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Arrigoni A, Rossettini G, Palese A, Thacker M, Esteves JE. Exploring the role of therapeutic alliance and biobehavioural synchrony in musculoskeletal care: Insights from a qualitative study. Musculoskelet Sci Pract 2024; 73:103164. [PMID: 39151365 DOI: 10.1016/j.msksp.2024.103164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/06/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Person-centred care underscores the therapeutic alliance (TA) as fundamental, fostering positive treatment outcomes through collaborative patient-clinician interactions. Biobehavioural synchrony within the TA, essential for effective care, reflects an adaptive process where organisms align responses during interactions. Enactivism and active inference provide profound insights into human perception, reshaping musculoskeletal care understanding. Touch and verbal communication, integral to the TA, foster synchrony and alignment of personal beliefs. AIM This study aimed to identify the tools used by manual therapists in musculoskeletal care to establish a TA with patients. Furthermore, it endeavours to evaluate the alignment of these strategies with current literature and their correlation with biobehavioural synchrony, enactivism, and the role of touch in active inference. METHODS The methodology followed rigorous qualitative research principles, particularly Grounded Theory and interpretative-constructivist principles, conducting eleven semi-structured interviews with open-ended questions. RESULTS The core category identified in the study is elucidated as follows: "Interwoven Connection: The Fabric of Therapeutic Synchrony." The interviews unveiled three main categories, each comprising sub-categories: (1) Creating a meaningful dialogue; (2) Promoting active patient participation; (3) Synchronisation. CONCLUSION Fostering meaningful dialogue, patient involvement, and therapeutic synchrony is crucial for a robust therapeutic alliance in musculoskeletal care. This underscores the importance of establishing a deep connection between clinicians and patients, central to effective person-centred care. Clinicians must prioritise two-way communication, empathy, and patient collaboration in defining personalised goals. Emphasizing touch and seeking patient feedback are also pivotal. Further research is needed to explore these elements and their impact.
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Affiliation(s)
| | - Giacomo Rossettini
- School of Physiotherapy, University of Verona, Via Bengasi 4, 37134, Verona, Italy; Department of Physiotherapy, Faculty of Sport Sciences, Musculoskeletal Pain and Motor Control Research Group, Universidad Europea de Madrid, 28670, Villaviciosa de Odón, Spain.
| | - Alvisa Palese
- Department of Medicine, University of Udine, Udine, Italy.
| | - Mick Thacker
- Department of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Jorge E Esteves
- Malta ICOM Educational, Santa Venera, Malta; UCO School of Osteopathy, Health Sciences University, London, UK; Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy.
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Messer TA, Blank F, Grand-Guillaume-Perrenoud JA, Aubry EM. The Impact of Obesity on Childbirth Expectations. J Midwifery Womens Health 2024. [PMID: 39252417 DOI: 10.1111/jmwh.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/25/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION Positive childbirth expectations are crucial for fostering a positive labor experience and enhancing the health and well-being of both the woman and her newborn. However, the impact of obesity on childbirth expectations remains underexplored. We aim to assess childbirth expectations in women living with obesity to enhance perinatal care tailored to their specific needs. METHODS Using an adapted version of the Childbirth Expectation Questionnaire (CEQ) in a nationwide online survey, we assessed expectations on childbirth of pregnant women living in Switzerland. We performed one-way analysis of variance and independent t tests to analyze associations between childbirth expectations and women's characteristics such as body mass index (BMI). Binomial logistic regressions estimated the likelihood of positive birth expectations occurring based on individual and contextual factors. RESULTS In total, 961 pregnant women responded to the CEQ through social media. Increased BMI was associated with lower mean scores in overall birth expectations (P = .008), whereas women accompanied by midwives during pregnancy showed significantly increased mean scores (P < .001). Regression analysis revealed that women living with obesity were less likely to have positive expectations for their upcoming childbirth when compared with others (adjusted odds ratio [aOR], 0.63; 95% CI, 0.42-0.95; P = .027). Conversely, midwifery care and plans for nonclinical births were associated with increased positive childbirth expectations (aOR, 3.65; 95% CI, 2.11-6.32; P < .001 and aOR, 4.77; 95% CI, 3.37-6.74; P < .001, respectively). DISCUSSION Women living with obesity exhibited significantly lower childbirth expectations compared with other women, impacting birth outcomes and satisfaction. Midwife involvement correlated with more positive expectations, emphasizing their role in improving women's realistic expectations and fostering well-being. Enhanced accessibility to models of care with midwifery continuity may be a crucial factor in promoting positive expectations among women living with obesity.
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Affiliation(s)
- Tamara A Messer
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Fabienne Blank
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | | | - Evelyne M Aubry
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Levenig CG, Hasenbring MI, Günnewig L, Titze C, Elsenbruch S, Schulte TL. Treatment Expectations-You Get What You Expect-and Depression Plays a Role. THE JOURNAL OF PAIN 2024; 25:104582. [PMID: 38821312 DOI: 10.1016/j.jpain.2024.104582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
Positive treatment expectations demonstrably shape treatment outcomes regarding pain and disability in patients with chronic low back pain. However, knowledge about positive and negative treatment expectations as putative predictors of interindividual variability in treatment outcomes is sparse, and the role of other psychological variables of interest, especially of depression as a known predictor of long-term disability, is lacking. We present results of the first prospective study considering expectations in concert with depression in a sample of 200 patients with chronic low back pain undergoing an inpatient interdisciplinary multimodal pain therapy. We analyzed the characteristics of pain and disability, treatment expectation, and depression assessed at the beginning (T0), at the end of (T1), and at 3-month follow-up (T2) of interdisciplinary multimodal pain therapy. Treatment expectations did emerge as a significant predictor of changes in pain intensity and disability, respectively, showing that positive expectations were associated with better treatment outcomes. Mediation analyses revealed a partially mediating effect of treatment expectations on the relation between depression and pain outcomes. PERSPECTIVE: These results expand knowledge regarding the role of treatment expectations in individual treatment outcome trajectories in chronic pain patients, paving the way for much-needed efforts toward optimizing patient expectations and personalized approaches in clinical settings.
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Affiliation(s)
- Claudia G Levenig
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, North-Rhine Westfalia, Germany.
| | - Monika I Hasenbring
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, North-Rhine Westfalia, Germany; Faculty of Health Sciences, University of Southern Denmark (SDU), Odense, Denmark
| | - Lea Günnewig
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, North-Rhine Westfalia, Germany
| | - Christina Titze
- Clinic of Orthopedics and Trauma Surgery, St. Josef-Hospital, Bochum, North-Rhine Westfalia, Germany
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, North-Rhine Westfalia, Germany
| | - Tobias L Schulte
- Clinic of Orthopedics and Trauma Surgery, St. Josef-Hospital, Bochum, North-Rhine Westfalia, Germany
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Strigo IA, Craig ADB, Simmons AN. Expectation of pain and relief: A dynamical model of the neural basis for pain-trauma co-morbidity. Neurosci Biobehav Rev 2024; 163:105750. [PMID: 38849067 DOI: 10.1016/j.neubiorev.2024.105750] [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: 01/25/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/09/2024]
Abstract
Posttraumatic Stress Disorder (PTSD) is highly co-morbid with chronic pain conditions. When present, PTSD significantly worsens chronic pain outcomes. Likewise, pain contributes to a more severe PTSD as evidenced by greater disability, more frequent use of harmful opioid analgesics and increased pain severity. The biomechanism behind this comorbidity is incompletely understood, however recent work strongly supports the widely-accepted role of expectation, in the entanglement of chronic pain and trauma symptoms. This work has shown that those with trauma have a maladaptive brain response while expecting stress and pain, whereas those with chronic pain may have a notable impairment in brain response while expecting pain relief. This dynamical expectation model of the interaction between neural systems underlying expectation of pain onset (traumatic stress) and pain offset (chronic pain) is biologically viable and may provide a biomechanistic insight into pain-trauma comorbidity. These predictive mechanisms work through interoceptive pathways in the brain critically the insula cortex. Here we highlight how the neural expectation-related mechanisms augment the existing models of pain and trauma to better understand the dynamics of pain and trauma comorbidity. These ideas will point to targeted complementary clinical approaches, based on mechanistically separable neural biophenotypes for the entanglement of chronic pain and trauma symptoms.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA.
| | | | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA; Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Drive, MC 151-B, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
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5
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Strigo IA, Kadlec M, Mitchell JM, Simmons AN. Identification of group differences in predictive anticipatory biasing of pain during uncertainty: preparing for the worst but hoping for the best. Pain 2024; 165:1735-1747. [PMID: 38501988 PMCID: PMC11247452 DOI: 10.1097/j.pain.0000000000003207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 03/20/2024]
Abstract
ABSTRACT Pain anticipation during conditions of uncertainty can unveil intrinsic biases, and understanding these biases can guide pain treatment interventions. This study used machine learning and functional magnetic resonance imaging to predict anticipatory responses in a pain anticipation experiment. One hundred forty-seven participants that included healthy controls (n = 57) and individuals with current and/or past mental health diagnosis (n = 90) received cues indicating upcoming pain stimuli: 2 cues predicted high and low temperatures, while a third cue introduced uncertainty. Accurate differentiation of neural patterns associated with specific anticipatory conditions was observed, involving activation in the anterior short gyrus of the insula and the nucleus accumbens. Three distinct response profiles emerged: subjects with a negative bias towards high pain anticipation, those with a positive bias towards low pain anticipation, and individuals whose predictions during uncertainty were unbiased. These profiles remained stable over one year, were consistent across diagnosed psychopathologies, and correlated with cognitive coping styles and underlying insula anatomy. The findings suggest that individualized and stable pain anticipation occurs in uncertain conditions.
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Affiliation(s)
- Irina A. Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, San Francisco, CA, United States
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States
| | - Molly Kadlec
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Health Care Center, San Francisco, CA, United States
| | - Jennifer M. Mitchell
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Alan N. Simmons
- San Diego Veterans Affairs Health Care Center, San Diego, CA, United States
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
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Gevers-Montoro C, Romero-Santiago B, Medina-García I, Larranaga-Arzamendi B, Álvarez-Gálovich L, Ortega-De Mues A, Piché M. Reduction of Chronic Primary Low Back Pain by Spinal Manipulative Therapy is Accompanied by Decreases in Segmental Mechanical Hyperalgesia and Pain Catastrophizing: A Randomized Placebo-controlled Dual-blind Mixed Experimental Trial. THE JOURNAL OF PAIN 2024; 25:104500. [PMID: 38369221 DOI: 10.1016/j.jpain.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/04/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
Chronic primary low back pain (CPLBP) refers to low back pain that persists over 3 months, that cannot be explained by another chronic condition, and that is associated with emotional distress and disability. Previous studies have shown that spinal manipulative therapy (SMT) is effective in relieving CPLBP, but the underlying mechanisms remain elusive. This randomized placebo-controlled dual-blind mixed experimental trial (NCT05162924) aimed to investigate the efficacy of SMT to improve CPLBP and its underlying mechanisms. Ninety-eight individuals with CPLBP and 49 controls were recruited. Individuals with CPLBP received SMT (n = 49) or a control intervention (n = 49), 12 times over 4 weeks. The primary outcomes were CPLBP intensity (0-100 on a numerical rating scale) and disability (Oswestry Disability Index). Secondary outcomes included pressure pain thresholds in 4 body regions, pain catastrophizing, Central Sensitization Inventory, depressive symptoms, and anxiety scores. Individuals with CPLBP showed widespread mechanical hyperalgesia (P < .001) and higher scores for all questionnaires (P < .001). SMT reduced pain intensity compared with the control intervention (mean difference: -11.7 [95% confidence interval, -11.0 to -12.5], P = .01), but not disability (P = .5). Similar mild to moderate adverse events were reported in both groups. Mechanical hyperalgesia at the manipulated segment was reduced after SMT compared with the control intervention (P < .05). Pain catastrophizing was reduced after SMT compared with the control intervention (P < .05), but this effect was not significant after accounting for changes in clinical pain. Although the reduction of segmental mechanical hyperalgesia likely contributes to the clinical benefits of SMT, the role of pain catastrophizing remains to be clarified. PERSPECTIVE: This randomized controlled trial found that 12 sessions of SMT yield greater relief of CPLBP than a control intervention. These clinical effects were independent of expectations, and accompanied by an attenuation of hyperalgesia in the targeted segment and a modulation of pain catastrophizing.
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Affiliation(s)
- Carlos Gevers-Montoro
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois- Rivières, Quebec, Canada; CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada; Madrid College of Chiropractic, RCU María Cristina, San Lorenzo de El Escorial, Madrid, Spain
| | - Blanca Romero-Santiago
- Madrid College of Chiropractic, RCU María Cristina, San Lorenzo de El Escorial, Madrid, Spain
| | - Isabel Medina-García
- Madrid College of Chiropractic, RCU María Cristina, San Lorenzo de El Escorial, Madrid, Spain
| | | | - Luis Álvarez-Gálovich
- Instituto Avanzado de Columna, Fundación Jiménez Díaz Hospital, Madrid, Madrid, Spain; Fujitega Research Foundation, Madrid, Madrid, Spain
| | | | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois- Rivières, Quebec, Canada; CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
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7
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Tidmarsh LV, Harrison R, Finlay KA. Prehabilitation: The underutilised weapon for chronic pain management. Br J Pain 2024; 18:354-364. [PMID: 39092207 PMCID: PMC11289902 DOI: 10.1177/20494637241250239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Objective Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, psychological prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to 'prehabilitate' patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions. Methods Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed. Results Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention. Conclusions Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify who requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation.
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Affiliation(s)
- Lydia V. Tidmarsh
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Richard Harrison
- Centre for Integrative Neuroscience and Neurodynamics, University of Reading, Reading, UK
| | - Katherine A. Finlay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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8
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Bertram W, Howells N, White SP, Sanderson E, Wylde V, Lenguerrand E, Gooberman-Hill R, Bruce J. Prevalence and patterns of neuropathic pain in people with chronic post-surgical pain after total knee arthroplasty. Bone Joint J 2024; 106-B:582-588. [PMID: 38821515 DOI: 10.1302/0301-620x.106b6.bjj-2023-0889.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Aims The aim of this study was to describe the prevalence and patterns of neuropathic pain over one year in a cohort of patients with chronic post-surgical pain at three months following total knee arthroplasty (TKA). Methods Between 2016 and 2019, 363 patients with troublesome pain, defined as a score of ≤ 14 on the Oxford Knee Score pain subscale, three months after TKA from eight UK NHS hospitals, were recruited into the Support and Treatment After Replacement (STAR) clinical trial. Self-reported neuropathic pain and postoperative pain was assessed at three, nine, and 15 months after surgery using the painDETECT and Douleur Neuropathique 4 (DN4) questionnaires collected by postal survey. Results Symptoms of neuropathic pain were common among patients reporting chronic pain at three months post-TKA, with half reporting neuropathic pain on painDETECT (191/363; 53%) and 74% (267/359) on DN4. Of those with neuropathic pain at three months, half continued to have symptoms over the next 12 months (148/262; 56%), one-quarter had improved (67/262; 26%), and for one-tenth their neuropathic symptoms fluctuated over time (24/262; 9%). However, a subgroup of participants reported new, late onset neuropathic symptoms (23/262; 9%). Prevalence of neuropathic symptoms was similar between the screening tools when the lower cut-off painDETECT score (≥ 13) was applied. Overall, mean neuropathic pain scores improved between three and 15 months after TKA. Conclusion Neuropathic pain is common in patients with chronic pain at three months after TKA. Although neuropathic symptoms improved over time, up to half continued to report painful neuropathic symptoms at 15 months after TKA. Postoperative care should include screening, assessment, and treatment of neuropathic pain in patients with early chronic postoperative pain after TKA.
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Affiliation(s)
- Wendy Bertram
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | | | - Simon P White
- Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Vikki Wylde
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Erik Lenguerrand
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
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9
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Hooten WM, Backonja M, Williams KA, Sturgeon JA, Gross JB, Borodianski S, Wang V, Tuan WJ, Zgierska AE, Moeller-Bertram T, Kriegel ML. Integrated pain care models and the importance of aligning stakeholder values. Pain Rep 2024; 9:e1160. [PMID: 38646660 PMCID: PMC11029933 DOI: 10.1097/pr9.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 04/23/2024] Open
Abstract
Sustained widespread deployment of clinically and cost-effective models of integrated pain care could be bolstered by optimally aligning shared stakeholder values.
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Affiliation(s)
- W. Michael Hooten
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Miroslav Backonja
- Division of Intramural Research, National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Kayode A. Williams
- Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, USA
- Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - John A. Sturgeon
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jacob B. Gross
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Wen-Jan Tuan
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Aleksandra E. Zgierska
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, PA, USA
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Krahé C, Koukoutsakis A, Fotopoulou A. Updating beliefs about pain following advice: Trustworthiness of social advice predicts pain expectations and experience. Cognition 2024; 246:105756. [PMID: 38442585 PMCID: PMC7616089 DOI: 10.1016/j.cognition.2024.105756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/09/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024]
Abstract
Prior expectations influence pain experience. These expectations, in turn, rely on prior pain experience, but they may also be socially influenced. Yet, most research has focused on self rather than social expectations about pain, and hardly any studies examined their combined effects on pain. Here, we adopted a Bayesian learning perspective to investigate how explicitly communicated social expectations ('advice about pain tolerance') affect own pain expectations, and ultimately pain tolerance, under varying conditions of social epistemic uncertainty (trustworthiness of the advice). N = 72 female participants took part in a coldpressor (cold water) task before (self-learning baseline) and after (socially-influenced learning) receiving advice about their likely pain tolerance from a confederate, the trustworthiness of whom was experimentally manipulated. We used path analysis to test the hypothesis that social advice from a highly trustworthy confederate would influence participants' expectations about pain more than advice from a less trustworthy source, and that the degree of this social influence would in turn predict pain tolerance. We further used a simplified, Bayesian learning, computational approach for explicit belief updating to examine the role of latent parameters of precision optimisation in how participants subsequently changed their future pain expectations (prospective posterior beliefs) based on the combined effect of the confederate's advice on their own pain expectations, and their own task experience. Results confirmed that participants adjusted their pain expectations towards the confederate's advice more in the high- vs. low-trustworthiness condition, and this advice taking predicted their pain tolerance. Furthermore, the confederate's trustworthiness influenced how participants weighted the confederate's advice in relation to their own expectations and task experience in forming prospective posterior beliefs. When participants received advice from a less trustworthy confederate, their own sensory experience was weighted more highly than their socially-influenced prior expectations. Thus, explicit social advice appears to impact pain by influencing one's own pain expectations, but low social trustworthiness leads to these expectations becoming more malleable to novel, sensory learning.
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Affiliation(s)
- Charlotte Krahé
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
| | - Athanasios Koukoutsakis
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Aikaterini Fotopoulou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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11
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Ruiz Romero MV, Lobato Parra E, Porrúa Del Saz A, Martínez Monrobé MB, Pereira Delgado CM, Gómez Hernández MB. [Management of chronic non-oncologic pain by multicomponent programs using non-pharmacologic therapies: A systematic review of the literature]. J Healthc Qual Res 2024; 39:168-187. [PMID: 38556371 DOI: 10.1016/j.jhqr.2024.02.004] [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: 12/20/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/02/2024]
Abstract
Chronic pain is a public health problem suffered by 20% of the world's population. Pharmacological approaches are insufficient, so a multi-therapeutic approach that also includes non-pharmacological therapies (psychological therapies, meditation, physical exercise, healthy habits, etc.) is proposed. The aim of this review was to review the existing scientific evidence on the effect of multicomponent programs with non-pharmacological therapies in people with chronic non-oncologic pain. To this end, a search for scientific articles was carried out in three databases (PubMed, Web of Science and PsycINFO) and 17 articles were selected, following the PRISMA recommendations. The patients who participated in these programs were mostly women, aged 18 to 80years, working or on sick leave due to pain, with secondary education or less and married. The most frequent pain was musculoskeletal, mainly low back pain. All the articles studied the effectiveness of two or more therapies, highlighting psychological therapies, physical exercise and education. Positive results were obtained in the reduction of different variables such as pain, pain catastrophizing, anxiety and depression, in addition to improving functionality and quality of life. It has also been shown that patients' prior expectations regarding the intervention influence its effectiveness. Although throughout the review there was great heterogeneity in the interventions, in the evaluation methods and in the results themselves, it can be concluded that multicomponent programs show positive results in the management of chronic pain, and should therefore be incorporated as a routine therapeutic treatment.
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Affiliation(s)
- M V Ruiz Romero
- Unidad de Calidad e Investigación, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España; Universidad Internacional de Valencia, Valencia, España
| | - E Lobato Parra
- Unidad de Calidad e Investigación, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España.
| | - A Porrúa Del Saz
- Servicio de Rehabilitación, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - M B Martínez Monrobé
- Unidad de Psicología, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - C M Pereira Delgado
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - M B Gómez Hernández
- Servicio de Rehabilitación, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
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Hue TF, Lotz JC, Zheng P, Black DM, Bailey J, Ewing SK, Fields AJ, Mehling W, Scheffler A, Strigo I, Petterson T, Wu LA, O'Neill C. Design of the COMEBACK and BACKHOME Studies, Longitudinal Cohorts for Comprehensive Deep Phenotyping of Adults with Chronic Low-Back Pain (cLBP): a part of the BACPAC Research Program. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.09.24305574. [PMID: 38645207 PMCID: PMC11030474 DOI: 10.1101/2024.04.09.24305574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Objective The University of California, San Francisco (UCSF) Core Center for Patient-centric, Mechanistic Phenotyping in Chronic Low Back Pain (REACH) is one of the three NIH Back Pain Consortium (BACPAC) Research Programs Mechanistic Research Centers (MRCs). The goal of UCSF REACH is to define cLBP phenotypes and pain mechanisms that can lead to effective, personalized treatments for patients across the population. The primary objective of this research project is to address the critical need for new diagnostic and prognostic markers, and associated patient classification protocols for chronic low back pain (cLBP) treatment. Design To meet this objective, REACH is conducting two large investigator-initiated translational research cohort studies called: The Longitudinal Clinical Cohort for Comprehensive Deep Phenotyping of Chronic Low-Back Pain (cLBP) Adults Study (comeBACK) and the Chronic Low-Back Pain (cLBP) in Adults Study (BACKHOME). Setting comeBACK is a longitudinal multicenter in-person observational study of 450 adults with chronic low back pain designed to perform comprehensive deep phenotyping. While, the BACKHOME study is a site-less longitudinal observational e-cohort of approximately 3000 U.S. adults with cLBP. To our knowledge, BACKHOME is the largest prospective remote registry of nationwide adults with cLBP. Methods Both the comeBACK and BACKHOME studies are collecting a robust and comprehensive set of risk factors, outcomes, and covariates in order to perform deep phenotyping of cLBP patients based on combined biopsychosocial variables to: define cLBP subtypes, establish phenotyping tools for routine clinical evaluation, and lead to improved cLBP outcomes in the future. The data from both studies will be used to establish techniques to develop a patient-centric definition of treatment success and to analyze cLBP patient traits to define clinically useful cLBP phenotypes, using a combination of traditional data analyses and deep learning methods. Conclusions These 2 pivotal studies, in conjunction with the ancillary studies being performed in both comeBACK and BACKHOME, and the other BACPAC-consortium research projects, we will be able to address a number of diagnostic and therapeutic issues in this complex and diverse patient population with cLBP. These studies will help clarify biopsychosocial mechanisms of cLBP with the aim to provide a foundation to improve the evaluation of treatment effectiveness and to spur new avenues of therapeutic research, including personalized outcome measures that constitute a clinically meaningful treatment effect for individual cLBP patients.
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Bosma R, Rosenbloom BN, Burke E, Aquino C, Stanley C, Coombs K, Nella A, James S, Clarke H, Flamer D, Bhatia A, Flannery J, Smith A, Di Renna T. An examination of referrals declined for chronic pain care: There is increasing mental health complexity within care-seeking patients with chronic pain over time. Can J Pain 2024; 8:2337074. [PMID: 38938328 PMCID: PMC11210908 DOI: 10.1080/24740527.2024.2337074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/27/2024] [Indexed: 06/29/2024]
Abstract
Background Chronic pain is a complex disease that requires interprofessional care for effective management. Despite the need for multidisciplinary care, disease and health care inequities can prevent individuals from attaining adequate treatment. Factors such as mental health, cost, and distance to a health care center can contribute to health care accessibility inequality. The aim of this study is to examine declined referrals at the Toronto Academic Pain Medicine Institute (TAPMI) to determine the reason for declining care and number of declined referrals. Methods A retrospective chart review of all declined referrals at TAPMI in 2018 and 2022 was conducted. Referral documentation and the intake decision were extracted from the electronic medical charts by the research team and verified by the clinical intake team. Chi-square tests were conducted to determine whether the proportion of declined referrals changed between the years reviewed. Results The number of declined referrals due to mental health complexities increased significantly from 51 (11%) in 2018 to 180 (18%) in 2022 (χ2 = 10.9, P = 0.0009). A significant rise in the number of declines due to mental health service requests was also observed (χ2 = 24.53, P < 0.00001). Other common reasons for declined referrals in 2018 and 2022 included duplicate service, no primary care provider, and health care service changes. Conclusion Mental health complexities continue to be a significant barrier to health care service acquisition for individuals living with chronic pain. The increase in patient complexity from 2018 to 2022 highlights the need for integrated health care resources.
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Affiliation(s)
- Rachael Bosma
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Brittany N. Rosenbloom
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Emeralda Burke
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Christian Aquino
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Cara Stanley
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Kimberly Coombs
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Adriano Nella
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Shamalla James
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, Transitional Pain Service, Toronto, Ontario, Canada
| | - David Flamer
- Pain Management Centre, Sinai Health, Toronto, Ontario, Canada
| | - Anuj Bhatia
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Comprehensive Integrated Pain Program – Interventional Pain Service, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - John Flannery
- Comprehensive Integrated Pain Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Andrew Smith
- IPARC, Center for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Tania Di Renna
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
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Uthaikhup S, Sremakaew M, Treleaven J, Jull G, Barbero M, Falla D, Cescon C. Changes in Multiple Aspects of Pain Outcomes After Rehabilitation: Analysis of Pain Data in a Randomized Controlled Trial Evaluating the Effects of Adding Sensorimotor Training to Manual Therapy and Exercise for Chronic Neck Pain. Clin J Pain 2024; 40:212-220. [PMID: 38297452 DOI: 10.1097/ajp.0000000000001194] [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: 08/17/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES To examine changes in pain outcomes to fully evaluate the effect of adding sensorimotor training to manual therapy and exercise in patients with chronic neck pain and sensorimotor deficits. Concordance was examined between pain distribution and pain intensity and patient-reported outcomes. METHODS Participants (n=152) were randomly allocated into 4 intervention groups: One group received local neck treatment (NT) comprising manual therapy and exercise and the other 3 groups received additional sensorimotor training (either joint position sense/oculomotor exercises, balance exercises or both). Treatment was delivered twice a week for 6 weeks. Pain and patient-reported outcomes were measured at baseline, posttreatment, and 3-, 6- and 12-month follow-ups. RESULTS There were greater changes in pain location, extent, and intensity at 6- and 12-month follow-ups in the sensorimotor training groups compared with the NT group ( P <0.05). A greater number of patients in the sensorimotor training groups gained ≥50% reduction in pain extent and intensity relative to the NT group at 6 and 12 months ( P <0.05). Clinical improvement in pain extent was concordant with pain intensity (adjusted kappa=056 to 0.66, %agreement=78.3 to 82.9, P <0.001) and disability (adjusted kappa=0.47 to 0.58, % agreement=73.7 to 79.0, P <0.01) at 3-, 6- and 12-month follow-ups, but not with function and well-being. The concordance tended to decline with time. DISCUSSION Multiple aspects of the pain experience improved in the longer term by adding sensorimotor training to NT for patients with neck pain and sensorimotor deficits. The concordance between pain and patient-reported outcomes was not always evident and varied over time, suggesting the need for multidimensional assessments of pain.
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Affiliation(s)
- Sureeporn Uthaikhup
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Munlika Sremakaew
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Julia Treleaven
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Australia
| | - Gwendolen Jull
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Australia
| | - Marco Barbero
- Department of Business Economics Health and Social Care, Rehabilitation Research Laboratory 2rLab, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Corrado Cescon
- Department of Business Economics Health and Social Care, Rehabilitation Research Laboratory 2rLab, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
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Scheidegger A, Gómez Penedo JM, Blättler LT, Aybek S, Bischoff N, Grosse Holtforth M. How Treatment Motivation Predicts Favorable Outcomes in Interdisciplinary Multimodal Pain Treatment Among Patients with Chronic Primary Pain. J Clin Psychol Med Settings 2024; 31:48-57. [PMID: 37081250 PMCID: PMC10924698 DOI: 10.1007/s10880-023-09958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
As motivation for psychological treatment at intake has been shown to predict favorable outcomes after an inpatient stay, this study aimed to further characterize the different components of psychological treatment motivation that predict favorable treatment outcomes. 294 inpatients with chronic primary pain participating in an interdisciplinary multimodal pain treatment in a tertiary psychosomatic university clinic completed a battery of psychological questionnaires at intake and discharge. Treatment motivation was assessed at intake using the scales of the FPTM-23 questionnaire, while pain intensity, pain interference, anxiety, and depression were assessed both at intake and discharge. After treatment, pain intensity, pain interference, anxiety, and depression were significantly reduced. While higher levels on the FPTM-23 scale of suffering predicted smaller decreases in anxiety after treatment, higher scores on the scale of hope, i.e., lower levels of hopelessness, predicted lower levels of pain interference, anxiety, and depression after treatment. None of the scales of treatment motivation predicted pain intensity levels after treatment. Above and beyond providing symptom relief, reducing hopelessness and fostering hope regarding the treatment process and outcome might help clinicians treat patients with chronic primary pain more effectively.
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Affiliation(s)
- Alina Scheidegger
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Psychology, University of Bern, Bern, Switzerland.
| | | | - Larissa Tatjana Blättler
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Selma Aybek
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nina Bischoff
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Grosse Holtforth
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
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16
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Andias R, Rodrigues M, Silva AG. Predictors of improvement in community adolescents with chronic neck pain: A secondary analysis using different improvement criteria. PM R 2024. [PMID: 38415907 DOI: 10.1002/pmrj.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/13/2023] [Accepted: 11/16/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Interventions based on pain neuroscience education and exercise have emerged as effective in the management of chronic neck pain in adolescents. No studies have explored factors that might be associated with recovery in adolescents with neck pain. OBJECTIVE To explore predictors of improvement after an intervention based on exercise and pain neuroscience education. DESIGN Secondary analysis of a randomized trial. SETTING Community. PARTICIPANTS 127 community adolescents with neck pain. INTERVENTIONS Blended-learning intervention based on exercise and pain neuroscience education. MAIN OUTCOME MEASURES A set of variables including sociodemographic data, pain characteristics, physical activity, disability, sleep, catastrophizing, fear of movement, self-efficacy, symptoms of central sensitization, knowledge of pain neuroscience, pressure pain thresholds, and neck muscles endurance were used to predict a clinical response at 1 week after intervention and at 6-month follow-up. RESULTS Different predictors of improvement and non-improvement to intervention were found, but common predictors were not found for all the improvement criteria explored and time points. CONCLUSIONS These findings suggest that using different criteria to characterize adolescents with neck pain as improved and non-improved after pain neuroscience education and exercise have an effect on the variables associated with a response to the intervention.
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Affiliation(s)
- Rosa Andias
- School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Mário Rodrigues
- Higher School of Technology and Management of Águeda, Institute of Electronics and Telematics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal
| | - Anabela G Silva
- CINTESIS.RISE@UA, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
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Dickson C, de Zoete RMJ, Berryman C, Weinstein P, Chen KK, Rothmore P. Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:104-115. [PMID: 37769242 PMCID: PMC10833081 DOI: 10.1093/pm/pnad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To identify and synthesize patient-related barriers to and enablers of the implementation of high-value physiotherapy (HVP) for chronic pain. Furthermore, to review what patient-related interventions have been used to facilitate the implementation of HVP for chronic pain, as well as their efficacy. METHODS We systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain. We used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized. RESULTS Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient's understanding of exercise benefits. Other barriers included fear of movement, fragmented care, and cost. Ten studies explored interventions, 9 of which aimed to improve exercise adherence. Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls. CONCLUSION Patients with chronic pain experience barriers to HVP, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. Our findings suggest that interventions seeking to enhance implementation of HVP need to consider the multifactorial barriers experienced by patients with chronic pain. STUDY REGISTRATION Open Science Framework (https://doi.org/10.17605/OSF.IO/AYGZV).
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Affiliation(s)
- Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Carolyn Berryman
- Allied Health and Human Performance Unit, IIMPACT in Health, The University of South Australia, Adelaide, 5001, Australia
- Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute, Adelaide, 5000, Australia
- Brain Stimulation, Imaging and Cognition Group, The University of Adelaide, Adelaide, 5000, Australia
| | - Philip Weinstein
- School of Public Health, The University of Adelaide, Adelaide, 5000, Australia
- South Australian Museum, Adelaide, 5000, Australia
| | - Kexun Kenneth Chen
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Paul Rothmore
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
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Kane NS, Hassabelnaby R, Sullivan NL, Graff F, Litke DR, Quigley KS, Pigeon WR, Rath JF, Helmer DA, McAndrew LM. Veteran Beliefs About the Causes of Gulf War Illness and Expectations for Improvement. Int J Behav Med 2024; 31:169-174. [PMID: 36973578 DOI: 10.1007/s12529-023-10166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Individuals' beliefs about the etiology of persistent physical symptoms (PPS) are linked to differences in coping style. However, it is unclear which attributions are related to greater expectations for improvement. METHOD AND RESULTS A cross-sectional regression analysis (N = 262) indicated that Veterans with Gulf War Illness (GWI) who attributed their GWI to behavior, (e.g., diet and exercise), had greater expectations for improvement (p = .001) than those who attributed their GWI to deployment, physical, or psychological causes (p values > .05). CONCLUSIONS Findings support the possible clinical utility of exploring perceived contributing factors of PPS, which may increase perceptions that improvement of PPS is possible. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02161133.
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Affiliation(s)
- Naomi S Kane
- Department of Veterans Affairs, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA.
- VA Ann Arbor Healthcare System, Ann Arbor, USA.
- Department of Psychiatry, Michigan Medicine, 2215 Fuller Road (116C), Ann Arbor, MI, 48105-2103, USA.
| | - Raghad Hassabelnaby
- Department of Veterans Affairs, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
- William Paterson University, Wayne, NJ, USA
| | - Nicole L Sullivan
- Department of Veterans Affairs, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
| | - Fiona Graff
- Department of Veterans Affairs, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
| | - David R Litke
- Department of Veterans Affairs, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Karen S Quigley
- Department of Veteran Affairs, Bedford Memorial Hospital, Bedford, MA, USA
- Northeastern University, Boston, MA, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA
- Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - Joseph F Rath
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Lisa M McAndrew
- Department of Veterans Affairs, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
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Basedow LA, Zerth SF, Salzmann S, Uecker C, Bauer N, Elsenbruch S, Rief W, Langhorst J. Pre-treatment expectations and their influence on subjective symptom change in Crohn's disease. J Psychosom Res 2024; 176:111567. [PMID: 38100897 DOI: 10.1016/j.jpsychores.2023.111567] [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: 09/17/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Treatment expectations reportedly shape treatment outcomes, but have not been studied in the context of multimodal therapy in Crohn's disease (CD). Therefore, the current study investigated the role of treatment expectations for subjective symptom changes in CD patients who have undergone an integrative multimodal therapy program. METHODS Validated questionnaires were completed at the start of the treatment program and post intervention. Pre-treatment expectations and experienced symptom change were assessed with the Generic Rating Scale for Previous Treatment Experiences, Treatment Expectations, and Treatment Effects (GEEE); stress levels were quantified with the Perceived Stress Scale (PSS-10) and disease specific quality of life was quantified with the disease-specific Inflammatory Bowel Disease Questionnaire (IBDQ). We performed multiple linear and Bayesian regression to determine how expectations related to symptom change. RESULTS N = 71 CD patients (66.2% female) were included. Stronger expectations regarding symptom improvement (b = 0.422, t = 3.70, p < .001) were associated with higher experienced symptom improvement. Additionally, Bayesian analysis provided strong evidence for including improvement expectations as a predictor of improvement experience (BFinclusion = 13.78). CONCLUSIONS In line with research in other disorders, we found that positive treatment expectations were associated with experienced symptom improvement. In contrast, we found no indication that an experience of symptom worsening was associated with positive or negative baseline treatment expectations. Induction of positive expectations might be a potential avenue for improving treatment outcomes in CD therapy.
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Affiliation(s)
- Lukas Andreas Basedow
- Philipps-Universität Marburg, Department of Clinical Psychology and Psychotherapy, 35037 Marburg, Germany.
| | - Simon Felix Zerth
- Philipps-Universität Marburg, Department of Clinical Psychology and Psychotherapy, 35037 Marburg, Germany.
| | - Stefan Salzmann
- Philipps-Universität Marburg, Department of Clinical Psychology and Psychotherapy, 35037 Marburg, Germany; Health and Medical University, Medical Psychology, 99084 Erfurt, Germany.
| | - Christine Uecker
- Sozialstiftung Bamberg, Department of Internal and Integrative Medicine, 96049 Bamberg, Germany; University of Duisburg Essen, Medicinal Faculty, Department of Integrative Medicine, 96049 Bamberg, Germany.
| | - Nina Bauer
- Sozialstiftung Bamberg, Department of Internal and Integrative Medicine, 96049 Bamberg, Germany; University of Duisburg Essen, Medicinal Faculty, Department of Integrative Medicine, 96049 Bamberg, Germany
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, 44789 Bochum, Germany; Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany.
| | - Winfried Rief
- Philipps-Universität Marburg, Department of Clinical Psychology and Psychotherapy, 35037 Marburg, Germany.
| | - Jost Langhorst
- Sozialstiftung Bamberg, Department of Internal and Integrative Medicine, 96049 Bamberg, Germany; University of Duisburg Essen, Medicinal Faculty, Department of Integrative Medicine, 96049 Bamberg, Germany.
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Myers H, Keefe FJ, George SZ, Kennedy J, Lake AD, Martinez C, Cook CE. Effect of a Patient Engagement, Education, and Restructuring of Cognitions (PEERC) approach on conservative care in rotator cuff related shoulder pain treatment: a randomized control trial. BMC Musculoskelet Disord 2023; 24:930. [PMID: 38041042 PMCID: PMC10691016 DOI: 10.1186/s12891-023-07044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Despite similar outcomes for surgery and physical therapy (PT), the number of surgeries to treat rotator cuff related shoulder pain (RCRSP) is increasing. Interventions designed to enhance treatment expectations for PT have been shown to improve patient expectations, but no studies have explored whether such interventions influence patient reports of having had surgery, or being scheduled for surgery. The purpose of this randomized clinical trial was to examine the effect of a cognitive behavioral intervention aimed at changing expectations for PT on patient-report of having had or being scheduled for surgery and on the outcomes of PT. METHODS The Patient Engagement, Education, and Restructuring of Cognitions (PEERC) intervention, was designed to change expectations regarding PT. PEERC was evaluated in a randomized, pragmatic "add-on" trial in by randomizing patients with RCRSP to receive either PT intervention alone (PT) or PT + PEERC. Fifty-four (54) individuals, recruited from an outpatient hospital-based orthopedic clinic, were enrolled in the trial (25 randomized to PT, 29 randomized to PT + PEERC). Outcomes assessed at enrollment, 6 weeks, discharge, and six months after discharge included the patient report of having had surgery, or being scheduled for surgery (primary) and satisfaction with PT outcome, pain, and function (secondary outcomes). RESULTS The average age of the 54 participants was 51.81; SD = 12.54, and 63% were female. Chronicity of shoulder pain averaged 174.61 days; SD = 179.58. Study results showed that at the time of six months follow up, three (12%) of the participants in the PT alone group and one (3.4%) in the PT + PEERC group reported have had surgery or being scheduled for surgery (p = .32). There were no significant differences between groups on measures of satisfaction with the outcome of PT (p = .08), pain (p = .58) or function (p = .82). CONCLUSIONS In patients with RCRSP, PT plus the cognitive behavioral intervention aimed at changing expectations for PT provided no additional benefit compared to PT alone with regard to patient report of having had surgery, or being scheduled to have surgery, patient reported treatment satisfaction with the outcome of PT, or improvements in pain, or function. TRIAL REGISTRATION The trial is registered on ClinicalTrials.gov: NCT03353272 (27/11/2017).
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Affiliation(s)
- Heather Myers
- Urbaniak Sports Science Institute, Department of Rehabilitation Services, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA.
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences; Psychology and Neuroscience, Medicine, and Anesthesiology, Duke University School of Medicine, 2200 W Main St, Suite 340, Durham, NC, 27705, USA
| | - Steven Z George
- Department of Orthopaedic Surgery, Duke University School of Medicine, 200 Morris Street, Durham, NC, 27701, USA
| | - June Kennedy
- Urbaniak Sports Science Institute, Department of Rehabilitation Services, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Ashley Davis Lake
- Urbaniak Sports Science Institute, Department of Rehabilitation Services, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Corina Martinez
- Urbaniak Sports Science Institute, Department of Rehabilitation Services, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Chad E Cook
- Department of Orthopaedics, Duke University School of Medicine, 311 Trent Drive, Durham, NC, 27705, USA
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Leech JB, MacPherson KL, Klopper M, Shumway J, Salvatori RT, Rhon DI, Young JL. The relationships between pain-associated psychological distress, pain intensity, patient expectations, and physical function in individuals with musculoskeletal pain: A retrospective cohort study. PM R 2023; 15:1371-1381. [PMID: 37041723 DOI: 10.1002/pmrj.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/06/2023] [Accepted: 03/15/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION The presence of pain-associated psychological distress (PAPD) in musculoskeletal disorders, including negative mood, fear-avoidance, and lack of positive affect/coping, is associated with prolonged disability. The importance of considering psychological influence on pain is well known, but practical ways of addressing it are not as straightforward. Identifying relationships between PAPD and pain intensity, patient expectations, and physical function may guide the development of future studies that assess causality and inform clinical practice. OBJECTIVE To assess the relationship between PAPD measured by the Optimal Screening for Prediction of Referral and Outcome-Yellow Flag tool, and baseline pain intensity, expectations of treatment effectiveness, and self-reported physical function at discharge. DESIGN Retrospective cohort study. SETTING Hospital-based outpatient physical therapy. PARTICIPANTS Patients 18 to 90 years old with spinal pain or lower extremity osteoarthritis. MAIN OUTCOME MEASURES Pain intensity and patient expectations of treatment effectiveness at intake, and self-reported physical function at discharge. RESULTS A total of 534 patients, 56.2% female, median (interquartile range [IQR]) age 61 (21) years with an episode of care between November 2019 and January 2021 were included. A multiple linear regression showed a significant association between PAPD and pain intensity with 6.4% (p < .001) of the variance explained. PAPD explained 3.3% (p < .001) of the variance in patient expectations. One additional yellow flag present resulted in a 0.17-point increase in pain intensity and 1.3% decrease in patient expectations. PAPD was also associated with physical function with 3.2% (p < .001) of the variance explained. PAPD explained 9.1% (p < .001) of the variance in physical function at discharge in the low back pain cohort only when assessed independently by body region. CONCLUSION These findings support the theory that the pain experience is complex and multiple factors should be considered when evaluating a patient with musculoskeletal pain. Clinicians who have identified PAPD may consider these relationships when planning or modifying interventions and pursuing multidisciplinary collaboration.
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Affiliation(s)
- Joseph B Leech
- Bellin College, Department of Physical Therapy, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
- The University of St. Augustine for Health Sciences, College of Rehabilitative Sciences, Doctor of Physical Therapy Program, Austin, Texas, USA
| | - Kevin L MacPherson
- Bellin College, Department of Physical Therapy, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
- South College, School of Physical Therapy, Doctor of Physical Therapy Program, Atlanta, Georgia, USA
| | - Mareli Klopper
- Bellin College, Department of Physical Therapy, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
| | - Joshua Shumway
- Bellin College, Department of Physical Therapy, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
| | - Robert T Salvatori
- Bellin College, Department of Physical Therapy, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
- The University of St. Augustine for Health Sciences, College of Rehabilitative Sciences, Doctor of Physical Therapy Program, Austin, Texas, USA
| | - Daniel I Rhon
- Bellin College, Department of Physical Therapy, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
| | - Jodi L Young
- Bellin College, Department of Physical Therapy, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
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22
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Ghorayeb JH, Chitneni A, Rupp A, Parkash A, Abd-Elsayed A. Dorsal root ganglion stimulation for the treatment of chronic pelvic pain: A systematic review. Pain Pract 2023; 23:838-846. [PMID: 37246484 DOI: 10.1111/papr.13255] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Chronic pelvic pain (CPP) is a difficult condition to treat. Due to complex pelvic innervation, dorsal column spinal cord stimulation (SCS) has not been shown to produce the same effect as dorsal root ganglion stimulation (DRGS) given emerging evidence suggesting that applying DRGS may result in favorable outcomes for individuals with CPP. The aim of this systematic review is to investigate the clinical use and effectiveness of DRGS for patients with CPP. MATERIALS AND METHODS A systematic review of clinical studies demonstrating the use of DRGS for CPP. Searches were conducted using four electronic databases (PubMed, EMBASE, CINAHL, and Web of Science) across August and September 2022. RESULTS A total of nine studies comprising 65 total patients with variable pelvic pain etiologies met the inclusion criteria. The majority of subjects implanted with DRGS reported >50% mean pain reduction at variable times of follow-up. Secondary outcomes reported throughout studies including quality of life (QOL) and pain medication consumption were reported to be significantly improved. CONCLUSIONS Dorsal root ganglion stimulation for CPP continues to lack supportive evidence from well-designed, high-quality studies and recommendations from consensus committee experts. However, we present consistent evidence from level IV studies showing success with the use of DRGS for CPP in reducing pain symptoms along with reports of improved QOL through periods as short as 2 months to as long as 3 years. Because the available studies at this time are of low quality with a high risk of bias, we strongly recommend the facilitation of high-quality studies with larger sample sizes in order to better ascertain the utility of DRGS for this specific patient population. At the same time, from a clinical perspective, it may be reasonable and appropriate to evaluate patients for DRGS candidacy on a case-by-case basis, especially those patients who report CPP symptoms that are refractory to noninterventional measures and who may not be ideal candidates for other forms of neuromodulation.
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Affiliation(s)
- Joe H Ghorayeb
- University of Medicine and Health Sciences, New York, New York, USA
| | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, New York, USA
| | - Adam Rupp
- Department of Physical Medicine and Rehabilitation, University of Kansas Health System, Kansas City, Kansas, USA
| | - Anishinder Parkash
- Department of Physical Medicine and Rehabilitation, Tower Health Reading Hospital/Drexel University COM, Redding, Pennsylvania, USA
| | - Alaa Abd-Elsayed
- Division of Pain Medicine, Department of Anesthesia, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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23
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Tankha H, Lumley MA, Gordon A, Schubiner H, Uipi C, Wager TD, Harris J, Ashar YK. "I don't have chronic back pain anymore": Patient Experiences in Pain Reprocessing Therapy for Chronic Back Pain. THE JOURNAL OF PAIN 2023; 24:1582-1593. [PMID: 37094744 PMCID: PMC11020878 DOI: 10.1016/j.jpain.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
In a recently published randomized controlled trial, two-thirds of the patients receiving a novel psychological treatment, pain reprocessing therapy (PRT), reported elimination or near-elimination of chronic back pain. The mechanisms of PRT and related treatments remain poorly understood but are hypothesized to center on pain reappraisal, fear reduction, and exposure-potentiated extinction. Here, we investigated treatment mechanisms from the participants' perspective. A sample of 32 adults with chronic back pain who received PRT completed semi-structured posttreatment interviews about their treatment experiences. The interviews were analyzed with multiphase thematic analysis. The analyses identified 3 major themes reflecting participants' understanding of how PRT led to pain relief: 1) reappraisal to reduce fear of pain, which included guiding participants to relate to pain as a helpful indicator, overcoming pain-related fear and avoidance, and reconceptualizing pain as a "sensation;" 2) the link between pain, emotions, and, stress, which included gaining insight into these connections and resolving difficult emotions; and 3) social connections, which included patient-provider alliance, therapist belief in the treatment model, and peer models of recovery from chronic pain. Our findings support the hypothesized mechanisms of PRT centered on pain reappraisal and fear reduction, but also highlight additional processes from the participants' perspective, including a focus on emotions and relationships. This study underscores the value of qualitative research methods in illuminating the mechanisms of novel pain therapies. PERSPECTIVE: This article presents participants' perspectives on their experience engaging in a novel psychotherapy for chronic pain, PRT. Through pain reappraisal, linking pain, emotions, and stress, and connecting with their therapist and peers, many participants reported an elimination or near-elimination of their chronic back pain with therapy.
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Affiliation(s)
- Hallie Tankha
- Department of Psychology, Wayne State University, Detroit, MI
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, MI
| | | | - Howard Schubiner
- Department of Internal Medicine, Ascension Providence Hospital, Southfield, MI
| | | | - Tor D. Wager
- Department of Brain and Psychological Sciences, Dartmouth College, Hanover, NH
| | - James Harris
- Division of General Internal Medicine, Department of Medicine and Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
| | - Yoni K. Ashar
- Division of General Internal Medicine, Department of Medicine and Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
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24
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Witkam RL, Kragt EAM, Arnts IJJ, Bronkhorst EM, van Dongen R, Kurt E, Steegers MAH, van Haren FGAM, Maandag NJG, Gort C, Henssen DJHA, Wegener JT, Vissers KCP. Spinal Cord Stimulation for Failed Back Surgery Syndrome: to Trial or Not to Trial? THE JOURNAL OF PAIN 2023; 24:1298-1306. [PMID: 36878384 DOI: 10.1016/j.jpain.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
Spinal cord stimulation (SCS) is a recommended therapy to treat failed back surgery syndrome (FBSS). A trial period is practiced to enhance patient selection. However, its fundamental evidence is limited, especially concerning long-term benefit and therapy safety. We compared the long-term (5.3 ± 4.0 years) clinical outcome and therapy safety of a trialed and nontrialed implantation strategy, including multidimensional variables and pain intensity fluctuations over time. A multicenter cohort analysis was performed in 2 comparable groups of FBSS patients. Regarding eligibility, patients had to be treated with SCS for at least 3 months. While the Trial group comprised patients who underwent an SCS implantation after a successful trial, the No-Trial group encompassed patients who underwent complete implantation within 1 session. The primary outcome measures were pain intensity scores and complications. The Trial and No-Trial groups consisted of 194 and 376 patients (N = 570), respectively. A statistically but not clinically significant difference in pain intensity (P = .003; effect = 0.506 (.172-.839)) was found in favor of the Trial group. No interaction between a time dependency effect and pain intensity was noted. Whereas trialed SCS patients were more likely to cease opioid usage (P = .003; OR = .509 (.326-.792)), patients in the No-Trial group endured fewer infections (P = .006; proportion difference = .43 (.007-.083)). Although the clinical relevance of our findings should be proven in future studies, this long-term real-world data study indicates that patient-centered assessments on whether an SCS trial should be performed have to be investigated. According to the current ambiguous evidence, SCS trials should be considered on a case-by-case basis. PERSPECTIVE: The currently available comparative evidence, together with our results, remains ambiguous on which SCS implantation strategy might be deemed superior. An SCS trial should be considered on a case-by-case basis, for which further investigation of its clinical utility in certain patient populations or character traits is warranted.
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Affiliation(s)
- Richard L Witkam
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Elisabeth A M Kragt
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge J J Arnts
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert van Dongen
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erkan Kurt
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique A H Steegers
- Department of Anaesthesiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Frank G A M van Haren
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Natasja J G Maandag
- Department of Anaesthesiology, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Cees Gort
- Department of Anaesthesiology, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Dylan J H A Henssen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jessica T Wegener
- Department of Anaesthesiology, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Kris C P Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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25
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Kallesøe KH, Wellnitz KB, Ørnbøl E, Rask CU. Clinical Impact of Systematic Assessment and Psychoeducation in Specialized Treatment of Adolescents with Severe Functional Somatic Disorders: Results from the AHEAD Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1101. [PMID: 37508598 PMCID: PMC10378561 DOI: 10.3390/children10071101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
Functional somatic disorders (FSD), characterized by persistent and disabling physical symptoms, are common in adolescents. Diagnostic uncertainty and insufficient illness explanations are proposed perpetuating factors that may constitute barriers for treatment engagement. This study describes the impact of manualized assessment and psychoeducation on diagnostic certainty and various clinical outcomes in adolescents with multi-system FSD. Ninety-one adolescents (15-19 years) received systematic assessment (4 h) and a subsequent psychiatric consultation (1.5 h). Clinical characteristics included self-reported physical health, symptom severity, illness perception, illness-related behavior, and psychological flexibility assessed before and approximately two months after assessment, prior to specialized treatment. Data were analyzed using t-tests. Immediately following assessment, 71 (80.7%) adolescents out of 88 reported a higher diagnostic certainty and 74 (84.1%) reported that attending assessment gave them positive expectations for future treatment. A clinically relevant improvement of physical health was not observed at two months but considerable reductions were seen in symptom severity, illness worry, negative illness perceptions, illness-related limiting behavior, and psychological inflexibility. The results emphasize that systematic assessment and psychoeducation are important in their own right in the specialized treatment of adolescents with severe FSD.
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Affiliation(s)
- Karen Hansen Kallesøe
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark
| | - Kaare Bro Wellnitz
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul Jensens Boulevard 11, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Incuba/Skejby Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul Jensens Boulevard 11, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Incuba/Skejby Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Incuba/Skejby Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
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26
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Wagner C, Gaab J, Hediger K. The Importance of the Treatment Rationale for Pain in Animal-Assisted Interventions: A Randomized Controlled Trial in Healthy Participants. THE JOURNAL OF PAIN 2023; 24:1080-1093. [PMID: 36641027 DOI: 10.1016/j.jpain.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023]
Abstract
Animal-assisted interventions (AAIs) is a promising treatment approach for pain, but possible mechanisms still need to be elucidated. This study set out to investigate the analgesic effects of an animal provided with a treatment rationale in a randomized controlled trial employing a standardized experimental heat-pain paradigm. We randomly assigned 128 healthy participants to: dog treatment (DT), placebo treatment (PT), dog and placebo treatment (DPT), and no treatment (NT). Primary outcomes were heat-pain tolerance and the corresponding self-reported ratings of pain unpleasantness and intensity. Results revealed no differences in heat-pain tolerance between the conditions. However, participants in the DT condition experienced heat-pain as significantly less unpleasant at the limit of their tolerance compared to participants in the NT condition (estimate = -0.96, CI = -1.58 to 0.34, P = .010). Participants in the DT condition also showed lower ratings of pain intensity at the limit of their tolerance compared to participants in the NT condition (estimate = -0.44, CI = -0.89 to 0.02, P = .060). This study indicates that a dog has analgesic effects on pain perception when integrated into the treatment rationale. We assume that providing a treatment rationale regarding the animal is important in AAIs for pain. PERSPECTIVE: This study shows that the presence of an animal is not sufficient for animal-assisted interventions (AAIs) to have an analgesic effect on pain unless they are provided with a treatment rationale. This could imply that not only the animal but also contextual factors are important in AAIs. TRIAL REGISTRATION: Clinical Trials NCT04361968.
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Affiliation(s)
- Cora Wagner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Karin Hediger
- Division of Clinical Psychology and Animal-Assisted Intervention, Faculty of Psychology, University of Basel, Basel, Switzerland; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; Faculty of Psychology, Open University, Heerlen, Netherlands; Clinic for Neurorehabilitation and Paraplegiology, REHAB Basel, Basel, Switzerland
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27
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Strigo IA, Simmons AN, Giebler J, Schilling JM, Moeller-Bertram T. Unsupervised learning for prognostic validity in patients with chronic pain in transdisciplinary pain care. Sci Rep 2023; 13:7581. [PMID: 37164996 PMCID: PMC10172363 DOI: 10.1038/s41598-023-34611-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023] Open
Abstract
Chronic pain is not a singular disorder and presents in various forms and phenotypes. Here we show data from a cohort of patients seeking treatment in a transdisciplinary pain clinic. Patients completed a multidimensional patient-reported battery as part of routine initial evaluation at baseline and at each of the four subsequent visits over 1-year follow-up (0, 1, 3, 6, 12 months). The goal of this work was to use unsupervised modeling approach to identify whether patients with chronic pain undergoing transdisciplinary intensive rehabilitation treatment: (1) can be derived based upon self-reported outcome measures at baseline (or before treatment initiation), (2) are clinically validated based on their clinical diagnosis and medication use, and (3) differ in treatment trajectories over 1 year of transdisciplinary treatment. We applied unsupervised clustering on baseline outcomes using nine patient-reported symptoms and examined treatment trajectories. The three-cluster solution was internally validated. Psychiatric diagnosis, chronic back pain-related disability and symptoms severity determined cluster assignment and treatment prognosis. Conversely, clinical pain severity had lesser effect. Furthermore, clusters showed stability over time despite symptoms improvement. The accurate and meaningful subgrouping of the underlying chronic pain phenotypes would greatly enhance treatment and provide personalized and effective pain management.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, San Francisco, CA, 94121, USA.
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Alan N Simmons
- Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Drive, MC 151-B, San Diego, 92151, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
- Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA
| | | | - Jan M Schilling
- Savas Health, Rancho Mirage, CA, USA
- Vitamed Research, LLC, Palm Desert, CA, USA
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28
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Bott FS, Nickel MM, Hohn VD, May ES, Gil Ávila C, Tiemann L, Gross J, Ploner M. Local brain oscillations and interregional connectivity differentially serve sensory and expectation effects on pain. SCIENCE ADVANCES 2023; 9:eadd7572. [PMID: 37075123 PMCID: PMC10115421 DOI: 10.1126/sciadv.add7572] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Pain emerges from the integration of sensory information about threats and contextual information such as an individual's expectations. However, how sensory and contextual effects on pain are served by the brain is not fully understood so far. To address this question, we applied brief painful stimuli to 40 healthy human participants and independently varied stimulus intensity and expectations. Concurrently, we recorded electroencephalography. We assessed local oscillatory brain activity and interregional functional connectivity in a network of six brain regions playing key roles in the processing of pain. We found that sensory information predominantly influenced local brain oscillations. In contrast, expectations exclusively influenced interregional connectivity. Specifically, expectations altered connectivity at alpha (8 to 12 hertz) frequencies from prefrontal to somatosensory cortex. Moreover, discrepancies between sensory information and expectations, i.e., prediction errors, influenced connectivity at gamma (60 to 100 hertz) frequencies. These findings reveal how fundamentally different brain mechanisms serve sensory and contextual effects on pain.
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Affiliation(s)
- Felix S. Bott
- Department of Neurology and TUM-Neuroimaging Center (TUM-NIC), TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Moritz M. Nickel
- Department of Neurology and TUM-Neuroimaging Center (TUM-NIC), TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Vanessa D. Hohn
- Department of Neurology and TUM-Neuroimaging Center (TUM-NIC), TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Elisabeth S. May
- Department of Neurology and TUM-Neuroimaging Center (TUM-NIC), TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Cristina Gil Ávila
- Department of Neurology and TUM-Neuroimaging Center (TUM-NIC), TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Laura Tiemann
- Department of Neurology and TUM-Neuroimaging Center (TUM-NIC), TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Markus Ploner
- Department of Neurology and TUM-Neuroimaging Center (TUM-NIC), TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Corresponding author.
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29
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Carrière JS, Donayre Pimentel S, Bou Saba S, Boehme B, Berbiche D, Coutu MF, Durand MJ. Recovery expectations can be assessed with single-item measures: findings of a systematic review and meta-analysis on the role of recovery expectations on return-to-work outcomes after musculoskeletal pain conditions. Pain 2023; 164:e190-e206. [PMID: 36155605 PMCID: PMC10026834 DOI: 10.1097/j.pain.0000000000002789] [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: 04/29/2022] [Revised: 08/15/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT The objective of this systematic review is to quantify the association between recovery expectations and return-to-work outcomes in adults with musculoskeletal pain conditions. In addition, this review has the second objective to compare the predictive utility of single-item and multi-item recovery expectation scales on return-to-work outcomes. Relevant articles were selected from Embase, PsycINFO, PubMed, Cochrane, and manual searches. Studies that assessed recovery expectations as predictors of return-to-work outcomes in adults with musculoskeletal pain conditions were eligible. Data were extracted on study characteristics, recovery expectations, return-to-work outcomes, and the quantitative association between recovery expectations and return-to-work outcomes. Risk of bias was assessed using the Effective Public Health Practice Project. Odds ratios were pooled to examine the effects of recovery expectations on return-to-work outcomes. Chi-square analyses compared the predictive utility of single-item and multi-item recovery expectation scales on return-to-work outcomes. Thirty studies on a total of 28,741 individuals with musculoskeletal pain conditions were included in this review. The odds of being work disabled at follow-up were twice as high in individuals with low recovery expectations (OR = 2.06 [95% CI 1.20-2.92] P < 0.001). Analyses also revealed no significant differences in the predictive value of validated and nonvalidated single-item measures of recovery expectations on work disability (χ 2 = 1.68, P = 0.19). There is strong evidence that recovery expectations are associated with return-to-work outcomes. The results suggest that single-item measures of recovery expectations can validly be used to predict return-to-work outcomes in individuals with musculoskeletal pain conditions.
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Affiliation(s)
- Junie S. Carrière
- École de réadaptation, Faculté de médecine et des sciences de la santé, Centre de Recherche Charles-Le Moyne, Centre d'action en prévention et en réadaptation de l'incapacité au travail, Université de Sherbrooke, Longueuil, QC, Canada
| | | | - Sabine Bou Saba
- School of Mind and Brain, Humboldt Universität zu Berlin, Berlin, Germany
| | - Blake Boehme
- Department of Psychology, University of Regina, Regina, Saskatchewan
| | - Djamal Berbiche
- Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-France Coutu
- École de réadaptation, Faculté de médecine et des sciences de la santé, Centre de Recherche Charles-Le Moyne, Centre d'action en prévention et en réadaptation de l'incapacité au travail, Université de Sherbrooke, Longueuil, QC, Canada
| | - Marie-José Durand
- École de réadaptation, Faculté de médecine et des sciences de la santé, Centre de Recherche Charles-Le Moyne, Centre d'action en prévention et en réadaptation de l'incapacité au travail, Université de Sherbrooke, Longueuil, QC, Canada
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30
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Gevers-Montoro C, Ortega-De Mues A, Piché M. Mechanisms of chiropractic spinal manipulative therapy for patients with chronic primary low back pain: protocol for a mechanistic randomised placebo-controlled trial. BMJ Open 2023; 13:e065999. [PMID: 36764718 PMCID: PMC9923302 DOI: 10.1136/bmjopen-2022-065999] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/25/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) is a highly prevalent and disabling condition. Identifying subgroups of patients afflicted with CLBP is a current research priority, for which a classification system based on pain mechanisms was proposed. Spinal manipulative therapy (SMT) is recommended for the management of CLBP. Yet, little data are available regarding its mechanisms of action, making it difficult to match this intervention to the patients who may benefit the most. It was suggested that SMT may influence mechanisms associated with central sensitisation. Therefore, classifying patients with CLBP according to central sensitisation mechanisms may help predict their response to SMT. METHODS AND ANALYSIS This protocol describes a randomised placebo-controlled trial aiming to examine which variables linked to central sensitisation may help predict the clinical response to SMT in a cohort of patients with CLBP. One hundred patients with chronic primary low back pain will be randomised to receive 12 sessions of SMT or placebo SMT over a 4-week period. Pain intensity and disability will be assessed as primary outcomes after completing the 4-week treatment (primary endpoint), and at 4-week and 12-week follow-ups. Baseline values of two pain questionnaires, lumbar pressure pain thresholds, concentrations of an inflammatory cytokine and expectations of pain relief will be entered as predictors of the response to SMT in a multiple regression model. Changes in these variables after treatment will be used in a second multiple regression model. The reference values of these predictors will be measured from 50 age and sex-matched healthy controls to allow interpretation of values in patients. Mixed analyses of variance will also be conducted to compare the primary outcomes and the predictors between groups (SMT vs placebo) over time (baseline vs post-treatment). ETHICS AND DISSEMINATION Ethical approval was granted by the Fundación Jiménez Díaz Clinical Research Ethics Committee. TRIAL REGISTRATION NUMBER NCT05162924.
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Affiliation(s)
- Carlos Gevers-Montoro
- Chiropractic, Real Centro Universitario Escorial Maria Cristina, San Lorenzo de El Escorial, Spain
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
| | - Arantxa Ortega-De Mues
- Chiropractic, Real Centro Universitario Escorial Maria Cristina, San Lorenzo de El Escorial, Spain
| | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
- CogNAC (Cognition, Neurosciences, Affect et Comportement) Research Group, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
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Day MA, Matthews N, Davies JN, Walker C, Bray N, Kim J, Jensen MP. Outcome Expectancies, Effects, and Mechanisms of Brief Training in Mindfulness Meditation vs. Loving-Kindness Meditation vs a Control Condition for Pain Management: A Randomized Pilot Study. J Pain Palliat Care Pharmacother 2023:1-11. [PMID: 36622873 DOI: 10.1080/15360288.2022.2141944] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/22/2022] [Accepted: 10/24/2022] [Indexed: 01/10/2023]
Abstract
This study investigated the analgesic effects of a single session of mindfulness meditation (MM) and loving-kindness meditation (LKM) relative to a control. A total of 100 adults with chronic or current problematic pain completed a survey and were randomized to a 20-minute MM, LKM, or audiobook control. Co-primary outcomes of pain intensity and unpleasantness and mediators of mindfulness and self-compassion were assessed pre- and posttraining. Expectancies were assessed pretraining. Pain type (chronic vs current problematic) was a covariate. Relative to the control, higher expectancies were reported for MM and LKM (P < .001). MM (d = 0.41, P = .032) and LKM (d = 0.38, P = .027) had medium effects on pain intensity, with greater decreases than control (d = 0.05, P = .768). All conditions had small effects on unpleasantness. Mindful observing increased more within MM (d = 0.52, P = .022) and the control (d = 0.50, P = .011) than LKM (d = 0.12, P = .50); self-compassion increased more in LKM (d = 0.36, P = .042) than MM (d = 0.27, P = .201) and the control (d = 0.22, P = .249). The mediation models were nonsignificant. Pain type was a nonsignificant covariate. Overall, MM and LKM were associated with positive expectancies and small-medium pain intensity reductions, which did not differ by pain type. Although MM and LKM were associated with changes in theorized mediators, these changes did not underlie improvement.
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Affiliation(s)
- Melissa A Day
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Natasha Matthews
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan N Davies
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Claire Walker
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Nicola Bray
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Jeffrey Kim
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Kunkel A, Bingel U. [Placebo effects in analgesia : Influence of expectations on the efficacy and tolerability of analgesic treatment]. Schmerz 2023; 37:59-71. [PMID: 36637498 PMCID: PMC9889476 DOI: 10.1007/s00482-022-00685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 01/14/2023]
Abstract
Expectations of patients influence the perception and neuronal processing of acute and chronic pain and modulate the effectiveness of analgesic treatment. The expectation of treatment is not only the most important determinant of placebo analgesia. Expectations of treatment also influence the efficacy and tolerability of "active" pharmacological and non-pharmacological treatment of pain. Recent insights into the psychological and neurobiological mechanisms underlying the clinically relevant effects of treatment expectations enable and call for the systematic integration and modulation of treatment expectations into analgesic treatment concepts. Such a strategy promises to optimize analgesic treatment and to prevent or reduce the burden of unwanted side effects and the misuse of analgesics, particularly of opioids. This review highlights the current concepts, recent achievements and also challenges and key open research questions.
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Affiliation(s)
- Angelika Kunkel
- Klinik für Neurologie, Zentrum für translationale Neuro- und Verhaltenswissenschaften, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Ulrike Bingel
- Klinik für Neurologie, Zentrum für translationale Neuro- und Verhaltenswissenschaften, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Individual treatment expectations predict clinical outcome after lumbar injections against low back pain. Pain 2023; 164:132-141. [PMID: 35543638 DOI: 10.1097/j.pain.0000000000002674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/15/2022] [Indexed: 01/09/2023]
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Positive, but not negative, treatment outcome expectancies mediate the relation between depressive symptoms and treatment-related pain reduction. J Behav Med 2022:10.1007/s10865-022-00380-9. [DOI: 10.1007/s10865-022-00380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022]
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Marschall H, Forman A, Lunde SJ, Kesmodel US, Hansen KE, Vase L. Is laparoscopic excision for superficial peritoneal endometriosis helpful or harmful? Protocol for a double-blinded, randomised, placebo-controlled, three-armed surgical trial. BMJ Open 2022; 12:e062808. [PMID: 36328387 PMCID: PMC9639085 DOI: 10.1136/bmjopen-2022-062808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Placebo-controlled surgical designs are recommended to ascertain treatment effects for elective surgeries when there is genuine doubt about the effectiveness of the surgery. Some elective surgeries for pain have been unable to show an effect beyond sham surgery, suggesting contributions from contextual factors. However, the nature of contextual factors in elective surgery is largely unexplored. Further, methodological difficulties in placebo-controlled surgical trials impact the ability to estimate the effectiveness of a surgical procedure. These include an overall lack of testing the success of blinding, absence of comparison to a no-surgery control group and dearth of test for neuropathic pain.For women with peritoneal endometriosis, there is uncertainty regarding the pain-relieving effect of surgery. Surgery may put patients at risk of complications such as postsurgical neuropathic pain, without guarantees of sufficient pelvic pain relief. The planned placebo-controlled trial aims to examine the effect of surgery on pelvic pain, widespread pain and neuropathic pain symptoms in women with peritoneal endometriosis, and to test the contribution of contextual factors to pain relief. METHODS AND ANALYSIS One hundred women with peritoneal endometriosis will be randomised to either diagnostic laparoscopy with excision of endometrial tissue (active surgery), purely diagnostic laparoscopy (sham surgery) or delayed surgery (no-surgery control group). Outcomes include pelvic pain relief, widespread pain, neuropathic pain symptoms and quality of life. Contextual factors are also assessed. Assessments will be obtained at baseline and 1, 3 and 6 months postrandomisation. Mixed linear models will be used to compare groups over time on all outcome variables. ETHICS AND DISSEMINATION The trial is approved by the Regional Ethics Committee in the Central Denmark Region (1-10-72-152-20). The trial is funded by a PhD scholarship from Aarhus University, and supported by a grant from 'Helsefonden' (20-B-0448). Findings will be published in international peer-reviewed journals and disseminated at international conferences. TRIAL REGISTRATION NUMBER NCT05162794.
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Affiliation(s)
- Henrik Marschall
- School of Business and Social Sciences, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sigrid Juhl Lunde
- School of Business and Social Sciences, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lene Vase
- School of Business and Social Sciences, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Nelson S, Smith AM, Jervis K, Silvia MN, Randall E. Will This Treatment Help My Child?: How Parent/Caregiver Treatment Expectations Relate to Intensive Pain Rehabilitation Outcomes for Youth With Chronic Pain. Clin J Pain 2022; 38:651-658. [PMID: 36075895 PMCID: PMC9720665 DOI: 10.1097/ajp.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE An extensive body of research has highlighted the impact that parent/caregiver factors have on functioning and treatment outcomes among youth with chronic pain. However, parent/caregiver expectations in pain treatment have been largely understudied, despite strong evidence that treatment expectations are associated with treatment engagement and overall outcomes in nonpain populations. Accordingly, the primary aim of this investigation was to preliminarily examine the manifestation and measurement of parent/caregiver treatment expectations in an intensive interdisciplinary pediatric pain treatment (IIPT) setting. METHODS Participants in this study (N=328) included children and adolescents who attended an IIPT program for chronic pain between August 2013 and March 2020 and their parent/caregiver(s). Outcomes examined include parent/caregiver self-report of treatment expectations for their child upon admission to the IIPT in addition to pain-related and psychosocial factors at admission and discharge. RESULTS Findings revealed a high level of expectations (ie, belief that the treatment will be helpful) on average, with higher parent/caregiver expectations associated with poorer functioning at admission to and discharge from the IIPT program. CONCLUSION Extremely high treatment expectations among parents of more disabled youth may be indicative of unrealistic hopes or the "need" for IIPT to help their child; tempering parental expectations with psychoeducation about IIPT goals and realistic outcomes may indirectly improve treatment outcomes for their children. Future research should examine the potentially unique and important role that treatment expectations, of both parent/caregivers and their children, may have in overall IIPT outcomes.
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Affiliation(s)
- Sarah Nelson
- Division of Pain Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Allison M. Smith
- Division of Pain Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kelsey Jervis
- Division of Pain Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital, Boston, MA, USA
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children’s Hospital, Waltham, MA
| | - Megan N. Silvia
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA
| | - Edin Randall
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children’s Hospital, Waltham, MA
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Bakhshaie J, Penn TM, Doorley J, Pham TV, Greenberg J, Bannon S, Saadi A, Vranceanu AM. Psychosocial Predictors of Chronic Musculoskeletal Pain Outcomes and their Contextual Determinants Among Black Individuals: A Narrative Review. THE JOURNAL OF PAIN 2022; 23:1697-1711. [PMID: 35644442 DOI: 10.1016/j.jpain.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Black communities are disproportionally affected by Chronic Musculoskeletal Pain (CMP), but little is known about the psychological predictors of CMP outcomes and their contextual determinants among Black individuals. To address this gap, we conducted a narrative review of extant literature to (1) report the major conceptual models mentioned in prior work explaining the link between contextual determinants and psychological responses to pain among Black individuals with CMP; and (2) describe psychological factors related to CMP outcomes in this population that are highlighted in the literature. We searched 4 databases (APA PsycNet, PubMed/MEDLINE, Scopus, and Google Scholar) using the following search terms: musculoskeletal pain, chronic pain, mental health, psychological, coping, health disparities, contextual factors, conceptual models, psychosocial, Black, African American, pain, disability, and outcomes. We illustrate 3 relevant conceptual models - socioecological, cumulative stress, and biopsychosocial - related to contextual determinants and several psychological factors that influence CMP outcomes among Black individuals: (1) disproportionate burden of mental health and psychiatric diagnoses, (2) distinct coping strategies, (3) pain-related perceived injustice and perceived racial/ethnic discrimination, and (4) preferences and expectations related to seeking and receiving pain care. The detailed clinical and research implications could serve as a blueprint for the providers and clinical researchers to address health disparities and improve care for Black individuals with CMP. PERSPECTIVE: This narrative review illustrates conceptual models explaining the link between contextual determinants and psychological responses to pain among Black individuals with chronic musculoskeletal pain. We discuss 3 relevant conceptual models - socioecological, cumulative stress, biopsychosocial -, and 4 psychological factors: disproportionate burden of mental health, distinct coping strategies, perceived injustice/discrimination, preferences/expectations.
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Affiliation(s)
- Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Terence M Penn
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - James Doorley
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Tony V Pham
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tulane Medical School, New Orleans, Louisiana; Duke University Global Health Master's Program, Durham, North Carolina
| | - Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Sarah Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Altaf Saadi
- Harvard Medical School, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Carriere JS, Martel MO, Loggia ML, Campbell CM, Smith MT, Haythornthwaite JA, Edwards RR. The Influence of Expectancies on Pain and Function Over Time After Total Knee Arthroplasty. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:1767-1776. [PMID: 35482515 PMCID: PMC9527599 DOI: 10.1093/pm/pnac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/11/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Expectancies have a well-documented influence on the experience of pain, responses to treatment, and postsurgical outcomes. In individuals with osteoarthritis, several studies have shown that expectations predict increased pain and disability after total knee replacement surgery. Despite the growing recognition of the importance of expectancies in clinical settings, few studies have examined the influence of expectancies throughout postsurgical recovery trajectories. The objective of the present study was to examine the role of presurgical expectancies on pain and function at 6-week, 6-month, and 1-year follow-ups after total knee arthroplasty. DESIGN AND PARTICIPANTS Data were collected from patients scheduled for total knee arthroplasty 1 week before surgery and then at 6 weeks, 6 months, and 1 year after surgery. Correlational and multivariable regression analyses examined the influence of expectancies on patients' perceptions of pain reduction and functional improvement at each time point. Analyses controlled for age, sex, body mass index, presurgical pain intensity and function, pain catastrophizing, anxiety, and depression. RESULTS Results revealed that expectancies significantly predicted pain reduction and functional improvement at 1-year follow-up. However, expectancies did not predict outcomes at the 6-week and 6-month follow-ups. Catastrophizing and depressive symptoms emerged as short-term predictors of postsurgical functional limitations at 6-week and 6-month follow-ups, respectively. CONCLUSIONS The results suggest that targeting high levels of catastrophizing and depressive symptoms could optimize short-term recovery after total knee arthroplasty. However, the results demonstrate that targeting presurgical negative expectancies could prevent prolonged recovery trajectories, characterized by pain and loss of function up to 1 year after total knee arthroplasty.
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Affiliation(s)
- Junie S Carriere
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Centre de Recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Marc Olivier Martel
- Faculties of Dentistry and Medicine, McGill University, Montreal, Quebec, Canada
| | - Marco L Loggia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Claudia M Campbell
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael T Smith
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Haythornthwaite
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert R Edwards
- Department of Anesthesiology, Brigham and Women’s Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts, USA
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Biesiekierski JR, Manning LP, Murray HB, Vlaeyen JWS, Ljótsson B, Van Oudenhove L. Review article: exclude or expose? The paradox of conceptually opposite treatments for irritable bowel syndrome. Aliment Pharmacol Ther 2022; 56:592-605. [PMID: 35775328 PMCID: PMC11327802 DOI: 10.1111/apt.17111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a heterogeneous disorder of gut-brain interaction (DGBI) maintained by interacting biological, psychological, and social processes. Interestingly, there are two contrasting yet evidence-based treatment approaches for reducing IBS symptoms: exclusion diets such as those low in fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) and exposure-based cognitive-behavioural therapy (CBT). Exclusion diets recommend patients avoid foods thought to be symptom-inducing, whereas exposure-based CBT encourages patients to expose themselves to foods. AIMS To address the paradox of conceptually opposite exclusion diets and exposure-based CBT for IBS. METHODS In this conceptual review, we describe the rationale, practical implementation, evidence base and strengths and weaknesses of each treatment. We conducted up-to-date literature search concerning the low FODMAP diet and CBT, and performed a secondary analysis of a previously conducted trial to illustrate a key point in our review. RESULTS The low FODMAP diet has demonstrated efficacy, but problems with adherence, nutritional compromise, and heightened gastrointestinal-specific anxiety raise caution. Exposure-based CBT has demonstrated efficacy with substantial evidence for gastrointestinal-specific anxiety as a key mechanism of action. Mediation analysis also showed that increased FODMAP intake mediated decreased symptom severity in exposure-based CBT. However, there is minimal evidence supporting which treatment "works best for whom" and how these approaches could be best integrated. CONCLUSIONS Even though exclusion diets and exposure-based CBT are conceptually opposite, they each have proven efficacy. Clinicians should familiarise themselves with both treatments. Further research is needed on predictors, mechanisms and moderators of treatment outcomes.
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Affiliation(s)
- Jessica R Biesiekierski
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Australia
- Department of Food, Nutrition and Dietetics, La Trobe University, Melbourne, Australia
| | - Lauren P Manning
- Department of Food, Nutrition and Dietetics, La Trobe University, Melbourne, Australia
| | - Helen Burton Murray
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
- Research Group Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), University of Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Cognitive and Affective Neuroscience Lab, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
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Schwartz M, Fischer LM, Bläute C, Stork J, Colloca L, Zöllner C, Klinger R. Observing treatment outcomes in other patients can elicit augmented placebo effects on pain treatment: a double-blinded randomized clinical trial with patients with chronic low back pain. Pain 2022; 163:1313-1323. [PMID: 35262315 PMCID: PMC9199107 DOI: 10.1097/j.pain.0000000000002513] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/08/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Clinical research on social observational learning (SoL) as an underlying mechanism for inducing expectancy and eliciting analgesic placebo effects is lacking. This double-blinded randomized controlled clinical trial investigated the influence of SoL on medication-augmenting placebo effects in 44 patients with chronic low back pain. Our hypothesis was that observing positive drug effects on pain and mobility in another patient could increase pain reduction and functional capacity. To test this, we compared the effects of observing positive treatment outcomes in a sham patient (the social learning group [SoLG]) vs hearing the same sham patient report neutral effects (the control group). In the SoLG, the sham patient told peers about pain reduction due to amitriptyline and demonstrated his improved mobility by bending forwards and sideways while he told the control group only that he was taking amitriptyline. The primary outcome was a reduction in clinical low back pain self-ratings. The secondary outcome was perceptions of pain-related disability. The exploratory outcome was mood and coping statements. Data collection occurred before and after the intervention and 2 weeks later. After the intervention, pain decreased in both groups (F [1, 41] = 7.16, P < 0.05, d = 0.83), with no difference between groups. However, the SoLG showed a significantly larger decrease in perceived disability (F [1, 41] = 5, P < 0.05, d = 0.63). The direct observation of patient with chronic low back pain of positive treatment outcomes in the sham patient seems to have enhanced the treatment effects while indirect verbal reports of reduced pain did not.
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Affiliation(s)
- Marie Schwartz
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Laura-Marie Fischer
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Corinna Bläute
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Jan Stork
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Luana Colloca
- University of Maryland School of Nursing & School of Medicine, Baltimore, MD, United States
| | - Christian Zöllner
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Regine Klinger
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Germany
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Stillianesis G, Cavaleri R, Tang CY, Summers SJ. Exploring Patient Perceptions of Noninvasive Brain Stimulation: A Systematic Review. Neuromodulation 2022; 25:487-493. [PMID: 35667767 DOI: 10.1111/ner.13461] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/15/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To synthesize and critically appraise literature exploring patient perceptions regarding the therapeutic use of noninvasive brain stimulation. MATERIAL AND METHODS A systematic search of CINHAL, PUBMED, Web of Science, and Medline was performed. Reference lists of relevant articles were also screened. Studies exploring participant perceptions regarding the therapeutic use of noninvasive brain stimulation were eligible for inclusion. Perceptions were divided into three domains: knowledge, experience, and attitudes. Noninvasive brain stimulation was defined as any neuromodulation technique that alters brain activity but does not require invasive methods such as surgery. No restrictions were placed upon study design or participant population. Two reviewers performed data extraction and risk of bias assessment. Data relating to methodological characteristics, participant demographics, type of noninvasive brain stimulation, and nature of perceptions (knowledge, experience, or attitudes) were extracted. RESULTS Four studies comprising data from 163 participants met the inclusion criteria. All studies investigated perceptions of repetitive transcranial magnetic stimulation (rTMS) in psychiatric populations. Most participants perceived rTMS to be safe and beneficial, demonstrated low levels of fear, and were willing to recommend the intervention to others. No studies were found investigating patient perception of transcranial direct current stimulation (tDCS). CONCLUSION The findings from this review suggest that rTMS is well accepted as a therapeutic treatment among psychiatric populations, providing support for its clinical utility. Future work is needed to determine if similar findings exist for other conditions (eg, chronic pain) and for other therapeutic forms of brain stimulation (eg, tDCS).
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Affiliation(s)
- Georgia Stillianesis
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, NSW, Australia
| | - Rocco Cavaleri
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, NSW, Australia
| | - Clarice Y Tang
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia; College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Simon J Summers
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, NSW, Australia; Research School of Biology, Australian National University, Canberra, ACT, Australia; Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
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Nøst TH, Woodhouse A, Dale LO, Hara KW, Steinsbekk A. Participants' experiences from group-based treatment at multidisciplinary pain centres - a qualitative study. Scand J Pain 2022; 22:365-373. [PMID: 34453878 DOI: 10.1515/sjpain-2021-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the study was to explore the experiences of participants in non-pharmacological group-based treatments delivered as part of a randomised controlled trial at Norwegian tertiary care pain centres. METHODS Individual semi-structured interviews with 15 persons were conducted. The data were analysed with a descriptive thematic cross-case analysis based on the method of systematic text condensation. RESULTS All participants talked about some aspects of the group-based treatments as a positive experience, but mainly the outcome was in line with their expectations; they hoped it would reduce their pain but did not expect it. There were no clear-cut differences in the experiences between the participants from the two different intervention groups. The content was experienced as both relevant and interesting but also to introduce concepts that were difficult to grasp and understand. Similarly, the experiences of participating in a group-based treatment were mostly stimulating but could also be challenging because of an expectancy of sharing personal stories. Although experiencing few changes to their pain they came away with techniques and lessons that were valuable to them. CONCLUSIONS In this study, taking part in group-based treatment was perceived as giving positive and valuable lessons, due to relevant content and learning from the professionals and fellow participants, but without any clear indication of reduced pain. Approval from ethical committee number 10260 REK Midt. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT04057144.
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Affiliation(s)
- Torunn Hatlen Nøst
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Astrid Woodhouse
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars-Oskar Dale
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Karen Walseth Hara
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- The Norwegian Labour and Welfare Service of Trøndelag, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Digital health care unit, Norwegian Centre for E-Health Research, Tromsø, Norway
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43
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Müßgens D, Burgard LC, Kleine-Borgmann J, Frettlöh J, Sorgatz H, Bingel U. Impact of the COVID-19 pandemic on patients with chronic pain in Germany: associations with expectations and control beliefs. Eur J Pain 2022; 26:1343-1354. [PMID: 35445510 PMCID: PMC9087415 DOI: 10.1002/ejp.1955] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background While the COVID‐19 pandemic is affecting people's well‐being worldwide, it may place a particularly high burden on people with chronic pain, as pain is known to be influenced by societal and psychological conditions. Methods In this observational study, we conducted telephone interviews with 196 patients with chronic pain to assess the impact of the pandemic on various aspects of their pain and everyday life. The initial interviews were conducted between April and May 2020 and were followed up by a second interview between August and December 2020. Results A substantial percentage of patients (39% at the first and 32% at the second interview) reported an increase in pain intensity due to the pandemic. Exploratory analyses revealed that patients who already suffered from greater pain and who experienced greater restrictions due to the pandemic were more likely to express pain worsening. Psychological factors such as negative expectations about the development of their pain and pain treatment and a high external locus of control were also associated with increases in pain. Conclusions These findings illustrate the complexity of chronic pain, suggesting that not only the impact of the pandemic on various areas of life but also the severity of the pain‐symptoms themselves and psychological factors influence the course of patients' symptoms during the pandemic. Significance This study underlines the importance of psychosocial factors in chronic pain and demonstrates that the societal and psychological impact of the COVID‐19 pandemic can affect patients' pain and their ability to cope with it. The extent to which patients experience pain aggravation seems to interact with other psychological factors such as pain expectations and control beliefs.
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Affiliation(s)
- Diana Müßgens
- Department of Neurology, Center of Translational Neuro- and Behavioral Sciences, University Medicine Essen, University Duisburg-, Essen, Germany
| | - Lisa Carolin Burgard
- Department of Neurology, Center of Translational Neuro- and Behavioral Sciences, University Medicine Essen, University Duisburg-, Essen, Germany
| | - Julian Kleine-Borgmann
- Department of Neurology, Center of Translational Neuro- and Behavioral Sciences, University Medicine Essen, University Duisburg-, Essen, Germany
| | - Jule Frettlöh
- Department of Neurology, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Hardo Sorgatz
- Technical University Human Sciences, Darmstadt, Germany
| | - Ulrike Bingel
- Department of Neurology, Center of Translational Neuro- and Behavioral Sciences, University Medicine Essen, University Duisburg-, Essen, Germany
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Schmidt K, Berding T, Kleine-Borgmann J, Engler H, Holle-Lee D, Gaul C, Bingel U. The beneficial effect of positive treatment expectations on pharmacological migraine prophylaxis. Pain 2022; 163:e319-e327. [PMID: 34010939 DOI: 10.1097/j.pain.0000000000002341] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/07/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Migraine is one of the leading causes of years lived with disability and considered to be a major global health concern. Pharmacological preventive treatment often causes side effects that limit the adherence to longer-term treatment regimens. Both experimental and clinical evidence suggests that positive expectations can modulate pain and analgesic treatment effects. However, the role of expectations in migraine prophylactic treatment has not systematically been investigated. Here, we examined the influence of treatment expectation before commencing pharmacological preventive treatment on its efficacy and tolerability in N = 134 episodic (30%) and chronic migraine (70%) patients in a prospective, longitudinal observational study over the course of 6 months. The migraine prophylaxis reduced the number of headache and migraine days with acceptable tolerability. Positive treatment expectation was associated with a generally lower number of headache and migraine days and a stronger reduction in headache days over the course of the treatment in chronic but not in episodic migraine patients. Moreover, patients with prior treatment showed a stronger reduction in headache days with higher expectation as compared to patients without prior experience. Our results underscore the relevance of further exploring the role of treatment expectation and its systematic modulation in patients with migraine and other pain conditions.
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Affiliation(s)
- Katharina Schmidt
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Tobias Berding
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Julian Kleine-Borgmann
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro-and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Dagny Holle-Lee
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Charly Gaul
- Migraine and Headache Clinic Königstein, Königstein, Germany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
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Stuhlreyer J, Schwartz M, Friedheim T, Zöllner C, Klinger R. Optimising treatment expectations in chronic lower back pain through observing others: a study protocol for a randomised clinical trial. BMJ Open 2022; 12:e059044. [PMID: 35017258 PMCID: PMC8753422 DOI: 10.1136/bmjopen-2021-059044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Chronic lower back pain (CLBP) is a frequent cause of medical consultations worldwide, and it results in decreased quality of life and disability. Current treatments for CLBP are often not effective, and alternatives are urgently needed. Three promising possibilities have emerged: (1) open-label placebo treatment reduces chronic pain, (2) placebo treatment is as efficacious as opioid treatment with a high correlation between patient expectation and treatment outcome, and (3) observing positive effects in another patient can improve functional capacity. We hypothesise that treatment expectations can be positively influenced through social observation and improve treatment outcome. METHODS AND ANALYSIS In our clinical trial, we will randomise patients with CLBP into five groups. Two groups receive either a 3 week course of treatment with an analgesic (ANA) (metamizole/dipyrone) or with open-label placebos (OLP). For one of each group, we will build treatment expectations through observational learning and assess its impact on the treatment. For this purpose, one group each will watch either a positive or a neutral video. The intervention groups will be compared with a control group that will not be given any medication or observational learning. Participants will be recruited via all institutions in the Hamburg metropolitan area that treat patients with CLBP. Patients are eligible for inclusion if they are at least 18 years or older, have CLBP (of at least 3 months duration), and agree to potentially receive an active ANA or an OLP. Patients with pain-related "red flags" will be excluded. The study requires 150 participants (30 participants per group) to assess the differences in the primary outcome, pain intensity. Secondary outcomes include changes in treatment expectations, anxiety, comorbid depression, stress-related neuroendocrine measures, functional and structural connectivity, functional capacity, and ANA consumption. All outcomes and treatment expectations will be measured before and after the intervention and 3 months post-intervention. ETHICS AND DISSEMINATION Ethical approval was obtained in January 2020 from the Hamburg Medical Ethics Council (ref number PV7067). Outcomes will be disseminated through publications in peer-reviewed journals and presentations at national and international conference meetings. TRIAL REGISTRATION NUMBER The approved trial protocol was registered at the German Clinical Trials Register (DRKS) and can be found at drks.de (Identifier: DRKS00024418).
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Affiliation(s)
- Julia Stuhlreyer
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marie Schwartz
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Friedheim
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zöllner
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Regine Klinger
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Pasquier M, Young JJ, Lardon A, Descarreaux M. Factors Associated With Clinical Responses to Spinal Manipulation in Patients With Non-specific Thoracic Back Pain: A Prospective Cohort Study. FRONTIERS IN PAIN RESEARCH 2022; 2:742119. [PMID: 35295527 PMCID: PMC8915706 DOI: 10.3389/fpain.2021.742119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/23/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction: The management of musculoskeletal disorders is complex and requires a multidisciplinary approach. Manual therapies, such as spinal manipulative therapy (SMT), are often recommended as an adjunct treatment and appear to have demonstrable effects on pain and short-term disability in several spinal conditions. However, no definitive mechanism that can explain these effects has been identified. Identifying relevant prognostic factors is therefore recommended for people with back pain. Objective: The main purpose of this study was to identify short-term candidate prognostic factors for clinically significant responses in pain, disability and global perceived change (GPC) following a spinal manipulation treatment in patients with non-specific thoracic back pain. Methods: Patients seeking care for thoracic spine pain were invited to participate in the study. Pain levels were recorded at baseline, post-intervention, and 1 week after a single session of SMT. Disability levels were collected at baseline and at 1-week follow-up. GPC was collected post-intervention and at 1-week follow-up. Biomechanical parameters of SMT, expectations for improvement in pain and disability, kinesiophobia, anxiety levels as well as perceived comfort of spinal manipulative therapy were assessed. Analysis: Differences in baseline characteristics were compared between patients categorized as responders or non-responders based on their pain level, disability level, and GPC at each measurement time point. Binary logistic regression was calculated if the statistical significance level of group comparisons (responder vs. non-responders) was equal to, or <0.2 for candidate prognostic factors. Results: 107 patients (62 females and 45 males) were recruited. Mean peak force averaged 450.8 N with a mean thrust duration of 134.9 ms. Post-intervention, comfort was associated with pain responder status (p < 0.05) and GPC responder status (p < 0.05), while expectation of disability improvement was associated with GPC responder status (p < 0.05). At follow-up, comfort and expectation of pain improvement were associated with responder GPC status (p < 0.05). No association was found between responder pain, disability or GPC status and biomechanical parameters of SMT at any time point. Discussion: No specific dosage of SMT was associated with short-term clinical responses to treatment. However, expectations of improvement and patient comfort during SMT were associated with a positive response to treatment.
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Affiliation(s)
- Mégane Pasquier
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Institut Franco-Européen de Chiropraxie, Toulouse, France
- *Correspondence: Mégane Pasquier
| | - James J. Young
- Center for Muscle and Joint Health Department, University of Southern Denmark, Odense, Denmark
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Arnaud Lardon
- Institut Franco-Européen de Chiropraxie, Toulouse, France
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Temporal–spectral signaling of sensory information and expectations in the cerebral processing of pain. Proc Natl Acad Sci U S A 2022; 119:2116616119. [PMID: 34983852 PMCID: PMC8740684 DOI: 10.1073/pnas.2116616119] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/14/2023] Open
Abstract
Pain is not only shaped by sensory information but also by an individual’s expectations. Here, we investigated how commonly analyzed electroencephalography (EEG) responses to pain signal sensory information, expectations, and discrepancies thereof (prediction errors) in the processing of pain. Bayesian analysis confirmed that pain perception was shaped by objective sensory information and expectations. In contrast, EEG responses at different latencies (including the N1, N2, and P2 components) and frequencies (including alpha, beta, and gamma oscillations) were shaped by sensory information but not by expectations. Thus, EEG responses to pain are more involved in signaling sensory information than in signaling expectations or prediction errors. Expectation effects are obviously mediated by other brain mechanisms than the effects of sensory information on pain. The perception of pain is shaped by somatosensory information about threat. However, pain is also influenced by an individual’s expectations. Such expectations can result in clinically relevant modulations and abnormalities of pain. In the brain, sensory information, expectations (predictions), and discrepancies thereof (prediction errors) are signaled by an extended network of brain areas which generate evoked potentials and oscillatory responses at different latencies and frequencies. However, a comprehensive picture of how evoked and oscillatory brain responses signal sensory information, predictions, and prediction errors in the processing of pain is lacking so far. Here, we therefore applied brief painful stimuli to 48 healthy human participants and independently modulated sensory information (stimulus intensity) and expectations of pain intensity while measuring brain activity using electroencephalography (EEG). Pain ratings confirmed that pain intensity was shaped by both sensory information and expectations. In contrast, Bayesian analyses revealed that stimulus-induced EEG responses at different latencies (the N1, N2, and P2 components) and frequencies (alpha, beta, and gamma oscillations) were shaped by sensory information but not by expectations. Expectations, however, shaped alpha and beta oscillations before the painful stimuli. These findings indicate that commonly analyzed EEG responses to painful stimuli are more involved in signaling sensory information than in signaling expectations or mismatches of sensory information and expectations. Moreover, they indicate that the effects of expectations on pain are served by brain mechanisms which differ from those conveying effects of sensory information on pain.
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Kimmey BA, McCall NM, Wooldridge LM, Satterthwaite T, Corder G. Engaging endogenous opioid circuits in pain affective processes. J Neurosci Res 2022; 100:66-98. [PMID: 33314372 PMCID: PMC8197770 DOI: 10.1002/jnr.24762] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 01/03/2023]
Abstract
The pervasive use of opioid compounds for pain relief is rooted in their utility as one of the most effective therapeutic strategies for providing analgesia. While the detrimental side effects of these compounds have significantly contributed to the current opioid epidemic, opioids still provide millions of patients with reprieve from the relentless and agonizing experience of pain. The human experience of pain has long recognized the perceived unpleasantness entangled with a unique sensation that is immediate and identifiable from the first-person subjective vantage point as "painful." From this phenomenological perspective, how is it that opioids interfere with pain perception? Evidence from human lesion, neuroimaging, and preclinical functional neuroanatomy approaches is sculpting the view that opioids predominately alleviate the affective or inferential appraisal of nociceptive neural information. Thus, opioids weaken pain-associated unpleasantness rather than modulate perceived sensory qualities. Here, we discuss the historical theories of pain to demonstrate how modern neuroscience is revisiting these ideas to deconstruct the brain mechanisms driving the emergence of aversive pain perceptions. We further detail how targeting opioidergic signaling within affective or emotional brain circuits remains a strong avenue for developing targeted pharmacological and gene-therapy analgesic treatments that might reduce the dependence on current clinical opioid options.
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Affiliation(s)
- Blake A. Kimmey
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Equal contributions
| | - Nora M. McCall
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Equal contributions
| | - Lisa M. Wooldridge
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Corder
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Rhon DI, Tucker CJ. Nonoperative Care Including Rehabilitation Should Be Considered and Clearly Defined Prior to Elective Orthopaedic Surgery to Maximize Optimal Outcomes. Arthrosc Sports Med Rehabil 2022; 4:e231-e236. [PMID: 35141556 PMCID: PMC8811522 DOI: 10.1016/j.asmr.2021.09.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Level of Evidence
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Affiliation(s)
- Daniel I. Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas, U.S.A
- Department of Rehabilitation Medicine, The Uniformed Services University of Health Science, Bethesda, Maryland, U.S.A
- Address correspondence to Daniel Rhon, Primary Care Musculoskeletal Research, Department of Rehabilitation Medicine, Brooke Army Medical Center, 3551 Roger Brooke Dr, JBSA Fort Sam Houston, TX 78234, U.S.A.
| | - Christopher J. Tucker
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
- Department of Surgery, The Uniformed Services University of Health Sciences, Bethesda, Maryland, U.S.A
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50
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Proulx-Bégin L, Herrero Babiloni A, Bouferguene S, Roy M, Lavigne GJ, Arbour C, De Beaumont L. Conditioning to Enhance the Effects of Repetitive Transcranial Magnetic Stimulation on Experimental Pain in Healthy Volunteers. Front Psychiatry 2022; 13:768288. [PMID: 35273527 PMCID: PMC8901579 DOI: 10.3389/fpsyt.2022.768288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/25/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE In this proof-of-concept study we sought to explore whether the combination of conditioning procedure based on a surreptitious reduction of a noxious stimulus (SRPS) could enhance rTMS hypoalgesic effects [i.e., increase heat pain threshold (HPT)] and augment intervention expectations in a healthy population. METHODS Forty-two healthy volunteers (19-35 years old) were enrolled in a randomized crossover-controlled study and were assigned to one of two groups: (1) SRPS and (2) No SRPS. Each participant received two consecutive sessions of active or sham rTMS over the M1 area of the right hand on two visits (1) active, (2) sham rTMS separated by at least one-week interval. HPT and the temperature needed to elicit moderate heat pain were measured before and after each rTMS intervention on the right forearm. In the SRPS group, conditioning consisted of deliberately decreasing thermode temperature by 3°C following intervention before reassessing HPT, while thermode temperature was held constant in the No SRPS group. Intervention expectations were measured before each rTMS session. RESULTS SRPS conditioning procedure did not enhance hypoalgesic effects of rTMS intervention, neither did it modify intervention expectations. Baseline increases in HPT were found on the subsequent intervention session, suggesting variability of this measure over time, habituation or a possible "novelty effect." CONCLUSION Using a SRPS procedure in healthy volunteers did not enhance rTMS modulating effects on experimental pain sensation (i.e., HPT). Future studies are therefore needed to come up with a conditioning procedure which allows significant enhancement of rTMS pain modulating effects in healthy volunteers.
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Affiliation(s)
- Léa Proulx-Bégin
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.,Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Alberto Herrero Babiloni
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Sabrina Bouferguene
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Gilles J Lavigne
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
| | - Caroline Arbour
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Louis De Beaumont
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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