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Sadler MS, Wash K, DePaul Trumbach LM, Cronan TA. A secondary analysis of three types of social support in relation to self-efficacy, disease impact, and depression in fibromyalgia. J Psychosom Res 2024; 184:111836. [PMID: 38936010 DOI: 10.1016/j.jpsychores.2024.111836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Fibromyalgia (FM) is a chronic pain condition associated with depression. However, self-efficacy (belief in own ability to manage symptoms) and social support may be protective. This study tested three types of social support (emotional, tangible, and instrumental) for moderation of the mediating effect of self-efficacy on the relationship between FM impact and depression over time. METHODS Six hundred participants with FM were randomly assigned to no intervention, social support group, or combined self-management and social support. The Fibromyalgia Impact Questionnaire, Norbeck Social Support Questionnaire, FM-modified Arthritis Self-Efficacy Scale, and Center for Epidemiological Studies-Depression surveys were administered at baseline, 6, 12, and 18 months. There were no significant intervention effects on the variables of interest, however, participants' scores were used to assess four longitudinal models. RESULTS Self-efficacy showed mediation both between (b = 0.104, p < .001, 95% CI = [0.071, 0.137]) and within (b = 0.89, p < .001, 95% CI = [0.073, 0.106]) individuals. Only tangible support demonstrated moderation of the relationship between FM impact and self-efficacy, and only between individuals (b = 0.154, p = .022, 95% CI = [0.022, 0.287]). CONCLUSION The results indicated that self-efficacy attenuated a portion of the effect of FM impact on depression over time. Additionally, higher levels of tangible support (the belief that your social network can provide you with assistance) were related to weaker influence of FM impact on self-efficacy over time. These factors may be important targets for the prevention of depression in people with FM.
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Affiliation(s)
- Melody S Sadler
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Kalila Wash
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Lauren M DePaul Trumbach
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Terry A Cronan
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA.
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Kaplan CM, Kelleher E, Irani A, Schrepf A, Clauw DJ, Harte SE. Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms. Nat Rev Neurol 2024; 20:347-363. [PMID: 38755449 DOI: 10.1038/s41582-024-00966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Nociplastic pain is a mechanistic term used to describe pain that arises or is sustained by altered nociception, despite the absence of tissue damage. Although nociplastic pain has distinct pathophysiology from nociceptive and neuropathic pain, these pain mechanisms often coincide within individuals, which contributes to the intractability of chronic pain. Key symptoms of nociplastic pain include pain in multiple body regions, fatigue, sleep disturbances, cognitive dysfunction, depression and anxiety. Individuals with nociplastic pain are often diffusely tender - indicative of hyperalgesia and/or allodynia - and are often more sensitive than others to non-painful sensory stimuli such as lights, odours and noises. This Review summarizes the risk factors, clinical presentation and treatment of nociplastic pain, and describes how alterations in brain function and structure, immune processing and peripheral factors might contribute to the nociplastic pain phenotype. This article concludes with a discussion of two proposed subtypes of nociplastic pain that reflect distinct neurobiological features and treatment responsivity.
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Affiliation(s)
- Chelsea M Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Eoin Kelleher
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anushka Irani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Division of Rheumatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
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Black LL, Black WR, Chadwick A, Christofferson JL, Katz H, Kragenbrink M. Investigation of patients' understanding of fibromyalgia: Results from an online qualitative survey. PATIENT EDUCATION AND COUNSELING 2024; 122:108156. [PMID: 38242011 PMCID: PMC10923085 DOI: 10.1016/j.pec.2024.108156] [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: 08/25/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE An important component to effective fibromyalgia treatment is patient education about the condition. While previous educational interventions have been developed, these have not incorporated the lived experiences of patients and may not address common misunderstandings among those who may benefit from these interventions. This study aimed to explore understanding, confusion, and gaps in knowledge about fibromyalgia among those who report a fibromyalgia diagnosis. METHODS Participants were recruited via clinic flyers and the social media page of a chronic pain research laboratory. Participants completed an online survey that assessed their knowledge of fibromyalgia via open-ended questions. Responses were analyzed via thematic analysis to identify, analyze, and report themes. RESULTS Thirty-eight participants completed the survey (63% female, ages 18-68). Common themes that arose from patients included being unsure of the cause of their fibromyalgia, frustration and confusion about the random/variable nature of symptoms and flares, feeling that their condition was invisible, and desiring more information on available treatments. CONCLUSION Participants in this study expressed confusion about many aspects of fibromyalgia and a desire for more understanding from others in their life about this condition. PRACTICE IMPLICATIONS Future interventions would benefit from tailoring fibromyalgia education to the specific knowledge and lived experiences of patients.
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Affiliation(s)
- Lora L Black
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, 1670 Upham Drive, Columbus, OH 43210, USA.
| | - William R Black
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 575 Children's Roadd, Columbus, OH 43215, USA; Department of Pediatrics, The Ohio State University College of Medicine, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - Andrea Chadwick
- Department of Anesthesiology, The University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Jennifer L Christofferson
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, 610 E 22nd Street, Kansas City, MO 64108, USA; Clinical Child Psychology Doctoral Program, University of Kansas College of Liberal Arts and Sciences, 1000 Sunnyside Avenue, Lawrence, KS 66045, USA
| | - Hannah Katz
- Department of Psychiatry & Behavioral Sciences, The University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Monica Kragenbrink
- Department of Psychiatry & Behavioral Sciences, The University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
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Wurz A, Duchek D, Ellis K, Bansal M, Carrier ME, Tao L, Dyas L, Kwakkenbos L, Levis B, El-Baalbaki G, Rice DB, Wu Y, Henry RS, Bustamante L, Harb S, Hebblethwaite S, Patten SB, Bartlett SJ, Varga J, Mouthon L, Markham S, Thombs BD, Culos-Reed SN. A qualitative interview study exploring the psychological health impacts of the SPIN-CHAT program among people with systemic sclerosis at the onset of COVID-19: perceptions of trial participants and research team members. Disabil Rehabil 2024; 46:533-545. [PMID: 36708187 DOI: 10.1080/09638288.2023.2169775] [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: 08/03/2022] [Accepted: 01/13/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Explore trial participants' and research team members' perceptions of the impact of the videoconference-based, supportive care program (SPIN-CHAT Program) during early COVID-19 for individuals with systemic sclerosis (SSc). METHODS Data were collected cross-sectionally. A social constructivist paradigm was adopted, and one-on-one videoconference-based, semi-structured interviews were conducted with SPIN-CHAT Trial participants and research team members. A hybrid inductive-deductive approach and reflexive thematic analysis were used. RESULTS Of the 40 SPIN-CHAT Trial participants and 28 research team members approached, 30 trial participants (Mean age = 54.9; SD = 13.0 years) and 22 research team members agreed to participate. Those who took part in interviews had similar characteristics to those who declined. Five themes were identified: (1) The SPIN-CHAT Program conferred a range of positive psychological health outcomes, (2) People who don't have SSc don't get it: The importance of SSc-specific programming, (3) The group-based format of the SPIN-CHAT Program created a safe space to connect and meet similar others, (4) The structure and schedule of the SPIN-CHAT Program reduced feelings of boredom and contributed to enhanced psychological health, (5) The necessity of knowledge, skills, and tools to self-manage SSc and navigate COVID-19. CONCLUSION Participants' and research team members' perspectives elucidated SPIN-CHAT Program benefits and how these benefits may have been realized. Results underscore the importance of social support from similar others, structure, and self-management to enhance psychological health during COVID-19. TRIAL REGISTRATION clinicaltrials.gov (NCT04335279)IMPLICATIONS FOR REHABILITATIONThe videoconference-based, supportive care SPIN-CHAT Program enhanced psychological health amongst individuals affected by systemic sclerosis.SPIN-CHAT Program participants and research team members shared that being around similar others, program structure, and self-management support were important and may have contributed to enhanced psychological health.Further efforts are required to explore experiences within supportive care programs to better understand if and how psychological health is impacted.
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Affiliation(s)
- Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Delaney Duchek
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Kelsey Ellis
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Mannat Bansal
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Lydia Tao
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Laura Dyas
- National Scleroderma Foundation, Michigan Chapter, Southfield, MI, USA
| | - Linda Kwakkenbos
- Clinical Psychology, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | | | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Yin Wu
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Richard S Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Laura Bustamante
- Department of Applied Human Sciences, Concordia University, Montreal, Canada
| | - Sami Harb
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | | | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Canada
- Research Institute, McGill University Health Centre, Montreal, Canada
| | - John Varga
- University of Michigan, Ann Arbor, MI, USA
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
- APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | - Sarah Markham
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
- Biomedical Ethics Unit, McGill University, Montreal, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Cancer Care, Alberta Health Services, Calgary, Canada
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Ward SJ, Coates AM, Baldock KL, Berryman C, Hill AM. Characterising concurrent pain experience and dietary patterns in people with chronic musculoskeletal pain: a feasibility study protocol. Pilot Feasibility Stud 2024; 10:13. [PMID: 38254236 PMCID: PMC10801926 DOI: 10.1186/s40814-023-01438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Nutrition-related factors linked to pain chronicity and disability include weight status and dietary behaviours. Dietary patterns associated with concurrent pain episodes, however, remain poorly characterised. This paper outlines the protocol for a feasibility study that aims to characterise pain-related dietary and lifestyle behaviours in people experiencing chronic musculoskeletal pain. METHODS The study will recruit participants who experience musculoskeletal pain on 5 or more days of the week for at least 3 months. Participants will attend two in-person clinic visits where physical measurements and a series of pain and lifestyle questionnaires will be completed. Visits will be conducted pre and post a 2-week self-monitoring period where participants will self-report concurrent diet, sleep, mood, and pain on four days and will wear a wrist-worn activity monitor (GENEActiv). Key feasibility metrics will evaluate participant recruitment, enrolment and retention rates, and compliance with the study data collection protocol. DISCUSSION There remains a lack of evidence behind dietary advice as an adjunct pain management tool. Upon completion of the protocol, feasibility outcomes will identify challenges to guide the design and delivery of a dietary intervention for chronic musculoskeletal pain.
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Affiliation(s)
- Susan J Ward
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Alison M Coates
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Katherine L Baldock
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Carolyn Berryman
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- Innovation IMPlementation And Clinical Translation (IIMPACT), University of South Australia, Adelaide, Australia
| | - Alison M Hill
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
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Kang Y, Trewern L, Jackman J, Irani Nee Soni A, McCartney D. Chronic pain: supported self-management. BMJ 2024; 384:e072362. [PMID: 38167273 DOI: 10.1136/bmj-2022-072362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
| | - Louise Trewern
- British Pain Society (patient author)
- Physiotherapy Pain Association
- Get-Involved-Evolving Through Patient Experience Committee at Torbay Hospital Pain Service
- Live Well With Pain
| | - John Jackman
- Oxford University Hospitals NHS Foundation Trust, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences
| | - Anushka Irani Nee Soni
- Division of Rheumatology, Mayo Clinic Florida
- FMRIB Pain Analgesia/Anaesthesia Imaging Neuroscience group
| | - David McCartney
- Oxford City Practice
- Medical Sciences Division, University of Oxford
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Valenza-Peña G, Martín-Núñez J, Heredia-Ciuró A, Navas-Otero A, López-López L, Valenza MC, Cabrera-Martos I. Effectiveness of Self-Care Education for Chronic Neck Pain: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:3161. [PMID: 38132051 PMCID: PMC10743108 DOI: 10.3390/healthcare11243161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Self-care programs for chronic neck pain are relevant to everyday life and can lead to long- term improvement. More studies on their effectiveness, key components and appropriate duration are needed. The aim of this study was to determine the effectiveness of self-care programs for patients with chronic neck pain. A systematic review and meta-analysis of randomized controlled trials was conducted according to the PRISMA guidelines. After searching in PubMed, Web of Science, Scopus and ScienceDirect, eleven studies met the inclusion criteria. Self-care education interventions typically consisted of education (i.e., pain neuro-science education or general educational concepts) accompanied by exercise or manual therapy. The most frequent components were addressing physical and psychological symptoms and engaging in self-care strategies. The least frequent ones were monitoring and recording symptoms and discussing with providers of medical care. The duration of the interventions ranged from three sessions to six months. Finally, individual and supervised modalities were the most frequent. After pooling the data, a meta-analysis was carried out according to four variables (i.e., pain, disability, kinesiophobia and catastrophization) and showed significant results (p < 0.05) in favor of self-care interventions. This systematic review and meta-analysis suggests that self-education interventions improve pain, psychological pain-related variables and disability in patients with chronic neck pain. The most frequently used components were addressing physical and psychological symptoms and engaging in self-care strategies. Future trials should focus on including other components, such as discussing symptoms with providers of medical care or self-monitoring symptoms. Additional areas of focus include more homogeneous doses and comparator treatments, as well as studies with better evidence to reach more solid conclusions.
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Affiliation(s)
| | | | | | | | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016 Granada, Spain; (G.V.-P.); (J.M.-N.); (A.H.-C.); (M.C.V.); (I.C.-M.)
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Lambarth A, Katsoulis M, Ju C, Warwick A, Takhar R, Dale C, Prieto-Merino D, Morris A, Sen D, Wei L, Sofat R. Prevalence of chronic pain or analgesic use in children and young people and its long-term impact on substance misuse, mental illness, and prescription opioid use: a retrospective longitudinal cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100763. [PMID: 38115960 PMCID: PMC10730316 DOI: 10.1016/j.lanepe.2023.100763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 12/21/2023]
Abstract
Background Epidemiological studies suggest chronic and recurrent pain affects around a quarter of children, while 8% report intense and frequent pain. The long-term implications of chronic pain in childhood are uncertain. Using electronic health records (EHRs) we used both disease codes and medicines prescription records to investigate the scale of chronic pain and long-term analgesic use in children and young people (CYP), and if chronic pain and/or use of analgesic medicines at an early age is associated with substance misuse, use of prescription opioids, and poor mental health in adulthood. Methods We conducted a cohort study using data from IQVIA Medical Research Data UK. We identified individuals aged 2-24 with exposure to either a diagnostic code indicating chronic pain (diagnosis-exposed), repeat prescription for medicines commonly used to treat pain (prescription-exposed), or both. Follow-up began at 25, and the unexposed population acted as comparators. We calculated hazard ratios (HR) for mental health and substance misuse outcomes, and rate ratios (RR) for opioid prescriptions in adulthood. Additionally, we investigated which diagnoses, if any, were over-represented in the prescription-exposed subgroup. Findings The cohort constituted 853,625 individuals; 146,431 had one or more of the exposures of interest (diagnosis-exposed = 115,101, prescription-exposed = 20,298, both-exposed = 11,032), leaving 707,194 as comparators. Median age at index exposure was 18.7 years (IQR 14.7-22.3). On average during follow-up, the pooled exposed group had, respectively, a 31% and 17% higher risk of adverse mental health and substance misuse outcomes (adjusted HR [95% CI] of 1.31 [1.29-1.32] and 1.17 [1.11-1.24]). Exposed individuals also received prescription opioids at double the rate of unexposed individuals on average during follow-up (adjusted RR 2.01 [95% CI 1.95-2.10]). Outcomes varied between exposure subgroups, with prescription- and both-exposure tending to have worse outcomes. Unlike these two subgroups, in the diagnosis-exposed subgroup we did not detect a greater risk of substance misuse. Interpretation Chronic pain in CYP is associated with increased prescription opioid use and adverse mental health outcomes in adulthood, as is repeat prescription for analgesic medicines, but only the latter is also associated with substance misuse in adulthood. It is essential to avoid the harms of under-treating pain in CYP while giving due consideration to the risks posed by analgesic medicines. Early recognition of chronic pain in CYP and utilising non-pharmacological management options may help minimise overprescribing, and long-term reliance on dependence-forming-drugs. Funding AL is an NIHR funded academic clinical fellow, and was supported by funding from UCLH Charities while carrying out this work. RS and DS are part of the Advanced Pain Discovery Platform and were supported by a UKRI and Versus Arthritis grant (MR/W002566/1) as part of the Consortium Against Pain Inequality. AW was supported by the Wellcome Trust (220558/Z/20/Z).
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Affiliation(s)
- Andrew Lambarth
- Department of Clinical Pharmacology and Therapeutics, St George's University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London, UK
| | - Michail Katsoulis
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - Chengsheng Ju
- Research Department of Practice and Policy, University College London School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Alasdair Warwick
- Institute of Cardiovascular Science, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Rohan Takhar
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Caroline Dale
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | | | - Andrew Morris
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
- Health Data Research UK, 215 Euston Road, London, NW1 2BE, UK
| | - Debajit Sen
- University College London Hospitals NHS Foundation Trust, 235 Euston Rd, London, NW1 2BU, UK
| | - Li Wei
- Research Department of Practice and Policy, University College London School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Health Data Research UK, 215 Euston Road, London, NW1 2BE, UK
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Blake H, Chaplin WJ, Wainwright E, Taylor G, McNamee P, McWilliams D, Abbott-Fleming V, Holmes J, Fecowycz A, Walsh DA, Walker-Bone K. The Web-Based Pain-at-Work Toolkit With Telephone Support for Employees With Chronic or Persistent Pain: Protocol for a Cluster Randomized Feasibility Trial. JMIR Res Protoc 2023; 12:e51474. [PMID: 37902814 PMCID: PMC10644198 DOI: 10.2196/51474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/19/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Chronic or persistent pain affects one's ability to work or be productive at work, generating high societal and economic burden. However, the provision of work-related advice and support for people with chronic pain is variable or lacking. The Pain-at-Work (PAW) Toolkit was cocreated with people who live with pain, health care professionals, and employers. It aims to increase knowledge about employee rights and how to access support for managing a painful chronic condition in the workplace and provides advice on lifestyle behaviors that facilitate the management of chronic pain. OBJECTIVE We aimed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing access to the PAW Toolkit and telephone support calls from an occupational therapist (PAW) with treatment as usual (ie, standard support from their employer). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, and safety of this digital workplace health intervention. We will assess the candidate primary and secondary outcomes' feasibility and test research processes for a definitive trial. METHODS This is an open-label, parallel 2-arm pragmatic feasibility cluster randomized controlled trial with exploratory health economics analysis and a nested qualitative interview study. We aim to recruit 120 participants from at least 8 workplace clusters (any type, >10 employees) in England. The recruitment of workplaces occurs via personal approach, and the recruitment of individual participants is web based. Eligible participants are vocationally active adults aged ≥18 years with internet access and self-reporting chronic pain interfering with their ability to undertake or enjoy productive work. A restricted 1:1 cluster-level randomization is used to allocate employment settings to PAW or treatment as usual; participants are unblinded to group allocation. Following site- and individual-level consent, participants complete a web-based baseline survey (time 0), including measures of work capacity, health and well-being, and health care resource use. Follow-up is performed at 3 months (time 1) and 6 months (time 2). Feasibility outcomes relate to recruitment; intervention fidelity (eg, delivery, reach, uptake, and engagement); retention; and follow-up. Qualitative evaluation (time 2) is mapped to the Capability, Opportunity, Motivation-Behavior model and will explore intervention acceptability to employees and employers, along with individual and contextual factors influencing the delivery and uptake of the intervention. RESULTS Ethics approval was obtained in March 2023. Trial recruitment began in June 2023. CONCLUSIONS The PAW Toolkit is the first evidence-based digital health intervention aimed at supporting the self-management of chronic or persistent pain at work. This study will inform the design of a definitive trial, including sample size estimation, approaches to cluster site identification, primary and secondary outcomes' selection, and the final health economic model. Findings will inform approaches for the future delivery of this digital health intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT05838677; https://clinicaltrials.gov/study/NCT05838677. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51474.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Wendy J Chaplin
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
| | - Elaine Wainwright
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Daniel McWilliams
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Jain Holmes
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Aaron Fecowycz
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - David Andrew Walsh
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Karen Walker-Bone
- School of Public Health and Preventive Medicine, Monash University, Australia, United Kingdom
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10
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Mashola MK, Korkie E, Mothabeng DJ. Development of a pain self-management intervention framework for people with spinal cord injury. Afr J Prim Health Care Fam Med 2023; 15:e1-e12. [PMID: 37916727 PMCID: PMC10623601 DOI: 10.4102/phcfm.v15i1.4039] [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: 02/15/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Pain is the most common reason for medical visits to primary health care practitioners. Pain self-management interventions are encouraged and there is no known self-management intervention framework available that clinicians and people with spinal cord injury (PWSCI) can use to guide treatment selection. AIM This study aimed to develop a pain self-management intervention framework for PWSCI. SETTING Online and facilitated in Gauteng, South Africa. METHODS A three-round modified e-Delphi method was used to reach an 80% consensus among a 21-expert panel. Fifty-nine interventions were distributed via REDCap and a final online audio meeting was held to either include or exclude interventions in the final framework. SPSS v27 was used to analyse descriptive data and content analysis was used for qualitative responses. RESULTS The final developed pain self-management framework consists of 56 interventions and includes interventions from multiple health professions to encompass medical, psychological, therapeutic and social interventions. Interventions are also specified for nociceptive and/or neuropathic pain and grouped according to the biopsychosocial model. CONCLUSION The interprofessional framework may be used as a guideline for PWSCI to alleviate pain, as well as assist health professionals in clinical decision-making, by providing them with the freedom to choose acceptable and adequate interventions that may be appropriate to treat the affected individual's pain.Contribution: Pain management is a basic need at the primary healthcare level and PWSCI need access to the broad range of interventions available to manage their pain. The framework highlights the variety of appropriate interventions to guide both health professionals and PWSCI with pain relief options.
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Affiliation(s)
- Mokgadi K Mashola
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria.
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11
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Shebeshi D, Allingham S, White J, Tardif H, Holloway D. Factors associated with general practitioner visits for pain in people experiencing chronic pain. J Prim Health Care 2023; 15:199-205. [PMID: 37756231 DOI: 10.1071/hc23004] [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: 01/12/2023] [Accepted: 03/22/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Patients with chronic pain (CP) are frequent users of general practitioners (GPs). Aim This study aimed to assess factors associated with the rate of GP visits related to pain in patients with CP. Methods This study used data collected by adult specialist pain management services (SPMS) that participated in the electronic Persistent Pain Outcomes Collaboration (ePPOC) in Australia. Adult patients (18 years or older) with CP (duration greater than 3 months) who were referred to SPMS from the calendar year 2015-2021 were included (N = 84 829). Results Patients who reported severe anxiety, stress, pain, pain interference, pain catastrophising and severely impaired pain self-efficacy were more likely to seek help from a GP. Patients with longer pain duration had a lower rate of GP visits. The rate of GP visits was 1.22 (IRR = 1.22, 95% CI: 1.19, 1.26) times higher in patients with severe pain severity, compared to patients with mild pain severity. Patients who used opioids were more likely to visit a GP (IRR = 1.32, 95% CI: 1.30, 1.34) than those who were not using opioids. Discussions More than half of the adult CP patients had greater than three GP visits in the 3 months before referral. This study would indicate that some patients may attend their GP to seek an opioid prescription. Given the rising use of opioids nationally, future study is required on opioid users' GP visitation practices. Additionally, the inverse association between pain duration and the rate of GP visits warrants further exploration.
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Affiliation(s)
- Dinberu Shebeshi
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Samuel Allingham
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Janelle White
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Hilarie Tardif
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - David Holloway
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
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12
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Cullens M, James C, Liu M, Vydyanathan A, Shaparin N, Schatman M, Hascalovici J. Defining Personas of People Living with Chronic Pain: An Ethnographic Research Study. J Pain Res 2023; 16:2803-2816. [PMID: 37600078 PMCID: PMC10438436 DOI: 10.2147/jpr.s420742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Pain is the leading reason for which people seek medical care in the United States, and chronic pain (CP) affects approximately 50 million people in the US Pain perception is deeply personal, is highly correlated with behavioral and emotional disorders, and is greatly influenced by physiological and environmental factors. The patient-provider relationship can have profound implications for clinical outcomes within the context of treating CP. However, limited access to pain specialists, the complex nature of many CP-causing conditions, the absence of instruments for objective pain measurement, and the need to foster a trust-based patient-provider relationship throughout treatment pose unique challenges. Objective To support a more optimal CP care delivery system that leverages a healthy therapeutic patient-provider relationship, we systematically gathered deeper knowledge of the behaviors, interpersonal dynamics, home environment, values, and mindsets of people who experience CP. Methods We employed ethnographic research methods to collect and analyze data on views, habits, strategies, attitudes, and life circumstances of a range of participants living with CP. We aggregated, analyzed, and summarized participant data to identify trends and similarities. Results Our findings suggest that patients can be broadly categorized into five predominant pain typologies, or "personas", which are characterized by respective symptom durations, care management preferences, values, communication styles, and behaviors. Conclusion Identifying CP personas may enhance the ability to personalize CP care and help foster more robust therapeutic relationships, which may lead to greater trust, improved patient satisfaction, and better clinical outcomes.
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Affiliation(s)
| | - Cyan James
- Clearing Relief Labs Inc., New York City, NY, USA
| | - Meran Liu
- Clearing Relief Labs Inc., New York City, NY, USA
| | - Amaresh Vydyanathan
- Relief Medical Group P.A, New York City, NY, USA
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA
- Multidisciplinary Pain Program, Montefiore Medical Center, Bronx, NY, USA
| | - Naum Shaparin
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA
- Multidisciplinary Pain Program, Montefiore Medical Center, Bronx, NY, USA
- The Arthur S. Abramson Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Schatman
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York City, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York City, NY, USA
| | - Jacob Hascalovici
- Relief Medical Group P.A, New York City, NY, USA
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA
- The Arthur S. Abramson Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Bronx, NY, USA
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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13
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Nicola M, Correia H, Ditchburn G, Drummond PD. Defining pain-validation: The importance of validation in reducing the stresses of chronic pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:884335. [PMID: 36313220 PMCID: PMC9614309 DOI: 10.3389/fpain.2022.884335] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
Purpose To validate an individual's feelings or behaviour is to sanction their thoughts or actions as worthy of social acceptance and support. In contrast, rejection of the individual's communicated experience indicates a denial of social acceptance, representing a potential survival threat. Pain-invalidation, though ill-defined, appears to be a fundamental component of psychosocial stress for people with chronic pain. As such, the aim of this paper was to define pain-validation and outline its importance for those with chronic pain. Methods The pain-validation construct was defined using themes inherent in the narratives of those with chronic pain, as identified in a previously published systematic search and thematic analysis, together with examination of additional literature on pain-validation in the clinical context. Results We present a construct definition, proposing that pain-validation must necessarily include: (i) belief that the pain experience is true for the individual, (ii) acceptability of the individual's expressions of pain, and (iii) communication of belief and acceptability to the individual experiencing pain. Further, we outline the importance of pain-validation as a protective factor and means of reducing many of the psychosocial stresses of chronic pain; for example, by indicating social support for pain-coping, buffering negative emotions, and re-enforcing unity and shared identity. Implications The role of pain-validation in the current era of pain management intervention is discussed. Adhering to interventions that involve cognitive and behavioural change is often difficult. Acknowledging and validating the acceptability of the patient's pain experience in the early stages of pain management may, therefore, be a key component of intervention that encourages compliance to the treatment plan and achieving therapeutic goals.
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14
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Fox AL, Swink LA, Prabhu N, Fruhauf CA, Portz JD, Van Puymbroeck M, Sharp JL, Leach HJ, Schmid AA. Manual development for a multi-modal, dyadic intervention for persistent pain: A Qualitative Study. Br J Pain 2022; 16:481-489. [PMID: 36389010 PMCID: PMC9644100 DOI: 10.1177/20494637221090461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Background People who experience persistent pain often require help from a family member, partner, or friend. These caregivers frequently have pain but are often not included in interventions. Caregivers and care receivers who both experience pain are more likely to be socially isolated, and experience communication conflict and decreased quality of life. Interventions should target caregiving dyads to help them manage their pain together. However, there are few intervention manuals or research protocols developed to support the dyad. Objective The purpose of this qualitative study was to explore the needs of caregiving dyads, including input from dyads and medical and allied health experts to inform the development of an intervention manual for dyads with persistent pain. Method A total of 16 caregiving dyads experiencing persistent pain, one care receiver (caregiver could not participate), and 8 health experts, recruited from the community, participated in focus groups. Data were transcribed verbatim, uploaded into NVivo software, and analyzed using constant comparison qualitative methods. Results Findings identified the importance of a new intervention to focus on modifiable approaches to managing pain as a dyad, addressing the emotional and psychological effects of experiencing pain as a dyad, and careful consideration of logistics to implement an intervention with dyads in persistent pain. Conclusion These results highlight important considerations to meet the needs of caregiving dyads with pain. This study informed the development of the MY-Skills intervention, a novel program that merges self-management education with adaptive yoga to treat persistent pain in caregiving dyads.
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Affiliation(s)
| | - Laura A Swink
- Eastern Colorado VA Geriatric Research
Education and Clinical Center (GRECC), Aurora, CO, USA
- University of Colorado: Anschutz
Medical Campus, Aurora, CO, USA
| | - Neha Prabhu
- Growing Self Counseling and Coaching,
Denver, CO, USA
| | | | - Jennifer D Portz
- University of Colorado: Anschutz
Medical Campus, Aurora, CO, USA
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15
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Self-management programs for chronic non-cancer pain: A rapid review of randomized trials. Neurol Sci 2022:1-13. [PMID: 35695082 DOI: 10.1017/cjn.2022.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Bostrøm K, Varsi C, Eide H, Børøsund E, Kristjansdottir ÓB, Schreurs KMG, Waxenberg LB, Weiss KE, Morrison EJ, Nordang EF, Stubhaug A, Nes LS. Engaging with EPIO, a digital pain self-management program: a qualitative study. BMC Health Serv Res 2022; 22:577. [PMID: 35488295 PMCID: PMC9052507 DOI: 10.1186/s12913-022-07963-x] [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] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/05/2022] [Indexed: 12/23/2022] Open
Abstract
Background Chronic pain conditions entail significant personal and societal burdens and improved outreach of evidence-based pain self-management programs are needed. Digital cognitive-behavioral self-management interventions have shown promise. However, evidence is still scarce and several challenges with such interventions for chronic pain exist. Exploring patients' experiences and engagement with digital interventions may be an essential step towards developing meaningful digital self-management interventions for those living with chronic pain. Objectives This study aimed to gain insight into the experiences of people with chronic pain when engaging with EPIO, an application (app)-based cognitive-behavioral pain self-management intervention program. Methods Participants (N = 50) living with chronic pain received access to the EPIO intervention in a feasibility pilot-study for 3 months. During this time, all participants received a follow-up phone call at 2–3 weeks, and a subsample (n = 15) also participated in individual semi-structured interviews after 3 months. A qualitative design was used and thematic analysis was employed aiming to capture participants’ experiences when engaging with the EPIO intervention program. Results Findings identifying program-related experiences and engagement were organized into three main topics, each with three sub-themes: (1) Engaging with EPIO; motivation to learn, fostering joy and enthusiasm, and helpful reminders and personalization, (2) Coping with pain in everyday life; awareness, practice and using EPIO in everyday life, and (3) The value of engaging with the EPIO program; EPIO – a friend, making peace with the presence of pain, and fostering communication and social support. Conclusions This qualitative study explored participants’ experiences and engagement with EPIO, a digital self-management intervention program for people living with chronic pain. Findings identified valued aspects related to motivation for engagement, and showed how such a program may be incorporated into daily life, and encourage a sense of acceptance, social support and relatedness. The findings highlight vital components for facilitating digital program engagement and use in support of self-management for people living with chronic pain. Trial registration ClinicalTrials.gov NCT03705104. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07963-x.
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Affiliation(s)
- Katrine Bostrøm
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Health and Social Sciences, Centre for Health and Technology, University of South-Eastern Norway, Drammen, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Ólöf B Kristjansdottir
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit On Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Karlein M G Schreurs
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Lori B Waxenberg
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Karen E Weiss
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Elise Flakk Nordang
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Audun Stubhaug
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Regional Advisory Unit On Pain, Oslo University Hospital, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. .,Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA.
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17
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Balestra AM, Chalk K, Spies C, Denke C, Krampe H, Tafelski S. Living with Chronic Pain During the COVID-19 Pandemic: A Qualitative Analysis. J Pain Res 2022; 15:969-981. [PMID: 35411185 PMCID: PMC8994632 DOI: 10.2147/jpr.s351846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/18/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose COVID-19 pandemic containment measures have led to changes in various areas of life, including restrictions on health care. Patients with chronic pain may have faced an increased burden during pandemic and the resources of this vulnerable population are unknown. Therefore, a qualitative study was conducted to understand how people with chronic pain have experienced the course of the pandemic. Patients and Methods Twenty semi-structured telephone interviews were conducted six months after the initial lockdown in Germany. The participants were patients with chronic pain who exhibited varying changes in their pain during the first German lockdown, recruited from a German outpatient pain clinic at a Department of Anesthesiology and Intensive Care. The semi-structured interview guidelines were designed to explore how patients with chronic pain experienced their pain during the pandemic, how they coped, and how they experienced pain management during this time. The interview recordings were transcribed verbatim and coded using the qualitative content analysis method. Results Four themes emerged from the results: differential impact on pain experience, difficulty coping with pain, supportive pain management, and endurance. Conclusion During this uncertain time, it was particularly important to maintain pain treatment in order to establish a sense of safety and stability. This underscores the special role of maintaining therapeutic contact during a pandemic and the potentially special role of telemedicine.
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Affiliation(s)
- Anna Marie Balestra
- Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Correspondence: Anna Marie Balestra, Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany, Tel +49 30 450 631 014, Fax +49 30 450 531 904, Email
| | - Katharina Chalk
- Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Denke
- Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Henning Krampe
- Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sascha Tafelski
- Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
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18
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Kelly M, Fullen B, Martin D, McMahon S, McVeigh JG. eHealth Interventions to Support Self-Management in People With Musculoskeletal Disorders, "eHealth: It's TIME"-A Scoping Review. Phys Ther 2022; 102:6506314. [PMID: 35079826 PMCID: PMC8994513 DOI: 10.1093/ptj/pzab307] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE eHealth-mediated interventions have been proposed as one option to support self-management in those with musculoskeletal disorders (MSDs). This scoping review aimed to chart the evidence regarding eHealth modalities, musculoskeletal diagnosis, and outcomes of eHealth-mediated self-management support interventions in persons with MSDs and identify any gaps within the literature. METHODS Six electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, Scopus, and the Cochrane Database of Systematic Reviews), 7 grey literature sources (eg, OpenGrey), and reference and citation lists of included studies were searched from database inception to July 2020. Published studies of adult participants with a MSD utilizing an eHealth intervention to support self-management were included. Studies were limited to those published in English. Two reviewers independently screened all studies. Data were extracted by 1 reviewer and reviewed by another reviewer. RESULTS After screening 3377 titles and abstracts followed by 176 full texts, 87 studies fulfilled the eligibility criteria. The majority were published in the last 5 years (n = 48; 55%), with almost one-third originating in the United States (n = 28; 32%). The most common eHealth modality type was internet based (n = 22; 35%), with almost one-half (n = 41; 47%) of the included studies involving participants with widespread musculoskeletal symptoms. The most commonly reported outcomes were related to body functions (ie, pain intensity) (n = 67; 45%), closely followed by activities and participation (ie, function) (n = 65; 44%), with environmental factors (ie, health care utilization) the least commonly reported (n = 17; 20%). CONCLUSIONS There is considerable variation within the eHealth-mediated self-management support intervention literature. Research is needed on the role of eHealth-mediated self-management support interventions across a broad range of MSDs to guide clinical practice. IMPACT This scoping review has identified gaps in the literature relating to specific eHealth modalities, musculoskeletal diagnoses, and health care utilization data, which should guide future research.
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Affiliation(s)
- Marie Kelly
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland,Department of Physiotherapy, Mercy University Hospital, Cork, Ireland,Address all correspondence to Marie Kelly at:
| | - Brona Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom,NIHR Applied Research Collaborative, North East and North Cumbria, United Kingdom
| | - Sinéad McMahon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
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19
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Diener I. Physiotherapy support for self-management of persisting musculoskeletal pain disorders. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1564. [PMID: 34859158 PMCID: PMC8603210 DOI: 10.4102/sajp.v77i1.1564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/15/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Musculoskeletal pain (MSKP) is an extremely common pain disorder in almost all populations. Self-management (SM) support is a programme to prepare people to self-manage their health condition effectively, while maintaining quality of life. SM is a cost-effective and context-specific strategy to address the global public health burden. OBJECTIVES Self-management needs a change in behaviour from seeking unnecessary medical care to safely self-managing symptoms. As changing individuals' behaviour is challenging, the objective of my literature review was to identify the characteristics, in both therapist and patient, to successfully engage in SM. METHOD A narrative literature review, that could inform evidence-based support programmes for SM of MSKP. RESULTS Studies on successful implementation of SM of MSKP do not report strong outcomes. However, in more recent years a few positive outcomes were reported, possibly as a result of research evidence for the application of psychosocial skills and contemporary pain neuroscience in the management of persistent MSKP. CONCLUSION Psychologically-informed physiotherapy, addressing psychosocial barriers to the maintenance of SM programmes, could facilitate more successful outcomes. CLINICAL IMPLICATIONS Before engaging in a SM support programme, obstacles to behaviour change must be identified and addressed in a SM support programme, to facilitate individuals towards taking safe responsibility for their healthcare. Therapists working with patients with persistent MSKP, should upskill themselves to be in line with the latest pain and psychosocial research literature. Moreover, communication skills training seems to be a priority for effective SM support programmes.
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Affiliation(s)
- Ina Diener
- Department of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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20
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Du S, Dong J, Jin S, Zhang H, Zhang Y. Acceptance and Commitment Therapy for chronic pain on functioning: A systematic review of randomized controlled trials. Neurosci Biobehav Rev 2021; 131:59-76. [PMID: 34536462 DOI: 10.1016/j.neubiorev.2021.09.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/04/2021] [Accepted: 09/08/2021] [Indexed: 01/08/2023]
Abstract
Chronic pain is a worldwide health problem, Acceptance and Commitment Therapy (ACT) is regarded as one of the promising interventions. ACT aims to help chronic pain patients to create space for pursuing valued life activities in spite of pain. This systematic review of randomized controlled trials (RCTs) examined the efficacy of ACT on functioning for chronic pain. Literature search was performed among seven databases, and 12 RCTs were retrieved. The revised Cochrane risk of bias tool (RoB 2.0) was employed to assess the quality of the 12 RCTs, of which 10 were rated as "low risks", and 2 as "some concerns". Effect sizes of single RCTs and the pooled effect sizes of meta analyses were all rated by Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Low to moderate evidence showed that ACT played a positive immediate role in functioning for patients with chronic pain; however, it is inconsistent whether the effect can be sustained. More RCTs are warranted within specific chronic pain conditions.
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Affiliation(s)
- Shizheng Du
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China.
| | - Jianshu Dong
- Shanghai Municipal Center for Health Promotion of Shanghai Municipal Health Commission, #122 South Shaanxi Road, Jing-an District, Shanghai, 200040, China.
| | - Shengji Jin
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China.
| | - Heng Zhang
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China.
| | - Yuqun Zhang
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China.
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21
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Tan C, Searle A, Wall C, Herriot P. Brief introductory group education programs for chronic disease patients in chronic disease management: a scoping review protocol. JBI Evid Synth 2021; 20:214-221. [PMID: 34171893 DOI: 10.11124/jbies-20-00464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To scope the literature available and map the range of features of brief introductory group education programs implemented in chronic disease management. INTRODUCTION Brief introductory group education programs are resource-efficient interventions used in chronic disease management to educate patients on basic disease concepts, self-management strategies, and to introduce specialist services. There is a lack of published research that synthesizes the characteristics, guiding principles, and outcomes reported in brief group education programs in chronic disease management. This scoping review will seek to identify brief introductory group education programs and describe the i) scope of literature available on brief introductory group education programs, ii) characteristics of programs, iii) guiding self-management principles used and the extent to which programs follow such principles, and iv) types of outcomes reported. INCLUSION CRITERIA Studies describing an introductory or brief group patient education program (one to four sessions, no more than eight hours) for the management of chronic disease in adults with ongoing chronic disease. METHODS MEDLINE, Scopus, CINAHL, Emcare, Web of Science, JBI Evidence Synthesis, and PsycINFO will be searched for English-language articles published from 2001 to the present. Titles and abstracts will be screened against inclusion/exclusion criteria, followed by full-text review, independently assessed by two reviewers. Eligible articles will be extracted and charted using a standardized data extraction form. A descriptive review to summarize and contextualize the extracted data will be conducted.
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Affiliation(s)
- Celia Tan
- School of Medicine, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia Pain Management Unit, Flinders Medical Centre, Adelaide, SA, Australia
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López-López L, Ariza-Mateos MJ, Rodríguez-Torres J, Cabrera-Martos I, Granados-Santiago M, Torres-Sánchez I, Valenza MC. Results of a self-management program added to standard physical therapy in chronic neck pain. PATIENT EDUCATION AND COUNSELING 2021; 104:1438-1444. [PMID: 33246873 DOI: 10.1016/j.pec.2020.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a self-management treatment added to a physical therapy program compared to a physical therapy program in patients with chronic neck pain. METHODS Fifty-three patients with chronic neck pain were randomly allocated to a physical therapy intervention (control group) or an individualized self-management combined with physical therapy intervention (experimental group). Both interventions were developed over a four-week period. Outcome measures included were Disability, Fear-Avoidance Beliefs, Health-Related Quality of Life, Pain, and Anxiety and Depression. All outcomes were measured before and after the treatment and at three-month follow-up. RESULTS There were not significant differences between groups at baseline. After the intervention both groups obtained better results in the Neck Disability Index but there were not significant differences between them (p > 0.05). At follow-up, the self-management group obtained significant better results compared to the control group (95 % CI: -5.20(-6.8 to -1.5), p = 0.032). CONCLUSIONS An individualized self-management program added to a physical therapy program led to a greater improvement in disability at 3 months follow up compared to a physical therapy program alone. Catastrophizing, pain, and health-related quality of life improved significantly after the intervention and at follow-up compared to the standard care alone. PRACTICAL IMPLICATIONS This study indicates that physical therapy for patients with chronic neck pain preferably should include self-management education.
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Affiliation(s)
- L López-López
- Department of Physical Therapy, School of Health Sciences, University of Granada, Spain
| | - M J Ariza-Mateos
- Department of Physical Therapy, School of Health Sciences, University of Granada, Spain
| | - J Rodríguez-Torres
- Department of Physical Therapy, School of Health Sciences, University of Granada, Spain
| | - I Cabrera-Martos
- Department of Physical Therapy, School of Health Sciences, University of Granada, Spain
| | - M Granados-Santiago
- Department of Physical Therapy, School of Health Sciences, University of Granada, Spain
| | - I Torres-Sánchez
- Department of Physical Therapy, School of Health Sciences, University of Granada, Spain
| | - M C Valenza
- Department of Physical Therapy, School of Health Sciences, University of Granada, Spain.
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Rujipong P, Kantaruksa K, Chaloumsuk N, Yothayai C. Pain Self-Management Strategies of Chronic Back Pain Sufferers in Thailand: A Qualitative Study (A Doctoral Project). Open Nurs J 2021. [DOI: 10.2174/1874434602115010085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Chronic low back pain is among the most common chronic musculoskeletal disorders worldwide. It is prevalent in Thailand, affecting up to 30% of the general population, with much higher rates among manual labourers. Pain self-management, including education, exercise, medication and other components, is an effective strategy for reducing pain intensity and disability rates for chronic low back pain sufferers.
Objective:
To investigate pain self-management strategies among chronic lower back pain sufferers in Thailand.
Methods:
The study design was a qualitative interview-based technique. The study setting was an orthopaedic outpatient department at a university hospital in Northern Thailand. Participants (n = 19) were selected based on recruitment criteria, and data was collected using demographic forms and in-depth interviews. Thematic analysis was used for qualitative analysis, with Wilcoxon signed-rank test used to assess changes in pain levels.
Results:
Participants used a combination of pain self-management modalities, including exercise, modified food consumption, increased rest, herbal treatments, hot and cold compression, Thai massage, and acupressure, along with psychological and spiritual coping tools like meditation and making merit. Ability to use these interventions was dependent on medical support from practitioners as well as social and other support. A small, but significant, mean difference in pain was also observed.
Conclusion:
Findings point to the possibility that there are significant cultural differences in pain self-management modalities and their effectiveness.
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Varsi C, Ledel Solem IK, Eide H, Børøsund E, Kristjansdottir OB, Heldal K, Waxenberg LB, Weiss KE, Schreurs KMG, Morrison EJ, Stubhaug A, Solberg Nes L. Health care providers' experiences of pain management and attitudes towards digitally supported self-management interventions for chronic pain: a qualitative study. BMC Health Serv Res 2021; 21:275. [PMID: 33766028 PMCID: PMC7992849 DOI: 10.1186/s12913-021-06278-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic pain constitutes a significant burden for the individuals affected, and is a frequent reason why patients seek health care services. While in-person psychosocial interventions can be of support to people living with chronic pain, such interventions are not always accessible. eHealth interventions may provide greater accessibility, but the evidence and use of digital self-management solutions for chronic pain are still limited and the lack of health care provider input in the development process of such solutions a concern. Therefore, the aim of the current study was to investigate health care providers' experiences of treating patients with chronic pain, their attitudes towards, and use of, digital solutions in pain management, and their suggestions for content and design elements for a potential digital pain self-management intervention. METHODS Twelve health care providers representing a variety of health care disciplines participated in semi-structured interviews. The interviews were analyzed using thematic analysis. RESULTS The material was analyzed into three main themes: [1] Patients with chronic pain and their current use of the health care services, [2] Health care providers' own motivation and impression of patient prerequisites for use of digital self-management interventions, and [3] Suggestions for content and design elements in a digital self-management intervention for people living with chronic pain. The challenges faced by patients living with chronic pain were described as numerous. Despite interest and positive attitudes, few of the health care providers had used or recommended eHealth solutions to their patients. A range of potential content and functionality elements were identified, including aspects of motivation and engagement and providers also emphasized the importance of easy access and positive, personal content to support existing treatment. CONCLUSIONS This study offers insights into health care providers' considerations for the potential of digital self-management interventions supporting patients living with chronic pain. Findings indicate the need for change and a more comprehensive treatment approach to pain management. eHealth solutions may contribute to such change, and providers pointed to a need for health care provider involvement, timely support and follow-up as important factors for integrating digital pain self-management interventions into clinical care. TRIAL REGISTRATION ClinicalTrials.gov : NCT03705104.
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Affiliation(s)
- Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway. .,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Ingrid Konstanse Ledel Solem
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hilde Eide
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway
| | - Olöf B Kristjansdottir
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | | | - Lori B Waxenberg
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Karen E Weiss
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Karlein M G Schreurs
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | | | - Audun Stubhaug
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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25
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Rodham K. The pain self-management paradox: why do we focus on the individual when life context plays such a major role? Pain Manag 2021; 11:333-340. [PMID: 33533287 DOI: 10.2217/pmt-2020-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although there has been a drive toward pain self-management, self-management has not yet in my opinion been successfully defined or evaluated and neither has it been consistently translated from idea to practice. In this perspective article, I identify gaps in our approach to pain management and argue that even though we know life context plays a huge role in influencing our health, by and large we fail to take this into account. I argue for a shift in focus away from the 'self' and explore how we might be able to do this within the constraints of our tired and over-stretched health system.
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Affiliation(s)
- Karen Rodham
- Department of Psychology, Staffordshire University, Leek Road, Stoke-on-Trent ST4 2DF, UK
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26
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Abstract
Abstract
Objective
The aim of this scoping review was to provide evidence for health practitioners to improve patient education practice for chronic pain management.
Methods
A scoping review was guided by Arksey and O'Malley's (2005)1 five-stage framework, investigated contemporary patient education programs (2007–2018) for chronic pain management in education content, formats of delivery, and tools used for evaluation. Content analysis and description were used for the outcome report.
Results
Seven quantitative studies were included. Education content consisted of General information, Cognitive behavior therapy (CBT), Self-management, and Pain neurophysiology (PN). Education delivery formats varied from workbook to workbook, face-to-face, online, when given for a group or individual or in a combined way. In total, 19 tools were reported for the evaluation of the education programs.
Conclusions
There is a variety in the education content and the delivery formats. The majority of programs showed effectiveness in patients’ chronic pain management based on their selected evaluation tools. This review showed that patient education programs can be useful in chronic pain management. The effectiveness of patient education programs focuses on the improved patients’ physical function and quality of life rather than the cessation of pain only.
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Morales-Fernández Á, Jimenez-Martín JM, Morales-Asencio JM, Vergara-Romero M, Mora-Bandera AM, Aranda-Gallardo M, Canca-Sanchez JC. Impact of a nurse-led intervention on quality of life in patients with chronic non-malignant pain: An open randomized controlled trial. J Adv Nurs 2020; 77:255-265. [PMID: 33136314 DOI: 10.1111/jan.14608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/03/2020] [Accepted: 09/30/2020] [Indexed: 12/01/2022]
Abstract
AIMS To determine the effect of a comprehensive nurse-led programme for patients with chronic non-malignant pain, on quality of life, level of pain, anxiety, and depression, as primary outcomes and patients' satisfaction as a secondary end point. DESIGN An open-label randomized controlled trial was carried out. METHODS The experimental group received both a nurse-led intervention on healthy lifestyles, education on self-esteem, pain awareness, communication, and relaxation techniques. The control group received usual care. Quality of life, level of pain, anxiety, and depression were the main outcomes. Data were obtained at baseline, immediately after the intervention, and 6 and 9 months. The study was carried out from 2015-2017. RESULTS The sample was composed of 279 patients. At 9 months, the effect size (non-parametric effect size statistic A) favoured the intervention group for SF-36 mental health score (A = 0.79; 95% CI: 0.73-0.85), anxiety (A = 0.58; 95% CI: 0.51-0.65), pain intensity (A = 0.57; 95% CI: 0.51-0.64), and depression (A = 0.58; 95% CI: 0.51-0.65). Smaller differences were found on physical scores between the intervention and the usual care group. Patients showed a high level of satisfaction with the introduced intervention. CONCLUSION A comprehensive nurse-led programme for patients with chronic non-malignant pain has a positive impact on their quality of life, level of pain, and mental health. IMPACT Studies have reported that the problem of chronic pain is not optimally controlled. A structured nurse-led programme has been tested to facilitate healthy behaviours to help patients manage their chronic pain and to provide them with the necessary tools for their self-care. This nurse-led intervention improved their mental health and decreased their level of pain.
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Affiliation(s)
- Ángeles Morales-Fernández
- Agencia Sanitaria Costa del Sol, Marbella, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | | | - José Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
| | | | - Ana María Mora-Bandera
- Agencia Sanitaria Costa del Sol, Marbella, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
| | - Marta Aranda-Gallardo
- Agencia Sanitaria Costa del Sol, Marbella, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
| | - José Carlos Canca-Sanchez
- Agencia Sanitaria Costa del Sol, Marbella, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
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28
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Suso-Ribera C, Castilla D, Zaragozá I, Mesas Á, Server A, Medel J, García-Palacios A. Telemonitoring in Chronic Pain Management Using Smartphone Apps: A Randomized Controlled Trial Comparing Usual Assessment against App-Based Monitoring with and without Clinical Alarms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186568. [PMID: 32916983 PMCID: PMC7559749 DOI: 10.3390/ijerph17186568] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The usefulness of mHealth in helping to target face-to-face interventions for chronic pain more effectively remains unclear. In the present study, we aim to test whether the Pain Monitor mobile phone application (app) is well accepted by clinicians, and can help improve existent medical treatments for patients with chronic musculoskeletal pain. Regarding this last goal, we compared three treatment conditions, namely usual treatment, usual treatment with an app without alarms and usual treatment with an app with alarms. All treatments lasted one month. The three treatments were compared for all outcomes, i.e., pain severity and interference, fatigue, depressed mood, anxiety and anger. METHODS In this randomized controlled trial, the usual monitoring method (i.e., onsite; n = 44) was compared with daily ecological momentary assessment using the Pain Monitor app-both with (n = 43) and without alarms (n = 45). Alarms were sent to the clinicians in the presence of pre-established undesired clinical events and could be used to make treatment adjustments throughout the one-month study. RESULTS With the exception of anger, clinically significant changes (CSC; 30% improvement) were greater in the app + alarm condition across outcomes (e.g., 43.6% of patients experienced a CSC in depressed mood in the app + alarm condition, which occurred in less than 29% of patients in the other groups). The clinicians were willing to use the app, especially the version with alarms. CONCLUSIONS The use of apps may have some benefits in individual health care, especially when using alarms to tailor treatments.
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Affiliation(s)
- Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, 12071 Castellón, Spain;
- Correspondence: ; Tel.: +34-964-387-643
| | - Diana Castilla
- Department of Personality, Assessment, and Psychological Treatments, Universidad de Valencia, 46010 Valencia, Spain;
- Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III) (Ciber Physiopathology Obesity and Nutrition, CB06/03 Instituto Salud Carlos III Health Institute), 28029 Madrid, Spain;
| | - Irene Zaragozá
- Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III) (Ciber Physiopathology Obesity and Nutrition, CB06/03 Instituto Salud Carlos III Health Institute), 28029 Madrid, Spain;
| | - Ángela Mesas
- Pain Clinic, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (Á.M.); (A.S.); (J.M.)
| | - Anna Server
- Pain Clinic, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (Á.M.); (A.S.); (J.M.)
| | - Javier Medel
- Pain Clinic, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (Á.M.); (A.S.); (J.M.)
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, 12071 Castellón, Spain;
- Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III) (Ciber Physiopathology Obesity and Nutrition, CB06/03 Instituto Salud Carlos III Health Institute), 28029 Madrid, Spain;
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Schmid AA, Fruhauf CA, Sharp JL, Van Puymbroeck M, Bair MJ, Portz JD. Yoga for People With Chronic Pain in a Community-Based Setting: A Feasibility and Pilot RCT. J Evid Based Integr Med 2020; 24:2515690X19863763. [PMID: 31394910 PMCID: PMC6689911 DOI: 10.1177/2515690x19863763] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The purpose of this feasibility pilot study was to assess benefits of 8 weeks of yoga in people with chronic pain. Participants completed baseline assessments and were randomized to yoga or usual care. Yoga was offered twice a week for 8 weeks. We assessed feasibility and the Brief Pain Inventory (BPI) was the primary outcome, assessing pain-severity and pain interference on daily activities. Eighty-three people were recruited; 67 people completed the study and were included in the analyses. Average age of participants was 50.78 ± 10.43 years and most participants had pain >10 years. The intervention appeared feasible and there were significant improvements (P < .05) in multiple measures for the yoga group, including a decrease in BPI interference scores from 7.15 ± 1.70 to 6.14 ± 2.21 (P = .007). There was a significant difference in body responsiveness and pain management scores between groups at 8 weeks. It appears that yoga was feasible and positively influenced multiple outcome measures for people with chronic pain.
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Affiliation(s)
| | | | | | | | - Matthew J Bair
- 3 Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jennifer Dickman Portz
- 1 Colorado State University, Fort Collins, CO, USA.,4 University of Colorado, Aurora, CO, USA
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30
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DUICA L, SZAKÁCS J, SILIȘTEANU Sînziana Călina. Study on the correlation between knee osteoarthritis and anxiety in patients aged over 55. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction. Osteoarthritis, which is a cause of chronic pain and disability with manifestation in any joint, with greater frequency in the joints of the lower limbs, upper limbs, but also at the spine level , affects around 250 million people in the entire world. This condition affects around 10% of the global population (18) and has an impressive impact on people, as it is one of the first 5 causes of disability. Material and method. The objectives of the treatment made by the patients diagnosed with knee osteoarthritis were: pain reduction, increased joint amplitude, increased muscle strength, increased muscle tone, increased quality of life and reintegration into the family and social environment. In the study, there were discussed demographic data regarding the patients. In order to assess the pain parameter, the VAS scale was used, as well as WOMAC subscales. To assess the quality of life of patients with knee osteoarthritis, the QOL scale (Quality of Life) was used. Anxiety was assessed with the help of a test that comprises the evaluation of symptoms at the cognitive, behavioral and physical level. Results and discussions. The pain was evaluated on the VAS scale, having a statistically significant evolution for the evaluation moments. Also with the help of the WOMAC index, two other parameters were evaluated, namely joint rigidity and functional capacity, the results being statistically significant in the 3 evaluation moments. The patients’ anxiety was evaluated with the help of the anxiety test; the results obtained were statistically significant at the 3 evaluation moments. Conclusions. It is vital that the recovery treatment in osteoarthritis be individualized and adapted to the age group. In our group, it enabled the reduction of pain and anxiety, the increase of the functional capacity and the quality of the patients’ lives.Taking into account the fact that the most affected group in the study group was the active professional one, we can evaluate the size of the recovery and the social, family and professional integration for these patients.
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Affiliation(s)
- Lavinia DUICA
- 1 Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, România 2 Hospital of Psychiatry „Doctor Gheorghe Preda” Sibiu, Romania
| | - Juliánna SZAKÁCS
- 3George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Faculty of Medicine, Department of Biophysics
| | - SILIȘTEANU Sînziana Călina
- 4 Railway Hospital Iasi - Specialty Ambulatory of Suceava 5 "Stefan cel Mare" University of Suceava FEFS-DSDU
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Ledel Solem IK, Varsi C, Eide H, Kristjansdottir OB, Børøsund E, Schreurs KMG, Waxenberg LB, Weiss KE, Morrison EJ, Haaland-Øverby M, Bevan K, Zangi HA, Stubhaug A, Solberg Nes L. A User-Centered Approach to an Evidence-Based Electronic Health Pain Management Intervention for People With Chronic Pain: Design and Development of EPIO. J Med Internet Res 2020; 22:e15889. [PMID: 31961331 PMCID: PMC7001051 DOI: 10.2196/15889] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/18/2019] [Accepted: 12/16/2019] [Indexed: 12/25/2022] Open
Abstract
Background Chronic pain conditions are complicated and challenging to live with. Electronic health (eHealth) interventions show promise in helping people cope with chronic illness, including pain. The success of these interventions depends not only on the technology and intervention content but also on the users’ acceptance and adherence. Involving all stakeholders (eg, patients, spouses, health care providers, designers, software developers, and researchers) and exploring their input and preferences in the design and development process is an important step toward developing meaningful interventions and possibly strengthening treatment outcomes. Objective The aim of this study was to design and develop a user-centered, evidence-based eHealth self-management intervention for people with chronic pain. Methods The study employed a multidisciplinary and user-centered design approach. Overall, 20 stakeholders from the project team (ie, 7 researchers, 5 editors, 7 software developers, and 1 user representative), together with 33 external stakeholders (ie, 12 health care providers, 1 health care manger, 1 eHealth research psychologist, and 17 patients with chronic pain and 2 of their spouses) participated in a user-centered development process that included workshops, intervention content development, and usability testing. Intervention content was developed and finalized based on existing evidence, stakeholder input, and user testing. Stakeholder input was examined through qualitative analyses with rapid and in-depth analysis approaches. Results Analyses from stakeholder input identified themes including a need for reliable, trustworthy, and evidence-based content, personalization, options for feedback, behavioral tracking, and self-assessment/registration as factors to include in the intervention. Evidence-based intervention content development resulted in one face-to-face introduction session and 9 app-based educational and exercise-based modules. Usability testing provided further insight into how to optimize the design of the intervention to the user group, identifying accessibility and a simple design to be essential. Conclusions The design and development process of eHealth interventions should strive to combine well-known evidence-based concepts with stakeholder input. This study, designing and developing the pain management intervention EPIO, illustrates how a stakeholder-centered design approach can provide essential input in the development of an eHealth self-management intervention for people with chronic pain. Trial Registration ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104
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Affiliation(s)
- Ingrid Konstanse Ledel Solem
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Hilde Eide
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway
| | - Olöf Birna Kristjansdottir
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Karlein M G Schreurs
- Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
| | - Lori B Waxenberg
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Karen E Weiss
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, United States
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Mette Haaland-Øverby
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Katherine Bevan
- Center for Learning and Mastery, Bærum Hospital, Vestre Viken Hospital Trust, Bærum, Norway
| | - Heidi Andersen Zangi
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Health, VID Specialized University, Oslo, Norway
| | - Audun Stubhaug
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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32
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A Concept Analysis of Coping with Chronic Pain in Older Adults. Pain Manag Nurs 2019; 20:563-571. [DOI: 10.1016/j.pmn.2019.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/02/2019] [Accepted: 03/15/2019] [Indexed: 12/29/2022]
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33
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Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. J Clin Med 2019; 8:jcm8111769. [PMID: 31652929 PMCID: PMC6912819 DOI: 10.3390/jcm8111769] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.
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Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
- Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland 1142, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
| | - Eva Huysmans
- Pain in Motion International Research Group.
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussel, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- I-CHER, Interuniversity Center for Health Economics Research, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium.
| | - Janelle Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Patrick Finan
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
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Axon DR, Patel MJ, Martin JR, Slack MK. Use of multidomain management strategies by community dwelling adults with chronic pain: evidence from a systematic review. Scand J Pain 2019; 19:9-23. [PMID: 30375350 DOI: 10.1515/sjpain-2018-0306] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/10/2018] [Indexed: 12/18/2022]
Abstract
Background and aims Multidomain strategies (i.e. two or more strategies) for managing chronic pain are recommended to avoid excessive use of opioids while producing the best outcomes possible. The aims of this systematic review were to: 1) determine if patient-reported pain management is consistent with the use of multidomain strategies; and 2) identify the role of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) in patient-reported pain management. Methods Bibliographic databases, websites, and reference lists of included studies were searched to identify published articles reporting community-based surveys of pain self-management from January 1989 to June 2017 using controlled vocabulary (and synonyms): pain; self-care; self-management; self-treatment; and adult. Two independent reviewers screened studies and extracted data on subject demographics, pain characteristics, pain self-management strategies, and pain outcomes. Pain self-management strategies were organized according to our conceptual model. Included studies were assessed for risk of bias. Differences between the researchers were resolved by consensus. Results From the 3,235 unique records identified, 18 studies published between 2002 and 2017 from 10 countries were included. Twenty-two types of pharmacological strategies were identified (16 prescription, six non-prescription). NSAIDs (15 studies, range of use 10-72%) and opioids (12 studies, range of use 5-72%) were the most commonly reported prescription pharmacological strategies. Other prescription pharmacological strategies included analgesics, acetaminophen, anticonvulsants, antidepressants, anxiolytics, salicylates, β-blockers and calcium channel blockers, disease-modifying anti-rheumatic drugs and steroids, muscle relaxants, topical products, triptans, and others. Twenty-two types of non-pharmacological strategies were identified: four medical strategies (10 studies), 10 physical strategies (15 studies), four psychological strategies (12 studies), and four self-initiated strategies (15 studies). Medical strategies included consulting a medical practitioner, chiropractic, and surgery. Physical strategies included exercise, massage, hot and cold modalities, acupuncture, physical therapy, transcutaneous electrical nerve stimulation, activity modification or restriction, assistive devices, and altering body position/posture. Psychological strategies included relaxation, prayer or meditation, therapy, and rest/sleep. Self-initiated strategies included dietary or herbal supplements, dietary modifications, and complementary and alternative medicine. Overall, the number of strategies reported among the studies ranged from five to 28 (out of 44 identified strategies). Limited data on pain outcomes was reported in 15 studies, and included satisfaction with pain management strategies, pain interference on daily activities, adverse events, lost work or restricted activity days, emergency department visits, and disabilities. Conclusions A wide variety and large number of pharmacological and non-pharmacological strategies to manage chronic pain were reported, consistent with the use of multidomain strategies. High levels of use of both NSAIDs and opioids also were reported. Implications Comprehensive review and consultation with patients about their pain management strategies is likely needed for optimal outcomes. Additional research is needed to determine: how many, when, and why multidomain strategies are used; the relationship between opioid use, multidomain management strategies, and level of pain; how multidomain strategies relate to outcomes; and if adding strategies to a pain management plan increases the risk of adverse events or interactions, and increases an individuals pain management burden.
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Affiliation(s)
- David R Axon
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, 1295 N. Martin Avenue, Tucson, AZ 85721, USA
| | - Mira J Patel
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Jennifer R Martin
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA.,University of Arizona Health Sciences Library, The University of Arizona, Tucson, AZ, USA
| | - Marion K Slack
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
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Mackey LM, Blake C, Squiers L, Casey MB, Power C, Victory R, Hearty C, Fullen BM. An investigation of healthcare utilization and its association with levels of health literacy in individuals with chronic pain. Musculoskeletal Care 2019; 17:174-182. [PMID: 30762926 DOI: 10.1002/msc.1386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Chronic pain patients are frequent and recurrent users of health services, which may have an impact on levels of health literacy (HL). Therefore, the aim of the present study was to investigate associations between healthcare utilization and varying levels of HL in individuals with and without chronic pain. METHODS A cross-sectional questionnaire was distributed in three pain clinics in Dublin, Ireland, comprising a demographic section, a validated HL assessment tool (Newest Vital Sign) and self-reported healthcare utilization in the previous year (i.e., general practitioner [GP] visits, accident and emergency room attendance, hospital services and allied health services). Patients with chronic pain, and a control group (no pain) were recruited. RESULTS Overall, 262 participants were recruited: those with chronic pain (n = 131) and controls (n = 131). Those in the chronic pain group were more likely to be female (p = 0.004), have less education (p = 0.01), be unable to work (p < 0.001), have a lower monthly income (p = 0.001), be more likely to have a medical card (i.e., free access to public health services) (p = 0.002) and have a greater number of comorbidities (p < 0.0001). Although bivariate analyses demonstrated increased healthcare utilization in chronic pain patients (i.e., GP visits, hospital services and allied therapies; p < 0.05), there was no difference in HL levels between groups in multivariate analysis (chronic pain: 54%, n = 71; control group 49%, n = 64; p = 0.39). Higher educational attainment, greater levels of income and being younger remained independently associated with higher levels of HL. CONCLUSIONS Further research is needed to understand the nature of how HL is acquired, both from individual and organizational perspectives. Once this has been established, it may facilitate the development or advancement of current HL-sensitive management strategies.
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Affiliation(s)
| | | | | | | | | | - Ray Victory
- St. Vincent's University Hospital, Dublin, Ireland
| | - Conor Hearty
- Mater Misericordiae University Hospital, Dublin, Ireland
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Campbell EA, Hynynen J, Burger B, Ala-Ruona E. Exploring the use of Vibroacoustic treatment for managing chronic pain and comorbid mood disorders: A mixed methods study. NORDIC JOURNAL OF MUSIC THERAPY 2019. [DOI: 10.1080/08098131.2019.1604565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Elsa A. Campbell
- Finnish Centre for Interdisciplinary Music Research, Department of Music, Art and Culture Studies, University of Jyväskylä, Jyvaskyla, Finland
- VIBRAC Skille-Lehikoinen Centre for Vibroacoustic Therapy and Research, Eino Roiha Foundation, University of Jyväskylä, Finland
| | - Jouko Hynynen
- Seinäjoki Central Hospital, South Ostrobothnia Healthcare District, Seinäjoki, Finland
| | - Birgitta Burger
- Finnish Centre for Interdisciplinary Music Research, Department of Music, Art and Culture Studies, University of Jyväskylä, Jyvaskyla, Finland
| | - Esa Ala-Ruona
- Finnish Centre for Interdisciplinary Music Research, Department of Music, Art and Culture Studies, University of Jyväskylä, Jyvaskyla, Finland
- VIBRAC Skille-Lehikoinen Centre for Vibroacoustic Therapy and Research, Eino Roiha Foundation, University of Jyväskylä, Finland
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Gjesdal K, Dysvik E, Furnes B. Nurses' experiences with health care in pain clinics: A qualitative study. Int J Nurs Sci 2019; 6:169-175. [PMID: 31406887 PMCID: PMC6608665 DOI: 10.1016/j.ijnss.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/15/2019] [Accepted: 03/05/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Recent research has focused on the effectiveness of different treatment regimens in pain clinics, where a call for more multifaceted treatment has been highlighted. Less attention has been paid to improvements within pain clinics, and how registered nurses-who usually play a key role-perceive and experience the accessibility, treatment options and follow-up offers at public pain clinics. OBJECTIVE The overall aim was to explore and describe how nurses experience health care provided to patients with chronic non-cancer pain at pain clinics. METHODS We used 10 individual interviews with nurses working at 10 different public pain clinics in Norway. The interviews were analyzed using qualitative content analysis. RESULTS One theme was developed from the content analysis: "Nurses' striving to provide whole-person care in pain clinics." The nurses experienced allocation of limited resources as challenging, especially when the dilemma between accepting new patients from the waiting list and offering follow-up to existing patients became apparent. Multifaceted treatment was perceived as vital, although resources, priorities, and theoretical understanding of pain within the team were challenging. CONCLUSIONS The needs for multifaceted and integrated treatments in chronic pain management were obvious, although this approach appeared to be too demanding of resources and time. Stronger cooperation between pain clinics in specialist care and health care providers in primary care to ensure better patient flow and treatment is required. Emphasis is placed on coherent theoretical approaches to pain management within the team in the pain clinics to ensure whole person care.
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Affiliation(s)
- Kine Gjesdal
- University of Stavanger, Faculty of Health Sciences, Norway
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38
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Ledel Solem IK, Varsi C, Eide H, Kristjansdottir OB, Mirkovic J, Børøsund E, Haaland-Øverby M, Heldal K, Schreurs KM, Waxenberg LB, Weiss KE, Morrison EJ, Solberg Nes L. Patients' Needs and Requirements for eHealth Pain Management Interventions: Qualitative Study. J Med Internet Res 2019; 21:e13205. [PMID: 30877780 PMCID: PMC6462891 DOI: 10.2196/13205] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A growing body of evidence supports the potential effectiveness of electronic health (eHealth) interventions in managing chronic pain. However, research on the needs and preferences of patients with chronic pain in relation to eHealth interventions is scarce. Eliciting user input in the development of eHealth interventions may be a crucial step toward developing meaningful interventions for patients for potentially improving treatment outcomes. OBJECTIVE This study aimed to explore the experiences of patients with chronic pain with regard to information and communication technology, understand how an eHealth intervention can support the everyday needs and challenges of patients with chronic pain, and identify possible facilitators and barriers for patients' use of an eHealth pain management intervention. METHODS Twenty patients living with chronic pain and five spouses participated in individual interviews. Semistructured interview guides were used to explore participants' needs, experiences, and challenges in daily life as well as their information and communication technology experiences and preferences for eHealth support interventions. Spouses were recruited and interviewed to gain additional insight into the patients' needs. The study used qualitative thematic analysis. RESULTS The participants were generally experienced technology users and reported using apps regularly. They were mainly in favor of using an eHealth self-management intervention for chronic pain and considered it a potentially acceptable way of gathering knowledge and support for pain management. The participants expressed the need for obtaining more information and knowledge, establishing a better balance in everyday life, and receiving support for improving communication and social participation. They provided suggestions for the eHealth intervention content and functionality to address these needs. Accessibility, personalization, and usability were emphasized as important elements for an eHealth support tool. The participants described an ideal eHealth intervention as one that could be used for support and distraction from pain, at any time or in any situation, regardless of varying pain intensity and concentration capacity. CONCLUSIONS This study provides insight into user preferences for eHealth interventions aiming to address self-management for chronic pain. Participants highlighted important factors to be considered when designing and developing eHealth interventions for self-management of chronic pain, illustrating the importance and benefit of including users in the development of eHealth interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104.
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Affiliation(s)
- Ingrid Konstanse Ledel Solem
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Varsi
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Hilde Eide
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway
| | - Olöf Birna Kristjansdottir
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Jelena Mirkovic
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Elin Børøsund
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Mette Haaland-Øverby
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Karina Heldal
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karlein Mg Schreurs
- Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
| | - Lori B Waxenberg
- Department of Clinical and Health Psychology, University of Florida, Florida, FL, United States
| | - Karen Elizabeth Weiss
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Washington, WA, United States
| | | | - Lise Solberg Nes
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States
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39
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Letzen JE, Seminowicz DA, Campbell CM, Finan PH. Exploring the potential role of mesocorticolimbic circuitry in motivation for and adherence to chronic pain self-management interventions. Neurosci Biobehav Rev 2019; 98:10-17. [PMID: 30543904 PMCID: PMC6401294 DOI: 10.1016/j.neubiorev.2018.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 12/28/2022]
Abstract
Adherence to pain self-management strategies is associated with favorable psychobehavioral outcomes among individuals with chronic pain. Substantive adherence to treatments teaching these adaptive skills often proves challenging, resulting in poor individual and societal outcomes. Evidence demonstrates motivation for behavior change as a key predictor of treatment adherence. Despite behavioral techniques that target motivation, however, nonadherence persists as a barrier to positive clinical outcomes in chronic pain. Understanding the neurobiological mechanisms underlying treatment motivation might highlight novel avenues for augmentative therapies. The purpose of this review is to present theory and evidence that the mesocorticolimbic system (i.e., brain circuitry associated with reward processing and motivation) contributes to treatment motivation among chronic pain patients, ultimately influencing adherence. We review evidence for motivation as a key adherence determinant, detail neuroimaging findings relating mesocorticolimbic circuitry and motivation, and discuss data supporting mesocorticolimbic dysfunction among chronic pain patients. We propose a neurobehavioral model for adherence to pain self-management interventions, listing testable hypotheses. Finally, we discuss potential research and intervention implications from the proposed model.
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Affiliation(s)
- Janelle E Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 5510 Nathan Shock Drive, Suite 101, Baltimore, MD, USA.
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, 650 W. Baltimore St., Baltimore, MD, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 5510 Nathan Shock Drive, Suite 101, Baltimore, MD, USA
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 5510 Nathan Shock Drive, Suite 101, Baltimore, MD, USA
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40
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41
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Reddan MC, Wager TD. Brain systems at the intersection of chronic pain and self-regulation. Neurosci Lett 2018; 702:24-33. [PMID: 30503923 DOI: 10.1016/j.neulet.2018.11.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic pain is a multidimensional experience with cognitive, affective, and somatosensory components that can be modified by expectations and learning. Individual differences in cognitive and affective processing, as well as contextual aspects of the pain experience, render chronic pain an inherently personal experience. Such individual differences are supported by the heterogeneity of brain representations within and across chronic pain pathologies. In this review, we discuss the complexity of brain representations of pain, and, with respect to this complexity, identify common elements of network-level disruptions in chronic pain. Specifically, we identify prefrontal-limbic circuitry and the default mode network as key elements of functional disruption. We then discuss how these disrupted circuits can be targeted through self-regulation and related cognitive strategies to alleviate chronic pain. We conclude with a proposal for how to develop personalized multivariate models of pain representation in the brain and target them with real-time neurofeedback, so that patients can explore and practice self-regulatory techniques with maximal efficiency.
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Affiliation(s)
| | - Tor D Wager
- University of Colorado, Boulder, United States.
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42
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Ikemoto T, Miki K, Matsubara T, Wakao N. Psychological Treatment Strategy for Chronic Low Back Pain. Spine Surg Relat Res 2018; 3:199-206. [PMID: 31440677 PMCID: PMC6698517 DOI: 10.22603/ssrr.2018-0050] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/02/2018] [Indexed: 12/20/2022] Open
Abstract
Studies have indicated that chronic low back pain (LBP) should be approached according to its morphological basis and in consideration of biopsychosocial interventions. This study presents an updated review on available psychological assessments and interventions for patients with chronic LBP. Psychosocial factors, including fear-avoidance behavior, low mood/withdrawal, expectation of passive treatment, and negative pain beliefs, are known as risk factors for the development of chronic LBP. The Örebro Musculoskeletal Pain Questionnaire, STarT Back Screening Tool, and Brief Scale for Psychiatric Problems in Orthopaedic Patients have been used as screening tools to assess the development of chronicity or identify possible psychiatric problems. The Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire, and Injustice Experience Questionnaire are also widely used to assess psychosocial factors in patients with chronic pain. With regard to interventions, the placebo effect can be enhanced by preferable patient-clinician relationship. Reassurance to patients with non-specific pain is advised by many guidelines. Cognitive behavioral therapy focuses on restructuring the negative cognition of the patient into realistic appraisal. Mindfulness may help improve pain acceptance. Self-management strategies with appropriate goal setting and pacing theory have proved to improve long-term pain-related outcomes in patients with chronic pain.
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Affiliation(s)
- Tatsunori Ikemoto
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Japan
- Pain Medicine & Research Information Center, nonprofit organization, Aichi, Japan
| | - Kenji Miki
- Center for Pain, Hayaishi Hospital, Osaka, Japan
- Pain Medicine & Research Information Center, nonprofit organization, Aichi, Japan
| | - Takako Matsubara
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
- Pain Medicine & Research Information Center, nonprofit organization, Aichi, Japan
| | - Norimitsu Wakao
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Japan
- Spine Center, Aichi Medical University Hospital, Nagakute, Japan
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43
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Anderson JK, Wallace LM. Evaluation of uptake and effect on patient-reported outcomes of a clinician and patient co-led chronic musculoskeletal pain self-management programme provided by the UK National Health Service. Br J Pain 2018; 12:104-112. [PMID: 29796262 PMCID: PMC5958511 DOI: 10.1177/2049463717734015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In the United Kingdom, chronic pain affects approximately 28 million adults, creating significant healthcare and socio-economic costs. The aim was to establish whether a programme designed to use best evidence of content and delivery will be used by patients with significant musculoskeletal pain problems. Of 528 patients recruited, 376 participated in a 7-week-long group-based self-management programme (SMP) co-delivered by clinical and lay tutors. Of these, 308 patients (mean age, 53 years; 69% females, 94% White) completed at least five SMP sessions. Six months after pre-course assessment, participants reported significantly improved patient activation and health status, lower depression and anxiety scores, decreased pain severity and interference, and improved self-management skills. There were no improvements in health state and pain self-efficacy. Uptake rate was 71% and completion 82%. The results should be of value to commissioners of pathways of care for the large numbers of patients attending the English NHS for chronic musculoskeletal pain.
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Affiliation(s)
- Joanna K Anderson
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Louise M Wallace
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
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Perry J, VanDenKerkhof EG, Wilson R, Tripp DA. Development of a Guided Internet-based Psycho-education Intervention Using Cognitive Behavioral Therapy and Self-Management for Individuals with Chronic Pain. Pain Manag Nurs 2017; 18:90-101. [PMID: 28262481 DOI: 10.1016/j.pmn.2016.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/06/2016] [Accepted: 12/23/2016] [Indexed: 12/30/2022]
Abstract
Evidence-based chronic pain treatment includes nonpharmacologic therapies. When addressing barriers to treatment, there is a need to deliver these therapies in a way that is accessible to all individuals who may benefit. To develop a guided Internet-based intervention for individuals with chronic pain, program content and sequence of evidence-based treatments for chronic pain, traditionally delivered via in-person sessions, were identified to be adapted for Internet delivery. With consideration to historical barriers to treatment, and through use of a concept map, therapeutic components and educational material were situated, in an ordered sequence, into six modules. An Internet-based chronic pain intervention was constructed to improve access to evidence-based chronic pain therapies. Research using this intervention, in the form of a pilot study for intervention refinement, was conducted, and a large-scale study to assess effectiveness is necessary prior to implementation. As clients may face barriers to multimodal treatment for chronic pain, nurses could introduce components of education, cognitive behavioral therapy and self-management to clients and prepare them for the "work" of managing chronic pain, through use of this Internet-based intervention.
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Affiliation(s)
- Jennifer Perry
- School of Nursing, Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Elizabeth G VanDenKerkhof
- School of Nursing, Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rosemary Wilson
- School of Nursing, Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Dean A Tripp
- Departments of Psychology, Anesthesiology, and Urology, Queen's University, Kingston, Ontario, Canada
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Bird ML, Callisaya ML, Cannell J, Gibbons T, Smith ST, Ahuja KD. Accuracy, Validity, and Reliability of an Electronic Visual Analog Scale for Pain on a Touch Screen Tablet in Healthy Older Adults: A Clinical Trial. Interact J Med Res 2016; 5:e3. [PMID: 26769149 PMCID: PMC4731681 DOI: 10.2196/ijmr.4910] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/07/2015] [Accepted: 09/22/2015] [Indexed: 11/13/2022] Open
Abstract
Background New technology for clinical data collection is rapidly evolving and may be useful for both researchers and clinicians; however, this new technology has not been tested for accuracy, reliability, or validity. Objective This study aims to test the accuracy of visual analog scale (VAS) for pain on a newly designed application on the iPad (iPadVAS) and measure the reliability and validity of iPadVAS compared to a paper copy (paperVAS). Methods Accuracy was determined by physically measuring an iPad scale on screen and comparing it to the results from the program, with a researcher collecting 101 data points. A total of 22 healthy community dwelling older adults were then recruited to test reliability and validity. Each participant completed 8 VAS (4 using each tool) in a randomized order. Reliability was measured using interclass correlation coefficient (ICC) and validity measured using Bland-Altman graphs and correlations. Results Of the measurements for accuracy, 64 results were identical, 2 results were manually measured as being 1 mm higher than the program, and 35 as 1 mm lower. Reliability for the iPadVAS was excellent with individual ICC 0.90 (95% CI 0.82-0.95) and averaged ICC 0.97 (95% CI 0.95-1.0) observed. Linear regression demonstrated a strong relationship with a small negative bias towards the iPad (−2.6, SD 5.0) with limits of agreement from −12.4 to 7.1. Conclusions The iPadVAS provides a convenient, user-friendly, and efficient way of collecting data from participants in measuring their current pain levels. It has potential use in documentation management and may encourage participatory healthcare. Trial Registration Australia New Zealand Clinical Trials Registry (ANZCTR): 367297; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367297&isReview=true (Archived by Webcite at http://www.webcitation.org/6d9xYoUbD).
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Affiliation(s)
- Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Launceston, Australia
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46
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Cabak A, Dąbrowska-Zimakowska A, Truszczyńska A, Rogala P, Laprus K, Tomaszewski W. Strategies for Coping with Chronic Lower Back Pain in Patients with Long Physiotherapy Wait Time. Med Sci Monit 2015; 21:3913-20. [PMID: 26670743 PMCID: PMC4734674 DOI: 10.12659/msm.894743] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Treatment efficacy for the increasing prevalence of back pain is a great challenge for both health care providers and individuals coping with this problem. This study aimed to evaluate pain coping strategies used by primary care patients with chronic lower back pain (CLBP) as a supplementation of medical diagnosis before a physiotherapy programme. MATERIAL AND METHODS A total of 88 people were divided into 3 age groups: young adults (21-40 years old), middle-aged adults (41-60 years old), and the elderly (over 60 years old). Data was gathered from rehabilitation centers and primary medical care facilities. A cross-sectional design was used. The Coping Strategies Questionnaire (CSQ) was completed before the physiotherapy course. RESULTS Patients complained of CLBP for 11.32±6.81 years on average. The most common strategies to cope with back pain included declaring that the pain is manageable, praying and hoping, as well as increased behavioral activity. Statistically significant differences in coping strategies were found between age groups. The elderly patients were more likely to "declare coping with pain" in comparison to the younger age groups (p<0.01). People over 60 years of age were more likely to declare active coping with pain, while young people reported catastrophizing. CONCLUSIONS Patients in different age groups had various difficulties in pain coping. Most of them required support in self-management of pain in addition to physiotherapy. The basic assessment of pain coping strategies should be consistently taken into account and included in rehabilitation protocols in chronic pain treatment.
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Affiliation(s)
- Anna Cabak
- Department of Physiotherapy, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
| | - Anna Dąbrowska-Zimakowska
- Department of Psychosocial Foundations of Rehabilitation and Bioethics, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
| | - Aleksandra Truszczyńska
- Department of Physiotherapy, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
| | | | - Katarzyna Laprus
- Department of Psychosocial Foundations of Rehabilitation and Bioethics, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
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Merolli M, Gray K, Martin-Sanchez F, Mantopoulos S, Hogg M. Using Social Media While Waiting in Pain: A Clinical 12-Week Longitudinal Pilot Study. JMIR Res Protoc 2015; 4:e101. [PMID: 26254245 PMCID: PMC4705018 DOI: 10.2196/resprot.4621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/20/2015] [Accepted: 07/10/2015] [Indexed: 01/06/2023] Open
Abstract
Background Chronic pain places an enormous burden on health care systems. Multidisciplinary pain management services are well documented as an effective means to improve patient outcomes. However, waiting lists to access these services are long and outcomes deteriorate. Innovative solutions such as social media are gaining attention as a way to decrease this burden and improve outcomes. It is a challenge to design research that demonstrates whether social media are acceptable to patients and clinically effective. Objective The aim was to conduct a longitudinal pilot study to understand what aspects of research design are key to the success of running a larger-scale study of social media use in the clinical management of chronic pain. Methods A 12-week study examined social media use by patients on the waiting list for the Royal Melbourne Hospital Pain Management Service. Selected social media resources were suggested for use by patients waiting for an appointment at the clinic. Patients filled out measures for pain interference and pain self-efficacy before and after the study. Follow-up was conducted at monthly intervals via telephone semistructured interviews to discuss engagement and garner individual perceptions towards social media use. A social media-use instrument was also administered as part of the after-study questionnaire. Results Targeted recruitment refined 235 patient referrals to 138 (58.7%) suitable potential participants. Contact was made with 84 out of 138 (60.9%) patients. After a further exclusion of 54 out of 84 (64%) patients for various reasons, this left 30 out of 84 (36%) patients fitting the inclusion criteria and interested in study participation. A final study cohort of 17 out of 30 (57%) was obtained. Demographics of the 17 patients were mixed. Low back pain was the primary condition reported as leading to chronic pain. Semistructured interviews collected data from 16 out of 17 (94%) patients who started the trial, and at final follow-up 9 out of 17 (53%) patients completed questionnaires. Low specificity of the resources to one’s condition and time poorness may have been barriers to engagement. Conclusions Results suggest that with refinements, this study design can be implemented successfully when conducting a larger social media study. At present, comment cannot be made on what effect using social media can have on patients on hospital waiting lists, nor whether those who use social media while waiting in pain achieve better outcomes from eventual participation in a chronic pain program. Long-term follow-up should be included in future studies to answer this. Future research should focus on multicenter randomized controlled trials, involving patients in the intervention design for improved participation and outcomes and for evidence to be sound.
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Affiliation(s)
- Mark Merolli
- Health and Biomedical Informatics Centre, The University of Melbourne, Melbourne, Australia.
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