Psychosocial differences between high-risk acute vs. chronic low back pain patients

Cross-cultural adaptation and psychometric properties of the Thai version of the patient-reported outcomes measurement information system short form- depression 8a in individuals with chronic low back pain

BACKGROUND

The study aimed to cross-culturally adapt the Patient-Reported Outcomes Measurement Information System Short Form v1.0 - Depression 8a (PROMIS SF v1.0 - Depression 8a) into Thai and evaluate its psychometric properties in individuals with chronic low back pain (CLBP).

METHODS

The PROMIS SF v1.0- Depression 8a was translated and cross-culturally adapted into Thai using the Functional Assessment of Chronic Illness Therapy translation methodology. Two hundred and sixty-nine individuals with CLBP completed the Thai version of PROMIS SF v1.0- Depression 8a (T-PROMIS-D-8a) scale and a set of measures assessing validity criterion domains. Structural validity, internal consistency, and test-retest reliability at a 7-day interval of the T-PROMIS-D-8a scale were computed and its construct validity was evaluated by computing correlations with the Thai version of Patient Health Questionnaire-9 (T-PHQ-9), Numeric Rating Scale of pain intensity (T-NRS), and Fear Avoidance Beliefs Questionnaire (T-FABQ).

RESULTS

Data from 269 participants were analyzed. Most participants were women (70%), and the sample had a mean age of 42.5 (SD 16.6) years. The findings supported the unidimensionality, internal consistency (Cronbach's alpha = 0.94), and test-retest reliability (ICC [2,1] = 0.86) of the T-PROMIS-D-8a. A floor effect was observed for 16% of the sample. Associations with the T-PHQ-9, T-NRS, and T-FABQ supported the construct validity of the T-PROMIS-D-8a.

CONCLUSIONS

The T-PROMIS-D-8a was successfully translated and culturally adapted. The findings indicated that the scale is reliable and valid for assessing depression in Thai individuals with CLBP.

Effect of stabilization exercise combined with respiratory resistance and whole body vibration on patients with lumbar instability: A randomized controlled trial

BACKGROUND

Lumbar stability exercise promotes deep muscle functions, and it is an effective intervention method for increasing proprioceptive sensation. This study aims to explore and compare the effects of lumbar stability exercise with respiratory resistance and whole body vibration on patients with lumbar instability.

METHODS

This study is a 3-group randomized control trial. Through screening tests, 48 patients with lumbar instability were selected and randomly assigned to SE group (n = 16), stabilization exercise program using respiratory resistance (SER) group (n = 16), and stabilization exercise program using respiratory resistance and whole body vibration (SERW) group (n = 16). In order to compare the effects depending on the intervention methods, quadruple visual analogue scale (QVAS), Functional Ability Roland-Morris low back pain and disability questionnaire ([RMDQ], center of pressure path length, velocity, and area), Korean version of fear-avoidance beliefs questionnaire, and Pulmonary Function were used for measurement.

RESULTS

All of the groups showed significant improvements in QVAS, RMDQ, Korean version of fear-avoidance beliefs questionnaire, and balance abilities before and after the interventions. The SER group and SERW group showed a significant difference in QVAS and RMDQ than the SE group (P < .05). In addition, balance ability showed a significant difference in SERW group (P < .05), where only the SER group showed a significant difference in pulmonary function indexes including forced vital capacity, forced expiratory volume in 1 second, maximum inspiratory pressure, and maximum expiratory pressure (P < .05).

CONCLUSION

Stabilization exercise program using respiratory resistance and whole-body vibration administered according to the purpose of intervention methods may be effective exercise programs for people with lumbar instability.

Anatomical study and clinical significance of the posterior ramus of the spinal nerve of the lumbar spine

Background and objectives: Chronic nonspecific back pain is a common clinical disease typically treated by ultrasound-guided spinal injection. This minimally invasive treatment targets the posterior ramus of the spinal nerve (PRSN). The target of the medial branch is clear, but there is unclear target for the intermediate and lateral branches. This study attempted to observe the distribution of PRSN in the dorsal region of transverse process to provide a more detailed anatomical basis for treating spinal pain.

Methods: The present study was conducted on 16 transverse processes of six adult male embalmed corpses. The dorsal area of the transverse process was divided into three equal zones, which are zone I, zone II and zone III from inside to outside. The origin, distribution, quantity, transverse diameter, and relationship with the bone structure of the PRSN on the transverse process were observed.

Results: Sixty PRSNs were found in the lumbar of six cadavers, of which 48 were divided into three branches, and 12 PRSNs were divided into two branches. The intermediate branch is mainly distributed in zone I, and the lateral branch is mainly distributed in zone II. Twenty-nine communicating branches were found in 48 adjacent segments of six specimens, all of which originated from the intermediate branch of the previous segment and connected with the lateral branch of the next segment.

Conclusion: This anatomical study describing the PRSN may have important clinical significance for spinal surgeons. Understanding the bony localization targets of the PRSN and the links between the PRSNs may benefit patients with low back pain who receive spinal injections.

Psychosocial morbidity profile in a community based sample of low back pain patients

Low back pain (LBP) is a major health concern and is closely associated with psychosocial morbidity and diminished Health-related quality of life (HRQoL). This is minimally investigated in community-based samples of developing nations like India. This study is aimed to specifically investigate the exposure-outcome associations between LBP and burden of disability (Modified Oswestry questionnaire (MODQ)), psychological morbidities (Depression, Anxiety and Stress Scale (DASS-21)), and HRQoL (Short Form -12 version 2 (SF12V2). A Cross-sectional study using a community-based sample of LBP positive population was conducted. The range of treatment options sought was also collected. Chi-square tests and independent t-test were used to analyze the data. Of 1531 recruited participants, 871(57%) were identified as LBP positive of whom 60% were females. Mean (SD) of age and pain intensity of LBP patients was 33 (11) years and numeric rating scale4.2 (2.6) respectively. Two-third reported minimal/moderate disability. Mean (SD) scores of depression 11.87 (4.05), anxiety (8.32), stress 13.7 (5.98), physical and mental summary scores of SF-12v2 were 47.9 (7.4) and 42.2 (10.4). A multitude of remedial options was sought for the ailment. LBP causes significant disability and psychological morbidity among affected population. This may adversely affect their HRQoL and subsequently productivity. Acupuncture was a preferred treatment sought by Indian LBP patients.

Efficacy of silver needle therapy for the treatment of chronic nonspecific low back pain: a prospective, single-center, randomized, parallel-controlled clinical trial

BACKGROUND

Chronic nonspecific low back pain (CNSLBP) troubles approximately 30% of people worldwide. Silver needle therapy (SNT) is a treatment method to relieve soft tissue pain through heating. Therefore, this study aimed to observe the effects of SNT on CNSLBP.

METHODS

In this study, 100 patients were randomly divided into 2 groups: silver needle (SN) group and control group (n = 50). In the SN group, patients received SNT and physiotherapy, while patients received physiotherapy alone in the control group. At the 6-month follow-up, the numerical rating scale (NRS), Oswestry Disability Index (ODI), Short-Form 12 of quality of life (SF-12), the natural logarithms of low-frequency measurement (InLF), and the natural logarithms of high-frequency measurement (InHF) of heart rate variability (HRV) were recorded.

RESULTS

In both groups, NRS, ODI, SF-12 scores, and HRV at 2 weeks after treatment were improved and maintained for 6 months. Compared with the control group, more significant improvements were observed in the NRS and SF-12 scores at 1, 2, 3, and 6 months and in the ODI scores at 1 and 2 months in the SN group (P <  0.05). However, there was no significant difference between the groups in the ODI scores at 3 and 6 months. InLF and InHF in the SN group were higher than those in the control group at 3 and 6 months (P <  0.05).

CONCLUSIONS

SNT relieved pain and improved quality of life and autonomic nerve activity, especially parasympathetic nerve, in patients with CNSLBP, without serious complications.

TRIAL REGISTRATION

Chinese Clinical Trial Registry No. ChiCTR-OOC-17013237 . Registered on November 11, 2017.

Screening Tools to Predict the Development of Chronic Low Back Pain: An Integrative Review of the Literature

OBJECTIVE

To identify and describe available instruments that can be used to screen patients with acute or subacute low back pain for a chronic low back pain trajectory.

DESIGN

Integrative literature review.

METHODS

An electronic search of PubMed/MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, and PsychINFO databases took place from May through July of 2014 using systematic search strategies to identify screening instruments developed to identify people at risk of chronic low back pain. After screening for inclusion and exclusion criteria as well as quality indicators, the identified studies were categorized based on whether the instrument measured psychological, clinical, or functional measures to predict chronic low back pain.

RESULTS

Initial searches identified 2,274 potential articles. After assessing for duplicates, title, and abstract content, there were 129 remaining articles. Articles were further excluded after analysis of the text, for a total of 42 studies reviewed. Most instruments reviewed were unable to provide evidence of predictive power for developing chronic low back pain.

CONCLUSIONS

This review identified numerous instruments developed to assess the likelihood of chronic low back pain in acute and subacute low back pain populations. Of the instruments reviewed, the STarT Back Screening Tool and the Örebro Musculoskeletal Pain Questionnaire demonstrated superior predictive power compared with other instruments. Both screening tools offer evidence of validation, translation into different languages and international application, and usage in various health care settings and provide data on predictive power.

Importance of Early Improvement in the Treatment of Low Back Pain With Physical Therapy

STUDY DESIGN

.: A retrospective observational study.

OBJECTIVE

Assess the time course of functional outcome improvements during a physical therapy (PT) episode of care for patients with low back pain. In addition, assess the impact of patient variables, such as symptom duration, on the time course of functional outcome improvements.

SUMMARY OF BACKGROUND DATA

Early improvement in patient-reported symptoms and functional limitations may play an important role in the eventual success of an intervention. Early improvements in pain are associated with greater improvement in disability and depression in patients with low back pain.

METHODS

A total 11,945 patients were included. Intake functional status (FS), FS change at discharge, predicted FS change at discharge, FS change at first progress report (FS1), duration of symptoms before treatment, and duration of PT episode of care were assessed. Pearson correlation analysis was used to assess correlation between collected variables and FS change.

RESULTS

The mean FS change was 16.995 units, mean FS1 was 12.024 units, total duration was 63.591 days, and duration at FS1 was 28.969 days, indicating 70.72% of FS change occurred in the first 45.45% of the episode of care. Similar results occurred in all symptom duration categories, ranging from "0 to 7 days' to "greater than 6 months' duration. Correlation analysis demonstrated that FS1 had the greatest correlation to FS. A strong correlation (r > 0.7) was demonstrated in all symptom duration categories ranging from 0.741 to 0.805.

CONCLUSION

The results of this study yield further support for the importance of rapid functional improvements during a PT episode of care. In addition, patients demonstrated roughly two-thirds of their improvement in the first 40% of visits regardless of their symptom duration. This study may help clinicians identify a need to modify a plan of care if insufficient early improvement is observed.

LEVEL OF EVIDENCE

3.

Effect of Low Back Pain Chronicity on Patient Outcomes Treated in Outpatient Physical Therapy: A Retrospective Observational Study

OBJECTIVE

To examine the potential relationship between physical therapy (PT) treatment outcomes and chronicity of low back pain (LBP) in the outpatient setting.

DESIGN

Retrospective observational study.

SETTING

Outpatient PT clinics across 11 states.

PARTICIPANTS

A total of 11,941 patients with LBP provided with PT services and discharged from care between January 1, 2017, and December 31, 2018.

MAIN OUTCOME MEASURES

Focus on Therapeutic Outcome Low Back Functional Status (FS) Patient-Reported Outcome Measure (PROM) was the primary outcomes measure used. It assesses the patients' perceived physical abilities for patients experiencing LBP impairments. It determined a functional score on a linear metric ranging from 0 (low functioning) to 100 (high functioning). The difference in score between the intake FS and final FS score produced the FS change, which represented the overall improvement of the episode of care.

RESULTS

The mean FS change was 16.997 (n=11,945). Patients with chronic symptoms (>90-d duration) had an FS change of 15.920 (n=7264) across 14.63 visits. Patients with subacute symptoms (15-90d) had an FS change of 21.66 (n=3631) across 14.05. Patients with acute symptoms (0-14d) had an FS change of 29.32 (n=1050) across 13.66 visits. Stepwise regression analysis revealed a significant â for chronicity (-4.155) with all models.

CONCLUSIONS

Overall, this study shows patients experiencing shorter duration of LBP symptoms before starting a PT episode of care experience significantly better outcomes than patients who waited. Furthermore, the number of treatment session and duration of care was similar between groups, indicating potential ineffective or insufficient care was provided for patients with chronic pain.

Exploring Neuromuscular Electrical Stimulation Intensity Effects on Multifidus Muscle Activity in Adults With Chronic Low Back Pain: An Ultrasound Imaging-Informed Investigation

Study design:

Cross-sectional study.

Background:

Neuromuscular electrical stimulation (NMES) is an effective tool for stimulating multifidus muscle contractions. Ultrasound imaging (USI) is valid and reliable for quantifying multifidus activity represented by percent thickness change from a resting to contracted state. Thus, USI may be used to help determine optimal NMES intensity.

Objectives:

To explore NMES intensity effects on multifidus thickening in adults with chronic low back pain (CLBP).

Methods:

Sixty patients with CLBP participated. L4/5 multifidus ultrasound images were obtained and percent thickness change from a resting to a contracted state was determined at baseline with a limb lift and during NMES application. During NMES, the examiner recorded the intensity, in milliampere, when the multifidus first started to thicken as observed with USI. The examiner also recorded the NMES intensity that resulted in no further multifidus thickening (ie, high-tolerance group) or, in cases where maximal thickening was not observed, the NMES intensity of the submaximal contraction (ie, low-tolerance group). Differences between participants with high versus low NMES tolerance were evaluated.

Results:

During NMES, the multifidus began thickening at a higher intensity for the high-tolerance group (n = 39), that is, 34 mA, compared with the low-tolerance group (n = 21), that is, 32 mA (P = .001). A greater mean intensity in the high-tolerance group, that is, 62 mA, as compared to 45 mA in the low-tolerance group, resulted in a larger percent thickness change, that is, 30.89% compared to 20.60%, respectively (P < .001).

Conclusions:

Results provide clinicians with NMES intensity targets to facilitate multifidus muscle thickening, which provides insight into muscle activity.

Effects of a Progressive Stabilization Exercise Program Using Respiratory Resistance for Patients with Lumbar Instability: A Randomized Controlled Trial

Background

This study investigated the effects of progressive stabilization exercise program carried out with respiratory resistance in patients with lumbar instability.

Material/Methods

Forty-three patients with lumbar instability were randomly assigned to experimental (n=20) and control groups (n=23). The experimental group performed progressive lumbar stabilization exercises along with respiratory resistance, and the control group only performed progressive lumbar stabilization exercises, for 40 min per session, 3 sessions a week, for 4 weeks. Numeric rating scale (NRS), Korean-Oswestry disability index (K-ODI), static balance ability, Fear-Avoidance Beliefs Questionnaire (FABQ), and pulmonary function test (PFT) were performed before and after the intervention program for comparison.

Results

The 2 groups showed significant differences in NRS, K-ODI, balance ability, and FABQ after the interventions (p<0.05), but greater improvements were shown by the experimental group in balance ability and FABQ values. PFT results in the experimental group showed a significant increase (p<0.05) in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and maximum voluntary ventilation (MVV). The experimental group showed a greater improvement (p<0.05) in FVC and MVV compared to the control group.

Conclusions

Progressive stabilization exercise program with respiratory resistance is an effective method with clinical significance in pain reduction, psychosocial stability, and enhancement of motor and respiratory functions.

Effects of scrambler therapy on pain and depression of patients with chronic low back pain: case study

[Purpose] This study was designed to investigate the effect of scrambler therapy on the pain and depression of patients with chronic low back pain. [Subject and Methods] Applied scrambler therapy to a 52 year-old man who was diagnosed with chronic low back pain, for 40 minutes once a day during the 10-day execution. Pain and depression were measured using the visual analogue scale and the Beck Depression Inventory. [Results] According to the measurement results, pain and depression decreased after ten sessions of scramble therapy. [Conclusion] Scrambler therapy shows positive effects on pain and depression of patients with chronic low back pain.

Psychosocial predictors in the transition from acute to chronic pain: a systematic review

Chronic non-cancer pain (CNCP) is a major health problem which psychosocial factors have significant implications in. There is a gap in regards to evidence for the prevention of chronicity specifically addressing psychological and social domains. Four databases were searched with terms related to "psychosocial", "acute pain", and "chronic pain". A total of 1,389 studies were identified in which titles, abstracts, and full texts were assessed for inclusion criteria. A data template was used to capture pertinent details, and overall themes and patterns were organized according to type of pain examined and psychosocial variables measured. Of the 18 articles that met inclusion criteria, fifteen (83%) of the articles reported an association between psychosocial factors and chronicity. A total of 5 of the studies (29%) demonstrated that depression was a possible predictor and 6 (35%) of the studies found fear-avoidance to be associated with chronicity. This review provides evidence that psychosocial factors are associated with chronicity within CNCP. These results suggest a need for targeting psychosocial predictors in prevention and early intervention through clinical guidelines and a national strategy to support a cultural change in pain care.

The impact of somatic symptoms on the course of major depressive disorder

OBJECTIVE

Somatic symptoms have been suggested to negatively affect the course of major depressive disorder (MDD). Mechanisms behind this association, however, remain elusive. This study examines the impact of somatic symptoms on MDD prognosis and aims to determine whether this effect can be explained by psychiatric characteristics, somatic diseases, lifestyle factors, and disability.

METHODS

In 463 MDD patients (mean age=44.9 years, 69.8% female) from the Netherlands Study of Depression and Anxiety (NESDA), we examined whether the type and number of somatic symptom clusters predicted the two-year persistence of MDD. Diagnoses of MDD were established with the Composite International Diagnostic Interview (CIDI) and somatic symptom clusters were assessed with the Four-Dimensional Symptom Questionnaire (4DSQ) somatization scale. Psychiatric characteristics, somatic diseases, lifestyle factors, and disability were taken into account as factors potentially underlying the association.

RESULTS

The cardiopulmonary, gastrointestinal, and general cluster significantly predicted the two-year persistence of MDD, but only when two or more of these clusters were present (OR=2.32, 95% CI=1.51-3.57, p=<0.001). Although the association was partly explained by MDD severity, the presence of multiple somatic symptom clusters remained a significant predictor after considering all potentially underlying factors (OR=1.69, 95%CI=1.07-2.68, p=0.03).

CONCLUSIONS

Somatic symptoms are predictors of a worse prognosis of MDD independent of psychiatric characteristics, somatic diseases, lifestyle factors, and disability. These results stress the importance of considering somatic symptoms in the diagnostic and treatment trajectory of patients with MDD. Future research should focus on identifying treatment modalities targeting depressive as well as somatic symptoms.

The evolving role of physical therapists in the long-term management of chronic low back pain: longitudinal care using assisted self-management strategies

Background

Longitudinal studies have shown that the symptoms of chronic low back pain (CLBP) will follow an episodic trajectory characterized by periods of high and low pain intensity that can persist for many years. There is a growing belief that the contemporary approach of limiting physical therapy to short, but intense courses of treatment for (CLBP) may be sub-optimal because these limited “windows” of clinical care are not congruent with the natural history of this condition. Recent research has suggested that people with CLBP undergo substantial, and individualized long-term variations in the neural processing of nociception over time. This has led to the concept of a “unique biosignature of pain” that may explain much of the variation in a person’s clinical picture. These and other findings have led to the reconceptualization of CLBP as an individualized, and continually evolving condition that may be more suitably managed by empowering the patient toward self-management strategies that can be modified as needed over time by the PT.

Objectives

The purpose of this Master Class Paper is to describe an emerging approach for the treatment of CLBP that emphasizes the formation of a long-term therapeutic alliance between the patient and the PT with an emphasis on individualized, patient-preferred approaches for activity-based self-management as an alternative to the contemporary approach of short, intense episodes of care directed toward pain reduction.

Conclusion

Longitudinal care using assisted self-management strategies is more congruent with the natural history of CLBP than are traditional approaches for PT intervention. This approach may empower patients to undergo lifestyle changes that will favorably influence long-term outcomes; however additional research is needed.

Interpersonal Responses and Pain Management Within the US Military

Purpose Chronic pain poses a significant problem for the US military. The benefits of self-management treatments for chronic pain are well-documented, but interpersonal responses also influence physical and psychological health and may not be addressed through self-management treatments alone. The current study examines whether perceived interpersonal responses to pain, as measured by the Multidimensional Pain Inventory (MPI), change as a result of participation in an intensive pain management program. It was hypothesized that interpersonal responses to pain would be significantly correlated to psychosocial and physical pain outcomes and that interpersonal responses to pain would change significantly for completers of a functional restoration (FR) program compared to those who were randomized to treatment-as-usual in the military medical system. Methods Forty-four participants were randomly assigned to one of two treatment groups. One treatment group received FR (n = 26) and the other group received treatment-as-usual (n = 18). Significant other responses to chronic pain were measured by the MPI (Pain 23(4):345-356, 1985). Participants also completed measures of impacted quality of life, reported disability, psychological distress, fear avoidance, pain interference, and physical activity. Results Perceived higher punishing responses from a significant other were significantly related to worse physical health-related quality of life (p = .037), work-related fear avoidance (p = .008), pain interference (p = .026), affective distress (p = .039), and pain while lifting (p = .017). Perceived higher solicitous responses from significant others were significantly associated with lower mental health-related quality of life (p = .011), household activity (p = 017), general activity (p = .042), self-reported disability (p = .030), lifting capacity (p = .005), and aerobic capacity (p = .009). Conclusions While findings are preliminary and of limited scope, it appears that the perception of significant others' responses may be impacted by psychosocial and physical pain outcomes and may change after treatment. More work in this area is needed to uncover the benefits one might achieve when a significant other is included within the FR treatment framework.

Eye Movement Desensitization and Reprocessing vs. Treatment-as-Usual for Non-Specific Chronic Back Pain Patients with Psychological Trauma: A Randomized Controlled Pilot Study

OBJECTIVE

Eye movement desensitization and reprocessing (EMDR)-an evidence-based approach to eliminate emotional distress from traumatic experiences-was recently suggested for the treatment of chronic pain. The aim of this study was to estimate preliminary efficacy of a pain-focused EMDR intervention for the treatment of non-specific chronic back pain (CBP).

DESIGN

Randomized controlled pilot study.

METHODS

40 non-specific CBP (nsCBP) patients reporting previous experiences of psychological trauma were consecutively recruited from outpatient tertiary care pain centers. After baseline assessment, patients were randomized to intervention or control group (1:1). The intervention group received 10 sessions standardized pain-focused EMDR in addition to treatment-as-usual (TAU). The control group received TAU alone. The primary outcome was preliminary efficacy, measured by pain intensity, disability, and treatment satisfaction from the patients' perspective. Clinical relevance of changes was determined according to the established recommendations. Assessments were conducted at the baseline, posttreatment, and at a 6-month follow-up. Intention-to-treat analysis with last observation carried forward method was used. Registered with http://ClinicalTrials.gov (NCT01850875).

RESULTS

Estimated effect sizes (between-group, pooled SD) for pain intensity and disability were d = 0.79 (CI_95%: 0.13, 1.42) and d = 0.39 (CI_95%: -0.24, 1.01) posttreatment, and d = 0.50 (CI_95%: 0.14, 1.12) and d = 0.14 (CI_95%: -0.48, 0.76) at 6-month follow-up. Evaluation on individual patient basis showed that about 50% of the patients in the intervention group improved clinically relevant and also rated their situation as clinically satisfactory improved, compared to 0 patients in the control group.

CONCLUSION

There is preliminary evidence that pain-focused EMDR might be useful for nsCBP patients with previous experiences of psychological trauma, with benefits for pain intensity maintained over 6 months.

Chronic pain and depression among primary care patients treated with buprenorphine

BACKGROUND

Pain and depression are each prevalent among opioid dependent patients receiving maintenance buprenorphine, but their interaction has not been studied in primary care patients.

OBJECTIVE

We set out to examine the relationship between chronic pain, depression, and ongoing substance use, among persons maintained on buprenorphine in primary care settings.

DESIGN

Between September 2012 and December 2013, we interviewed buprenorphine patients at three practice sites.

PARTICIPANTS

Opioid dependent persons at two private internal medicine offices and a federally qualified health center participated in the study.

MAIN MEASURES

Pain was measured in terms of chronicity, with chronic pain being defined as pain lasting at least 6 months; and in terms of severity, as measured by self-reported pain in the past week, measured on a 0-100 scale. We defined mild chronic pain as pain severity between 0 and 39 and lasting at least 6 months, and moderate/severe chronic pain as severity ≥ 40 and lasting at least 6 months. To assess depression, we used the Center for Epidemiologic Studies Depression (CESD) ten-item symptom scale and the two-item Patient Health Questionnaire (PHQ-2).

KEY RESULTS

Among 328 participants, 169 reported no chronic pain, 56 reported mild chronic pain, and 103 reported moderate/severe chronic pain. Participants with moderate/severe chronic pain commonly used non-opioid pain medications (56.3%) and antidepressants (44.7%), yet also used marijuana, alcohol, or cocaine (40.8%) to help relieve pain. Mean CESD scores were 7.1 (±6.8), 8.3 (±6.0), and 13.6 (±7.6) in the no chronic, mild, and moderate/severe pain groups, respectively. Controlling for covariates, higher CESD scores were associated with a higher likelihood of moderate/severe chronic pain relative to both no chronic pain (OR = 1.09, p < 0.001) and mild chronic pain (OR = 1.06, p = 0.04).

CONCLUSION

Many buprenorphine patients are receiving over-the-counter or prescribed pain medications, as well as antidepressants, and yet continue to have significant and disabling pain and depressive symptoms. There is a clear need to address the pain-depression nexus in novel ways.

Better or Worse: a Study of Day-to-Day Changes over Five Months of Rosen Method Bodywork Treatment for Chronic Low Back Pain

Background

Fluctuations of good days and bad days—in physical symptoms and emotional states—are common for individuals with chronic illness. This pilot study examines these fluctuations during bodywork treatment.

Purpose

We analyzed changes in daily self-reports over a period of five months for five individuals who received weekly treatments of Rosen Method Bodywork (RMB), which uses touch and words to enhance body awareness of physical sensations and emotional states.

Subjects and Design

Five subjects (aged 31–56) who had chronic low back pain (CLBP) received 16 weekly treatments given by three experienced RMB practitioners.

Measures

Pre- and posttreatment assessments covered demographics, disability, and pain. Clients also completed daily bedtime assessments of pain, fatigue, emotional state, and sense of control during the entire treatment period.

Results

All clients reported reductions in pain and/or disability in post- compared to pretreatment. In spite of a high level of day-to-day variability in the daily assessments, there were significant reductions in pain and fatigue, and significant increases in positive emotional state and sense of control across the treatment period. In reaching this end, however, some clients had slow and steady improvements, some improved more rapidly, while others got worse before they got better.

Conclusions

The natural course of healing—with its inevitable fluctuations in symptoms—is part of a process leading to successful treatment outcomes. Rosen Method Bodywork may be especially helpful in developing and accepting both sensory and emotional body awareness changes that facilitate overall improvement.

Low preparedness before the loss of a wife to cancer and the widower's chronic pain 4-5 years later-a population-based study

OBJECTIVE

The focus of this study was on the impact of spousal loss on the development of chronic pain thereafter. More specifically, the aim was to investigate the effect of experiencing low preparedness before a wife's death and the widower's chronic pain 4-5 years after loss.

METHODS

In a population-based study in the years 2004-2005, anonymous questionnaires were sent out to 907 men in Sweden who had lost a wife to cancer in 2000 and 2001. The questionnaires contained questions on the man's preparedness for his wife's death and his physical and psychological health at follow-up.

RESULTS

Altogether, 691 out of 907 questionnaires were retrieved (76%). Younger widowers (38-61 years old) with a low degree of preparedness for their wife's death had an increased risk of experiencing symptoms of chronic pain (odds ratio 6.67; 2.49-17.82) 4-5 years after loss. The same results did not apply for older widowers (62-80 years old) (odds ratio 0.81; 0.32-2.05). Widowers who experienced chronic pain were at an increased risk for psychological morbidity, depression (relative risk [RR] 2.21; 1.31-3.74), anxiety (RR 2.11; 1.33-3.37), and sleep disorders (RR 2.19; 1.30-3.69).

CONCLUSION

Our data suggest that low preparedness for a wife's death may increase risk of chronic pain among younger widowers 4-5 years after loss. In addition, we found comorbidity between psychological symptoms and chronic pain among widowers. These findings call for studies on possible mechanisms in the association between low preparedness and morbidity and on how to increase preparedness for a wife's death to cancer.

Assessment of research quality of telehealth trials in pain management: a meta-analysis

Although telehealth-based pain management research has grown over the last decade, it is difficult to determine the state of the research because of methodological differences and variability in quality among existing studies. In a previous systematic review, we outlined these differences and preliminarily explored the promise of telehealth for pain intervention. We completed a PRISMA compliant meta-analysis of telehealth pain management research to more precisely describe the state of the research and to uncover gaps in the existing literature that highlight directions for future research. We identified 10 relevant studies completed between 2000 and 2011 including 3 noninferiority and 7 superiority studies. Meta-analysis revealed an overall benefit of telehealth interventions over control conditions and equivalence with in-person intervention. However, some of the reviewed studies found no benefit for telehealth over control conditions. Some methodological concerns among the examined research included poor research quality, small sample sizes, and the examination of telehealth pain interventions without proven efficacy for in-person treatment. Recommendations for future studies are reviewed.

Psychosocial work characteristics, need for recovery and musculoskeletal problems predict psychological distress in a sample of British workers

From an original sample of 2454 participants free of self-reported psychological distress, 1463 workers completed a 15-month follow-up. Baseline measures included exposure to job demands, decision latitude, social support and need for recovery. Psychological distress was assessed using the General Health Questionnaire at baseline and at follow-up. The findings showed that medium and high exposure to job demands and social support increased the risk of reporting psychological distress at 15-months (relative risk (RR) = 1.65, 1.45). The highest adjusted RR was observed for workers reporting a high need for recovery after work (RR 2.12, 1.90) and this finding was independent of the effects of job demands, decision latitude and social support. Neither decision latitude, nor low back problems increased the risk of reporting future psychological distress, although neck problems (RR = 1.66) and hand/wrist problems (RR = 1.45) did. It was concluded that need for recovery appears to be an important indicator of individual workers who are at risk of developing psychological distress long term. STATEMENT OF RELEVANCE: This paper reports the findings of a longitudinal study showing that need for recovery from work was the strongest predictor, relative to psychosocial work characteristics (job demands, decision latitude and social support), and musculoskeletal problems, of psychological distress 15 months later in individuals initially free from distress.

Musculo-skeletal pain, quality of life and depression in mothers of children with cerebral palsy

OBJECTIVE

To evaluate musculoskeletal pain (MSP) in mothers of children with cerebral palsy (CP), and to determine the effects of zone of pain on health-related quality of life (QoL) and symptoms of depression.

PATIENTS AND METHODS

The study included a total of 81 children with CP, together with their mothers (group 1), and a total of 60 healthy children, together with their mothers (group 2). Presence of MSP, and the zone of pain in mothers were evaluated [lower back pain (LBP), pain in other zones, without pain]. Mothers' QoL was assessed with Short Form-36 (SF-36) scale, and presence of symptoms of depression was assessed with Beck Depression Inventory (BDI). Multivariate analysis of variance test analysis was performed to see the main effects of the factors mother having a child with CP (group 1, group 2) and zone of pain (LBP, other, no pain) on the BDI scores and SF-36 QoL sub parameters of mothers. Logistic regression analysis was performed to determine the parameters predicting the presence of LBP in mothers in group 1.

RESULTS

MSP and LBP were found to be significantly higher in group 1. Main effect of the mother having a child with CP on BDI score and physical role (PR) and mental health (MH) parameters was found to be significant. Mean BDI scores of mothers in group 1 was found to be significantly higher as compared to the other group, and mean PR parameter and MH values were found to be significantly lower. Main effect of the zone of pain (arising from the group of mothers with LBP) was found to be significant on physical functioning, bodily pain, general health perception, MH parameters and BDI. Logistic regression analysis showed that MH and bodily pain parameters significantly predicted the presence of LBP.

CONCLUSION

Deterioration of MH in mothers with cerebral palsied child may be causing them to experience more LBP. Experience of increased LBP causes deterioration of health-related QoL.

The comparative effectiveness of a multimodal program versus exercise alone for the secondary prevention of chronic low back pain and disability

OBJECTIVE

The objective of this study was to examine whether a multimodal, secondary prevention program (MP) is superior to a general physical exercise program (EP) in influencing the process leading to chronic low back pain (LBP) in nurses with a history of back pain.

DESIGN

The study was conducted as a randomized controlled parallel-group trial.

SETTING

The interventions were performed in a single center at the Department of Physical and Rehabilitation Medicine at the University of Munich in Germany.

PARTICIPANTS

A total of 235 nurses from 14 nearby hospitals and nursing homes who experienced at least one episode of back pain during the previous 2 years were invited into the study. Of these, 183 nurses were enrolled and 169 (83 in the MP and 86 in the EP) qualified for the intent-to-treat analysis.

INTERVENTIONS

The EP consisted of 11 group sessions, each lasting 1 hour. After introductory sessions, subsequent sessions included general physical strengthening and stretching exercises as well as instructions for a home-training program. The MP consisted of 17 group sessions of 1.75 hours and one individual session of 45 minutes. In addition to the full EP, the MP included 5 psychological units, 7 segmental stabilization exercises units, and 8 ergonomic and workplace-specific units.

MAIN OUTCOME MEASUREMENTS

The primary study end-point variable was pain interference, and the secondary study end-point variables were pain intensity and functioning as measured with the West Haven-Yale Multidimensional Pain Inventory and the Short Form-36, respectively. These study end-point variables were defined a priori.

RESULTS

There was no statistically significant difference between the 2 groups. Small-to-moderate effects were observed in both intervention programs across all study end-point variables. For pain interference, the effect size at 12 months after intervention was 0.58 in the MP and 0.47 in the EP.

CONCLUSIONS

A multimodal program is not superior to a general exercise program in influencing the process leading to chronic LBP in a population of nurses with a history of pain. The most likely explanation is a common psychological mechanism leading to improved pain interference that is irrespective of the program used. Considering the lower resources of the general exercise program, the expense for a multimodal program is not justified for the secondary prevention of LBP and disability.