have an opportune position to provide expert pain care by proactively providing evidence-based care for patients systematically. The purpose of this article is to stimulate discussion on three paradigms important to population-focused pain management: (1) prevention; (2) restoration and rehabilitation; and (3) palliation, which are in line with current national policy initiatives for improving patients' care experience, improving overall health and quality of life, and reducing associated health care costs.
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Affiliation(s)
- Alisa Johnson
- Pain Research and Intervention Center of Excellence, College of Dentistry, University of Florida, Gainesville, Florida.
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence, College of Dentistry, University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida
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An eCoach-Pain for Patients with Chronic Musculoskeletal Pain in Interdisciplinary Primary Care: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111661. [PMID: 34770177 PMCID: PMC8583019 DOI: 10.3390/ijerph182111661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 11/23/2022]
Abstract
eHealth could support cost-effective interdisciplinary primary care for patients with chronic musculoskeletal pain. This study aims to explore the feasibility of the eCoach-Pain, comprising a tool measuring pain complexity, diaries, pain education sessions, monitoring options, and chat function. Feasibility was evaluated (June–December 2020) by assessing learnability, usability, desirability, adherence to the application, and experiences from patients and general practitioners, practice nurses mental health, and physiotherapists. Six primary healthcare professionals (PHCPs) from two settings participated in the study and recruited 29 patients (72% female, median age 50.0 years (IQR = 24.0)). PHCPs participated in a focus group. Patient data was collected by evaluation questionnaires, individual interviews, and eCoach-Pain-use registration. Patients used the eCoach during the entire treatment phase (on average 107.0 days (IQR = 46.0); 23 patients completed the pain complexity tool and used the educational sessions, and 12 patients the chat function. Patients were satisfied with the eCoach-Pain (median grade 7.0 (IQR = 2.8) on a 0–10 scale) and made some recommendations for better fit with patient-specific complaints. According to PHCPs, the eCoach-Pain is of added value to their treatment, and patients also see treatment benefits. However, the implementation strategy is important for successful use of the eCoach-Pain. It is recommended to improve this strategy and involve a case-manager per patient.
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Pain Neuroscience Education Combined with Therapeutic Exercises Provides Added Benefit in the Treatment of Chronic Neck Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168848. [PMID: 34444594 PMCID: PMC8394804 DOI: 10.3390/ijerph18168848] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Chronic neck pain is common in the adult general population. Although the etiology of chronic neck pain is under debate, it is clear that chronic neck pain is multifactorial, with both physical and psychosocial contributors. OBJECTIVE To determine whether adding pain neuroscience education (PNE) to therapeutic exercises improved their pain-disability index, pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy in subjects with chronic nonspecific neck pain. METHODS This study was a three-arm randomized control trial. Seventy-two patients with chronic nonspecific neck pain were allocated to three groups: therapeutic exercises alone (n = 24), combined (therapeutic exercises + PNE; (n = 24), and a control group (n = 24). Each program took place three times a week, lasting for six weeks. The disability index, pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy measured by the Neck Pain and Disability Scale (NPAD), Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ), and Pain Self-Efficacy Questionnaire (PSEQ), respectively. Participants were assessed before and after the six-week intervention, and there was no further follow-up. RESULTS For the outcomes NPAD, PSC, and FABQ, combined intervention demonstrated more significant improvements than therapeutic exercises alone (p ≤ 0.05), whereas no differences were observed between the two intervention groups for PSEQ (p = 0.99). In addition, significant differences were favoring experimental groups versus control for all outcomes (p ≤ 0.001). CONCLUSION Therapeutic exercises combined with pain neuroscience education reduced the pain-disability index, pain catastrophizing, and fear-avoidance beliefs more than therapeutic exercises alone in patients with chronic neck pain. For pain self-efficacy, there was no statistically significant difference between the two intervention groups; however, the combined group had a more significant effect than therapeutic exercises alone. Further studies with longer periods and follow-up are required.
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Barbari V, Storari L, Maselli F, Testa M. Applicability of pain neuroscience education: Where are we now? J Back Musculoskelet Rehabil 2021; 34:511-520. [PMID: 33749636 DOI: 10.3233/bmr-200091] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Explaining pain to patients through pain neuroscience education (PNE) is currently a widespread treatment studied in the musculoskeletal context. Presently, there is sufficient evidence supporting the effectiveness of PNE in patients with chronic musculoskeletal disorders. However, clinicians must pay attention to the actual possibility to transfer research findings in their specific clinical context. OBJECTIVE We analysed the applicability of results of studies focused on PNE, which has not been done previously. METHODS A detailed discussion on PNE applicability is provided, starting from published randomized controlled trials that investigated the effectiveness of PNE. RESULTS This paper markedly points out the awareness of clinicians on the need for an accurate contextualization when choosing PNE as an intervention in clinical practice.
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35
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Minen M, Kaplan K, Akter S, Espinosa-Polanco M, Guiracocha J, Khanns D, Corner S, Roberts T. Neuroscience Education as Therapy for Migraine and Overlapping Pain Conditions: A Scoping Review. PAIN MEDICINE 2021; 22:2366-2383. [PMID: 34270769 DOI: 10.1093/pm/pnab131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuroscience Education Therapy (NET) has been successfully used for numerous overlapping pain conditions, but few studies have investigated NET for migraine. OBJECTIVE We sought to (1) review the literature on NET used for the treatment of various pain conditions to assess how NET has been studied thus far and (2) recommend considerations for future research of NET for the treatment of migraine. DESIGN/METHODS Following the PRISMA guideline for scoping reviews (PRISMA-ScR) Co-author (TR), a Medical Librarian, searched the MEDLINE, PsychInfo, Embase & Cochrane Central Clinical Trials Registry databases for peer-reviewed articles describing NET to treat migraine and other chronic pain conditions. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. RESULTS Overall, a NET curriculum consists of the following topics: pain does not equate to injury, pain is generated in the brain, perception, genetics, reward systems, fear, brain plasticity, and placebo/nocebo effects. Delivered through individual, group, or a combination of individual and group sessions, NET treatments often incorporate exercise programs and/or components of other evidence-based behavioral treatments. NET has significantly reduced catastrophizing, kinesiophobia, pain intensity, and disability in overlapping pain conditions. In migraine-specific studies, when implemented together with traditional pharmacological treatments, NET has emerged as a promising therapy by reducing migraine days, pain intensity and duration, and acute medication intake. CONCLUSION NET is an established treatment for pain conditions, and future research should focus on refining NET for migraine, examining delivery modality, dosage, components of other behavioral therapies to integrate, and migraine-specific NET curricula.
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Affiliation(s)
- Mia Minen
- Department of Neurology, NYU Langone Health, 222 E 41st Street, Floor 9, New York, NY, 10017.,Department of Population Health, NYU Langone Health
| | - Kayla Kaplan
- Department of Biological Sciences, Barnard College, New York, NY
| | - Sangida Akter
- Department of Psychology, The City College of New York, New York, NY
| | | | - Jenny Guiracocha
- Department of Psychology, The City College of New York, New York, NY
| | - Dennique Khanns
- Department of Chemistry and Biochemistry, The City College of New York, New York, NY, USA
| | - Sarah Corner
- Department of Neurology, NYU Langone Health, 222 E 41st Street, Floor 9, New York, NY, 10017
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Willaert W, Leysen L, Lenoir D, Meeus M, Cagnie B, Nijs J, Sterling M, Coppieters I. Combining Stress Management With Pain Neuroscience Education and Exercise Therapy in People With Whiplash-Associated Disorders: A Clinical Perspective. Phys Ther 2021; 101:6184954. [PMID: 33764474 DOI: 10.1093/ptj/pzab105] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/08/2021] [Accepted: 02/28/2021] [Indexed: 11/12/2022]
Abstract
Individuals classified as having whiplash-associated disorder (WAD) grade II, which reflects approximately 93% of people with WAD who are commonly managed by health care professionals, exhibit both physical (eg, pain and disability) and psychological (eg, fear of movement, anxiety, posttraumatic stress) problems that, in approximately 50% of cases, persist beyond 3 months. There is still much ongoing debate regarding factors predictive of poor recovery. The strongest associations have been found for high initial pain and disability following whiplash injury. In addition, a growing body of evidence supports the clinical importance of characteristic features, such as disturbed nociceptive processing (eg, local or general hyperalgesia to cold and mechanical stimuli), inefficient cognitions and beliefs about pain/movement/recovery, and posttraumatic stress symptoms, in the development and maintenance of physical and psychological manifestations in individuals with WAD. For this reason, the field shifted away from single interventions that mainly follow a biomedical approach, such as exercise therapy and activity programs, to gold standard multimodal care (at least 2 distinct therapeutic modalities given by 1 or more health care professionals) that acknowledges the biopsychological nature of WAD. To date, there exist several multimodal care approaches to managing WAD; however, for most, the efficacy has been found to be rather limited. One may argue that the limited success of some approaches can be attributed to the fact that they focused mainly on rehabilitating the physical symptoms (eg, pain, disability) rather than also the associated cognitive (eg, catastrophizing) and psychological (eg, posttraumatic stress symptoms) symptoms of the condition, leaving much room for improvement. In this article, current and previous evidence is used to explain why and how a comprehensive and multimodal treatment for people with WAD-consisting of a combination of pain neuroscience education, cognition-targeted exercise therapy, and stress management-can be applied in clinical practice.
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Affiliation(s)
- Ward Willaert
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium
| | - Laurence Leysen
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium
| | - Dorine Lenoir
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Michele Sterling
- Recover Injury Research Centre and NHMRC CRE in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Queensland, Australia
| | - Iris Coppieters
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
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37
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Van Bogaert W, Coppieters I, Kregel J, Nijs J, De Pauw R, Meeus M, Cagnie B, Danneels L, Malfliet A. Influence of Baseline Kinesiophobia Levels on Treatment Outcome in People With Chronic Spinal Pain. Phys Ther 2021; 101:6145902. [PMID: 33611503 DOI: 10.1093/ptj/pzab076] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 10/23/2020] [Accepted: 01/03/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Pain neuroscience education (PNE) combined with cognition-targeted exercises is an effective treatment for people with chronic spinal pain (CSP). However, it is unclear why some patients benefit more from this treatment. We expect that patients with more pronounced maladaptive pain cognitions, such as kinesiophobia, might show poorer treatment responses. OBJECTIVE The objective of this study was to assess the influence of baseline kinesiophobia levels on the treatment outcomes of PNE combined with cognition-targeted exercises in people with CSP. This study was a secondary analysis of a multicenter, double-blind, randomized controlled trial. METHODS Outcome measures included a numeric rating scale for pain (NRS), the Pain Disability Index (PDI), quality of life (Medical Outcomes Study 36-Item Health Survey [SF-36]), Pain Catastrophizing Scale (PCS), and Pain Vigilance and Awareness Questionnaire (PVAQ). Regression models were built using treatment (PNE plus cognition-targeted exercises or neck/back school plus general exercises), baseline scores on the Tampa Scale for Kinesiophobia (TSK), and time (in months) as independent variables. RESULTS A significant 3-way interaction effect was found for the models of PDI, PCS, PVAQ, and the SF-36 mental domain, with estimates of -0.01, -0.01, -0.01, and 0.07, respectively. A significant effect of baseline TSK scores was found for the physical domain of the SF-36 (estimate = -3.16). For the NRS, no significant effect of baseline TSK scores was found. CONCLUSION Our findings indicate that PNE plus cognition-targeted exercises can successfully decrease the unfavorable influence of pretreatment kinesiophobia on disability, mental health, pain catastrophizing, and hypervigilance over time in people with CSP. Nevertheless, higher scores in pretreatment kinesiophobia might still be a key factor for the lack of improvement in pain catastrophizing and hypervigilance following treatment. Regardless of the followed treatment program, pretreatment kinesiophobia was also shown to significantly influence physical health in people with CSP. IMPACT This study provides novel insight into the unfavorable influence of kinesiophobia on treatment outcomes in people with CSP, and how PNE plus cognition-targeted exercises can limit this impact. Because this is one of the first studies to research possible predictors of this experimental treatment, its findings motivate further exploration of other possible influencing factors for treatment success of PNE plus cognition-targeted exercises. LAY SUMMARY People with chronic spinal pain and high levels of fear of movement were found to have worse treatment outcomes compared to people with low levels of fear of movement. However, our experimental treatment, which includes pain neuroscience education combined with exercise therapy that reintroduces specific movements patients might fear, can decrease this negative influence of fear of movement in these patients.
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Affiliation(s)
- Wouter Van Bogaert
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Iris Coppieters
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Jeroen Kregel
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, http://www.paininmotion.be
| | - Jo Nijs
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Robby De Pauw
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, http://www.paininmotion.be.,Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Anneleen Malfliet
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
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Bülow K, Lindberg K, Vaegter HB, Juhl CB. Effectiveness of Pain Neurophysiology Education on Musculoskeletal Pain: A Systematic Review and Meta-Analysis. PAIN MEDICINE 2021; 22:891-904. [DOI: 10.1093/pm/pnaa484] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Abstract
Objectives
To estimate the effectiveness and safety of Pain Neurophysiology Education (PNE) on pain, disability, and psychological distress at post-intervention and long-term (closest to twelve months after initiating the intervention) in musculoskeletal pain (MSKP).
Methods
Randomized Controlled Trials (RCT) were identified in six engines, reference lists, ClinicalTrials.gov, and by contacting key researches. Risk of bias was assessed using Cochrane Collaboration Risk of Bias Tool 2.0. Meta-analyses, using Restricted Maximum Likelihood Method, were conducted to estimate standardized mean differences (SMD) and overall quality of evidence was evaluated according to GRADE.
Results
In total, 18 RCTs (n = 1,585) were included. There was small to moderate effects of PNE on pain at post-intervention and long-term: SMD = -0.32 (95% confidence interval [CI]: −.58; −.05) and SMD = −0.40 (95% CI: −.78; −.03), respectively. On disability, PNE had a small effect at post-intervention: SMD = -0.17 (95% CI: −.34; −.01) but was insignificant at long-term: SMD = −0.27 (95% CI: −.59; .06). Likewise, there was a small to moderate effect on psychological distress at post-intervention: SMD = −0.36 (95% CI: −.67; −.06) but was insignificant at long-term: SMD = −0.37 (95% CI: −.75; .01). Quality of evidence was low across all outcomes. Additional analyses showed significant effects of PNE, corresponding to moderate effects, on pain and psychological distress at both time points in chronic MSKP.
Conclusions
Overall quality of evidence was low, supporting PNE being safe and having small to moderate effects on pain at both time points, and on disability as well as psychological distress at post-intervention.
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Affiliation(s)
- Kasper Bülow
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kasper Lindberg
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Bjarke Vaegter
- Pain Research Group / Pain Center, Department of Anesthesiology and Intensive Care Medicine, University Hospital Odense, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
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Fortún-Rabadán R, Jiménez-Sánchez C, Flores-Yaben O, Bellosta-López P. Workplace physiotherapy for musculoskeletal pain-relief in office workers: A pilot study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:75. [PMID: 34084822 PMCID: PMC8057194 DOI: 10.4103/jehp.jehp_888_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Musculoskeletal pain is highly prevalent among office workers and causes high costs to the public health system. Strategies including education and exercise are recommended, with major benefits when conducted by physical therapists in the occupational environment. However, the required investment is uncommon among companies. This study aimed to evaluate the efficacy of a multimodal physiotherapy intervention to relieve musculoskeletal pain in office workers. MATERIALS AND METHODS The study employed a single group study with a pre-post study design and was conducted at Universidad San Jorge in 2018. Outcome variables were: workplace ergonomics (INSHT Guide), existence and severity of musculoskeletal disorders (Nordic Musculoskeletal Questionnaire), musculoskeletal pain intensity (Numeric Rating Scale), and Clinical Global Impression Scale. Office workers in a university setting (n = 24, 19 females) were assessed at baseline, after 4 weeks of in-person sessions and following 3 weeks of autonomous performance. The physiotherapy program included education, ergonomic supervision, self-treatment, strengthening, and stretching exercises. A repeated-measures ANOVA or Friedman test (with post hoc comparisons) and Chi-squared test were used to compare the study variables. RESULTS At baseline, cervical spine (54%), shoulder (42%), and lumbar regions (37.5%) were the most symptomatic regions according to the Nordic Musculoskeletal Questionnaire. Even if the proportion of symptomatic areas did not decrease significantly after the intervention, a great reduction of musculoskeletal pain intensity was observed after the program in the cervical (P < 0.001), lower back (P = 0.005), shoulder (P = 0.006) regions, and in the overall pain level (P < 0.001). CONCLUSIONS These results support that a multimodal physiotherapy program can relieve work-related musculoskeletal pain in office workers and serve as a basis for future controlled trials.
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Affiliation(s)
- Rocío Fortún-Rabadán
- iPhysio Research Group, Department of Physical Therapy, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Carolina Jiménez-Sánchez
- iPhysio Research Group, Department of Physical Therapy, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
- Hospital Mutua de Accidentes de Zaragoza, Zaragoza, Spain
| | - Olatz Flores-Yaben
- iPhysio Research Group, Department of Physical Therapy, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Pablo Bellosta-López
- iPhysio Research Group, Department of Physical Therapy, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
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Saracoglu I, Aksoy CC, Afsar E, Arik MI. Does pain neuroscience education improve pain knowledge, beliefs and attitudes in undergraduate physiotherapy students? PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1898. [PMID: 33528084 DOI: 10.1002/pri.1898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/07/2020] [Accepted: 12/25/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND To evaluate the effect of a brief pain neuroscience education (PNE) session on physiotherapy students' knowledge of pain and their beliefs and attitudes about the treatment of patients with chronic low back pain. METHODS This study was a single-center, cross-sectional study including 205 physiotherapy undergraduate students. The participants completed the Neurophysiology of Pain Questionnaire (NPQ) and Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). They then received a 70-min neuroscience education session covering the mechanisms and biopsychosocial aspects of chronic low back pain. The questionnaires were readministered immediately after the educational session and at 6 months posteducation. RESULTS Our analysis included data from 156 participants (mean age: 20.9 ± 2.51, 69.8% women) who completed the questionnaires pre-, post-, and 6 months after the educational session. To assess the effect of the education on the scores of the questionnaires, a repeated-measures ANOVA was conducted. There was a significant interaction observed for NPQ over time (p = 0.00; η 2 = 0.654), for PABS-PT factor 1(p < 0.001; η2 = 0.50) and for PABS-PT factor 2 over time (p = 0.02; η 2 = 0.04) CONCLUSION: This study showed that a 70-min session of PNE improves the level of pain knowledge in undergraduate physiotherapy students and influences their beliefs and attitudes concerning chronic low back pain. These findings suggest that adding PNE to the curricula of physiotherapy and rehabilitation programs may be beneficial.
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Affiliation(s)
- Ismail Saracoglu
- Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
| | - Cihan Caner Aksoy
- Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
| | - Emrah Afsar
- Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
| | - Meltem Isintas Arik
- Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
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Watson JA, Ryan CG, Atkinson G, Williamson P, Ellington D, Whittle R, Dixon J, Martin DJ. Inter-Individual Differences in the Responses to Pain Neuroscience Education in Adults With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. THE JOURNAL OF PAIN 2021; 22:9-20. [DOI: 10.1016/j.jpain.2020.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/21/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022]
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Schmitt AJ, Beidler E, O'Connor S, Eagle S, Wallace J, Anderson M, Kontos A. Development and factor structure of the perceptions of concussion inventory for athletes (PCI-A). Brain Inj 2020; 35:292-298. [PMID: 33370168 DOI: 10.1080/02699052.2020.1861655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: This study evaluated the factor structure of the Perceptions of Concussion Inventory for Athletes (PCI-A) using exploratory factor analytic (EFA) techniques in a sample of collegiate student-athletes. Perception differences by sex and sport-related concussion (SRC) risk level were explored.Methods: This cross-sectional-design study included 298 male and 183 female collegiate student-athletes from 18 sports at six institutions. Participants completed a demographic and concussion history survey, and the PCI-A.Results: The EFA revealed a 6-factor solution (Anxiety, Effects, Clarity, Treatment, Control, and Symptom Variability) that accounted for 56.1% of the variance in responses. Female collegiate student-athletes displayed statistically higher levels of Anxiety, Clarity, Symptom Variability, and Control than males. Lower concussion risk sport athletes reported statistically higher levels of anxiety surrounding SRC and concerns relating to the long-term and major effects of an SRC.Conclusions: This study provides evidence that the PCI-A is an acceptable measure to examine the perceptions of collegiate student-athletes regarding SRC. The findings supported a six-factor structure of the PCI-A in the current study for collegiate student-athletes compared to the seven-factor structure indicated in previous research. The findings reveal sex and concussion risk sport differences in PCI-A responses.
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Affiliation(s)
- Ara J Schmitt
- Department of Counseling, Psychology, and Special Education, Duquesne University, Pittsburgh, PA, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, PA, USA
| | - Siobhan O'Connor
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Shawn Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA
| | - Jessica Wallace
- Department of Health Science, University of Alabama, Tuscaloosa, AL, USA
| | - Morgan Anderson
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Anthony Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA
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Uchida K, Murata S, Kawaharada R, Tsuboi Y, Isa T, Okumura M, Matsuda N, Nakatsuka K, Horibe K, Kogaki M, Ono R. Association Between Kinesiophobia and Life Space Among Community-Dwelling Older People with Chronic Musculoskeletal Pain. PAIN MEDICINE 2020; 21:3360-3365. [PMID: 32935125 DOI: 10.1093/pm/pnaa216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Kinesiophobia (i.e., fear of movement caused by pain) is increasingly acknowledged as a determinant of disuse among patients with chronic musculoskeletal pain. Kinesiophobia may affect life space-a crucial indicator of an active lifestyle among older people. This study aimed to investigate the previously unexamined association between kinesiophobia and life space among community-dwelling older people with chronic musculoskeletal pain. DESIGN Cross-sectional study. SETTING Community. SUBJECTS We analyzed data from 194 community-dwelling older people (age ≥65 years, mean age = 75.7 years, 71.6% women) with chronic musculoskeletal pain. METHODS Kinesiophobia, life space, and pain severity were assessed using the Tampa Scale for Kinesiophobia, Life Space Assessment, and Brief Pain Inventory. Linear regression models were applied to analyze the associations between kinesiophobia and life space, and pain severity and life space. RESULTS In our sample, the prevalence rates for chronic musculoskeletal pain were 10.82% (N = 21) for neck, 55.15% (N = 107) for lower back, 25.26% (N = 49) for shoulder, and 50.00% (N = 97) for knee. The results suggest that higher kinesiophobia is associated with smaller life space (adjusted beta = -0.91, 95% CI = -1.43 to -0.45, P < 0.001), even after adjustment for age, gender, years of education, pain severity, and presence of comorbidity. On the contrary, no significant association between pain severity and life space was observed (adjusted beta = -0.61, 95% CI = -2.92 to 1.72, P = 0.624). CONCLUSIONS Our findings suggest that kinesiophobia plays an important role in the determination of life space among older people with chronic musculoskeletal pain.
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Affiliation(s)
- Kazuaki Uchida
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Shunsuke Murata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Rika Kawaharada
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Yamato Tsuboi
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan.,Japan Society for the Promotion of Science, Chiyoda, Tokyo, Japan
| | - Tsunenori Isa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Maho Okumura
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Naoka Matsuda
- Division of Rehabilitation Medicine, Kobe Mariners Hospital, Kobe, Hyogo, Japan
| | - Kiyomasa Nakatsuka
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Kana Horibe
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Masahumi Kogaki
- Takumi Day-Care Facility in Children, Nishinomiya, Hyogo, Japan
| | - Rei Ono
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
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Keessen P, Latour CHM, van Duijvenbode ICD, Visser B, Proosdij A, Reen D, Scholte Op Reimer WJM. Factors related to fear of movement after acute cardiac hospitalization. BMC Cardiovasc Disord 2020; 20:495. [PMID: 33228521 PMCID: PMC7686769 DOI: 10.1186/s12872-020-01783-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background Fear of movement (kinesiophobia) after an acute cardiac hospitalization (ACH) is associated with reduced physical activity (PA) and non-adherence to cardiac rehabilitation (CR). Purpose To investigate which factors are related to kinesiophobia after an ACH, and to investigate the support needs of patients in relation to PA and the uptake of CR. Methods Patients were included 2–3 weeks after hospital discharge for ACH. The level of kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK-NL Heart). A score of > 28 points is defined as ‘high levels of kinesiophobia’ (HighKin) and ≤ 28 as ‘low levels of kinesiophobia’ (LowKin). Patients were invited to participate in a semi-structured interview with the fear avoidance model (FAM) as theoretical framework. Interviews continued until data-saturation was reached. All interviews were analyzed with an inductive content analysis.
Results Data-saturation was reached after 16 participants (median age 65) were included in this study after an ACH. HighKin were diagnosed in seven patients. HighKin were related to: (1) disrupted healthcare process, (2) negative beliefs and attitudes concerning PA. LowKin were related to: (1) understanding the necessity of PA, (2) experiencing social support. Patients formulated ‘tailored information and support from a health care provider’ as most important need after hospital discharge.
Conclusion This study adds to the knowledge of factors related to kinesiophobia and its influence on PA and the uptake of CR. These findings should be further validated in future studies and can be used to develop early interventions to prevent or treat kinesiophobia and stimulate the uptake of CR.
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Affiliation(s)
- P Keessen
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands. .,Cardiovitaal Cardiac Rehabilitation Centre, Amsterdam, The Netherlands.
| | - C H M Latour
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands
| | - I C D van Duijvenbode
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands
| | - B Visser
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands
| | - A Proosdij
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands
| | - D Reen
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands
| | - W J M Scholte Op Reimer
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Pas R, Leysen L, De Goeij W, Vossebeld L, Van Wilgen P, De Groef A, De Kooning M. Pain Neuroscience Education in cancer survivors with persistent pain: A pilot study. J Bodyw Mov Ther 2020; 24:239-244. [PMID: 33218517 DOI: 10.1016/j.jbmt.2020.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 03/18/2020] [Accepted: 06/07/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To describe the Pilot Study: Pain Neuroscience Education in Cancer Survivors and describe the innovative educational component of Pain Neuroscience Education (PNE). DESIGN Quasi experimental design. METHOD The PNE program, encompassing a one-on-one education session and an information leaflet was given to 30 cancer survivors. At baseline and two weeks after the PNE, participants were asked to fill out following outcome measures; pain intensity, pain catastrophizing, and HRQoL. FINDINGS Following PNE, a significant decrease on pain intensity (p = 0.001), on the SF-36 subscale pain (p = 0.003) and for the following PCS subscales: Helplessness (p < 0.001), Rumination (p = 0.002) and Total score (p < 0.001) was found compared to baseline. CONCLUSIONS Although the current results need to be verified in a larger randomized, controlled trial, preliminary evidence shows a decrease in pain intensity and pain catastrophizing following PNE in cancer survivors with persistent pain.
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Affiliation(s)
- Roselien Pas
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Laurence Leysen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Wanda De Goeij
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium; The Berekuyl Academy, Harderwijk, the Netherlands
| | - Leonieke Vossebeld
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium; The Berekuyl Academy, Harderwijk, the Netherlands
| | - Paul Van Wilgen
- Pain in Motion International Research Group, Belgium; Transcare Transdisciplinary Pain Management Centre, Groningen, the Netherlands
| | - An De Groef
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Leuven, Belgium
| | - Margot De Kooning
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussel, Belgium
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Romm MJ, Ahn S, Fiebert I, Cahalin LP. A Meta-Analysis of Therapeutic Pain Neuroscience Education, Using Dosage and Treatment Format as Moderator Variables. Pain Pract 2020; 21:366-380. [PMID: 33131210 DOI: 10.1111/papr.12962] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This meta-analysis aimed to assess the overall effect of therapeutic pain neuroscience education (TPNE) on chronic musculoskeletal pain and to further assess whether such an effect differs by TPNE dosage as well as other treatment format components. Dosage included the number of TPNE sessions provided as well as the amount of time per TPNE session. Structural components included TPNE provided alone as treatment or combined with other pain management modalities, as well as the inclusion of group-based treatment sessions. METHODS Electronic databases were utilized to search for randomized controlled trials that included TPNE. The overall effectiveness of TPNE was estimated on 4 pain outcome measures, including kinesiophobia, pain intensity, pain disability, and pain catastrophizing. The differential effectiveness of TPNE was examined using a mixed-methods moderator analysis on various study-level characteristics to identify potential moderators affecting the overall results. RESULTS Significant effects of TPNE were found on all the outcome measures. The only moderator that displayed a significant effect was group-based treatment on kinesiophobia (z = -2.23, P < 0.05, 95% confidence interval [CI] -2.70 to -0.20). Between-group analysis revealed that only interventions that included group sessions were found to be statistically significant (z = 2.20, P < 0.05) and displayed a large effect size (d = 0.80, 95% CI 0.09 to 1.50). DISCUSSION Therapeutic pain neuroscience education had a statistically significant impact on all the explored pain outcome measures. However, when investigating the treatment dosage and format moderator variables, they appeared to not have a statistically significant effect except for group-based interventions on kinesiophobia levels. CONCLUSION This meta-analysis examined the efficacy of TPNE for patients with chronic pain. It assessed various pain outcome measures following intervention. In addition, this research identified that various moderator variables do not have and do have an impact on the treatment modality of TPNE.
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Affiliation(s)
| | - Soyeon Ahn
- Department of Educational and Psychological Studies, University of Miami, Miami, Florida, U.S.A
| | - Ira Fiebert
- Physical Therapy Department, University of Miami, Miami, Florida, U.S.A
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Pas R, Rheel E, Van Oosterwijck S, Foubert A, De Pauw R, Leysen L, Roete A, Nijs J, Meeus M, Ickmans K. Pain Neuroscience Education for Children with Functional Abdominal Pain Disorders: A Randomized Comparative Pilot Study. J Clin Med 2020; 9:jcm9061797. [PMID: 32526929 PMCID: PMC7356615 DOI: 10.3390/jcm9061797] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
This article explores the effectiveness of a newly developed Pain Neuroscience Education program for children (PNE4Kids) with functional abdominal pain disorder (FAPD). Children (6–12 years) with FAPD were randomly assigned to 1) the experimental group (n = 14), participating in one hypnotherapy session (i.e., usual care) and one additional PNE4Kids session, or 2) the control group (n = 14), participating in two hypnotherapy sessions. Parental pain catastrophizing, the child’s functional disability (parental-proxy), pain-related fear (parent-proxy) and pain intensity, were assessed at baseline and one and three weeks after each therapy session. Pressure algometry and a conditioned pain modulation paradigm were performed at baseline and three weeks after completion of the last therapy session. Parents from both the experimental as well as the control group showed significantly less parental pain catastrophizing (p < 0.01). Children showed significantly less functional disability (p < 0.05), pain-related fear (p < 0.01) and local pressure pain sensitivity (p < 0.05) at short-term follow-up (three weeks after last intervention) in both groups. No significant (p > 0.05) between-group differences were found. Hypnotherapy combined with PNE4Kids did not result in better clinical outcomes compared to hypnotherapy alone. Study limitations include the application of one single PNE4Kids session and the short follow-up time.
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Affiliation(s)
- Roselien Pas
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), D.S.022, 2610 Wilrijk, Belgium;
- Correspondence: ; Tel.: +32-(0)2-477-45-29
| | - Emma Rheel
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Sophie Van Oosterwijck
- Pain in Motion International Research Group;
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Campus UZ, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
| | - Anthe Foubert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), D.S.022, 2610 Wilrijk, Belgium;
- Pain in Motion International Research Group;
| | - Robby De Pauw
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Campus UZ, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
| | - Laurence Leysen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Ann Roete
- Antwerp University Hospital, department of Pediatrics, 2610 Wilrijk, Belgium;
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
| | - Mira Meeus
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), D.S.022, 2610 Wilrijk, Belgium;
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Campus UZ, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
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Nijs J, Wijma AJ, Willaert W, Huysmans E, Mintken P, Smeets R, Goossens M, van Wilgen CP, Van Bogaert W, Louw A, Cleland J, Donaldson M. Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians. Phys Ther 2020; 100:846-859. [PMID: 31995191 DOI: 10.1093/ptj/pzaa021] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/07/2019] [Accepted: 10/06/2019] [Indexed: 12/28/2022]
Abstract
Pain neuroscience education (PNE) and motivational interviewing (MI) have been widely implemented and tested in the field of chronic pain management, and both strategies have been shown to be effective in the short term (small effect sizes) for the management of chronic pain. PNE uses contemporary pain science to educate patients about the biopsychosocial nature of the chronicity of their pain experience. The goal of PNE is to optimize patients' pain beliefs/perceptions to facilitate the acquisition of adaptive pain-coping strategies. MI, on the other hand, is a patient-centered communication style for eliciting and enhancing motivation for behavior change by shifting the patient away from a state of indecision or uncertainty. Conceptually, PNE and MI appear to be complementary interventions, with complementary rather than overlapping effects; MI primarily improves cognitive and behavioral awareness and, potentially, adherence to treatment principles, whereas PNE potentially increases pain knowledge/beliefs, awareness, and willingness to explore psychological factors that are potentially associated with pain. Therefore, combining PNE with MI might lead to improved outcomes with larger and longer-lasting effect sizes. The combined use of PNE and MI in patients having chronic pain is introduced here, along with a description of how clinicians might be able to integrate PNE and MI in the treatment of patients experiencing chronic pain. Clinical trials are needed to examine whether combining PNE with MI is superior to PNE or MI alone for improving pain and quality of life in patients having chronic pain.
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Affiliation(s)
- Jo Nijs
- Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Building F-KIMA, Laarbeeklaan 103, BE-1090 Brussels, Belgium; and Department of Physical Medicine and Physiotherapy, Chronic Pain Rehabilitation, University Hospital Brussels, Brussels, Belgium
| | - Amarins J Wijma
- Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel; Department of Physical Medicine and Physiotherapy, Chronic Pain Rehabilitation, University Hospital Brussels; and Transcare Pain, Transdisciplinary Treatment Center, Groningen, the Netherlands
| | - Ward Willaert
- Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Pain in Motion International Research Group,Vrije Universiteit Brussel; Department of Physical Medicine and Physiotherapy, Chronic Pain Rehabilitation, University Hospital Brussels; and Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Eva Huysmans
- Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel; Department of Physical Medicine and Physiotherapy, Chronic Pain Rehabilitation, University Hospital Brussels; Research Foundation-Flanders (FWO); and Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Paul Mintken
- Department of Physical Therapy, School of Medicine, University of Colorado, Aurora, Colorado, and Wardenburg Health Center, University of Colorado, Boulder, Colorado
| | - Rob Smeets
- Research School CAPHRI, Maastricht University, Maastricht, the Netherlands, and CIR Revalidatie Eindhoven/Zwolle, Eindhoven/Zwolle, the Netherlands
| | - Mariëlle Goossens
- Research School CAPHRI, Maastricht University, and CIR Revalidatie Eindhoven/Zwolle
| | - C Paul van Wilgen
- Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel; and Transcare Pain, Transdisciplinary Treatment Center
| | - Wouter Van Bogaert
- Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel
| | - Adriaan Louw
- Department of Physical Therapy, International Spine and Pain Institute, Louisville, Kentucky
| | - Josh Cleland
- Department of Physical Therapy, Franklin Pierce University, Manchester, New Hampshire
| | - Megan Donaldson
- Physical Therapy Program, School of Medicine, Tufts University, Boston, Massachusetts
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Nijs J, Wijma AJ, Leysen L, Pas R, Willaert W, Hoelen W, Ickmans K, Wilgen CPV. Explaining pain following cancer: a practical guide for clinicians. Braz J Phys Ther 2019; 23:367-377. [PMID: 30606621 PMCID: PMC6823686 DOI: 10.1016/j.bjpt.2018.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pain is one of the most prevalent and debilitating symptom following cancer treatment. OBJECTIVES This paper entails a practical guide for clinicians willing to apply pain neuroscience education (PNE) in this specific population, or clinical researchers willing to examine the effects of PNE in patients suffering from pain following cancer. RESULTS Patient-specific information (i.e. beliefs, cognitions, pain memories, social factors) as well as identification of the dominant pain mechanism are needed to tailor the education to the specific needs and beliefs of the patient. Therapists require an in-depth understanding of pain mechanisms, the skills to explain to their patients various pain mechanisms, specific communication skills (e.g. Socratic-style dialogof education) and experience with current evidence-based biopsychosocially-driven pain management strategies for successful implementation of PNE in the clinic. Rather than purely focusing on the biomedical characteristics of pain following cancer (e.g., tissue damage due to past cancer treatment), PNE implies teaching patients about the underlying biopsychosocial mechanisms of pain. Its application is backed-up by mounting evidence supporting the effectiveness of PNE in non-cancer pain populations, and a pilot study in patients having pain following cancer. CONCLUSION PNE is a potential solution to improve pain outcome in cancer survivors. Further research using sufficiently powered and well-designed randomized clinical trials should be conducted to examine the potential of PNE in patients having pain following cancer.
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Affiliation(s)
- Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.
| | - Amarins J Wijma
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Transcare Transdisciplinary Pain Management Center, Groningen, The Netherlands
| | - Laurence Leysen
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Roselien Pas
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ward Willaert
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Wouter Hoelen
- De Berekuyl, Private Practice for Physiotherapy in Oncology & Lymphology, Hierden, The Netherlands; The Berekuyl Academy, Hierden, The Netherlands
| | - Kelly Ickmans
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - C Paul van Wilgen
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Transcare Transdisciplinary Pain Management Center, Groningen, The Netherlands
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50
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Harrison LE, Pate JW, Richardson PA, Ickmans K, Wicksell RK, Simons LE. Best-Evidence for the Rehabilitation of Chronic Pain Part 1: Pediatric Pain. J Clin Med 2019; 8:E1267. [PMID: 31438483 PMCID: PMC6780832 DOI: 10.3390/jcm8091267] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023] Open
Abstract
Chronic pain is a prevalent and persistent problem in middle childhood and adolescence. The biopsychosocial model of pain, which accounts for the complex interplay of the biological, psychological, social, and environmental factors that contribute to and maintain pain symptoms and related disability has guided our understanding and treatment of pediatric pain. Consequently, many interventions for chronic pain are within the realm of rehabilitation, based on the premise that behavior has a broad and central role in pain management. These treatments are typically delivered by one or more providers in medicine, nursing, psychology, physical therapy, and/or occupational therapy. Current data suggest that multidisciplinary treatment is important, with intensive interdisciplinary pain rehabilitation (IIPT) being effective at reducing disability for patients with high levels of functional disability. The following review describes the current state of the art of rehabilitation approaches to treat persistent pain in children and adolescents. Several emerging areas of interventions are also highlighted to guide future research and clinical practice.
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Affiliation(s)
- Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Joshua W Pate
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Patricia A Richardson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Kelly Ickmans
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Psychology division, Karolinska Institutet, 171 65 Stockholm, Sweden
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA.
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