Exploring how people with chronic pain understand their pain: a qualitative study

Recent trends in Tuina for chronic pain management: A bibliometric analysis and literature review

BACKGROUND

The utilization of Tuina as a therapeutic intervention for the management of chronic pain has experienced a gradually increase in its popularity, and the purpose of this bibliometric analysis is to offer a comprehensive understanding of the current state and frontier trends, as well as to provide recommendations for future research directions.

METHODS

Publications on Tuina for chronic pain published between 2004 and 2023 were retrieved from the Web of Science Core Collection (WoSCC). Microsoft Excel, CiteSpace, VOSViewer, and the R package "bibliometrix" were used to quantitatively analyse the annual publication volume, countries/regions, journals, institutions, cited references, authors, and keywords.

RESULTS

A total of 287 publications were retrieved. The number of annual publications on the use of Tuina for treating chronic pain has gradually increased. Most publications were published in China and the United States. Notably, the most productive institution and author were identified as Shanghai University of Traditional Chinese Medicine and Min Fang, respectively. Medicine ranked first as the most influential affiliate and most productive journal. These publications came from 1,650 authors, among whom Edzard Ernst had the most co-citations. Keyword analysis revealed that the new research frontier was low back pain.

CONCLUSION

The utilization of Tuina for the treatment of chronic pain has been gaining increasing recognition. Acupuncture, randomised controlled trials, systematic reviews, etc. were the main research subjects. Furthermore, low back pain is the new research frontier. This study provides an in-depth perspective on Tuina for chronic pain, which provides valuable reference material for clinicians with insights of therapeutic strategy, educators with valuable topics, and researchers with new research directions.

"I wish I knew then what I know now" - pain science education concepts important for female persistent pelvic pain: a reflexive thematic analysis

ABSTRACT

Pain science education (PSE) provides people with an understanding of "how pain works" grounded in the biopsychosocial model of pain; it has been demonstrated to improve outcomes in musculoskeletal pain conditions. Preliminary evidence suggests PSE may be effective for female individuals with persistent pelvic pain, but how the content of PSE needs to be modified for this group remains to be determined. A reflexive thematic analysis of qualitative data was performed to identify PSE concepts that female individuals with persistent pelvic pain consider important and why. Twenty individual, semistructured interviews were conducted with adult females who had engaged with PSE and had self-identified as having "improved" pelvic pain. Most participants had been diagnosed with endometriosis (n = 16). Four themes were generated capturing PSE concepts considered important by female individuals with "improved" pelvic pain: (1) "A sensitised nervous system leads to overprotective pain" validated their pelvic pain as being real; (2) "Pain does not have to mean the body is damaged (although sometimes it does)" provided reassurance that pelvic pain does not mean their condition is worsening; (3) "How I think, feel, and 'see' my pain can make it worse" enabled participants to find optimal ways to manage their pain; and (4) "I can change my pain… slowly" provided hope that pelvic pain can improve and empowered them to pursue pain improvement as a viable goal. This study generated 4 PSE learning concepts that were important to female individuals with improved pelvic pain and may be incorporated into PSE curricula for female individuals with pelvic pain.

Association of chronic pain with suicide attempt and death by suicide: a two-sample Mendelian randomization

Prior studies have suggested an association between chronic pain and suicidal behavior. However, evidence supporting the causal nature of this association, and the role played by depression, remain difficult to establish due to confounding. We investigated associations of chronic pain with suicide attempt and death by suicide as well as the mediating role of depression in this association using a genetically informed method strengthening causal inference. We conducted a two-sample Mendelian randomization. Independent SNPs (N = 97) from the multisite chronic pain GWAS (NGWAS = 387,649) were used as instrumental variables to test associations of chronic pain with suicide attempt (measured from hospital records; NGWAS = 50,264) and death by suicide (measured from official death causes; NGWAS = 18,085). Indirect associations of chronic pain with suicide attempt and death by suicide via major depressive disorder (NGWAS = 173,005) were estimated. Primary analyses were supported by a range of sensitivity and outlier analyses. We found evidence supporting the contribution of chronic pain to increasing the risk of suicide attempt (OR = 1.67, CI = 1.21-2.35) and death by suicide (OR = 2.00, CI = 1.10-3.62). Associations were consistent across sensitivity analysis methods, and no evidence for outliers driving these associations was found. Through mediation analyses, we found that major depressive disorder explained a substantial proportion of the association between chronic pain and suicide attempt (proportion mediated = 39%; ORindirect association = 1.32, CI = 1.09-1.61) and death by suicide (proportion mediated = 34%; ORindirect association = 1.40, CI = 1.13-1.73). Our findings suggest that both pain management interventions and prevention of depression are likely to be effective strategies to reduce suicide risk in individuals with chronic pain.

Making sense of pain in inflammatory bowel disease (IBD): A qualitative study

OBJECTIVES

Inflammatory bowel disease (IBD) is a chronic, gastrointestinal tract condition, in which pain is one of the most widespread and debilitating symptoms, yet research about how individuals make sense of their IBD pain is lacking. The current study aimed to explore how individuals with IBD understand their pain.

METHODS

Twenty participants, recruited via the Crohn's & Colitis UK charity, were interviewed about their understanding of their IBD pain using the Grid Elaboration Method that elicits free associations on which it invites elaboration. Thematic analysis was used to organise transcribed verbatim data.

RESULTS

Three related themes - making sense of my pain, navigating my care and support and it takes its toll - comprising seven sub-themes, illustrated the ways in which participants made sense of pain experientially, multi-dimensionally, and in the broader context of IBD and its symptoms. The psychological impact of pain was evident across all interviews.

CONCLUSIONS

The findings are consistent with other research in IBD pain, demonstrating the importance of pain in IBD. Sense-making underpins both emotional and practical responses to pain and ideally is constructed as an integral part of clinical care of IBD.

How the home features in young adults' representations of loneliness: The impact of COVID-19

Loneliness is a rapidly growing problem globally and has attracted a great deal of attention in light of the COVID-19 pandemic. Young adults, and in particular, those residing in deprived areas are currently the loneliest group in the United Kingdom. Utilizing a novel-free association technique, young adults' experiences of loneliness were explored both prior to (n = 48) and during (n = 35) the COVID-19 pandemic. Drawing on social representations theory, a thematic analysis revealed that many young adults associated the experience of loneliness with their homes. Therefore, this comparative study aims to investigate how the home features in young adults' representations of loneliness, prior to and during the COVID-19 pandemic using a systematic qualitative methodology. Three salient themes emerged from the data in both periods: 'The Lonely Home,' 'The Socially Connected Home' and 'The Safe, Peaceful, Authentic Home'. 'The Lonely Home' and 'The Socially Connected Home' emerged as a dialogical antimony. Representations of home were similar across the two periods; however, there were some notable differences. In particular, the themes 'The Socially Connected Home' and 'The Safe, Peaceful, Authentic Home' were less frequently mentioned by the during-COVID-19 sample where the 'The Lonely Home' was more frequently mentioned by the during-COVID-19 sample. Overall, discussion of the home was more negatively valenced in the during-COVID-19 sample compared to the pre-COVID-19 sample. This comparative, exploratory study alerts us to the nature of the role that home plays in exacerbating or ameliorating loneliness both prior to and during the COVID-19 pandemic.

From Challenge to Opportunity: Virtual Qualitative Research During COVID-19 and Beyond

COVID-19 has required researchers to adapt methodologies for remote data collection. While virtual interviewing has traditionally received limited attention in the qualitative literature, recent adaptations to the pandemic have prompted increased discussion and adoption. Yet, current discussion has focussed on practical and ethical concerns and retained a tone of compromise, of coping in a crisis. This paper extends the nascent conversations begun prior to the pandemic to consider the wider methodological implications of video-call interviews. Beyond the short-term, practical challenges of the pandemic, these adaptations demonstrate scope for longer-term, beneficial digitalisation of both traditional and emergent interview methods. Updating traditional interview methods digitally has demonstrated how conversion to video interviewing proves beneficial in its own right. Virtual focus-group-based research during COVID-19, for example, accessed marginalised populations and elicited notable rapport and rich data, uniting people in synchronous conversation across many environments. Moreover, emergent interview methods such as the Grid Elaboration Method (a specialised free-associative method) demonstrated further digitalised enhancements, including effective online recruitment with flexible scheduling, virtual interactions with significant rapport, and valuable recording and transcription functions. This paper looks beyond the pandemic to future research contexts where such forms of virtual interviewing may confer unique advantages: supporting researcher and participant populations with mobility challenges; enhancing international research where researcher presence or travel may be problematic. When opportunities for traditional face-to-face methods return, the opportunity for virtual innovation should not be overlooked.