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Benedict TM, Nitz AJ, Gambrel MK, Louw A. Pain neuroscience education improves post-traumatic stress disorder, disability, and pain self-efficacy in veterans and service members with chronic low back pain: Preliminary results from a randomized controlled trial with 12-month follow-up. MILITARY PSYCHOLOGY 2024; 36:376-392. [PMID: 38913769 PMCID: PMC11197901 DOI: 10.1080/08995605.2023.2188046] [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: 04/14/2022] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
Post-traumatic stress disorder (PTSD) and chronic low back pain (CLBP) are frequently co-morbid. Some research suggests that PTSD and CLBP may share common neurobiological mechanisms related to stress. Traditional biomedical education may be ineffective for PTSD and CLBP, especially when co-morbid. The purpose of this study is to determine if pain neuroscience education (PNE) is more effective than traditional education in reducing PTSD, disability, pain, and maladaptive beliefs in patients with CLBP. Participants with CLBP and possible PTSD/PTSD-symptoms were recruited for this study. Participants were randomly allocated to a PNE group or a traditional education group. The intervention included 30 minutes of education followed by a standardized exercise program once a week for 4-weeks with a 4 and 8-week follow-up and healthcare utilization assessed at 12-months. Forty-eight participants consented for this research study with 39 allocated to treatment (PNE n = 18, traditional n = 21). PNE participants were more likely to achieve a clinically meaningful reduction in PTSD symptoms and disability at short-term follow-up. At 12-months, the PNE group utilized healthcare with 76% lower costs. In participants with CLBP, PNE may reduce hypervigilance toward pain and improve PTSD symptoms. Participants who received PNE were more confident body-tissues were safe to exercise. These beliefs about pain could contribute to a decrease in perceived disability and healthcare consumption for CLBP.
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Affiliation(s)
- Timothy M. Benedict
- Baylor University – Keller Army Community Hospital, Division 1 Sports Physical Therapy Fellowship, United States Military Academy, West Point, New York
| | - Arthur J. Nitz
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
| | - Michael K. Gambrel
- Department of Physical Therapy, Veterans Affairs Medical Center, Lexington, Kentucky
| | - Adriaan Louw
- Director of Pain Science, Evidence in Motion, Story City, Iowa
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Basnet R, Jensen MP, Pathak A, Gurung G, Thagunna NS, Elisa Maharjan, Hansford H, Riju Maharjan, Nicholas M, Sharma S. Self-Efficacy in Nepali Adults With Musculoskeletal Pain: Measurement Properties of Hard-Copy and Online Versions of the Pain Self-Efficacy Questionnaire. THE JOURNAL OF PAIN 2024; 25:918-933. [PMID: 37871683 DOI: 10.1016/j.jpain.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023]
Abstract
The Pain Self-Efficacy Questionnaire (PSEQ) is commonly used in pain self-efficacy research. Yet its Nepali translation is unavailable, limiting the ability to conduct cross-cultural research on the role of self-efficacy in musculoskeletal pain and its management. This study aimed to 1) translate and culturally adapt the 10-item (PSEQ-10) and 2-item (PSEQ-2) versions of the PSEQ into Nepali, 2) evaluate their measurement properties in Nepali adults with musculoskeletal pain, and 3) evaluate whether the type of administration (ie, hard-copy vs online) affected their measurement properties. The measurement properties of different administrations of the Nepali PSEQ-10 and PSEQ-2 were evaluated in 180 Nepali adults (120 hard-copy and 60 online administrations) with musculoskeletal pain. We conducted confirmatory factor analyses and estimated the measures' internal consistencies, test-retest reliabilities, and smallest detectable changes using standard error of measurement. We planned to conclude that the measures were valid if ≥ 75% of the validity hypotheses were supported. The results supported unidimensionality for the Nepali PSEQ-10. The Nepali PSEQ-2 and PSEQ-10 evidenced excellent internal consistencies (Cronbach alphas = .90-.95) and good to excellent test-retest reliabilities (intraclass correlation coefficient = .61-.85) for both administrations. Construct validity (r's ≥ .20) and concurrent validity (r's ≥ .83) were supported, as hypothesized. Both hard-copy and online administrations of the Nepali PSEQ-2 and PSEQ-10 are similar, reliable, and valid ways to assess self-efficacy in Nepali adults with musculoskeletal pain. The findings should facilitate telehealth and cross-cultural research on pain self-efficacy in Nepal. PERSPECTIVE: This is the first Nepali adaptation of a self-efficacy scale with testing of measurement properties for hard-copy and online administrations. It will facilitate the assessment of pain self-efficacy in clinical practice and research and facilitate a deeper cross-cultural understanding of the role of self-efficacy in musculoskeletal pain.
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Affiliation(s)
- Ritu Basnet
- Department of Psychology, K and K International College, Tribhuvan University, Kathmandu, Nepal; Department of Physiotherapy, Scheer Memorial Hospital, Banepa, Bagmati, Nepal; Department of Psychiatry and Mental Health, Maharajgunj Medical Campus, T.U. Institute of Medicine, Kathmandu, Nepal
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Anupa Pathak
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gagan Gurung
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand; Te Whatu Ora, National Public Health Service, Southern, Dunedin, New Zealand
| | - Narendra Singh Thagunna
- Department of Psychology, K and K International College, Tribhuvan University, Kathmandu, Nepal; Department of Psychology, Padma Kanya Multiple Campus, Tribhuvan University, Kathmandu, Nepal
| | - Elisa Maharjan
- Department of Physical Medicine and Rehabilitation, Star Hospital, Lalitpur, Bagmati, Nepal
| | - Harrison Hansford
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Riju Maharjan
- Department of Physiotherapy, Upendra Devkota Memorial Hospital, Bansbari, Kathmandu, Nepal
| | - Michael Nicholas
- Pain Management Research Institute, The Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
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Hoevenaars EHW, Smolders JMH, Veenstra K, O'Dowd J, Heesterbeek PJC. Improvement in functional outcome 1 year after nonsurgical multidisciplinary treatment for chronic pain after total knee arthroplasty: A prospective cohort study. Knee Surg Sports Traumatol Arthrosc 2024; 32:461-472. [PMID: 38284904 DOI: 10.1002/ksa.12058] [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: 10/13/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE The purpose of this study was to evaluate a multidisciplinary intervention developed for patients with debilitating chronic pain after total knee arthroplasty (TKA) unresponsive to existing treatment options. METHODS A treatment-based prospective cohort study was caried out in 30 TKA patients with debilitating chronic pain at least 1 year after TKA. The treatment was a multidisciplinary intervention. Main inclusion criteria: no indication for surgery. Primary outcome was function measured by KOOS-PS, OKS, OKS-APQ and WORQ. Secondary outcome measures were pain, fear of movement, self-efficacy, quality of life (QoL), health care and pain medication use, work rehabilitation and patient satisfaction. The assessments took place pre- and directly posttreatment, at 1, 3 and 12 months follow-up. The clinical relevance was assessed by predefined minimal important clinical change (MCIC). RESULTS At baseline patients were on average 64.7 (±7.9) years old, 67% were female, and they had knee pain for 42 (10-360) months. The results at 12-month follow-up: first, a significant improvement was shown in function, pain, fear of movement, self-efficacy and QoL. Second, in 38.5%-69.2% of patients clinical relevant improvement was shown for functional outcome, 31% for pain, and 50% for self-efficacy. Third, 42% of patients reported 'no healthcare use in the past three months'. CONCLUSION One year after a multidisciplinary treatment a clinically relevant improvement was shown in terms of function, pain, self-efficacy and QoL. It seems to be a promising treatment option in this difficult-to-treat patient group with debilitating chronic pain after TKA. Future research should examine the effect of the treatment in a larger study population, considering a control group, and focusing on the working population and evaluating cost-efficacy. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | - José M H Smolders
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Kirsten Veenstra
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - John O'Dowd
- Hampshire Hospitals NHS Trust, Basingstoke, UK
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Ege F. The relationship between kinesiophobia severity and clinical parameters in patients with mechanical low back pain. J Back Musculoskelet Rehabil 2024; 37:285-294. [PMID: 37482977 DOI: 10.3233/bmr-220365] [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] [Indexed: 07/25/2023]
Abstract
BACKGROUND Low back pain is an important widespread health problem that can occur at any age, causing serious socioeconomic losses. OBJECTIVE The objective of this study is to investigate the relationship between kinesiophobia severity and pain severity, depression, and quality of life in patients with mechanical low back pain. METHODS The study sample consisted of 155 patients, of whom 72 were female and 83 were male, aged between 18 and 75 years with mechanical low back pain. Quality of life was assessed with the 36-Item Short Form Health Survey (SF-36), pain intensity with the Visual Analogue Scale (VAS), kinesiophobia with the Tampa Kinesiophobia Scale (TKS), and depression with the Beck Depression Inventory (BDI). Patients were divided into the low (TKS ⩽ 37) and high kinesiophobia (TKS > 37) groups according to the scores they obtained from TKS. RESULTS VAS-pain severity and BDI scores were significantly higher in the high kinesiophobia group than in the low kinesiophobia group (p< 0.001). On the other hand, the SF-36 subscale scores were significantly higher in the low kinesiophobia group than in the high kinesiophobia group (p< 0.001). The TKS scores were moderately correlated with VAS-pain severity (r= 0.470; p< 0.001) and BDI scores (r= 0.584; p< 0.001) in the positive direction, and strongly correlated with all sub-parameters of quality of life in the negative direction (p< 0.001). CONCLUSION The results indicated that the severity of kinesiophobia in patients with non-inflammatory low back pain is associated with pain severity, depression, and poor quality of life.
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Hampel P, Neumann A. [Is the relationship between depressive symptoms and work-related factors mediated by pain self-efficacy in non-specific chronic low back pain?]. Schmerz 2023:10.1007/s00482-023-00701-0. [PMID: 36894792 DOI: 10.1007/s00482-023-00701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND The transition from acute to non-specific chronic low back pain (CLBP) is especially associated with psychological factors. However, working mechanisms of psychological factors have been little examined in non-specific CLBP, especially the mediator effect of pain self-efficacy. OBJECTIVE Does pain self-efficacy mediate the long-term prediction of work-related factors by depressive symptoms? METHODS Within the framework of an exploratory secondary analysis, simple mediation analyses were conducted to longitudinally predict prognosis of gainful employment, as well as subjective physical and mental work ability by depressive symptoms mediated by pain self-efficacy in 382 inpatients with non-specific CLBP. RESULTS The findings suggest that depressive symptoms prior to rehabilitation predicted levels of all three work-related factors 24 months after rehabilitation, and pain self-efficacy 12 months after rehabilitation mediated this relationship. CONCLUSION To improve the success of work-related rehabilitation in the long-term, pain self-efficacy in particular, but also depressive symptoms should be targeted by treatments of non-specific CLBP.
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Affiliation(s)
- Petra Hampel
- Institut für Gesundheits‑, Ernährungs- und Sportwissenschaften, Europa-Universität Flensburg, Auf dem Campus 1, 24943, Flensburg, Deutschland.
| | - Anne Neumann
- Institut für Gesundheits‑, Ernährungs- und Sportwissenschaften, Europa-Universität Flensburg, Auf dem Campus 1, 24943, Flensburg, Deutschland
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Yates E, Buckley L, Sterling M, Cruwys T, Ashton-James CE, Rankin R, Elphinston RA. Interest in Digital Peer-Delivered Interventions and Preferences to Improve Pain Self-Efficacy and Reduce Loneliness amongst Patients with Chronic Pain: A Mixed Methods Co-Design Study (Preprint). JMIR Form Res 2022; 7:e41211. [PMID: 37058351 PMCID: PMC10148220 DOI: 10.2196/41211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Two important factors that prolong and exacerbate chronic noncancer pain (CNCP) and disability are low pain self-efficacy and loneliness. Yet, few interventions have shown long-term sustained improvements in pain self-efficacy, and there are no evidence-based treatments that target social connectedness in people living with CNCP. More effective and accessible interventions designed to target self-efficacy and social connectedness could ease the burden of CNCP. OBJECTIVE To co-design accessible interventions to increase pain self-efficacy, social connection, pain-related outcomes, and quality of life, this study explored patients' interest and preferences for digital peer-delivered interventions for CNCP as well as implementation barriers and enablers. METHODS This cross-sectional mixed methods study was part of a larger longitudinal cohort study. Adult Australian residents (N=186) with CNCP diagnosed by a medical professional or pain specialist were included. Participants were initially recruited through advertising on professional pain social media accounts and websites. Questions examined whether patients were interested in digital peer-delivered interventions and their preferences for specific features (eg, Newsfeed). Pain self-efficacy and loneliness were assessed using validated questionnaires, and the association between these factors and interest in digital peer-delivered support was explored. Open-ended questions explored implementation barriers, enablers, and suggestions for consideration in intervention design. RESULTS There was interest in accessing digital peer-delivered interventions, with almost half of the sample indicating that they would access it if it was available. Those who indicated an interest in digital peer interventions reported both lower pain self-efficacy and greater loneliness than those who were not interested. Intervention content that incorporated education, links to health services and resources, and delivery of support by peer coaches were the most frequently preferred intervention features. Three potential benefits were identified: shared experience, social connection, and shared pain management solutions. Five potential barriers were identified: negative focus on pain, judgment, lack of engagement, negative impact on mental health, privacy and security concerns, and unmet personal preferences. Finally, there were 8 suggestions from participants: moderation of the group, interest subgroups, professional-led activities, psychological strategies, links to professional pain resources, newsletter, motivational content, live streaming, and online meetups. CONCLUSIONS Digital peer-delivered interventions were of particular interest to those with CNCP who had lower levels of pain self-efficacy and higher levels of loneliness. Future co-design work could tailor digital peer-delivered interventions to these unmet needs. Intervention preferences and implementation barriers and enablers identified in this study could guide further co-design and the development of such interventions.
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Affiliation(s)
- Eloise Yates
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- Australian Pain Management Association, Brisbane, Australia
| | - Lisa Buckley
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- National Health and Medical Research Council Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia
| | - Tegan Cruwys
- Research School of Psychology, The Australian National University, Canberra, Australia
| | | | - Renee Rankin
- Australian Pain Management Association, Brisbane, Australia
| | - Rachel A Elphinston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- National Health and Medical Research Council Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Metro South Health Hospital and Health Service, Brisbane, Australia
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Hoevenaars EHW, Beekhuizen M, O'Dowd J, Spruit M, van Hooff ML. Non-surgical treatment for adult spinal deformity: results of an intensive combined physical and psychological programme for patients with adult spinal deformity and chronic low back pain-a treatment-based cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1189-1196. [PMID: 35325299 DOI: 10.1007/s00586-022-07156-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 02/01/2022] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES No evidence-based treatment exists for adult spinal deformity (ASD) patients with chronic low back pain (CLBP). AIM OF THIS STUDY evaluate a combined physical and psychological programme (CPPP) for ASD patients with CLBP and to compare this with a non-ASD-cohort with CLBP. METHODS Data were extracted from the database of CLBP-patients for whom surgery is not an option and completed CPPP. Two cohorts were selected: an ASD-cohort (n = 80) based on a Cobb angle of > 10° and a consecutive age- and gender-matched non-ASD-cohort (n = 240). PRIMARY OUTCOME functional status (Oswestry Disability Index; ODI). SECONDARY OUTCOMES pain intensity, self-efficacy and quality of life. ASSESSMENTS pre and post treatment, one-month and one-year follow-up (FU). CLINICAL RELEVANCE minimal important clinical change (MCIC; ODI 10 points), patient acceptable symptom state (PASS; ODI ≤ 22). RESULTS Demographics ASD-cohort: 79% female, mean age 50.9 (± 14.1) years, mean CLBP duration 15.5 (± 12.5) years, mean Cobb angle 21.4 (± 9.4)°. Non-ASD-cohort: not significantly different. Both cohorts improved in functional status (F[1,318] = 142.982, p < .001; r = 0.31). The ASD-cohort improved from mean ODI 39.5(± 12.0) at baseline to mean ODI 31.8(± 16.5) at one-year FU. CLINICAL RELEVANCE 51% of the ASD patients reached MCIC and 33% reached a PASS. An interaction effect is shown between time and both cohorts (F[1,318] = 8.2, p = .004; r = 0.03); however, not clinically relevant. All secondary outcomes: improvement at one-year FU. CONCLUSION This is the first study showing beneficial outcomes of a non-surgical treatment in selected ASD patients with longstanding CLBP. Improvement is shown in functional status, and appeared equivalent to the non-ASD cohort. LEVEL OF EVIDENCE 1: Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
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Affiliation(s)
- Evelien H W Hoevenaars
- The RealHealth Institute, Sint Maartenskliniek, Zevenheuvelenweg 48a, 6571 CK, Berg en Dal, The Netherlands.
| | - Michiel Beekhuizen
- Department of Orthopedics, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands
| | - John O'Dowd
- Hampshire Hospitals NHS Trust, Aldermaston Rd, Basingstoke, RG24 9NA, UK
| | - Maarten Spruit
- Department of Orthopedics, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands
| | - Miranda L van Hooff
- Department of Research, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands.,Department for Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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