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Mbarga J, Favre C, Ribeiro C, Pichonnaz C, Ancey C, Foley RA, Leger B, Luthi F. Beyond activity patterns: The complex process of activity management among individuals with chronic musculoskeletal pain after an orthopaedic trauma. Eur J Pain 2024; 28:1127-1143. [PMID: 38294106 DOI: 10.1002/ejp.2246] [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: 03/23/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
CONTEXT Individuals must change the way they perform activities in response to chronic pain. In the literature, three activity patterns are commonly described: avoidance, pacing, and persistence. Many studies have explored these activity patterns. However, little research has delved into the factors that lead people to adopt a particular activity behaviour. This study aimed to explore the relationship that people with chronic musculoskeletal pain have with activity and highlight the factors underlying their practices. METHODS The qualitative study was conducted by researchers in the social sciences, physiotherapy, psychology, and rehabilitation medicine. Observations of vocational workshops and semi-structured interviews were conducted with 33 persons undergoing rehabilitation for chronic musculoskeletal pain after an accident. RESULTS Patients' declarations and actions show that any one patient will alternate between activity patterns: the same person may adopt a strategy of avoidance, pacing or persistence depending on the context, the importance of the activity, personal objectives, and representations of self, pain, and activity. The decision to engage in a particular behaviour is based on a process of self-negotiation weighted by the circumstances, the nature of the activity, the importance attached to it, and the individual's perceived ability. CONCLUSION Our study emphasized the complexity of physical, social, and contextual factors that intervene in the relationship toward activity. Rather than favouring pacing, the therapist's role in rehabilitation might be to reinforce the reflexive process and the patient's adaptability in approaching the activity, to foster the capacity to find flexible solutions. SIGNIFICANCE Patients choose an activity pattern (avoidance, pacing, persistence) according to the challenges they face in their daily lives. Context, representations of self and activity, as well as goals sought influence these choices. Some patients report having learned to adapt their activity management strategies. Therefore, therapeutic approaches in the rehabilitation context could focus on these adaptive capacities to offer patients optimal pain and activity management and develop their ability to use different strategies according to the circumstance.
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Affiliation(s)
- J Mbarga
- Department of Applied Research and Development, HESAV School of Health Sciences - HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - C Favre
- Department of Psychosomatic, Clinique Romande de Réadaptation, Sion, Switzerland
| | - C Ribeiro
- Department of Applied Research and Development, HESAV School of Health Sciences - HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - C Pichonnaz
- Department of Physiotherapy, HESAV School of Health Sciences - HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - C Ancey
- Department of Physiotherapy, HESAV School of Health Sciences - HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - R-A Foley
- Department of Applied Research and Development, HESAV School of Health Sciences - HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - B Leger
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
| | - F Luthi
- Department of Musculoskeletal Rehabilitation and Institute for Research in Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
- Division of Physical Medicine and Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
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Wu J, Yang P, Wu X, Yu X, Zeng F, Wang H. Analysis of physical activity and prescription opioid use among US adults: a cross-sectional study. BMC Public Health 2024; 24:698. [PMID: 38443876 PMCID: PMC10913271 DOI: 10.1186/s12889-024-18220-7] [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: 09/12/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Opioid crisis has become a global concern, but whether physical activity (PA) can effectively reduce prescription opioid use remains unclear. The study aimed to examine the relationship of different domains of PA (e.g., occupation-related PA [OPA], transportation-related PA [TPA], leisure-time PA [LTPA]) with prescription opioid use and duration of prescription opioid use. METHODS This cross-sectional study was conducted on 27,943 participants aged ≥ 18 years from National Health and Nutrition Examination Survey (NHANES, 2007- March 2020). We examined the relationship of different domains of PA with prescription opioid use and duration of prescription opioid use using multivariable logistic regression. Stratified analysis and a series of sensitivity analysis were used to elevate robustness. All analyses were conducted using appropriate sampling weights. RESULTS Of the 27,943 participants, the mean age was 45.10 years, with 14,018 [weighted, 50.0%] females and 11,045 [weighted, 66.0%] non-Hispanic White. After multivariable adjustment, inverse associations between PA and prescription opioid use were observed for sufficient (≥ 150 min/week) total PA (OR,0.68 95%CI [0.56-0.81]), TPA (OR,0.73 95%CI [0.58-0.92]), and LTPA (OR,0.60 95%CI [0.48-0.75]) compared with insufficient PA(< 150 min/week), but not for sufficient OPA (OR,0.93 95%CI [0.79-1.10]). In addition, the associations were dose-responsive, participants had 22-40%, 27-36%, and 26-47% lower odds of using prescription opioids depending on the duration of total PA, TPA, and LTPA, respectively. Nevertheless, the impact of PA on prescription opioid use varied by duration of opioid use. Sufficient total PA was associated with elevated odds of short-term use of prescription opioids (< 90 days). Comparatively, sufficient total PA, TPA, and LTPA had different beneficial effects on reducing long-term use of prescription opioids (≥ 90 days) depending on the strength of opioids. CONCLUSIONS This study demonstrated sufficient total PA, TPA, and LTPA were inversely associated with prescription opioid use and varied depending on the duration and strength of prescription opioid use. These findings highlight PA can provide policy guidance to address opioid crisis.
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Affiliation(s)
- Junpeng Wu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University; The Key Laboratory of Precision Anesthesia & Perioperative Organ Protection, Guangzhou North Road, Guangzhou, 510515, Guangdong, China
| | - Panpan Yang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University; The Key Laboratory of Precision Anesthesia & Perioperative Organ Protection, Guangzhou North Road, Guangzhou, 510515, Guangdong, China
| | - Xiaodan Wu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University; The Key Laboratory of Precision Anesthesia & Perioperative Organ Protection, Guangzhou North Road, Guangzhou, 510515, Guangdong, China
| | - Xiaoxuan Yu
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangdong, China
| | - Fanfang Zeng
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Guangdong, China
| | - Haitang Wang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University; The Key Laboratory of Precision Anesthesia & Perioperative Organ Protection, Guangzhou North Road, Guangzhou, 510515, Guangdong, China.
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Rabey M, Slater H, Hebron C, Moloney N. Societal beliefs about pain may be more balanced than previously thought. Results of the Guernsey pain survey. BMC Musculoskelet Disord 2024; 25:72. [PMID: 38238802 PMCID: PMC10795459 DOI: 10.1186/s12891-023-07088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/02/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Musculoskeletal pain is multidimensional and associated with significant societal impact. Persistent or chronic pain is a public health priority. A step towards high-value care is a contemporary understanding of pain. While pain-related knowledge has been examined in specific conditions (e.g. neck pain) knowledge of the public's broader understanding regarding musculoskeletal pain per se, warrants investigation. This study examined the public's knowledge and beliefs regarding musculoskeletal pain and pain management. METHODS This observational cohort study was conducted in Guernsey (January 2019-February 2020). Participants (n = 1656; 76.0% female) completed an online questionnaire capturing: demographics, pain experience, work absenteeism, understanding of pain and pain management, multidimensional influences, physical activity, pain catastrophising and healthcare decision-making. Statements were deemed true/false/equivocal and mapped to biopsychosocial/biomedical/neutral perspectives based upon contemporary literature. Descriptive statistics were analysed for each statement. Participants' responses were examined for alignment to a contemporary viewpoint and themes within responses derived using a semi-quantitative approach modelled on direct content analysis. Comparisons between participants with/without pain were examined (χ2-squared/Wilcoxon Rank Sum test). RESULTS Within the cohort 83.6% reported currently experiencing pain. The overarching theme was perspectives that reflected both biomedical and contemporary, multidimensional understandings of pain. Sub-themes included uncertainty about pain persistence and evidence-based means to reduce recurrence, and reliance upon healthcare professionals for guiding decision-making. Compared to those with pain, those without had a greater belief that psychological interventions may help and lower pain catastrophising. CONCLUSIONS Participants' understanding of pain demonstrated both biomedical and multidimensional pain understanding consistent with elements of a contemporary understanding of pain.
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Affiliation(s)
- Martin Rabey
- Thrive Physiotherapy, St. Martin, Guernsey.
- School of Allied Health, Curtin University, Kent St. Bentley, WA, 6102, Australia.
| | - Helen Slater
- School of Allied Health, Curtin University, Kent St. Bentley, WA, 6102, Australia
- enAble Institute, Curtin University, Kent St. Bentley, WA, 6102, Australia
| | - Clair Hebron
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Niamh Moloney
- Thrive Physiotherapy, St. Martin, Guernsey
- School of Allied Health, Curtin University, Kent St. Bentley, WA, 6102, Australia
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Enomoto K, Sasaki J. Relationship between perfectionism, overactivity, pain severity, and pain interference in individuals with chronic pain: A cross-lagged panel model analysis. Scand J Pain 2024; 24:sjpain-2023-0087. [PMID: 38451487 DOI: 10.1515/sjpain-2023-0087] [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: 07/02/2023] [Accepted: 12/22/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Overactivity is a characteristic of individuals with chronic pain. Previous cross-sectional studies demonstrated a relationship between perfectionism and overactivity. Therefore, the present study used a longitudinal design to determine whether pain severity and pain interference were exacerbated by overactivity and whether overactivity was exacerbated by perfectionism. METHODS Participants with chronic pain were recruited using crowdsourcing. The participants completed the questionnaires at three time points: T1, T2, and T3 (September, October, and November 2021, respectively). The questionnaire assessed overactivity, perfectionistic strivings, perfectionistic concerns, pain severity, and pain interference. We created cross-lagged panel models to examine the hypothesized relationships among pain, overactivity, and perfectionism. RESULTS After excluding ineligible participants and invalid response sets, we analyzed the questionnaires completed by 666 participants at T1, 560 at T2, and 554 at T3. The average duration of chronic pain at T1 was 36.35 ± 53.53 months. Perfectionistic strivings were partially linked to overactivity, and pain interference was partially related to overactivity. Contrary to our expectations, overactivity did not predict pain severity or pain interference. CONCLUSIONS The hypotheses that perfectionism exacerbates overactivity and that overactivity exacerbates pain severity and pain interference were not supported. These results may have been affected by the quality of the assessment of overactivity. Therefore, further research with a refined evaluation of overactivity is required.
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Affiliation(s)
- Kiyoka Enomoto
- Pain Management Clinic, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu, Shiga, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan
| | - Jun Sasaki
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
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Barakou I, Hackett KL, Finch T, Hettinga FJ. Self-regulation of effort for a better health-related quality of life: a multidimensional activity pacing model for chronic pain and fatigue management. Ann Med 2023; 55:2270688. [PMID: 37871249 PMCID: PMC10595396 DOI: 10.1080/07853890.2023.2270688] [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: 07/20/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE To propose a comprehensive multidimensional model of activity pacing that improves health-related quality of life and promotes sustained physical activity engagement among adults with chronic conditions. MATERIALS AND METHODS A narrative review was conducted to examine the existing literature on activity pacing, health-related quality of life, pain and fatigue management, and physical activity promotion in chronic conditions. RESULTS The literature revealed a lack of a cohesive approach towards a multidimensional model for using activity pacing to improve health-related quality of life. A comprehensive multidimensional model of activity pacing was proposed, emphasizing the importance of considering all aspects of pacing for sustained physical activity engagement and improved health-related quality of life. The model incorporates elements such as rest breaks, self-regulatory skills, environmental factors, and effective coping strategies for depression/anxiety. It takes into account physical, psychological, and environmental factors, all of which contribute significantly to the enhancement of health-related quality of life, physical function, and overall well-being, reflecting a holistic approach. CONCLUSIONS The model offers guidance to researchers and clinicians in effectively educating patients on activity pacing acquisition and in developing effective interventions to enhance physical activity engagement and health outcomes among adults with chronic conditions. Additionally, it serves as a tool towards facilitating discussions on sustained physical activity and a healthy lifestyle for patients, which can eventually lead to improved quality of life.
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Affiliation(s)
- Ioulia Barakou
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - Katie L. Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
- CRESTA Fatigue Clinic, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
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Andrews NE, Ireland D, Vijayakumar P, Burvill L, Hay E, Westerman D, Rose T, Schlumpf M, Strong J, Claus A. Acceptability of a Pain History Assessment and Education Chatbot (Dolores) Across Age Groups in Populations With Chronic Pain: Development and Pilot Testing. JMIR Form Res 2023; 7:e47267. [PMID: 37801342 PMCID: PMC10589833 DOI: 10.2196/47267] [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: 03/14/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The delivery of education on pain neuroscience and the evidence for different treatment approaches has become a key component of contemporary persistent pain management. Chatbots, or more formally conversation agents, are increasingly being used in health care settings due to their versatility in providing interactive and individualized approaches to both capture and deliver information. Research focused on the acceptability of diverse chatbot formats can assist in developing a better understanding of the educational needs of target populations. OBJECTIVE This study aims to detail the development and initial pilot testing of a multimodality pain education chatbot (Dolores) that can be used across different age groups and investigate whether acceptability and feedback were comparable across age groups following pilot testing. METHODS Following an initial design phase involving software engineers (n=2) and expert clinicians (n=6), a total of 60 individuals with chronic pain who attended an outpatient clinic at 1 of 2 pain centers in Australia were recruited for pilot testing. The 60 individuals consisted of 20 (33%) adolescents (aged 10-18 years), 20 (33%) young adults (aged 19-35 years), and 20 (33%) adults (aged >35 years) with persistent pain. Participants spent 20 to 30 minutes completing interactive chatbot activities that enabled the Dolores app to gather a pain history and provide education about pain and pain treatments. After the chatbot activities, participants completed a custom-made feedback questionnaire measuring the acceptability constructs pertaining to health education chatbots. To determine the effect of age group on the acceptability ratings and feedback provided, a series of binomial logistic regression models and cumulative odds ordinal logistic regression models with proportional odds were generated. RESULTS Overall, acceptability was high for the following constructs: engagement, perceived value, usability, accuracy, responsiveness, adoption intention, esthetics, and overall quality. The effect of age group on all acceptability ratings was small and not statistically significant. An analysis of open-ended question responses revealed that major frustrations with the app were related to Dolores' speech, which was explored further through a comparative analysis. With respect to providing negative feedback about Dolores' speech, a logistic regression model showed that the effect of age group was statistically significant (χ22=11.7; P=.003) and explained 27.1% of the variance (Nagelkerke R2). Adults and young adults were less likely to comment on Dolores' speech compared with adolescent participants (odds ratio 0.20, 95% CI 0.05-0.84 and odds ratio 0.05, 95% CI 0.01-0.43, respectively). Comments were related to both speech rate (too slow) and quality (unpleasant and robotic). CONCLUSIONS This study provides support for the acceptability of pain history and education chatbots across different age groups. Chatbot acceptability for adolescent cohorts may be improved by enabling the self-selection of speech characteristics such as rate and personable tone.
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Affiliation(s)
- Nicole Emma Andrews
- RECOVER Injury Research Centre, The University of Queensland, Herston, Australia
- Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- The Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Australia
| | - David Ireland
- Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
| | - Pranavie Vijayakumar
- Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Lyza Burvill
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Elizabeth Hay
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Daria Westerman
- Queensland Interdisciplinary Paediatric Persistent Pain Service, Queensland Children's Hospital, South Brisbane, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Mikaela Schlumpf
- Queensland Interdisciplinary Paediatric Persistent Pain Service, Queensland Children's Hospital, South Brisbane, Australia
| | - Jenny Strong
- Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- The Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Andrew Claus
- Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
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Fehrmann E, Fischer-Grote L, Kienbacher T, Tuechler K, Mair P, Ebenbichler G. Perceived psychosocial stressors and coping resources in chronic low back pain patients as classified by the avoidance-endurance model. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:996945. [DOI: 10.3389/fresc.2022.996945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Abstract
ObjectivesThe Avoidance-Endurance Model distinguishes between subgroups of low back pain (LBP) patients with three maladaptive styles of coping with pain: fear-avoidance (FAR), distress-endurance (DER), eustress-endurance (EER), and one adaptive coping style (AR). This study aimed to compare the quantity of patients' perceived psychosocial stressors and coping resources across these subgroups.Materials and methodsThis cross-sectional study was conducted at an outpatient rehabilitation center for patients with chronic musculoskeletal pain. One hundred and thirty-seven patients (69 women/68 men) with chronic LBP were assessed using the following: a demographic checklist, the visual analogue scale, Avoidance-Endurance Questionnaire, Roland-Morris Disability Questionnaire, Pain Disability Index, and 36-Item Short Form. Subsequently, patients participated in semi-structured interviews led by clinical psychologists, which were intended to identify their perception of stressors and coping resources. The quantity of psychosocial stressors and coping resources were analyzed using deductive and inductive content analyses and then compared between subgroups using chi-square-tests.ResultsFARs experienced significantly higher levels of “mental suffering” (p = <0.001) and “other workplace problems” compared to ARs and EERs (p = <0.001). DERs reported significantly higher levels of “mental suffering” (p = <0.001), “job stress” (p = 0.022), and “familial losses” (p = 0.029) compared to ARs, whereas the AR group demonstrated significantly more “coping resources” (p = 0.001) compared to FARs.ConclusionAEM-subgroups differed in the quantity of perceived psychosocial stressors and coping resources with AR, who demonstrated a lower risk for pain chronicity and reported the highest quantity of resources. The variability across subgroups may imply differences in patientś needs regarding therapeutic interventions and suggests that a resource-centered approach to cope with stress and pain may be beneficial.
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Kasahara S, Matsudaira K, Sato N, Niwa S. Attention-Deficit/hyperactivity disorder and centralized pain: A review of the case of John F. Kennedy. Clin Case Rep 2022; 10:e6422. [PMID: 36245472 PMCID: PMC9547351 DOI: 10.1002/ccr3.6422] [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: 07/27/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022] Open
Abstract
John Fitzgerald Kennedy (JFK), the 35th President of the USA, had chronic low back pain deemed to be centralized pain. Reportedly, attention‐deficit/hyperactivity disorder (ADHD) could associate with centralized pain. Based on his biographies, JFK could have had ADHD, a plausible cause of pain that afflicted him.
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Affiliation(s)
- Satoshi Kasahara
- Department of Anesthesiology and Pain Relief CenterThe University of Tokyo HospitalBunkyo‐kuJapan,Department of Pain MedicineFukushima Medical University School of MedicineFukushimaJapan
| | - Ko Matsudaira
- Department of Pain MedicineFukushima Medical University School of MedicineFukushimaJapan,Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research CenterThe University of Tokyo HospitalBunkyo‐kuJapan
| | - Naoko Sato
- Nursing DepartmentThe University of Tokyo HospitalBunkyo‐kuJapan
| | - Shin‐Ichi Niwa
- Department of Psychiatry, Aizu Medical CenterFukushima Medical UniversityFukushimaJapan
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Vaezipour A, Andrews N, Oviedo-Trespalacios O, Amershi F, Horswill M, Johnston V, Delhomme P. Exploring driving behaviour from the perspectives of individuals with chronic pain and health professionals. APPLIED ERGONOMICS 2022; 102:103755. [PMID: 35381464 DOI: 10.1016/j.apergo.2022.103755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
Chronic pain affects one in five Australians, and this could impact daily activities such as driving. Driving is a complex task, which requires the cognitive and physical ability to predict, identify, and respond to hazards to avoid crashing. However, research exploring the factors that influence safe driving behaviour for chronic pain individuals is limited. A qualitative study was conducted which involved semi-structured interviews with 23 people who had experienced persistent pain for at least three months and 17 health professionals who had experience working with individuals with chronic pain. The aim of this study was to obtain a deeper understanding of the experiences and challenges that people with chronic pain may have in their day-to-day driving. Participants were also asked about currently available driving assessments and strategies for individuals with chronic pain in the Australian healthcare system. The themes emerging from the interviews highlighted the need for clearer guidelines and educational materials regarding the impact of chronic pain on an individual's ability to drive. These themes included the physical and cognitive challenges resulting from chronic pain, as well as the potential side effects of pain medications. In addition, participants identified a number of self-regulation strategies and driving assessments currently available for monitoring safe driving behaviour in Australia. This study improves our understanding of how chronic pain affects driving behaviour, as reported by individuals experiencing the pain and relevant health professionals. Recommendations for improving the safety of drivers with chronic pain are discussed, including possible technological interventions and better public education.
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Affiliation(s)
- Atiyeh Vaezipour
- RECOVER Injury Research Centre, The University of Queensland, Australia.
| | - Nicole Andrews
- RECOVER Injury Research Centre, The University of Queensland, Australia; Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service, Queensland, Australia; Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Queensland, Australia
| | | | - Fatima Amershi
- Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service, Queensland, Australia; Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Mark Horswill
- School of Psychology, The University of Queensland, Australia
| | - Venerina Johnston
- RECOVER Injury Research Centre, The University of Queensland, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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10
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Goodall J, Brown T. Patients' experiences of occupational therapy within a multidisciplinary pain management programme: A qualitative study. Br J Pain 2022; 16:290-302. [PMID: 35646343 PMCID: PMC9136995 DOI: 10.1177/20494637211054697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Occupational problems are common for adults experiencing chronic pain, but occupational therapists are not always accessed as part of the multidisciplinary team. Despite evidence of benefit for work-focused interventions, there is limited evidence for broader benefit from occupational therapy interventions within the context of multidisciplinary pain management. The aim of this study was to explore the experiences of programme attendees who received structured intervention from an occupational therapist as part of a multidisciplinary pain management programme, and gain an understanding as to how they felt it influenced changes they made to occupational participation. METHOD A qualitative approach was undertaken with 9 individual patients recruited from a group pain management programme for adults with chronic low back pain. Semi-structured interviews were carried out, recorded and transcribed. Thematic analysis was used to identify themes in the data. RESULTS Three key themes were identified: 1) the helpfulness of activity pacing techniques 2) the value of participating in a therapeutic activity-based session and 3) an increased understanding of the importance of leisure and creative activities in the context of their lives. CONCLUSION Participants perceived the specific occupational therapy content of the programme to be helpful in a number of different ways. The findings suggest that occupational therapy can be important in facilitating patients to apply theoretical techniques in the real world, thereby increasing the likelihood of long term benefit.
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Enomoto K, Kugo M, Fukui S, Sasaki J. Cognitive behavioral therapy for an individual suffering from chronic pain with overactivity and sleep disturbance: A case report. Clin Case Rep 2022; 10:e05838. [PMID: 35600031 PMCID: PMC9122793 DOI: 10.1002/ccr3.5838] [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: 12/10/2021] [Revised: 03/22/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
Patients suffering from chronic pain (CP) with overactivity frequently experience sleep disturbance. We presented a 35‐year‐old woman suffering from CP. To improve the sleep disturbance of individuals suffering from CP with overactivity, it is important to combine cognitive behavioral therapy for insomnia and activity pacing.
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Affiliation(s)
- Kiyoka Enomoto
- Graduate School of Human Sciences Osaka University Suita Japan
- Japan Society for the Promotion of Science Tokyo Japan
- Pain Management Clinic Shiga University of Medical Science Hospital Otsu Japan
| | - Masato Kugo
- Department of Rehabilitation Shiga University of Medical Science Hospital Otsu Japan
| | - Sei Fukui
- Pain Management Clinic Shiga University of Medical Science Hospital Otsu Japan
| | - Jun Sasaki
- Graduate School of Human Sciences Osaka University Suita Japan
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Common reported barriers and facilitators for self-management in adults with chronic musculoskeletal pain: A systematic review of qualitative studies. Musculoskelet Sci Pract 2021; 56:102433. [PMID: 34416557 DOI: 10.1016/j.msksp.2021.102433] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Self-management strategies are considered a necessary component of chronic musculoskeletal pain management to address ongoing symptoms and challenges. However uptake of self-management can be impeded by a number of factors. OBJECTIVES The aim of this study was to explore common impeding and facilitating factors of self-management strategies from the patient perspective. METHODS An electronic search was performed between 2009 to May 2020 for the following databases: MEDLINE, AMED, PsychINFO, Cochrane Library, PubMed, CINAHL, PEDro, and Google Scholar. The search terms included peer-reviewed qualitative or mixed-method studies investigating the perspective of chronic musculoskeletal pain patients in regards to the use of self-management strategies. Study rigor and bias was assessed using the CASP (Critical Appraisal Skills Programme) questionnaire specific to qualitative studies. Qualitative data was coded using a three-stage thematic synthesis process. Confidence in findings was assessed using CERQual (The Confidence in the Evidence from Review of Qualitative Research). RESULTS Twenty-seven studies were included with 487 participants. Six major themes were identified and divided into external and internal influencing factors. The external influencing factors were made up of the following three themes: health care practitioner role, supportive environment, accessibility. While the three internal influencing themes were: physical factors, knowledge and understanding, and psychological factors. CONCLUSION Learning to self-manage for patients in chronic pain required ongoing support either from healthcare practitioners or from social circles. To further assist the self-management process practitioners can improve self-efficacy through increasing patient knowledge of chronic pain, utilising goal setting and finding ways an individual can access ongoing support, either from the practitioner or through group programs.
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Abstract
BACKGROUND Pain is a complex and highly subjective phenomenon that can be modulated by several factors. On the basis of results from experimental and clinical studies, the existence of endogenous pain modulatory mechanisms that can increase or diminish the experience of pain is now accepted. METHODS In this narrative review, the pain modulatory effects of exercise, stress, and cognitions in humans are assessed. RESULTS Experimental studies on the effect of exercise have revealed that pain-free participants show a hypoalgesic response after exercise. However, in some patients with chronic pain, this response is reduced or even hyperalgesic in nature. These findings will be discussed from a mechanistic point of view. Stress is another modulator of the pain experience. Although acute stress may induce hypoalgesia, ongoing clinical stress has detrimental effects on pain in many patients with chronic pain conditions, which have implications for the understanding, assessment, and treatment of stress in patients with pain. Finally, cognitive strategies play differing roles in pain inhibition. Two intuitive strategies, thought suppression and focused distraction, will be reviewed as regards experimental, acute, and chronic pain. CONCLUSION On the basis of current knowledge on the role of exercise, stress, and cognitive pain control strategies on the modulation of pain, implications for treatment will be discussed.
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Overactivity in Chronic Pain, the Role of Pain-related Endurance and Neuromuscular Activity: An Interdisciplinary, Narrative Review. Clin J Pain 2021; 36:162-171. [PMID: 31833914 DOI: 10.1097/ajp.0000000000000785] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Decades of research have convincingly shown that fear of pain and pain-related avoidance behavior are important precursors of disability in daily life. Reduced activity as a consequence of avoidance, however, cannot be blamed for chronic disability in all patients. A contrasting behavior, pain-related dysfunctional endurance in a task and overactivity has to be considered. Currently, there is a need to better understand the psychological determinants of overactivity, dysfunctional endurance, and neurobiomechanical consequences. METHODS This is a narrative review. RESULTS The first part of this review elucidates research on self-reported overactivity, showing associations with higher levels of pain and disability, especially in spinal load positions, for example, lifting, bending, or spending too long a time in specific positions. In addition, measures of habitual endurance-related pain responses, based on the avoidance-endurance model, are related to objective assessments of physical activity and, again, especially in positions known to cause high spinal load (part 2). The final part reveals findings from neuromuscular research on motor control indicating the possibility that, in particular, overactivity and dysfunctional endurance may result in a number of dysfunctional adaptations with repetitive strain injuries of muscles, ligaments, and vertebral segments as precursors of pain. DISCUSSION This narrative review brings together different research lines on overactivity, pain-related endurance, and supposed neuromuscular consequences. Clinicians should distinguish between patients who rest and escape from pain at low levels of pain, but who have high levels of fear of pain and those who predominantly persist in activities despite severely increasing pain until a break will be enforced by intolerable pain levels.
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Antcliff D, Keenan AM, Keeley P, Woby S, McGowan L. "Pacing does help you get your life back": The acceptability of a newly developed activity pacing framework for chronic pain/fatigue. Musculoskeletal Care 2021; 20:99-110. [PMID: 33955642 DOI: 10.1002/msc.1557] [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: 02/25/2021] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We have developed and feasibility tested an activity pacing framework for clinicians to standardise their recommendations of activity pacing to patients with chronic pain/fatigue. This study aimed to explore the acceptability and fidelity to this framework in preparation for a future trial of activity pacing. DESIGN Acceptability and fidelity were explored using semi-structured interviews. Data were analysed using framework analysis. PARTICIPANTS Patients who attended a rehabilitation programme for chronic pain/fatigue underpinned by the framework, and clinicians (physiotherapists and psychological wellbeing practitioners) who led the programmes. RESULTS Seventeen interviews were conducted, involving 12 patients with chronic pain/fatigue and five clinicians. The framework analysis revealed four deductive themes: (1) Acceptability of the activity pacing framework, (2) Acceptability of the feasibility study methods, (3) Processes of change and (4) Barriers and facilitators to activity pacing; and one inductive theme: (5) Perspectives of patients and clinicians. CONCLUSIONS The activity pacing framework appeared acceptable to patients and clinicians, and adherence to the framework was demonstrated. Processes of behaviour change included patients' regulation of activities through activity pacing. Barriers to pacing included work/social commitments and facilitators included identifying the benefits of pacing on symptoms. Different perspectives emerged between clinicians and patients regarding interpretations of symptom-contingent and quota-contingent strategies. The framework recognises fluctuations in symptoms of chronic pain/fatigue and encourages a quota-contingent approach with flexibility. Future work will develop a patient friendly guide ahead of a clinical trial to explore the effects of pacing.
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Affiliation(s)
- Deborah Antcliff
- Physiotherapy Department, Bury Care Organisation, Northern Care Alliance NHS Group, Bury, England, UK.,School of Healthcare, University of Leeds, Leeds, England, UK
| | - Anne-Maree Keenan
- School of Healthcare, University of Leeds, Leeds, England, UK.,NIHR Leeds Biomedical Research Centre, Leeds, England, UK
| | - Philip Keeley
- School of Nursing and Midwifery, Keele University, Keele, England, UK
| | - Steve Woby
- Research and Innovation Department, Northern Care Alliance NHS Group, Salford, England, UK.,School of Health and Society, University of Salford, Salford, England, UK.,Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, England, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, England, UK
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16
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Heigl F, Tobler-Ammann B, Villiger PM, Gantschnig BE. Relationship between the perceived burden of suffering and the observed quality of ADL task performance before and after a 12-week pain management programme. Scand J Occup Ther 2021; 29:660-669. [PMID: 33813985 DOI: 10.1080/11038128.2021.1903988] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND/OBJECTIVE Constant pain causes suffering and affects performance of activities of daily living (ADL). In clients with chronic musculoskeletal pain, we wanted to determine (i) the relationship between the perceived burden of suffering (measured with the Pictorial Representation of Illness and Self Measure (PRISM)) and the observed quality of ADL task performance (measured with the Assessment of Motor and Process Skills (AMPS)); and (ii) the change in these assessments before and after a 12-week pain programme. METHODS In this cross-sectional cohort study, we retrospectively collected data from participants in a Swiss pain management programme. We calculated the relationship, correlations and effect sizes for the PRISM and AMPS using non-parametric tests. We set the level of significance at α = 0.05. RESULTS Out of 138 clients, 74 participated. We found no significant correlations between the PRISM and AMPS (p = 0.55-0.36), except for the PRISM and AMPS process ability measure after the pain management programme (p = 0.023). Pre-post-correlations of the AMPS and PRISM were significant, with medium to strong effect sizes (-0.48-0.66). CONCLUSION Participation in this pain programme improved both, the PRISM and AMPS scores. The lack of correlation between these assessments in clients with chronic musculoskeletal pain, however, strongly argues for a thorough clinical assessment.
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Affiliation(s)
- Franziska Heigl
- Department of Rheumatology and Immunology, University Hospital (Inselspital), and University of Bern, Bern, Switzerland
| | - Bernadette Tobler-Ammann
- Department of Orthopaedic, Plastic and Hand Surgery, Hand Therapy Research Unit, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Peter M Villiger
- Department of Rheumatology and Immunology, University Hospital (Inselspital), and University of Bern, Bern, Switzerland
| | - Brigitte E Gantschnig
- Department of Rheumatology and Immunology, University Hospital (Inselspital), and University of Bern, Bern, Switzerland.,Institute of Occupational Therapy, School of Health Professions, ZHAW Zürich University of Applied Sciences, Winterthur, Switzerland
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17
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Suso-Ribera C, Catalá P, Ecija C, Sanromán L, López-Gómez I, Pastor-Mira Á, Peñacoba-Puente C. Exploring the contextual role of pain severity as a moderator of the relationship between activity patterns and the physical and mental functioning of women with fibromyalgia. Eur J Pain 2020; 25:257-268. [PMID: 32996660 DOI: 10.1002/ejp.1669] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/27/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In past years, and mostly due to contextual psychological therapies, it has been argued that particular behavioural patterns may be useful in certain contexts, but not in others. The goal of this study has been to explore whether pain severity is indeed a contextual factor influencing the relationship between two controversial activity patterns, namely pacing and persistence, and functionality in people with fibromyalgia. METHODS Participants were 231 women diagnosed with fibromyalgia. A multivariate regression was conducted to explore the moderating role of pain severity in the relationship between activity patterns and outcomes (i.e. fibromyalgia impact and depressive symptoms). RESULTS Excessive persistence (interaction: t = -2.45, p = 0.015) and pain-contingent persistence (interaction: t= -2.13, p = 0.034) were more strongly associated with fibromyalgia impact when people experienced less severe pain. Pacing for pain reduction was only significantly related to depressive symptoms at very severe (M = 10) pain levels (interaction: β= -0.18, t= -2.73). CONCLUSIONS The results here reported suggest that the context in which behaviour occurs is relevant when the utility of certain behaviour patterns is considered. The clinical implications of this are clear, as it would justify adapting the recommendations given to patients according to their pain severity status. SIGNIFICANCE This manuscript shows that some activity patterns (i.e. pacing to conserve energy for valued activities) might be advisable regardless of pain levels. Conversely, some patterns might be especially recommended (i.e. pain-reduction pacing) or inadvisable (i.e. excessive and pain-contingent persistence) depending on pain levels (i.e. severe and mild pain, respectively).
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Affiliation(s)
- Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellon, Spain
| | - Patricia Catalá
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Carmen Ecija
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Lucía Sanromán
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | | | - Ángeles Pastor-Mira
- Department of Behavioral Sciences and Health, Miguel Hernández University, Alicante, Spain
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Andrews NE, Chien CW, Ireland D, Varnfield M. Overactivity assessment in chronic pain: The development and psychometric evaluation of a multifaceted self-report assessment. Eur J Pain 2020; 25:225-242. [PMID: 32965735 PMCID: PMC7821341 DOI: 10.1002/ejp.1664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
Background Overactivity in the context of chronic pain (i.e. activity engagement that significantly exacerbates pain) is an important clinical issue that has gained empirical attention in the last decade. Current assessment concepts of overactivity tend to focus on frequency to quantify the severity of the pain behaviour. This study aimed to develop and validate a more comprehensive self‐assessment, the Overactivity in Persistent Pain Assessment (OPPA). Methods A sample of 333 individuals with chronic pain completed the OPPA. A subset of 202 individuals also completed a set of existing measures of pain‐related outcomes and activity patterns. The remaining 131 participants were provided with a second copy of the OPPA to fill in one week following their initial assessment. Results A principal component analysis confirmed that the OPPA items were best represented by a single construct. The OPPA was found to correlate with pain‐related measures in an expected way that is supported by both theory and qualitative data. When compared to existing overactivity measures, the OPPA was the only measure to contribute significantly to the regression models predicting higher levels of pain severity, more pain interference and lower levels of activity participation after controlling for age, gender and activity avoidance. In addition, the OPPA scale exhibited acceptable internal consistency and good test–retest reliability. Conclusion The results of this study reinforce the potentially important role of overactivity in the maintenance of pain‐related suffering and supports a corresponding assessment tool with preliminary psychometric evidence for clinical and research applications. Significance This study deconstructs the overactivity concept and develop a corresponding assessment based on five quantifiable severity features: severity of pain exacerbation, maladaptive coping strategies used, impact on occupational performance, recovery time and frequency. Results of the psychometric evaluation indicate that this comprehensive assessment of overactivity severity features may be necessary to understand the impact of overactivity on pain severity and physical functioning from both a clinical and research perspective.
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Affiliation(s)
- Nicole E Andrews
- RECOVER Injury Research Centre, The University of Queensland, Herston, Qld., Australia.,Department of Occupational Therapy, The Royal Brisbane and Women's Hospital, Herston, Qld., Australia.,Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Herston, Qld., Australia
| | - Chi-Wen Chien
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - David Ireland
- The Australian eHealth Research Centre, CSIRO, Herston, Qld., Australia
| | - Marlien Varnfield
- The Australian eHealth Research Centre, CSIRO, Herston, Qld., Australia
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20
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Antcliff D, Keenan AM, Keeley P, Woby S, McGowan L. Engaging stakeholders to refine an activity pacing framework for chronic pain/fatigue: A nominal group technique. Musculoskeletal Care 2019; 17:354-362. [PMID: 31750627 DOI: 10.1002/msc.1430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/05/2019] [Accepted: 09/07/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Due to the current absence of a standardized guide for activity pacing, the concept of pacing is interpreted in various ways by healthcare professionals, patients and researchers. Consequently, the effects of pacing across different conditions are unclear. The present study aimed to undertake the second stage in the development of an activity pacing framework for chronic pain/fatigue. METHODS The newly developed activity pacing framework was refined using a consensus method. A nominal group technique (NGT) was selected to engage stakeholders to reach agreement on the top 10 priorities for inclusion in the framework and accompanying appendices. Participants included patients with diagnoses of chronic pain/fatigue and healthcare professionals working in fields of chronic pain/fatigue. RESULTS Ten participants were recruited via purposive sampling: four patients, two physiotherapists, two occupational therapists and two psychological wellbeing practitioners. The top priorities for the pacing framework included a clear definition of pacing, and stating the aims and context of pacing. The appendices were refined as a teaching guide, including priorities of detailing the stages of pacing, the overactivity-underactivity cycle/pain cycle and goal setting. CONCLUSIONS Incorporating a diverse panel of stakeholders was an effective and inclusive method to refine the activity pacing framework. The framework has been purposefully designed for wider use across patients with chronic pain/fatigue and by various healthcare professionals. The framework provides a comprehensive definition, background and manual for healthcare professionals to instruct activity pacing. Further study will test the clinical usability of the framework, to enable the standardization of activity pacing in future investigations.
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Affiliation(s)
- Deborah Antcliff
- Physiotherapy Department, Bury and Rochdale Care Organisation, Northern Care Alliance NHS Group, Bury, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | | | - Philip Keeley
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Steve Woby
- Research and Innovation Department, Northern Care Alliance NHS Group, Bury, UK.,School of Health and Society, University of Salford, Salford, UK.,Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
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21
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Lundberg T, Melander S. Key Push and Pull Factors Affecting Return to Work Identified by Patients With Long-Term Pain and General Practitioners in Sweden. QUALITATIVE HEALTH RESEARCH 2019; 29:1581-1594. [PMID: 30920899 DOI: 10.1177/1049732319837227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Research shows that working is positive for people with long-term pain but that work-related support from health professionals is inadequate. One explanation for this inadequacy is that patients and providers differ in terms of perspectives on motivation to work. In this article, we compare factors that 31 patients and 15 general practitioners consider important to promote return to work for people with long-term pain. We analyzed the interviews with thematic analysis and a motivational push and pull framework to cover different motivational factors, societal and individual, that might push or pull patients from or toward work. Providers said that a difference between working and nonworking patients is their level of individual motivation, while the patients' stories showed that the main difference was the physical (non)ability to push themselves to work. We suggest that work-related support can be improved by addressing such differences in clinical practice.
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Antcliff D, Keenan AM, Keeley P, Woby S, McGowan L. Survey of activity pacing across healthcare professionals informs a new activity pacing framework for chronic pain/fatigue. Musculoskeletal Care 2019; 17:335-345. [PMID: 31430038 PMCID: PMC6973284 DOI: 10.1002/msc.1421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Activity pacing is considered a key component of rehabilitation programmes for chronic pain/fatigue. However, there are no widely used guidelines to standardize how pacing is delivered. This study aimed to undertake the first stage in developing a comprehensive evidence-based activity pacing framework. METHODS An online survey across pain/fatigue services in English National Health Service trusts explored healthcare professionals' opinions on the types/uses of pacing, aims, facets and perceived effects. Data were analysed using descriptive statistics for closed-ended questions and thematic analysis for open-ended questions. Purposeful recruitment with a snowball effect engaged 92 healthcare professionals (physiotherapists, occupational therapists, nurses, doctors and psychologists) to the study. RESULTS Pacing was highly utilized, with perceived long-term benefits for patients (n = 83, 90.2% healthcare professionals instructed pacing). The most endorsed aim of pacing was "achievement of meaningful activities" (24.5% of ranked votes). The least endorsed aim was "to conserve energy" (0.1% of ranked votes). The most frequently supported facet of pacing was "breaking down tasks" (n = 91, 98.9%). The least supported facet was "stopping activities when symptoms increase" (n = 6, 6.5%). Thematic analysis showed recurring themes that pacing involved flexibility and sense of choice. CONCLUSIONS Pacing is a multidimensional coping strategy and complex behaviour. The message is clear that pacing should enable increases in meaningful activities, as opposed to attempting to avoid symptoms. The survey findings have informed the development of an activity pacing framework to guide healthcare professionals on the multiple components of pacing. This will help to standardize and optimize treatments for chronic pain/fatigue and enable future investigations.
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Affiliation(s)
- Deborah Antcliff
- Physiotherapy Department, Bury and Rochdale Care Organisation, Northern Care Alliance NHS Group, Bury, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | | | - Philip Keeley
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Steve Woby
- Research and Innovation Department, Northern Care Alliance NHS Group, Salford, UK.,School of Health and Society, University of Salford, Salford, UK.,Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
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Stevens ML, Lin CWC, van der Ploeg HP, De Sousa M, Castle J, Nicholas MK, Maher CG. Feasibility, Validity, and Responsiveness of Self-Report and Objective Measures of Physical Activity in Patients With Chronic Pain. PM R 2019; 11:858-867. [PMID: 30609195 DOI: 10.1002/pmrj.12058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 11/22/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Accurate tools for measuring physical activity are important for monitoring patients with chronic pain. However, these tools have not been properly validated in this population. OBJECTIVE To determine the suitability of two physical activity measures for use in chronic pain populations. DESIGN Longitudinal observational study. SETTING Pain Management and Research Centre. PARTICIPANTS Sixty-four patients presenting to the Pain Management and Research Centre with chronic pain. METHODS Participants underwent a 3-week pain management program that included cognitive behavioral strategies, education, and multiple exercises sessions per day. Physical activity was measured by the Active Australia Survey and the Actigraph GT3X at the start and end of the program. Feasibility of the physical activity measures was assessed. Criterion validity and responsiveness between the measures was compared. Correlation of physical activity with self-rated global rating of change (GROC) scales in health were calculated. MAIN OUTCOME MEASUREMENTS Minutes per day spent in low, moderate, and vigorous physical activity; global rating of change. RESULTS Fifty-two percent (n = 33) and 78% (n = 50) of participants had valid Actigraph and Active Australia data, respectively, for both time points. For criterion validity and responsiveness correlations varied (rho = -.12-.52). All correlations between physical activity measures and GROC were small or negligible (rho ≤ .18). CONCLUSION Feasibility of the Actigraph was poor compared to the Active Australia Survey. The criterion validity and responsiveness of the Active Australia Survey to the Actigraph was inconsistent and the relationship of both these measures to clinical outcomes was poor. However, limitations due to missing data mean that further research is required. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Matthew L Stevens
- Musculoskeletal Health Sydney, School of Public Health, University of Sydney, Sydney, Australia
| | - Chung-Wei C Lin
- Musculoskeletal Health Sydney, School of Public Health, University of Sydney, Sydney, Australia
| | - Hidde P van der Ploeg
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Maria De Sousa
- Pain Management Research Institute, University of Sydney at the Royal North Shore Hospital, Sydney, Australia
| | - Jessica Castle
- Pain Management Research Institute, University of Sydney at the Royal North Shore Hospital, Sydney, Australia
| | - Michael K Nicholas
- Pain Management Research Institute, University of Sydney at the Royal North Shore Hospital, Sydney, Australia
| | - Chris G Maher
- Musculoskeletal Health Sydney, School of Public Health, University of Sydney, Sydney, Australia
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Patterns of pain-related activity: replicability, treatment-related changes, and relationship to functioning. Pain 2019; 159:2522-2529. [PMID: 30074594 DOI: 10.1097/j.pain.0000000000001357] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Changes in activity patterns frequently accompany the experience of chronic pain. Two activity patterns, avoidance and overdoing, are hypothesized to contribute to the development of ongoing pain and pain-related disability, while activity pacing is frequently introduced to enhance pain management and functioning. Two studies were conducted to assess whether reliable subgroups with differing activity patterns could be identified in different pain populations and to evaluate changes in these subgroups after a group format, pain management program. In study 1, individuals with ongoing pain being assessed for treatment at 2 different tertiary care pain centres completed a measure of pain-related activity. Separate cluster analyses of these samples produced highly similar cluster solutions. For each sample, a 2-cluster solution was obtained with clusters corresponding to the activity patterns described by the avoidance-endurance model of pain. In study 2, a subset of individuals completing a 12-session, group format, pain management program completed measures of pain-related activity, pain intensity, and physical and psychological functioning at the beginning and end of the program. At the conclusion of the program, 4 clusters of pain-related activity were identified. Individuals who used high levels of activity pacing and low levels of avoidance consistently reported significantly better functioning relative to all other individuals. Observed changes in activity patterns from pre-treatment to post-treatment suggested that decreasing the association between activity pacing and avoidance was associated with better functioning. These results have implications for both the assessment of activity pacing and for its use as an intervention in the management of ongoing pain.
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Gatzounis R, Crombez G, S Schrooten MG, S Vlaeyen JW. A break from pain! Interruption management in the context of pain. Pain Manag 2018; 9:81-91. [PMID: 30516435 DOI: 10.2217/pmt-2018-0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Activity interruptions, namely temporary suspensions of an ongoing task with the intention to resume it later, are common in pain. First, pain is a threat signal that urges us to interrupt ongoing activities in order to manage the pain and its cause. Second, activity interruptions are used in chronic pain management. However, activity interruptions by pain may carry costs for activity performance. These costs have recently started to be systematically investigated. We review the evidence on the consequences of activity interruptions by pain for the performance of the interrupted activity. Further, inspired by literature on interruptions from other research fields, we suggest ways to improve interruption management in the field of pain, and provide a future research agenda.
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Affiliation(s)
- Rena Gatzounis
- Research Group Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, The Netherlands.,Research Group Health Psychology, Faculty of Psychology & Educational Sciences, University of Leuven, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical & Health Psychology, Faculty of Psychology & Educational Sciences, Ghent University, Belgium
| | - Martien G S Schrooten
- Research Group Health Psychology, Faculty of Psychology & Educational Sciences, University of Leuven, Belgium.,Centre for Health & Medical Psychology, School of Law, Psychology & Social Work, Örebro University, Sweden
| | - Johan W S Vlaeyen
- Research Group Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, The Netherlands.,Research Group Health Psychology, Faculty of Psychology & Educational Sciences, University of Leuven, Belgium
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Lagueux É, Dépelteau A, Masse J. Occupational Therapy's Unique Contribution to Chronic Pain Management: A Scoping Review. Pain Res Manag 2018; 2018:5378451. [PMID: 30538795 PMCID: PMC6260403 DOI: 10.1155/2018/5378451] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/17/2018] [Indexed: 12/24/2022]
Abstract
Occupational therapy (OT) makes a unique contribution to chronic pain (CP) management due to its overarching focus on occupation. The aim of this scoping review was to describe current knowledge about this contribution by documenting OT roles, models, assessments, and intervention methods used with adults living with CP. A systematic search exploring 10 databases and gray literature from 2006 to 2017 was conducted. Fifty-two sources were retained and analysed. Results bring forward the main role of OT being improving activities and participation (76.9 %), the Canadian Model of Occupational Performance (9.6 %), and the Canadian Occupational Performance Measure (21.2 %). Within the 30 reported interventions, 73.3% related directly to the person, 20% pertained to occupation (activities and participation), and 6.7% addressed environmental factors. The distinction and complementarity between the bottom-up and the top-down approaches to OT intervention were discussed. This review highlights OT specificity in adult CP management.
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Affiliation(s)
- Émilie Lagueux
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Andréa Dépelteau
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Julie Masse
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
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Andrews NE, Strong J, Meredith PJ, Branjerdporn GS. Approach to activity engagement and differences in activity participation in chronic pain: A five-day observational study. Aust Occup Ther J 2018; 65:575-585. [DOI: 10.1111/1440-1630.12516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole E. Andrews
- Division of Occupational Therapy; School of Health and Rehabilitation Sciences; The University of Queensland; St. Lucia Queensland Australia
- Department of Occupational Therapy; The Royal Brisbane and Women's Hospital; Herston Queensland Australia
- The Professor Tess Cramond Multidisciplinary Pain Centre; The Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Jenny Strong
- Division of Occupational Therapy; School of Health and Rehabilitation Sciences; The University of Queensland; St. Lucia Queensland Australia
- Department of Occupational Therapy; The Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Pamela J. Meredith
- Division of Occupational Therapy; School of Health and Rehabilitation Sciences; The University of Queensland; St. Lucia Queensland Australia
| | - Grace S. Branjerdporn
- Division of Occupational Therapy; School of Health and Rehabilitation Sciences; The University of Queensland; St. Lucia Queensland Australia
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Egan A, Lennon O, Power CK, Fullen BM. "I've Actually Changed How I Live"-Patients' Long-Term Perceptions of a Cognitive Behavioral Pain Management Program. PAIN MEDICINE 2018; 18:220-227. [PMID: 28204751 DOI: 10.1093/pm/pnw148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective To determine patients’ perceptions regarding cognitive behavioral pain management programs, and to determine what, if any, strategies learned on the program patients continue to use long-term to manage their pain. Design A qualitative, focus-group based study. Setting An outpatient multidisciplinary pain management program in a university teaching hospital. Patients Patients with chronic pain who had previously completed a 4-week cognitive behavioral pain management program (2001–2014). Methods Sixteen patients attended one of four focus groups. A battery of semi-structured questions explored their perceptions of the cognitive behavioral program, and which strategies they found useful and continued to use long-term to manage their pain. Results Six key themes emerged: 1) universal long-term positive feedback on the utility of the program; 2) the program facilitated long-term changes in daily life; 3) participants now considered themselves as the “new me”; 4) request for more updates on emerging new treatments/pain knowledge; 5) recognizing that the key to maximizing gain from the program was to be open, to listen, and accept; and 6) participants sharing pain management knowledge with others in pain. Conclusion There was universal positive feedback for the pain management program. Despite the years since they participated in one, patients continue to use key strategies to effectively manage their pain (pacing, relaxation), embedding them in their daily lives to maximize their quality of life.
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Affiliation(s)
- Aine Egan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Campus, Dublin
| | - Olive Lennon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Campus, Dublin
| | - Camillus K Power
- Department of Anesthesia and Pain Medicine, Tallaght Hospital, Dublin, Ireland
| | - Brona M Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Campus, Dublin.,Centre for Translational Pain Research, University College Dublin, Belfield Campus, Dublin
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What do clinicians consider when assessing chronic low back pain? A content analysis of multidisciplinary pain centre team assessments of functioning, disability, and health. Pain 2018; 159:2128-2136. [DOI: 10.1097/j.pain.0000000000001285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Devan H, Hale L, Hempel D, Saipe B, Perry MA. What Works and Does Not Work in a Self-Management Intervention for People With Chronic Pain? Qualitative Systematic Review and Meta-Synthesis. Phys Ther 2018; 98:381-397. [PMID: 29669089 DOI: 10.1093/ptj/pzy029] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 02/13/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Self-management interventions fostering self-efficacy improve the well-being of people with chronic pain. PURPOSE The purpose of this study was to synthesize the enablers (what works) and barriers (what does not) of incorporating self-management strategies for people in everyday life after completion of a pain self-management intervention. DATA SOURCES Major electronic databases (MEDLINE, AMED, PsycINFO, Cochrane Library, PubMed, CINAHL, Scopus, and Google Scholar) were searched from inception to July 2016. STUDY SELECTION Study selection included qualitative and mixed-method studies that explored the perceptions of individuals with chronic pain after completion of a self-management intervention. DATA EXTRACTION A thematic analysis approach was used to synthesize the review findings, and a Confidence in the Evidence from Reviews of Qualitative Research (CERQual) Approach was used to assess the level of confidence. DATA SYNTHESIS Thirty-three studies with 512 participants were included. Enablers to self-management included self-discovery-the ability to distinguish self (ie, body, thoughts, and feelings) from pain; feeling empowered by incorporating self-management strategies into practice; and supportive ambience via collaborative relationships with clinicians and support from family and friends. Barriers to self-management included difficulty with sustaining motivation for pain self-management; distress experienced from ongoing pain, anxiety, and depression; and unsupportive relationships with clinicians, family, and friends. LIMITATIONS This review only included interventions that involved at least 4 self-management skills; thus, informative studies may have been missed. The follow-up period varied from immediately after the intervention to 72 months following the intervention; therefore, it is uncertain which of the key enablers and barriers were most influential long term. Only articles published in the English language were included; studies conducted in low- and middle-income countries could not be located. CONCLUSIONS The sustained effort to self-manage chronic pain could be exhausting, and motivation could wane over time following intervention. Providing intermittent support in the form of booster sessions and peer support groups may be important. Person-centered care via shared decision making and guided problem solving is essential to facilitating ongoing self-management.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Leigh Hale
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago
| | - Dagmar Hempel
- Pain Management Service, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Barbara Saipe
- Pain Management Service, Capital and Coast District Health Board (CCDHB)
| | - Meredith A Perry
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago
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Baeza-Velasco C, Bulbena A, Polanco-Carrasco R, Jaussaud R. Cognitive, emotional, and behavioral considerations for chronic pain management in the Ehlers–Danlos syndrome hypermobility-type: a narrative review. Disabil Rehabil 2018; 41:1110-1118. [DOI: 10.1080/09638288.2017.1419294] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Carolina Baeza-Velasco
- Laboratory of Psychopathology and Health Processes, University Paris Descartes - Sorbonne Paris Cité, Boulogne Billancourt, France
- Inserm U1061, La Colombière Hospital, Montpellier, France
| | - Antonio Bulbena
- Department of Psychiatry, Autonoma University of Barcelona, Barcelona, Spain
| | | | - Roland Jaussaud
- Department of Internal Medicine and Clinical Immunology, Medicine School, University of Lorraine, CHRU Nancy, Nancy, France
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Finlay KA, Peacock S, Elander J. Developing successful social support: An interpretative phenomenological analysis of mechanisms and processes in a chronic pain support group. Psychol Health 2018; 33:846-871. [PMID: 29300123 DOI: 10.1080/08870446.2017.1421188] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The experience of long-term membership of a successful chronic pain support group (CPSG) was explored to identify; (i) factors associated with social support, and; (ii) ways that health care professionals (HCPs) could help CPSGs become more effective and supportive. DESIGN Interpretative Phenomenological Analysis enabled exploration of participants' experiences of membership and rationales for continued attendance. MAIN OUTCOME MEASURES Twelve participants (four males, eight females), recruited from a regional CPSG, completed semi-structured interviews lasting from 45 to 120 minutes. Following verbatim transcription, idiographic then cross-case analyses were undertaken. RESULTS Three superordinate themes emerged: (1) Investing in the new normal; (2) The nurturing environment; (3) Growth facilitation through social evolution. Increased investment and identification with membership, generated snowballing social engagement, enhancing pain management/well-being through collective humour and peer-to-peer support. Explicit guidance by HCPs in early stages of group formation/development, and subsequent implicit influences on group attitudes and actions, promoted the group's development into its current healthy, supportive state. CONCLUSION Contrary to stereotypes, membership offered positive respite from chronic pain through collective coping. Successful CPSGs forge an independent identity, fostering strong group investment and an ability to live well with chronic pain. HCPs can provide a stabilising foundation for CPSGs to develop positively and supportively.
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Affiliation(s)
- Katherine A Finlay
- a Department of Psychology, School of Science and Postgraduate Medicine , University of Buckingham , Buckingham , UK
| | - Sue Peacock
- b Department of Health Psychology , Milton Keynes Hospital NHS Foundation Trust , Milton Keynes , UK
| | - James Elander
- c Centre for Psychological Research , University of Derby , Derby , UK
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Scott-Dempster C, Toye F, Barker K. The experience of activity pacing in chronic pain management-An interpretive phenomenological analysis of out-patient physiotherapists and patients. Physiother Theory Pract 2017; 33:841-849. [PMID: 28786699 DOI: 10.1080/09593985.2017.1357149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Activity pacing (AP) is widely used to manage chronic pain. However, recent developments in pain management do not necessarily include AP. Research has explored the experience of AP for physiotherapists who specialize in chronic pain. The innovation of this study is to build on previous research by exploring the experiences of patients and physiotherapists who do not specialize in chronic pain. METHODS We interviewed eight patients with chronic musculoskeletal pain who had used AP and eight physiotherapists working in an out-patient department who had not specialized in chronic pain. Interviews were recorded, and transcribed verbatim and Interpretative Phenomenological Analysis (IPA) were used for analysis. RESULTS We present the following themes: 1) I have tried everything and have no other place to go; 2) AP provides a tangible, physical structure that can be used flexibly; 3) working to retune the brain to a different way of life; 4) retuning the brain can pay off in the end as "less is more"; 5) working hard to connect with patients; 6) connecting with patients can be exhausting; and 7) the patient needs to be on board. CONCLUSION AP can provide a useful vehicle for psychological change through experiential learning. It can support psychological flexibility and is not incompatible with other biopsychosocial approaches.
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Affiliation(s)
- Clare Scott-Dempster
- a Physiotherapy Department , Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust , Oxford , UK
| | - Francine Toye
- a Physiotherapy Department , Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust , Oxford , UK
| | - Karen Barker
- a Physiotherapy Department , Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust , Oxford , UK.,b Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford , UK
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Abstract
Activity pacing is frequently included among the strategies provided to individuals with chronic pain to manage pain and improve functioning. Individuals with chronic pain may, however, limit their use of activity pacing because they perceive significant obstacles to its use. This study describes the development of a measure to assess obstacles to activity pacing and examines the relationship of this measure to activity patterns and functioning. A sample of 637 individuals with chronic pain completed items describing potential obstacles to activity pacing as part of their pretreatment assessment. Item analyses were used to construct a 14-item measure of obstacles to activity pacing. A subset of these individuals completed the measure again after completion of a group treatment program. The resulting measure demonstrated excellent internal consistency and was minimally affected by social desirability. Correlations with measures of activity and psychosocial functioning provided initial construct validity for the measure. Sex differences were found with women initially identifying more obstacles to activity pacing. Fewer obstacles were identified by both men and women after treatment, and these changes were related to modest changes in activity patterns and functioning. The present results identify a number of obstacles that may limit the use of activity pacing by individuals with chronic pain. Treatment may result in a decrease in the number of obstacles identified, and this change is related to changes in the individual's activity pattern and psychosocial functioning.
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Andrews N, Deen M. Defining Activity Pacing: Is It Time to Jump Off the Merry-Go-Round? THE JOURNAL OF PAIN 2016; 17:1359-1362. [DOI: 10.1016/j.jpain.2016.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/15/2016] [Accepted: 05/18/2016] [Indexed: 10/20/2022]
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Jelvegård S, Timpka T, Bargoria V, Gauffin H, Jacobsson J. Perception of Health Problems Among Competitive Runners: A Qualitative Study of Cognitive Appraisals and Behavioral Responses. Orthop J Sports Med 2016; 4:2325967116673972. [PMID: 28210643 PMCID: PMC5298561 DOI: 10.1177/2325967116673972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Approximately 2 of every 3 competitive runners sustain at least 1 health problem each season. Most of these problems are nontraumatic injuries with gradual onset. The main known risk indicator for sustaining a new running-related injury episode is a history of a previous injury, suggesting that behavioral habits are part of the causal mechanisms. PURPOSE Identification of elements associated with purposeful interpretations of body perceptions and balanced behavioral responses may supply vital information for prevention of health problems in runners. This study set out to explore competitive runners' cognitive appraisals of perceived symptoms on injury and illness and how these appraisals are transformed into behavior. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS The study population consisted of Swedish middle- and long-distance runners from the national top 15 list. Qualitative research methods were used to categorize interview data and perform a thematic analysis. The categories resulting from the analysis were used to construct an explanatory model. RESULTS Saturation of the thematic classification required that data from 8 male and 6 female runners (age range, 20-36 years) were collected. Symptoms interpreted to be caused by illness or injury with a sudden onset were found to lead to immediate action and changes to training and competition programs (activity pacing). In contrast, perceptions interpreted to be due to injuries with gradual onset led to varied behavioral reactions. These behavioral responses were planned with regard to short-term consequences and were characterized by indifference and neglect of long-term implications, consistent with an overactivity behavioral pattern. The latter pattern was consistent with a psychological adaptation to stimuli that is presented progressively to the athlete. CONCLUSION Competitive runners appraise whether a health problem requires immediate withdrawal from training based on whether the problem is interpreted as an illness and/or has a sudden onset. The ensuing behaviors follow 2 distinct patterns that can be termed "activity pacing" and "overactivity."
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Affiliation(s)
- Sara Jelvegård
- Athletics Research Center, Linköping University, Linköping, Sweden
| | - Toomas Timpka
- Athletics Research Center, Linköping University, Linköping, Sweden
- Swedish Athletics Association, Stockholm, Sweden
| | - Victor Bargoria
- Athletics Research Center, Linköping University, Linköping, Sweden
- Department of Orthopaedics and Rehabilitation, Moi University, Eldoret, Kenya
| | - Håkan Gauffin
- Athletics Research Center, Linköping University, Linköping, Sweden
| | - Jenny Jacobsson
- Athletics Research Center, Linköping University, Linköping, Sweden
- Swedish Athletics Association, Stockholm, Sweden
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Andrews NE, Strong J, Meredith PJ, Fleming JA. The relationship between overactivity and opioid use in chronic pain: a 5-day observational study. Pain 2016; 157:466-474. [PMID: 26458090 DOI: 10.1097/j.pain.0000000000000384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
With increasing concerns about the potential harm of long-term opioid therapy, there is a need for the development and implementation of alternative treatment strategies for patients with chronic pain who have been using opioids for a prolonged period of time. Based on the findings from a recent qualitative investigation that suggested there may be a bidirectional association between opioid reliance and habitual overactivity behaviour (activity engagement that significantly exacerbates pain), this study was designed to quantitatively investigate the association between opioid use and habitual overactivity over a 5-day period in a group of chronic pain patients. Participants provided a list of their prescribed pain medication, completed a self-report measure of habitual overactivity, and then commenced 5 days of data collection. Data collection required participants to wear an activity monitor and to complete a diary that detailed their daily activities and the time at which they took medication. Individuals reporting higher levels of habitual overactivity were more likely to be prescribed opioids. In addition, higher levels of habitual overactivity were associated with more frequent pro re nata ("as needed") opioid use over the 5 days, and with a discrepancy between the prescribed and actual oral morphine-equivalent daily dose, where more medication was taken than was prescribed. There was no predominant context for pro re nata use. The results of this study support the idea that habitual overactivity behaviour may play a role in the development of reliance on opioid medication and that such an association may provide a potential treatment target for opioid therapy rationalisation.
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Affiliation(s)
- Nicole Emma Andrews
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia Department of Occupational Therapy, The Royal Brisbane and Women's Hospital, Queensland, Australia The Professor Tess Cramond Multidisciplinary Pain Centre, The Royal Brisbane and Women's Hospital, Queensland, Australia
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Abstract
Findings from a 5-day observation study link high levels of self-reported overactivity to repeated periods of prolonged activity engagement followed by significant pain increases. Overactivity is a frequently used term in chronic pain literature. It refers to the phenomenon whereby individuals engage in activity in a way that significantly exacerbates pain, resulting in periods of incapacity. Overactivity, as a construct, has been derived solely from patients' self-reports, raising concerns about the legitimacy of the construct. Self-reported overactivity reflects an individual's “belief,” collected retrospectively, that their earlier activity levels have resulted in increased levels of pain. This may be different to an individual actually engaging in activity in a way that significantly exacerbates pain. In this study, a 5-day observational study design was used to investigate the validity of overactivity as a construct by examining the relationship between a self-report measure of overactivity, patterns of pain, and objectively measured physical activity over time. A sample of 68 adults with chronic pain completed a questionnaire investigating self-reported habitual engagement in overactivity and activity avoidance behaviour, before commencing 5 days of data collection. Over the 5-day period, participants wore an activity monitor and recorded their pain intensity 6 times a day using a handheld computer. Associations were found between (1) high levels of pain and both high overactivity and high avoidance, (2) high levels of overactivity and more variation in pain and objective activity across days, and (3) high levels of overactivity and the reoccurrence of prolonged activity engagement followed by significant pain increases observed in data sets. These results offer some preliminary support for the validity of overactivity as a legitimate construct in chronic pain.
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Rice DB, Mehta S, Pope JE, Harth M, Shapiro A, Teasell RW. Dispositional Affect in Unique Subgroups of Patients with Rheumatoid Arthritis. Pain Res Manag 2016; 2016:1024985. [PMID: 27445594 PMCID: PMC4904597 DOI: 10.1155/2016/1024985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/29/2015] [Indexed: 02/08/2023]
Abstract
Background. Patients with rheumatoid arthritis may experience increased negative outcomes if they exhibit specific patterns of dispositional affect. Objective. To identify subgroups of patients with rheumatoid arthritis based on dispositional affect. The secondary objective was to compare mood, pain catastrophizing, fear of pain, disability, and quality of life between subgroups. Methods. Outpatients from a rheumatology clinic were categorized into subgroups by a cluster analysis based on dispositional affect. Differences in outcomes were compared between clusters through multivariate analysis of covariance. Results. 227 patients were divided into two subgroups. Cluster 1 (n = 85) included patients reporting significantly higher scores on all dispositional variables (experiential avoidance, anxiety sensitivity, worry, fear of pain, and perfectionism; all p < 0.001) compared to patients in Cluster 2 (n = 142). Patients in Cluster 1 also reported significantly greater mood impairment, pain anxiety sensitivity, and pain catastrophizing (all p < 0.001). Clusters did not differ on quality of life or disability. Conclusions. The present study identifies a subgroup of rheumatoid arthritis patients who score significantly higher on dispositional affect and report increased mood impairment, pain anxiety sensitivity, and pain catastrophizing. Considering dispositional affect within subgroups of patients with RA may help health professionals tailor interventions for the specific stressors that these patients experience.
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Affiliation(s)
- Danielle B. Rice
- Lawson Health Research Institute, London, ON, Canada N6C 0A7
- St. Joseph's Health Care, Parkwood Institute, London, ON, Canada N6C 0A7
| | - Swati Mehta
- Lawson Health Research Institute, London, ON, Canada N6C 0A7
- St. Joseph's Health Care, Parkwood Institute, London, ON, Canada N6C 0A7
- Western University, London, ON, Canada N6A 3K7
| | - Janet E. Pope
- St. Joseph's Health Care, Parkwood Institute, London, ON, Canada N6C 0A7
- Western University, London, ON, Canada N6A 3K7
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada N6A 3K7
| | - Manfred Harth
- St. Joseph's Health Care, Parkwood Institute, London, ON, Canada N6C 0A7
- Western University, London, ON, Canada N6A 3K7
| | - Allan Shapiro
- St. Joseph's Health Care, Parkwood Institute, London, ON, Canada N6C 0A7
| | - Robert W. Teasell
- Lawson Health Research Institute, London, ON, Canada N6C 0A7
- St. Joseph's Health Care, Parkwood Institute, London, ON, Canada N6C 0A7
- Western University, London, ON, Canada N6A 3K7
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada N6A 3K7
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Exploring cognitive factors in pain persistence behavior. Pain 2015; 156:1178-1179. [DOI: 10.1097/j.pain.0000000000000179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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