Sex Differences in the Mediating Effect of Kinesiophobia on Chronic Pain, Dysesthesia, and Health-Related Quality of Life in Japanese Individuals Aged 65 Years Old and Older Treated with Surgery for Lumbar Spinal Stenosis

The Functional Efficiency of Older Patients after Lumbar Spine Surgery, the Impact of Pain, and the Passage of Time: Tips for Care Providers

Chronic back pain in adults is often a cause of absenteeism from work, limitations in social interactions, and difficulties in performing daily activities. This study aimed to check whether the functioning of everyday activities in elderly patients after neurosurgery improved over time compared to their condition before the procedure and whether there is a connection between fitness, self-esteem, and pain intensity. This was a cross-sectional study carried out using an anonymous survey. This study included patients over 60 years of age from the neurosurgical ward. The following scales were used to assess cognitive functioning, depression, functional status: basic and instrumental activities of daily living (IADL), back pain disability (QBPDS), pain intensity, and self-esteem. The level of independence in terms of IADL and QBPDS increased, and the intensity of pain decreased. Surgery reduced pain intensity from 8 ± 0.8 to 6.1 ± 1.4 points. The level of self-esteem (RSES) remained at a low level. The passage of time after neurosurgical treatment has a beneficial effect on reducing pain intensity and increasing independence in life activities. Daily physical activity and rehabilitation are important factors supporting the return to independence.

Kinesiophobia and associated variables in patients with heart failure

AIMS

Patients with heart failure (HF) can exhibit kinesiophobia, an excessive, debilitating, and irrational fear of movement. This study aimed to enhance the understanding of kinesiophobia in patients with HF by analysing associations with the following variables: musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, frailty, sex, and age.

METHODS AND RESULTS

In this cross-sectional study, 107 participants were included, with ages ranging from 28 to 97 years (57% men, mean age 73.18 ± 12.68 years). Multiple regression analyses were performed with all variables, including polynomial regressions for variables with a non-linear relationship. Kinesiophobia was significantly correlated (P < 0.01) with musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, and being at risk of frailty, while age and sex were not statistically significant. Frailty disability and musculoskeletal pain intensity were variables linearly associated with kinesiophobia, while quality of sleep and disability had a non-linear relationship with kinesiophobia.

CONCLUSION

Kinesiophobia needs to be evaluated and better understood in patients with HF to improve physical activity and exercise adherence. This study found that musculoskeletal pain intensity, quality of sleep, disability, and frailty risk have a significant association with kinesiophobia in patients with HF. Our results suggest multi-dimensional associations of kinesiophobia in patients with HF, which require further examination and understanding.

Sex differences in conditioned pain modulation effects and its associations with autonomic nervous system activities in healthy, younger individuals: a pilot study

Introduction

Sex differences in conditioned pain modulation (CPM) have not been sufficiently explored.

Objectives

This pilot study aimed to examine sex differences in CPM effects and associations between autonomic activities and CPM effects in healthy, younger individuals.

Methods

University students were recruited from February to March 2021 and divided by sex. They remained seated for 10 minutes as a rest period, then immersed their right hands in cold water for 2 minutes as a cold period. The pressure pain threshold (PPT) was measured after each period, presenting the CPM index (%) using the formula: (PPTcold/PPTrest) × 100. Autonomic nervous system variables were calculated using the formula-(autonomic variablecold/autonomic variablerest) × 100-and suffixed by "index" such as low-frequency/high-frequency (LF/HF) index. Some psychological questionnaires were self-recorded. Sex differences in the CPM index were statistically compared, and a simple linear regression analysis between the CPM and autonomic indices was conducted.

Results

Thirty-two participants were analyzed (14 women and 18 men; aged 21.1 ± 0.6 and 20.9 ± 0.3 years, respectively). Conditioned pain modulation effects were not different at 127.0 ± 19.1% in women and 124.0 ± 18.7% in men. The LF/HF index, LF normalized unit (nu) index (LFnu), and HFnu index had significant predictor variables for the CPM index across overall samples. The LF/HF index and LFnu index were significant predictor variables for the CPM index for women but not for men.

Conclusions

Conditioned pain modulation effects between groups seem to be similar. The LF/HF and LFnu indices in women were significant, indicating that descending pain modulations in women might be more associated with autonomic activities than those in men.

Relationship Between Central Sensitization-Related Symptoms and Pain-Related Disability After Cervical Spine Surgery: A Structural Equation Model

BACKGROUND

It is unknown if central sensitization (CS)-related symptoms have an intermediate role that might explain how disability develops from pain after cervical spinal surgery.

AIMS

The study aim was to investigate the role of CS-related symptoms in the relationship between pain and disability reported after cervical spinal surgery.

DESIGN

Cross-sectional study.

SETTINGS

Tertiary care spinal surgery center.

PARTICIPANTS/SUBJECTS

The participants included individuals with a cervical degenerative condition who had undergone surgery.

METHODS

The following patient-reported outcome measures were evaluated: (1) Numerical Rating Scale; (2) Neck Disability Index; and (3) Short Form of the Central Sensitization Inventory. A hypothesized model containing the CS-related symptoms and the relationships between pain and disability was constructed and tested by structural equation modeling.

RESULTS

Questionnaires were mailed to 280 individuals, and responses were obtained from 145 participants. Of these respondents, 99 (68.3%) were males and 46 (31.7%) were females, with a mean age of 64.4 ± 12.3 years. The latent variable for pain, represented by the neck (coefficient: 0.856, p < .001) and upper limb pain (0.568, p < .001), influenced CS-related symptoms (coefficient: 0.504, p < .001). Pain directly affected disability (coefficient: 0.497, p < .001) and indirectly through CS-related symptoms. Bootstrap analysis confirmed this indirect effect (point estimate: 2.85, 95% confidence interval: 1.04 to 6.30, p = .04).

CONCLUSIONS

The results revealed that neck and upper limb pain affected disabilities both directly and through CS-related symptoms. Future research should focus on the efficacy of biopsychosocial approaches for patients after cervical spine surgery with a high risk of disability due to CS-related symptoms.

The relationship of kinesiophobia in patients with lymphedema: a case-control investigation

Introduction

Kinesiophobia and lymphedema appear to be related conditions, and it is important to understand this relationship, as many of the symptoms and comorbidities presented by individuals with lower limb lymphedema are prevented and treated through movement, thus constituting kinesiophobia as a barrier to intervention. The objective of this study is, therefore, to evaluate and analyze the kinesiophobic beliefs reported by individuals with and without lower limb lymphedema, regarding the agreement, severity and differences found, and to establish levels of kinesiophobia.

Methods

A case-control study with a total sample of 80 participants (40 with lower limb lymphedema and 40 without) was performed. Both groups (with and without lymphedema) were characterized anthropologically, sociodemographically, and clinically. In the case group, lymphedema was evaluated. Participants in both groups completed the Tampa Scale for Kinesiophobia - 13 items (TSK-13).

Results

Individuals with lower limb lymphedema had higher TSK-13 scores than their matched group without lymphedema. The items belonging to the activity avoidance subscale had the highest agreement and score in both groups. Differences between groups were mainly established for items belonging to the somatic focus subscale, showing that individuals with lower limb lymphedema have kinesiophobic beliefs related to the perceived severity of their lymphedema. The prevalence of kinesiophobia was increased in both groups, but the severity was mild.

Conclusions

Considering the apparent tendency of people with lower limb lymphedema to present kinesiophobia and movement-limiting beliefs regarding the condition, greater attention should be paid to its assessment, prevention and treatment from a multidisciplinary and multimodal perspective, which takes into account the multiplicity of factors inherent to kinesiophobia and lymphedema and thus reduce their impact on the management of lymphedema.

Influence of radiological factors, psychosocial factors, and central sensitization-related symptoms on clinical symptoms in patients with lumbar spinal canal stenosis

BACKGROUND

No study to date has concurrently evaluated the impact of radiological factors, psychosocial factors, and central sensitization (CS) related symptoms in a single lumbar spinal canal stenosis (LSS) patient cohort.

OBJECTIVE

To investigate the associations between these factors and clinical symptoms in LSS patients.

METHODS

We recruited 154 patients with LSS scheduled for surgery. Patient-reported outcome measures and imaging evaluation including clinical symptoms, psychosocial factors, CS-related symptoms, and radiological classifications. Spearman's rank correlation coefficient and multiple regression analyses were employed.

RESULTS

Spearman's correlation revealed CS-related symptoms positively correlated with low back pain (r= 0.25, p< 0.01), leg pain (r= 0.26, p< 0.01), and disability (r= 0.32, p< 0.01). Pain catastrophizing positively correlated with leg pain (r= 0.23, p< 0.01) and disability (r= 0.36, p< 0.01). Regression analysis showed that pain catastrophizing was associated with disability (β= 0.24, 95%CI = 0.03-0.18), and CS-related symptoms with low back pain (β= 0.28, 95%CI = 0.01-0.09). Radiological classifications were not associated with clinical symptoms.

CONCLUSION

Our findings suggest that psychosocial factors and CS-related symptoms, rather than radiological factors, seem to contribute to clinical symptoms in patients with LSS.