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Mihlberg E, Arnbak BAM. Prognostic factors for long-term improvement in pain and disability among patients with persistent low back pain. Chiropr Man Therap 2024; 32:26. [PMID: 38918850 PMCID: PMC11202371 DOI: 10.1186/s12998-024-00546-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Prognostic research in low back pain (LBP) is essential for understanding and managing the condition. This study aimed to, (1) describe the proportions with mild-moderate and severe pain and disability at baseline, 1-year and 4-year follow-up, and (2) investigate prognostic factors for improvement in pain and disability over 4 years in a cohort of secondary care LBP patients. METHODS This was a secondary analysis of a cohort of patients with LBP aged 18-40 years recruited from a non-surgical outpatient spine clinic between March 2011 and October 2013 (n = 1037). Questionnaires were collected at baseline, 1-year, and 4-year follow-up. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ 0-100) and pain intensity using the Numeric Rating Scale (NRS 0-10). 'Mild-moderate pain' was defined as NRS < 7 and 'severe pain' as NRS ≥ 7. Likewise, 'mild-moderate disability' was defined as RMDQ < 58.3, and 'severe disability' was RMDQ ≥ 58.3. In the prognostic analysis, improvement in pain and disability over 4 years was defined as meeting both criteria: decrease of ≥ 2 on the NRS and of ≥ 20.8 on the RMDQ. Sixteen candidate prognostic factors were assessed by multivariate logistic regression. RESULTS Among patients with information available at all three time points (n = 241), 54%/48% had persistent mild-moderate pain/disability, while only 7%/15% had persistent severe pain/disability. Of patients included in the multivariate prognostic analysis regarding improvement over 4 years (n = 498), 32% had improved in pain and disability after 4 years. Positive associations were found for pain intensity (OR 1.34 [95%CI: 1.17-1.54]), disability (OR 1.01 [1.00-1.02]), and regular employment or studying (OR 1.67 [1.06-2.64]), and negative associations for episode duration (OR 0.99 [0.99-1.00]) and risk of persistent pain (OR 0.58 [0.38-0.88]). CONCLUSION Patients with persistent LBP in secondary care had mostly mild-moderate pain and disability consistently at all three time points, with few having consistently severe symptoms over 4 years. Moreover, approximately half of the included patients improved in pain and disability. We found that pain intensity, disability, episode duration, regular employment or studying, and risk of persistent pain predicted a long-term improvement. However, the limited availability of complete follow-up data may affect generalisability.
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Affiliation(s)
- Elin Mihlberg
- Center of Muscle and Joint health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, DK-5230, Denmark
| | - Bodil Al-Mashhadi Arnbak
- Center of Muscle and Joint health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, DK-5230, Denmark.
- Department of Radiology, Hospital Lillebaelt, Beriderbakken 4, Vejle, DK-7100, Denmark.
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Solá VP, Montes JM, Calvo ET, Gasull V, Campayo JG, Diez JMO, Berrocoso E, Mico JA, Agüera L. Consensus on the detection and management of patients with depression and pain as an associated somatic symptom. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00055-8. [PMID: 37952640 DOI: 10.1016/j.sjpmh.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/13/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Globally, depression is the most common psychiatric disorder and is frequently associated with somatic symptom disorders, including pain as a physical symptom. There is a current need to improve the detection and management of the individuals in which depression and pain coexist. Hence, the aim of this document is to provide recommendations in the diagnosis and management of patients with major depressive disorder (MDD) who have pain as a physical symptom (PPS), in order to reduce the variability of clinical practice. MATERIAL AND METHODS The methodology used is based on the internationally recognized RAND/UCLA consensus method. The scientific committee, consisted of a group of eight multidisciplinary experts, defined 12 clinically relevant questions. After the systematic review of the literature, the scientific committee assessed the evidence and developed recommendations. The panel group with 15 participants validated these recommendations using a single Delphi round. To conclude, there was a final consensus meeting held to redefine with minor modifications the final recommendations. RESULTS The scientific committee developed a total of 19 recommendations on the diagnosis and detection, impact of PPS in MDD, treatment of MDD with associated PPS, use of healthcare resources, additional recommendations, and care coordination of these patients. Globally, a substantial level of agreement (≥80%) was reached on all items during the Delphi round. All the 19 achieved consensus, seven of them (37%) were agreed with unanimity during the Delphi round. The recommendations with higher consensus were in relation to diagnosis, impact of PPS in MDD, treatment and use of healthcare resources. CONCLUSIONS Currently, the evidence base for patients with MDD and PPS is still being developed and this consensus statement aims to bridge that gap by providing practical recommendations.
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Affiliation(s)
- Víctor Pérez Solá
- Institut de Neuropsiquiatria i Addiccions, Parc de salut mar, Barcelona, Spain; CIBERSAM, Madrid, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain.
| | - José Manuel Montes
- Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá, Alcala de Henares, CIBERSAM, Spain
| | - Eva Trillo Calvo
- Medicina de Familia, Centro de Salud Campo de Belchite, Belchite, Zaragoza, Spain
| | - Vicente Gasull
- Medicina de Familia, Centro de Salud Torrent II, Valencia, Spain
| | | | - Jose Manuel Olivares Diez
- Servicio de Psiquiatría del Area Sanitaria de Vigo, Director del Area de Neurociencias, Instituto de Investigación Sanitaria Galicia Sur (IISGS, Cibersam), Spain
| | - Esther Berrocoso
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychology, University of Cadiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain
| | - Juan Antonio Mico
- Departamento de Neurociencias, Farmacología y Psiquiatría, Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Universidad de Cádiz, Cádiz, Spain
| | - Luis Agüera
- Servicio de Psiquiatría del Hospital Universitario 12 de Octubre, Madrid, Spain; Associate Professor of the Faculty of Medicine, Universidad Complutense, Madrid, Spain
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Corrêa LA, Bittencourt JV, Mathieson S, Nogueira LAC. Pain-related interference and pain-related psychosocial factors of three different subgroups of patients with chronic low back pain. Musculoskelet Sci Pract 2023; 63:102718. [PMID: 36641362 DOI: 10.1016/j.msksp.2023.102718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Low back pain (LBP) subgroup identification and management are a research priority. The clarification of subgroup differences could assist clinicians in clinical decisions contributing to a tailored treatment. OBJECTIVES To compare pain-related interference and pain-related psychosocial factors among subgroups of chronic low back pain (localised low back pain, peripheral neuropathic back pain, and widespread pain). DESIGN Cross-sectional study. METHODS A cross-sectional study was conducted on 444 participants with chronic low back pain. Pain-related interference was investigated by the Brief Pain Inventory and Patient-Specific Functional Scale. Pain-related psychosocial factors assessment included psychosocial factors from Brief Screening Questions and maladaptive beliefs from Back Beliefs Questionnaire, self-efficacy, and expectation questions. Participants' characteristics, pain-related interference, and pain-related psychosocial factors were compared among the three groups. RESULTS A one-way ANCOVA presented statistically significant differences among the groups for current pain intensity [F(2,441) = 6.77, p = 0.001], pain duration [F(2,425) = 9.83, p < 0.001], pain-related interference by Brief Pain Inventory [F(2,441) = 11.97, p < 0.001], and pain-related psychosocial factors regarding symptoms of anxiety [F(2,441) = 3.85, p = 0.022], symptoms of depression [F(2,441) = 6.74, p = 0.001], social isolation [F(2,441) = 6.54, p = 0.002], catastrophising [F(2,441) = 9.72, p < 0.001], perceived stress [F(2,441) = 3.93, p = 0.020], maladaptive beliefs [F(2,441) = 6.89, p = 0.001], and expectation [F(2,441) = 6.66, p = 0.001]. CONCLUSION Participants with widespread pain presented higher pain-related interference and pain-related psychosocial factors compared to the localised low back pain group. Participants with peripheral neuropathic back pain and widespread pain presented with similar characteristics.
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Affiliation(s)
- Leticia Amaral Corrêa
- Rehabilitation Science Postgraduation Program - Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil.
| | - Juliana Valentim Bittencourt
- Rehabilitation Science Postgraduation Program - Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Stephanie Mathieson
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduation Program - Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil; Physiotherapy Department - Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
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Chimenti RL, Post AA, Silbernagel KG, Hadlandsmyth K, Sluka KA, Moseley GL, Rio E. Kinesiophobia Severity Categories and Clinically Meaningful Symptom Change in Persons With Achilles Tendinopathy in a Cross-Sectional Study: Implications for Assessment and Willingness to Exercise. FRONTIERS IN PAIN RESEARCH 2022; 2:739051. [PMID: 35295417 PMCID: PMC8915659 DOI: 10.3389/fpain.2021.739051] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/10/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: (1) Validate thresholds for minimal, low, moderate, and high fear of movement on the 11-item Tampa Scale of Kinesiophobia (TSK-11), and (2) Establish a patient-driven minimal clinically important difference (MCID) for Achilles tendinopathy (AT) symptoms of pain with heel raises and tendon stiffness. Methods: Four hundred and forty-two adults with chronic AT responded to an online survey, including psychosocial questionnaires and symptom-related questions (severity and willingness to complete heel raises and hops). Kinesiophobia subgroups (Minimal ≤ 22, Low 23–28, Moderate 29–35, High ≥ 36 scores on the TSK-11), pain MCID subgroups (10-, 20-, 30-, >30-points on a 0- to 100-point scale), and stiffness MCID subgroups (5, 10, 20, >20 min) were described as median [interquartile range] and compared using non-parametric statistics. Results: Subgroups with higher kinesiophobia reported were less likely to complete three heel raises (Minimal = 93%, Low = 74%, Moderate = 58%, High = 24%). Higher kinesiophobia was associated with higher expected pain (Minimal = 20.0 [9.3–40.0], Low = 43.0 [20.0–60.0], Moderate = 50.0 [24.0–64.0], High = 60.5 [41.3–71.0]) yet not with movement-evoked pain (Minimal = 25.0 [5.0–43.0], Low = 31.0 [18.0–59.0], Moderate = 35.0 [20.0–60.0], High = 43.0 [24.0–65.3]). The most common pain MCID was 10 points (39% of respondents). Half of respondents considered a 5-min (35% of sample) or 10-min (16%) decrease in morning stiffness as clinically meaningful. Conclusions: Convergent validity of TSK-11 thresholds was supported by association with pain catastrophizing, severity of expected pain with movement, and willingness to complete tendon loading exercises. Most participants indicated that reducing their pain severity to the mild range would be clinically meaningful.
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Affiliation(s)
- Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Andrew A Post
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | | | - Katherine Hadlandsmyth
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - G Lorimer Moseley
- Sansom Institute for Health Research, IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Ebonie Rio
- School of Allied Health, LaTrobe Sport and Exercise Medicine Research Center, La Trobe University, Bundoora, VIC, Australia
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Leivas EG, Corrêa LA, Nogueira LAC. The relationship between low back pain and the basic lumbar posture at work: a retrospective cross-sectional study. Int Arch Occup Environ Health 2022; 95:25-33. [PMID: 34626219 DOI: 10.1007/s00420-021-01778-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to analyze the relationship between work-related lumbar posture (sitting, standing, walking, alternating posture) and LBP in workers. METHODS This is a retrospective study comprising 529 records of adult workers from a database of a private company. Predominant work-related lumbar posture was classified based on time spent in each posture. A total of 22 personal, occupational, clinical, and psychosocial covariates were evaluated. LBP symptoms in the last 12 months and during the last 7 days were the outcomes of the study. The multivariate analysis model evaluated the independent relationship between the work-related lumbar posture classification and other potential exposure factors with LBP. RESULTS The adjusted logistic regression model indicated that predominant walking reduced the likelihood to report LBP during the last 12 months when compared to standing (OR = 0.54; 95% CI 0.30, 0.99; p = 0.048), but there is no association between work-related postures and recent LBP. The adjusted analyses also revealed an association between LBP during the last 12 months and female sex, blue-collar task, frequently feeling tiredness, pain at any other body region previous 12 months, previous LBP, and monotonous work. Recent LBP was associated with female sex, pain at any other body region last 7 days, and previous LBP. CONCLUSIONS Standing posture increases the likelihood to report LBP during the last 12 months when compared to walking. LBP over previous year and during the previous 7 days was associated with personal and clinical factors.
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Affiliation(s)
- Eduardo Gallas Leivas
- Rehabilitation Science Postgraduation Program, Augusto Motta University Center, Praça das Nações, 34, Bonsucesso., Rio de Janeiro, RJ, CEP 21041-010, Brazil
| | - Leticia Amaral Corrêa
- Rehabilitation Science Postgraduation Program, Augusto Motta University Center, Praça das Nações, 34, Bonsucesso., Rio de Janeiro, RJ, CEP 21041-010, Brazil
| | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduation Program, Augusto Motta University Center, Praça das Nações, 34, Bonsucesso., Rio de Janeiro, RJ, CEP 21041-010, Brazil.
- Physiotherapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil.
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Kha TV, Stenager E, Hoang H, Bruun-Plesner K, Fuglsang KS, Søgaard la Cour B, Handberg G, Vaegter HB. Preliminary validity and test-retest reliability of two depression questionnaires compared with a diagnostic interview in 99 patients with chronic pain seeking specialist pain treatment. Scand J Pain 2021; 20:717-726. [PMID: 32706755 DOI: 10.1515/sjpain-2020-0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/08/2020] [Indexed: 01/14/2023]
Abstract
Objectives Depression symptomatology is highly prevalent in patients with chronic pain, but accurate identification of major depression may be challenged due to time constraints and diagnostic interviews are therefore not routinely performed in clinical practice. Assessment of depression may be facilitated through the use of full-length depression screening questionnaires with acceptable construct validity and test-retest reliability. However, as previously indicated screening questionnaires may overestimate depression in patients with chronic pain, possibly due to overlapping symptoms. However, the failure to screen for depression may raise a concern for missing relevant cases with depression. The objectives of this study were to (1) quantify the validity of the 9-items Patient-Health Questionnaire (PHQ9) and the Major Depression Inventory (MDI) compared with a diagnostic interview in patients with chronic pain seeking specialist pain treatment, and (2) assess the relative test-retest reliability of PHQ9 and MDI over two weeks. Methods Responses to the PHQ9 and MDI were compared with a Present-State-Examination (PSE) interview in 99 patients with chronic pain referred to interdisciplinary pain treatment. PHQ9 and MDI were completed twice over two weeks. Construct validity were assessed with the area under the curve (AUC) analysis, and performance characteristics derived from 2 × 2 contingency tables in which scores on the screening questionnaires were dichotomized and compared with the classification of clinical depression based on the diagnostic interview. Relative test-retest reliability was assessed with intraclass correlation coefficients (ICC). Results Based on the PSE interview, the prevalence of depression was 22.2%, and according to the PHQ9 and MDI questionnaires the prevalence was 26.3 and 34.3%, respectively. Compared with the diagnostic PSE, the PHQ9 and MDI questionnaires had areas under the curve of 0.83 and 0.88, respectively. Both questionnaires had high negative predictive values (PHQ9: cut-off of 11; MDI: cut-off of 26), but low positive predictive values for all possible scores. ICC values were excellent. Conclusions The PHQ9 and MDI questionnaires reliably identified chronic pain patients unlikely to have clinical depression, but showed limited validity identifying patients with clinical depression. These preliminary results may have clinical implications in depression screening in patients with chronic pain seeking specialist pain treatment. Clinicians in a specialty care pain clinic can use these screening questionnaires to identify patients without depression, but caution should be used when positive cases are identified by PHQ9 or MDI due to the risk of false positives.
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Affiliation(s)
- Thuy Vy Kha
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Research Unit in Mental Health, Åbenrå, Department of Regional Health Services, University of Southern Denmark, Odense, Denmark.,Department of Psychiatry, University of Southern Denmark, Odense, Denmark
| | - Huong Hoang
- Department of Psychiatry, University of Southern Denmark, Odense, Denmark
| | - Karin Bruun-Plesner
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark
| | | | | | - Gitte Handberg
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark
| | - Henrik Bjarke Vaegter
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark
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Vaegter HB, Christoffersen LO, Enggaard TP, Holdggard DEM, Lefevre TN, Eltved R, Reisenhus CH, Licht TW, Laustsen MM, Hansson SH, Jensen PF, Larsen TRF, Alpiger S, Mogensen BG, Høybye MT. Socio-Demographics, Pain Characteristics, Quality of Life and Treatment Values Before and After Specialized Interdisciplinary Pain Treatment: Results from the Danish Clinical Pain Registry (PainData). J Pain Res 2021; 14:1215-1230. [PMID: 33976571 PMCID: PMC8106464 DOI: 10.2147/jpr.s306504] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/24/2021] [Indexed: 01/01/2023] Open
Abstract
Background and Aims PainData is an electronic internet-based clinical pain registry established to improve the understanding and treatment of high-impact chronic pain. The primary aim of this paper is to describe socio-demographics, pain characteristics, quality of life, and treatment values at baseline and follow-up in individuals referred to public and private interdisciplinary pain centers in Denmark between 2018 and 2020. Methods Self-reported patient-reported outcomes collected through PainData before (n=12,257) and after (n=4,111) treatment across 13 public and private interdisciplinary specialized pain centers in Denmark (87% of all pain centers in Denmark) are described. Results Mean duration of pain was 10 years, and one in three patients reported chronic widespread pain. More than 40% reported opioid use, and 50% had tried four or more different treatment modalities prior to referral. More than 60% reported poor sleep, severe fatigue, and memory and/or concentration deficits. Mean scores on pain catastrophizing, fear of movement, and pain-related disability were high, whereas scores on pain acceptance and self-efficacy were low. Physical and mental health were rated as poor and fair, respectively. One in four patients reported being very much improved or much improved after treatment. Items commonly reported after treatment were increased knowledge about pain, emotions and mood (66.5%), being better at accepting life with chronic pain (63.1%), and improved activity pacing (60.6%). Conclusion The PainData registry, containing data from a large cohort of individuals, can help to improve the understanding and treatment of high-impact chronic pain, and collaborations with other researchers are welcome.
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Affiliation(s)
- Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | | | | | | | - Randi Eltved
- Pain Clinic, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Christina Høegh Reisenhus
- Interdisciplinary Pain Center, Lillebaelt Hospital, University Hospital of Southern Denmark, Odense, Denmark
| | | | | | | | - Per Føge Jensen
- Interdisciplinary Pain Center, Gentofte Hospital, Gentofte, Denmark
| | | | | | | | - Mette Terp Høybye
- Interdisciplinary Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark.,Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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8
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Vaegter HB, Høybye MT, Bergen FH, Parsons CE. Sleep disturbance in patients attending specialized chronic pain clinics in Denmark: a longitudinal study examining the relationship between sleep and pain outcomes. Scand J Pain 2021; 21:539-547. [PMID: 33838100 DOI: 10.1515/sjpain-2020-0155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/21/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Sleep disturbances are highly prevalent in patients with chronic pain. However, the majority of studies to date examining sleep disturbances in patients with chronic pain have been population-based cross-sectional studies. The aims of this study were to 1) examine the frequency of sleep disturbances in patients referred to two interdisciplinary chronic pain clinics in Denmark, 2) explore associations between sleep disturbances and pain intensity, disability and quality of life at baseline and follow-up, and 3) explore whether changes in sleep quality mediated the relationships between pain outcomes at baseline and pain outcomes at follow-up. METHODS We carried out a longitudinal observational study, examining patients enrolled in two chronic pain clinics assessed at baseline (n=2,531) and post-treatment follow-up (n=657). Patients reported on their sleep disturbances using the sleep quality subscale of the Karolinska Sleep Questionnaire (KSQ), their pain intensity using 0-10 numerical rating scales, their pain-related disability using the Pain Disability Index (PDI), and quality of life using the EuroQol-VAS scale. The average time between baseline and follow-up was 207 days (SD=154). RESULTS At baseline, the majority of patients reported frequent sleep disturbances. We found a significant association at baseline between self-reported sleep disturbances and pain intensity, pain-related disability, and quality of life, where greater sleep disturbance was associated with poorer outcomes. At follow-up, patients reported significant improvements across all pain and sleep outcomes. In two mediation models, we showed that changes in sleep disturbances from baseline to follow-up were significantly associated with (i) pain intensity at follow-up, and (ii) pain disability at follow-up. However, baseline pain intensity and disability scores were not associated with changes in sleep disturbances and, we did not find evidence for significant mediation of either pain outcome by changes in sleep disturbances. CONCLUSIONS Self-reported sleep disturbances were associated with pain outcomes at baseline and follow-up, with greater sleep disturbances associated with poorer pain outcomes. Changes in sleep quality did not mediate the relationships between baseline and follow-up scores for pain intensity and disability. These findings contribute to a growing body of evidence confirming an association between sleep and chronic pain experience, particularly suggestive of a sleep to pain link. Our data following patients after interdisciplinary treatment suggests that improved sleep is a marker for a better outcome after treatment.
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Affiliation(s)
- Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mette Terp Høybye
- Department of Clinical Medicine, Interacting Minds Center, Aarhus University, Aarhus, Denmark.,Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | | | - Christine E Parsons
- Department of Clinical Medicine, Interacting Minds Center, Aarhus University, Aarhus, Denmark
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Baseline Patient Characteristics Commonly Captured Before Surgery Do Not Accurately Predict Long-Term Outcomes of Lumbar Microdiscectomy Followed by Physiotherapy. Spine (Phila Pa 1976) 2020; 45:E885-E891. [PMID: 32118698 PMCID: PMC7337113 DOI: 10.1097/brs.0000000000003448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To develop and internally validate prognostic models based on commonly collected preoperative data for good and poor outcomes of lumbar microdiscectomy followed by physiotherapy. SUMMARY OF BACKGROUND DATA Lumbar microdiscectomy followed by physiotherapy is a common intervention for lumbar radiculopathy. Postoperatively, a considerable percentage of people continues to experience pain and disability. Prognostic models for recovery are scarce. METHODS We included 298 patients with lumbar radiculopathy who underwent microdiscectomy followed by physiotherapy. Primary outcomes were recovery and secondary outcomes were pain and disability at 12 months follow-up. Potential prognostic factors were selected from sociodemographic and biomedical data commonly captured preoperatively. The association between baseline characteristics and outcomes was evaluated using multivariable logistic regression analyses. RESULTS At 12 months follow-up, 75.8% of the participants met the criterion for recovery. Variables in the model for good recovery included: younger age, leg pain greater than back pain, high level of disability, and a disc herniation at another level than L3-L4. The model for poor recovery included: lower educational level, prior back surgery, and disc herniation at L3-L4. Following internal validation, the explained variance (Nagelkerke R) and area under the curve for both models were poor (≤0.02 and ≤0.60, respectively). The discriminative ability of the models for disability and pain were also poor. CONCLUSION The outcome of microdiscectomy followed by postoperative physiotherapy cannot be predicted accurately by commonly captured preoperative sociodemographic and biomedical factors. The potential value of other biomedical, personal, and external factors should be further investigated. LEVEL OF EVIDENCE 3.
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Corrêa LA, Bittencourt JV, Ferreira ADS, Reis FJJD, de Almeida RS, Nogueira LAC. The Reliability and Concurrent Validity of PainMAP Software for Automated Quantification of Pain Drawings on Body Charts of Patients With Low Back Pain. Pain Pract 2020; 20:462-470. [PMID: 31961038 DOI: 10.1111/papr.12872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/05/2019] [Accepted: 01/12/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The assessment of painful areas through printed body charts is a simple way for clinicians to identify patients with widespread pain in primary care. However, there is a lack in the literature about a simple and automated method designed to analyze pain drawings in body charts in clinical practice. PURPOSE To test the inter- and intra-rater reliabilities and concurrent validity of software (PainMAP) for quantification of pain drawings in patients with low back pain. METHODS Thirty-eight participants (16 [42.10%] female; mean age 50.24 [11.54] years; mean body mass index 27.90 [5.42] kg/m2 ; duration of pain of 94.35 [96.11] months) with a current episode of low back pain were recruited from a pool of physiotherapy outpatients. Participants were instructed to shade all their painful areas on a body chart using a red pen. The body charts were digitized by separate raters using smartphone cameras and twice for one rater to analyze the intra-rater reliability. Both the number of pain sites and the pain area were calculated using ImageJ software (reference method). The PainMAP software used image processing methods to automatically quantify the data from the same digitized body charts. RESULTS The reliability analyses revealed that PainMAP has excellent inter- and intra-rater reliabilities to quantify the number of pain sites (intraclass correlation coefficient [ICC]2,1 : 0.998 [95% confidence interval (CI) 0.996 to 0.999]; ICC2,1 : 0.995 [95% CI 0.991 to 0.998]) and the pain area [ICC2,1 : 0.998 (95% CI 0.995 to 0.999); ICC2,1 : 0.975 (95% CI 0.951 to 0.987)], respectively. The standard error of the measurement was 0.22 (4%) for the number of pain sites and 0.03 cm2 (4%) for the pain area. The Bland-Altman analyses revealed no substantive differences between the 2 methods for the pain area (mean difference = 0.007 [95% CI -0.053 to 0.067]). CONCLUSION PainMAP software is reliable and valid for quantification of the number of pain sites and the pain area in patients with low back pain.
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Affiliation(s)
- Leticia Amaral Corrêa
- Rehabilitation Science Postgraduation Program, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | - Juliana Valentim Bittencourt
- Rehabilitation Science Postgraduation Program, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | - Arthur de Sá Ferreira
- Rehabilitation Science Postgraduation Program, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | | | - Renato Santos de Almeida
- Rehabilitation Science Postgraduation Program, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil.,Physiotherapy Department, Gaffree and Guinlé University Hospital (HUGG), Rio de Janeiro, Brazil
| | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduation Program, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil.,Physiotherapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
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Improvements in clinical pain and experimental pain sensitivity after cognitive functional therapy in patients with severe persistent low back pain. Pain Rep 2019; 5:e802. [PMID: 32072097 PMCID: PMC7004508 DOI: 10.1097/pr9.0000000000000802] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/22/2019] [Accepted: 11/09/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction: Multidisciplinary care is recommended for disabling persistent low back pain (pLBP) nonresponsive to primary care. Cognitive functional therapy (CFT) is a physiotherapy-led individualised intervention targeting psychological, physical, and lifestyle barriers to recovery, to self-manage pLBP. Objectives: This pilot study investigated clinical outcomes and pain thresholds after a 12-week CFT pathway in patients with severe pLBP referred to a University Pain Center. Exploratory analyses compared changes in clinical outcomes, opioid consumption, and costs after CFT with changes after a multidisciplinary pain management (MPM) pathway. Methods: In total, 47 consecutively referred pLBP patients consented to the CFT pathway. At baseline, 3 and 6 months, clinical outcomes and PPTs were assessed. Control patients (n = 99) who had completed an MPM pathway in the last 3 years were matched from the clinical pain registry used in the Pain Center in a 3:1 ratio based on propensity scores derived from relevant baseline variables of the CFT cases. Results: Most clinical outcomes and low back pressure pain threshold were improved at 3 and 6 months after the CFT pathway. Compared with MPM, CFT patients had significantly larger reductions in disability and improved quality of life after the interventions at a lower cost (−3688€ [confidence interval: −3063 to −4314€]). Reduction in pain intensity and proportion of patients withdrawing from opioids (18.2% vs 27.8%) were similar between CFT and MPM groups. Conclusion: Improvements in clinical and experimental pain were found after the CFT pathway. Fully powered randomized controlled trials comparing CFT with an MPM program in patients with disabling pLBP are warranted to control for the current limitations.
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Cause-specific mortality of patients with severe chronic pain referred to a multidisciplinary pain clinic: a cohort register-linkage study. Scand J Pain 2018; 19:93-99. [DOI: 10.1515/sjpain-2018-0094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/17/2018] [Indexed: 12/28/2022]
Abstract
Abstract
Background and aims
Almost 20% of the adult population suffers from chronic pain. Chronic pain may be linked to an elevated mortality; however, results from previous studies are inconsistent. Some studies find similar mortality levels in chronic pain patients and pain-free controls while other studies show elevated mortality levels among chronic pain patients, primarily with respect to cancer, diseases of the circulatory and respiratory systems, and suicide. These conflicting results are potentially due to different population samples and different operational definitions of chronic pain. Further research on overall and cause-specific mortality in patients with severe chronic pain is needed to inform clinical practice. The objective of this register-linkage study was to investigate whether patients with severe chronic pain referred to multidisciplinary pain treatment have higher cause-specific mortality rates than the general population.
Methods
In this register-linkage cohort study, data from 6,142 chronic pain patients (female: n=3,941, male: n=2,201, mean age: 48.2±14.2; range: 16–97 years) attending an interdisciplinary Pain Center in Odense, Denmark from 2005 to 2014 were linked to the Danish Register of Causes of Death. Age and gender standardized mortality ratios (SMRs) with their 95% confidence intervals (CI) were calculated and compared with those of the general population. Data from the general population was extracted from the Danish Register of Causes of Death, and Causes of death were classified according to national Classification of Disease (ICD-10).
Results
In all, 276 deaths (women: n=152, men: n=124) were observed among the chronic pain patients, and a six-fold higher overall mortality rate was found [SMR: 6.2 (95% CI: 5.5–7.0)] compared with the general population. Elevated cause-specific mortality rates were noted for chronic patients with respect to cancer and neoplasms [4.7 (95% CI: 3.7–5.9)], diseases of the circulatory system [5.7 (95% CI: 4.3–7.3)], diseases of the respiratory system [8.7 (95% CI: 6.2–11.9)], and suicide [7.3 (95% CI: 2.7–15.9)].
Conclusions
The overall mortality rate of patients with severe chronic pain in this study was six-fold higher than the rate of the general population in this region. This was reflected in select specific causes of death (cancer and neoplasms, diseases of the circulatory system, diseases of the respiratory system, and suicide). The results are in agreement with previous studies and emphasize the need to understand which factors causally affect this increased mortality allowing for targeted interventions in similar chronic pain populations.
Implications
Potential reasons for the excess mortality should be adequately addressed by future studies in order to better target this in the management of these patients. The chronic pain population included in this study may have several comorbidities contributing to the increased mortality. To better address these aspects, complete medical profiles are needed in future studies. In addition, implementation of management strategies towards potential risk factors such as poor diet, low levels of physical activity, smoking, and high BMI as well as sleep deprivation and morphine use previously shown associated with having pain may reduce the excess mortality ratio.
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