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Adenis N, Gosselin K, Stetsenko N, Thevenon A. Clarification of the "pain neuroscience education" concept in the management of patients with persistent low back pain: A scoping review. J Back Musculoskelet Rehabil 2023; 36:995-1010. [PMID: 37458022 DOI: 10.3233/bmr-220370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Patient education is a recommended treatment strategy for persistent low back pain (PLBP). Pain neuroscience education (PNE) is an emerging concept with boundaries still unclear. OBJECTIVE To clarify the PNE concept and identify its key characteristics in PLBP management. METHODS A systematic search was conducted using the following databases: Pubmed, ScienceDirect, Google Scholar, Cochrane, and Pedro. INCLUSION CRITERIA publications in English or French on pain neuroscience education and chronic low back pain, educational books cited in white literature. Three reviewers independently selected eligible studies for final inclusion. Numerical analysis and narrative synthesis were carried out from the extracted data. RESULTS From 919 identified publications, 54 were selected. Ten educational resources were added. PNE refers to a theoretical framework, a specific educational intervention, and an overall care approach. It is characterized by the intention to help the patient reconceptualize their PLBP from a tissue injury marker to a protective, neurobiological perspective, and then to increase adherence to biopsychosocial rehabilitation and normalize cognitive-behavioral responses. Pain sciences concepts are presented with an optimization of learning strategies. CONCLUSION PNE stands out from other educational and cognitive behavioral approaches through its objective of changing the pain concept.
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Affiliation(s)
- Nicolas Adenis
- URePSSS University of Lille, Lille, France
- Physiotherapy Practice, Lille, France
| | | | | | - André Thevenon
- URePSSS University of Lille, Lille, France
- Pôle RRSS, Lille, France
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Sillevis R, Trincado G, Shamus E. The immediate effect of a single session of pain neuroscience education on pain and the autonomic nervous system in subjects with persistent pain, a pilot study. PeerJ 2021; 9:e11543. [PMID: 34131526 PMCID: PMC8174152 DOI: 10.7717/peerj.11543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/10/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The autonomic nervous system is a system that operates at the subconscious level and has been associated with neurobehavioral aspects of pain. Overall, persistent pain has a stimulating effect on the sympathetic nervous system. A promising emerging nonpharmacological treatment to manage persistent pain is neuroscience-based pain education. The overarching goal of neuroscience-based pain education is to change cognitions about pain and the pain experience through education. The aim was to determine the immediate and short-term impact of a neuroscience-based pain education video on the autonomic nervous system and pain in a subgroup of individuals with persistent pain. METHODS A convenience sample of 26 subjects were recruited for this study. Each subject indicated their pain level at the time of testing using a Visual Analogue Scale. Automated pupillometry was utilized to measure pupil diameter. After two minutes of accommodation to the goggles, the pupil was measured continuously for 60 s. Following this a 5-minute video presentation "Understanding Pain" was watched, followed by a continuous pupil measurement for 60 s. Three minutes after this measure, the final pupil diameter measurement was taken for 60 s. After completing the final pupil measure, the subject was asked to fill out a second Visual Analogue Scale and a Global Rate of Change. OUTCOMES Each subject completed a Global Rating of Change Scale and the mean score was 1.14 (SD = 1.61 and a SEM = 0.), supporting the hypothesis of an overall self-perceived benefit from the intervention. There was a statistically significant difference in pain following the video, P < 0.01. A significant correlation was observed between the self-perceived decrease in pain level and the Global Rating of Change score, p = 0.02. There was no statistically significant difference in the mean pupil diameter following the video with p = 0.76 for the right eye and p = 0.250 for the left eye. DISCUSSION This pilot study demonstrated that a 5-minute neuroscience-based pain education video reduced perceived pain in a small sample of subjects with persistent pain. Watching the neuroscience-based pain education video did not seem to result in an immediate generalized autonomic nervous system response. However, it resulted in a different reaction on each eye. This unequal response might be the result of the hemispheric lateralization of the ANS. This study supports the fact that the pain experience is determined by the balance between conscious cognitive processes and subconscious processes based on previous psychological experiences.
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Affiliation(s)
- Rob Sillevis
- Rehabilitations Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States of America
| | - Gabriel Trincado
- Rehabilitations Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States of America
| | - Eric Shamus
- Rehabilitations Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States of America
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Development of the Conceptualization of Pain Questionnaire: A Measure to Study How Children Conceptualize Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073821. [PMID: 33917429 PMCID: PMC8038728 DOI: 10.3390/ijerph18073821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/24/2021] [Accepted: 04/02/2021] [Indexed: 11/24/2022]
Abstract
(1) Background: Research has shown that thoughts about pain are important for the management of chronic pain in children. In order to monitor changes in thoughts about pain over time and evaluate the efficacy of treatments, we need valid and reliable measures. The aims of this study were to develop a questionnaire to assess a child’s concept of pain and to evaluate its psychometric properties; (2) Methods: This is a cross-sectional, two-phase, mixed-method study. A total of 324 individuals aged 8 to 17 years old responded to the newly created questionnaire. The Conceptualization of Pain Questionnaire (COPAQ) was calibrated using the Rasch model. The chi-square test was used for the fit statistics. Underfit and overfit of the model were determined and a descriptive analysis of infit and outfit was conducted to identify who responded erratically. Internal consistency was measured using the Person Separation Index (PSI); (3) Results: Fit to the Rasch model was good. Suitable targeting indicated which items were simple to answer; Person Fit identified 9.56% children who responded erratically; PSI = 0.814; (4) Conclusions: The findings suggest that COPAQ is a measure of a child’s concept of pain that is easy to administer and respond to. It has a good fit and a good internal consistency.
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Saracoglu I, Aksoy CC, Afsar E, Arik MI. Does pain neuroscience education improve pain knowledge, beliefs and attitudes in undergraduate physiotherapy students? PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1898. [PMID: 33528084 DOI: 10.1002/pri.1898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/07/2020] [Accepted: 12/25/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND To evaluate the effect of a brief pain neuroscience education (PNE) session on physiotherapy students' knowledge of pain and their beliefs and attitudes about the treatment of patients with chronic low back pain. METHODS This study was a single-center, cross-sectional study including 205 physiotherapy undergraduate students. The participants completed the Neurophysiology of Pain Questionnaire (NPQ) and Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). They then received a 70-min neuroscience education session covering the mechanisms and biopsychosocial aspects of chronic low back pain. The questionnaires were readministered immediately after the educational session and at 6 months posteducation. RESULTS Our analysis included data from 156 participants (mean age: 20.9 ± 2.51, 69.8% women) who completed the questionnaires pre-, post-, and 6 months after the educational session. To assess the effect of the education on the scores of the questionnaires, a repeated-measures ANOVA was conducted. There was a significant interaction observed for NPQ over time (p = 0.00; η 2 = 0.654), for PABS-PT factor 1(p < 0.001; η2 = 0.50) and for PABS-PT factor 2 over time (p = 0.02; η 2 = 0.04) CONCLUSION: This study showed that a 70-min session of PNE improves the level of pain knowledge in undergraduate physiotherapy students and influences their beliefs and attitudes concerning chronic low back pain. These findings suggest that adding PNE to the curricula of physiotherapy and rehabilitation programs may be beneficial.
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Affiliation(s)
- Ismail Saracoglu
- Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
| | - Cihan Caner Aksoy
- Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
| | - Emrah Afsar
- Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
| | - Meltem Isintas Arik
- Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
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5
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Agarwal V, Louw A, Puentedura EJ. Physician-Delivered Pain Neuroscience Education for Opioid Tapering: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3324. [PMID: 32403225 PMCID: PMC7246593 DOI: 10.3390/ijerph17093324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 12/12/2022]
Abstract
We describe the case of a 75-year-old female with chronic low back pain (CLBP), on opioids for more than 15 years. She presented with an acute episode of nausea, vomiting, abdominal pain, and shortness of breath. After a complete work-up, it was concluded that her presenting symptoms were likely due to her high levels of CLBP and high dose opioids. At the time of intervention, her opioid dosage was between 50-90 MME (Morphine milligram equivalent) (Norco 8 × 7.5 mg/day + Fentanyl 12 mcg patch). She was subsequently seen by the physician for seven outpatient internal medicine appointments over nine months and received Pain Neuroscience Education (PNE) in conjunction with monitored tapering of opioids and other medication associated with her CLBP. This case report demonstrates how a physician might deliver PNE as a viable nonpharmacological treatment option for the tapering of long-term opioids for chronic pain.
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Affiliation(s)
- Vikas Agarwal
- Department of Internal Medicine, Mosaic Life Care, St. Joseph, MO 64506, USA;
| | - Adriaan Louw
- Pain Science Division, Evidence in Motion, San Antonio, TX 78247, USA;
| | - Emilio J. Puentedura
- Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
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Fletcher R, Braithwaite FA, Woodhouse M, MacInnes A, Stanton TR. Does readiness to change influence pain-related outcomes after an educational intervention for people with chronic pain? A pragmatic, preliminary study. Physiother Theory Pract 2019; 37:608-619. [PMID: 31267821 DOI: 10.1080/09593985.2019.1636436] [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: 10/26/2022]
Abstract
Background: There is a strong association between chronic pain and unhelpful pain cognitions. Educating patients on pain neuroscience has been shown to reduce pain catastrophization, kinesiophobia, and self-perceived disability. This study investigated whether a group-based pain neuroscience education (PNE) session influenced pain-related outcomes, and whether readiness to change moderated these outcomes.Method: In a pragmatic pre-post-intervention study using a convenience sample, adults with chronic pain participated in one, 90-120 minute PNE session. Pain-related outcomes (i.e. pain catastrophization, kinesiophobia, disability, and pain neuroscience knowledge) and the Pain Stage of Change Questionnaire (PSOCQ) were assessed at baseline and immediately post-intervention. Paired t-tests evaluated pre-post changes in outcomes, and linear regression examined the impact of PSOCQ score changes on PNE-induced changes in clinical outcomes.Results: Sixty-five participants were recruited. All outcomes showed positive intervention effects (p < .01). Relationships between changes in PSOCQ subscale scores and change in post-intervention pain-related outcomes were found; 'Pre-Contemplation' was positively associated with pain catastrophization (p = .01), and 'Action' was negatively associated with kinesiophobia (p = .03).Conclusion: Consistent with previous research, there were improvements in outcomes associated with chronic pain after PNE. Some of these improvements were predicted by changes in PSOCQ scores, however, these findings are preliminary and require further investigation using controlled research designs.
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Affiliation(s)
- Roland Fletcher
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland.,Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Fraser Health Authority, JPOCSC Pain Management Clinic, Surrey, British Columbia, Canada
| | - Felicity A Braithwaite
- Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mellissa Woodhouse
- Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Aaron MacInnes
- Fraser Health Authority, JPOCSC Pain Management Clinic, Surrey, British Columbia, Canada.,Faculty of Medicine, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tasha R Stanton
- Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
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Treatment monitoring as a component of psychologically informed physical therapy: A case series of patients at high risk for persistent low back pain related disability. Musculoskelet Sci Pract 2019; 41:36-42. [PMID: 30909109 PMCID: PMC6528824 DOI: 10.1016/j.msksp.2019.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/29/2019] [Accepted: 03/14/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychologically Informed Physical Therapy (PIPT) aims to identify individuals at high risk for transitioning to chronicity and merge impairment-focused physical therapy with cognitive behavioral therapy principles. Treatment monitoring is an important part of PIPT and involves identifying changes in clinical measures to inform clinical decision making. OBJECTIVES The purpose of this case series is to describe treatment monitoring using psychological and physical impairment measures for patients identified as 'high-risk' for persistent low back pain (LBP) related disability. DESIGN Secondary analysis of patients (n = 23) identified as 'high-risk' using the STarT Back Tool and enrolled in two-phased, sequential study that evaluated feasibility and generated preliminary PIPT treatment effects for 4-week clinical outcomes. METHOD Physical therapists (n = 5) used psychological [Fear-Avoidance Beliefs Questionnaire (FABQ-PA, FABQ-W), Tampa Scale for Kinesiophobia (TSK-11), Pain Catastrophizing Scale (PCS) and Fear of Daily Activities Questionnaire (FDAQ)] and the Physical Impairment Index (PII) measures for PIPT treatment monitoring. Clinical outcome measures [Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI)] were administered at intake and 4-weeks later. Linear regression models evaluated independent contribution of intake and 4-week changes in psychological measures and PII scores as predictors of 4-week NPRS and ODI scores. RESULTS FABQ-PA and PCS changes provided largest contributions to prediction of 4-week ODI scores. Treatment monitoring measures did not explain additional variability in 4-week NPRS scores after baseline scores were considered. CONCLUSIONS For patients at high risk for persistent LBP psychological measures consistently performed better as treatment monitoring variables compared to physical impairment measures. Treatment monitoring for PIPT with psychological measures provides opportunities to refine prediction of disability outcomes. Findings from this exploratory case series should be interpreted with caution based on its small sample size and lack of statistical power which prohibits definitive conclusions to be made on any of the treatment monitoring measures.
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Lennox Thompson B, Gage J, Kirk R. Living well with chronic pain: a classical grounded theory. Disabil Rehabil 2019; 42:1141-1152. [DOI: 10.1080/09638288.2018.1517195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Bronwyn Lennox Thompson
- Department of Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Jeffrey Gage
- College of Nursing, California Baptist University, Riverside, CA, USA
| | - Ray Kirk
- UC Health, University of Canterbury, Christchurch, New Zealand
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9
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Malfliet A, Kregel J, Meeus M, Danneels L, Cagnie B, Roussel N, Nijs J. Patients With Chronic Spinal Pain Benefit From Pain Neuroscience Education Regardless the Self-Reported Signs of Central Sensitization: Secondary Analysis of a Randomized Controlled Multicenter Trial. PM R 2018; 10:1330-1343.e1. [DOI: 10.1016/j.pmrj.2018.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/19/2018] [Accepted: 04/25/2018] [Indexed: 10/16/2022]
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Vier C, Bracht MA, Neves ML, Junkes-Cunha M, Santos ARS. Effects of spinal manipulation and pain education on pain in patients with chronic low back pain: a protocol of randomized sham-controlled trial. Integr Med Res 2018; 7:271-278. [PMID: 30271716 PMCID: PMC6160616 DOI: 10.1016/j.imr.2018.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 02/05/2023] Open
Abstract
Background Low back pain (LBP) has more than doubled in the last 20 years, probably influenced by biopsychosocial factors. Noninvasive treatments have been applied in individuals with chronic nonspecific LBP as spinal manipulation and pain education. However, the neurophysiological effects of these treatments are not clear. The aim of this research is to verify the pain control, functional and neurophysiological effects of spinal manipulation, and pain education in individuals with chronic nonspecific LBP. Methods This research is an assessor and subject blinded, 2-arm, randomized sham-controlled trial and will be conducted at Governador Celso Ramos Hospital, Florianópolis, Brazil. One hundred and twenty-eight individuals with chronic nonspecific LBP will be recruited for this study. Individuals will be randomly allocated into one of the two groups: (1) spinal manipulation plus pain education or (2) sham treatment plus pain education. Each group will be received two sessions per week over six weeks of treatment. The measures will be applied at baseline, six weeks, and three months after randomization. The primary outcome will be a pain intensity at six weeks postrandomization. Secondary outcomes will be pressure pain threshold, disability, fear and avoidance beliefs, kinesiophobia, risk of poor prognosis, quality of life, and inflammatory biomarkers. Discussion Evidence has shown that psychosocial factors are more involved in chronic pain than we thought a few years ago. Then, studies investigating both functional and neurophysiological effects of these interventions to evaluate the effectiveness of treatment and what else is happening at the cellular level in nervous system are needed.
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Affiliation(s)
- Clécio Vier
- Graduate Program in Neurosciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil.,Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil
| | - Marcelo Anderson Bracht
- Graduate Program in Neurosciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil.,Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil
| | - Marcos Lisboa Neves
- Graduate Program in Neurosciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil.,Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil
| | - Maíra Junkes-Cunha
- Graduate Program in Neurosciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil.,Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil
| | - Adair Roberto Soares Santos
- Graduate Program in Neurosciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil.,Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil
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McClinton S, Heiderscheit B, McPoil TG, Flynn TW. Physical therapist decision-making in managing plantar heel pain: cases from a pragmatic randomized clinical trial. Physiother Theory Pract 2018; 36:638-662. [PMID: 29979912 DOI: 10.1080/09593985.2018.1490941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Plantar heel pain (PHP) is a common condition managed by physical therapists that can, at times, be difficult to treat. Management of PHP is complicated by a variety of pathoanatomic features associated with PHP in addition to several treatment approaches with varying efficacy. Although clinical guidelines and clinical trial data support a general approach to management, the current literature is limited in case-specific descriptions of PHP management that addresses unique combinations of pathoanatomical, physical, and psychosocial factors that are associated with PHP. Purpose: The purpose of this case series is to describe physical therapist decision-making of individualized multimodal treatment for PHP cases presenting with varied clinical presentations. Treatment incorporated clinical guidelines and recent evidence including a combination of manual therapy, patient education, stretching, resistance training, and neurodynamic interventions. A common clinical decision-making framework was used to progress individualized treatment from a focus on symptom modulation initially to increased load tolerance of involved tissues and graded activity. In each case, patients met their individual goals and demonstrated clinically meaningful improvements in pain, function, and global rating of change that were maintained at the 1-2-year follow-up. Implications: This case series provides details of physical therapist management of a variety of PHP clinical presentations that can be used to complement clinical practice guidelines in the management of PHP.
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Affiliation(s)
- Shane McClinton
- Doctor of Physical Therapy Program, Des Moines University , Des Moines, IA, USA
| | - Bryan Heiderscheit
- Departments of Orthopedics & Rehabilitation and Biomedical Engineering, and Doctor of Physical Therapy Program, University of Wisconsin-Madison , Madison, WI, USA
| | - Thomas G McPoil
- School of Physical Therapy, Regis University , Denver, CO, USA
| | - Timothy W Flynn
- School of Physical Therapy, South College , Knoxville, TN, USA
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Use of Pain Neuroscience Education, Tactile Discrimination, and Graded Motor Imagery in an Individual With Frozen Shoulder. J Orthop Sports Phys Ther 2018; 48:174-184. [PMID: 29257926 DOI: 10.2519/jospt.2018.7716] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Case report. Background Aggressive physical therapy in the freezing stage of frozen shoulder may prolong the course of recovery. Central sensitization may play a role in the early stages of frozen shoulder. Pain neuroscience education, tactile discrimination, and graded motor imagery have been used in a number of conditions with central sensitization. The purpose of this case report was to describe the examination and treatment of a patient in the freezing stage of frozen shoulder using pain neuroscience education, tactile discrimination, and graded motor imagery. Case Description A 54-year-old woman with a diagnosis of frozen shoulder was referred by an orthopaedic surgeon following lack of progress after 4 weeks of intensive daily physical therapy. Pain at rest was 7/10, and her Shoulder Pain and Disability Index score was 64%. She had painful and limited active range of motion and elevated fear-avoidance beliefs. Tactile discrimination and limb laterality were impaired, with signs of central sensitization. A "top-down" approach using pain neuroscience education, tactile discrimination, and graded motor imagery was used for the first 6 weeks, followed by a "bottom-up" impairment-based approach. Outcomes The patient was seen for 20 sessions over 12 weeks. At discharge, her Shoulder Pain and Disability Index score was 22%, resting pain was 0/10, and fear-avoidance beliefs improved. Improvements in active range of motion, laterality, and tactile discrimination were also noted. Discussion Intensive physical therapy in the freezing stage of frozen shoulder may be detrimental to long-term outcomes. This case report suggests that a top-down approach may allow a quicker transition through the freezing stage of frozen shoulder. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2018;48(3):174-184. Epub 19 Dec 2017. doi:10.2519/jospt.2018.7716.
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Louw A, Podalak J, Zimney K, Schmidt S, Puentedura EJ. Can pain beliefs change in middle school students? A study of the effectiveness of pain neuroscience education. Physiother Theory Pract 2018; 34:542-550. [DOI: 10.1080/09593985.2017.1423142] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA
| | | | - Kory Zimney
- School of Health Sciences; Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
| | - Stephen Schmidt
- Physical Therapy Rehabilitation, Kaiser Foundation Rehabilitation Center, Vallejo, CA, USA
| | - Emilio J Puentedura
- School of Allied Health Sciences, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV, USA
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Louw A, Zimney K, Johnson EA, Kraemer C, Fesler J, Burcham T. De-educate to re-educate: aging and low back pain. Aging Clin Exp Res 2017; 29:1261-1269. [PMID: 28275956 DOI: 10.1007/s40520-017-0731-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/20/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patients' beliefs about their condition have been shown to play a significant role in their pain experience and response to treatment, especially when a patient sees their tissue health as vulnerable or aged. Educational can alter these beliefs. Prior to new information, patients often have to be de-educated regarding common misbeliefs to undergo re-education. AIMS To determine if a brief de-education session regarding aging and low back pain (LBP) can shift pain ratings, fear-avoidance beliefs, beliefs regarding aging and LBP, and limited active trunk flexion. METHODS Fifty adults ranging from 50 to 93 years of age (SD = 10.73) with a 15.1 years of LBP were education on the poor correlation between aging and LBP. Prior to and immediately after the education pain ratings for LBP and leg pain (numeric pain rating scale-NPRS), fear-avoidance (fear avoidance beliefs questionnaire-FABQ), beliefs regarding aging and LBP (Likert scale) and active trunk flexion were measured. RESULTS Significant changes were found in positive shifts with LBP (p = 0.002), leg pain (p = 0.042), FABQ-physical activity subscale (p = 0.004) and active trunk forward flexion (p < 0.001). DISCUSSION The results show that education aimed at altering beliefs regarding LBP and aging result in a positive shift in pain, fear avoidance related to physical activity and active trunk flexion. CONCLUSION Prior to providing patients with new healthcare information, de-educating them regarding poor beliefs may be helpful in shifting them towards new, healthier paradigms associated with their condition.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, PO Box 232, Story City, IA, 50248, USA.
| | - Kory Zimney
- Department of Physical Therapy, School of Health Sciences, University of South Dakota, 414 E Clark Street, Vermillion, SD, 57069, USA
| | - Eldon A Johnson
- RehabAuthority, 3170 43rd St S, Suite 101, Fargo, ND, 58104, USA
| | - Chris Kraemer
- RehabAuthority, 3170 43rd St S, Suite 101, Fargo, ND, 58104, USA
| | - Justin Fesler
- Advanced PT, 19416 Highridge Way, Trabuco Canyon, CA, 92679, USA
| | - Tyler Burcham
- Rehabilitation Director and Clinic Administrator, RehabAuthority Physical Therapy, 1100 19th Avenue, North Suite K, Fargo, ND, 58102, USA
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Louw A, Puentedura EJ, Zimney K, Cox T, Rico D. The clinical implementation of pain neuroscience education: A survey study. Physiother Theory Pract 2017; 33:869-879. [PMID: 28820626 DOI: 10.1080/09593985.2017.1359870] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Pain neuroscience education (PNE) has gained considerable attention in research. Three systematic reviews have shown increasing efficacy of PNE decreasing pain, disability, pain catastrophization, movement restrictions, and healthcare utilization. In the development of any new therapeutic approach, it is proposed that there are three stages: development, validation, and implementation. To date, the development and validation of PNE have been well-established. The third stage, implementation, however, lacks when it comes to PNE. The purpose of this study was to survey physical therapists (PT) on their experience and implementation of PNE, following a 15-hour PNE class. Upon development and validation of a PT-PNE survey, a random sample of PTs was invited to take the online survey. Two hundred and eighty-six PTs (female 56%) completed the PNE questionnaire. Ninety-one percent of PTs reported not being taught PNE in PT school. PT's are applying PNE into clinical practice to a variety of patients, experience outcomes in line with the current best-evidence, but struggle establishing which patients are ideal for PNE. The same five patient characteristics associated with success were also associated with failure, albeit in a different ranking order. This finding highlight the need to further investigate the factors associated with success and failure of PNE.
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Affiliation(s)
- Adriaan Louw
- a International Spine and Pain Institute , Story City , IA , USA
| | - Emilio J Puentedura
- b Department of Physical Therapy , University of Nevada Las Vegas , Las Vegas , NV , USA
| | - Kory Zimney
- c Department of Physical Therapy , University of South Dakota , Vermillion , SD , USA
| | - Terry Cox
- d Warren B. Davis Family Physical Therapy Center , Southwest Baptist University , Bolivar , MO , USA
| | - Debbie Rico
- e Physical Therapy Education , Rockhurst University , MO , USA
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Jones MD, Valenzuela T, Booth J, Taylor JL, Barry BK. Explicit Education About Exercise-Induced Hypoalgesia Influences Pain Responses to Acute Exercise in Healthy Adults: A Randomized Controlled Trial. THE JOURNAL OF PAIN 2017; 18:1409-1416. [PMID: 28778814 DOI: 10.1016/j.jpain.2017.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/13/2017] [Accepted: 07/11/2017] [Indexed: 11/26/2022]
Abstract
The mechanisms through which acute exercise reduces pain (ie, exercise-induced hypoalgesia [EIH]) are poorly understood. This study aimed to determine if education about EIH affected pain responses after acute exercise in healthy adults. Participants received 15 minutes of education either about EIH (intervention, n = 20) or more general education about exercise and pain (control, n = 20). After this, the participants' knowledge and beliefs about exercise and pain were assessed. Pressure pain thresholds were then measured before and after 20 minutes of cycle ergometer exercise. Compared with the control group, the intervention group believed more strongly that pain could be reduced by a single session of exercise (P = .005) and that the information they had just received had changed what they thought about the effect of exercise on pain (P = .045). After exercise, pressure pain threshold increased in both groups, but the median increase was greater in the intervention group compared with the control group (intervention = .78 kg/cm2, control = .24 kg/cm2, P = .002, effect size [r] of difference = .49). These results suggest that cognitive processes in the appraisal of pain can be manipulated to influence EIH in healthy adults. PERSPECTIVE This study shows that preceding a bout of exercise with pain education can alter pain responses after exercise. This finding has potential clinical implications for exercise prescription for people with chronic pain whereby pain education before exercise could be used to improve pain responses to that exercise.
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Affiliation(s)
- Matthew D Jones
- Department of Exercise Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia.
| | - Trinidad Valenzuela
- Department of Exercise Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; School of Kinesiology, Finis Terrae University, Santiago, Chile
| | - John Booth
- Department of Exercise Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Janet L Taylor
- Department of Exercise Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Benjamin K Barry
- Department of Exercise Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; School of Clinical Medicine, The University of Queensland, Brisbane, Australia
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Louw A, Nijs J, Puentedura EJ. A clinical perspective on a pain neuroscience education approach to manual therapy. J Man Manip Ther 2017; 25:160-168. [PMID: 28694679 PMCID: PMC5498797 DOI: 10.1080/10669817.2017.1323699] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain. PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more. PNE's neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy. Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person's pain experience by increasing fear-avoidance and pain catastrophization. An area of physical therapy where the biomedical model is used a lot is manual therapy. This contrast between PNE and manual therapy has seemingly polarized followers from each approach to see PNE as a 'hands-off' approach even having clinicians categorize patients as either in need of receiving PNE (with no hands-on), or hands-on with no PNE. In this paper, we explore the notion of PNE and manual therapy co-existing. PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization. Using a model of sensitization (innocuous, noxious, and allodynia), we argue that PNE can be used in a manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant. Level of Evidence: VII.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA
- Corresponding author.
| | - Jo Nijs
- Faculty of Physical Education and Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Emilio J. Puentedura
- Department of Physical Therapy, University of Nevada Las Vegas, School of Allied Health Sciences, Las Vegas, NV, USA
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Malfliet A, Van Oosterwijck J, Meeus M, Cagnie B, Danneels L, Dolphens M, Buyl R, Nijs J. Kinesiophobia and maladaptive coping strategies prevent improvements in pain catastrophizing following pain neuroscience education in fibromyalgia/chronic fatigue syndrome: An explorative study. Physiother Theory Pract 2017; 33:653-660. [PMID: 28605207 DOI: 10.1080/09593985.2017.1331481] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Many patients with chronic fatigue syndrome(CFS) and/or fibromyalgia(FM) have little understanding of their condition, leading to maladaptive pain cognitions and coping strategies. These should be tackled during therapy, for instance by pain neurophysiology education (PNE). Although positive effects of PNE are well-established, it remains unclear why some patients benefit more than others. This paper aims at exploring characteristics of patients responding poor to PNE to further improve its effectiveness. Data from two RCT's were pooled to search for baseline predictors. Subjects (n = 39) suffering from CFS/FM, as defined by the American College of Rheumatology, underwent PNE treatment. The Pain Catastrophizing Scale (PCS); Pain Coping Inventory (PCI); and Tampa Scale of Kinesiophobia (TSK) were defined as outcome measures. There was a significant negative relationship between baseline TSK and the change in both PCS total score (r = -0.584; p < 0.001) and PCS rumination (r = -0.346; p < 0.05). There was a significant negative relationship between the change in PCS total score and baseline PCI worrying (r = -0.795; p < 0.001) and retreating (r = -0.356; p < 0.05). FM/CFS patients who tend to worry allot about their pain and with high levels of kinesiophobia are likely to experience less reductions in catastrophizing following PNE. It seems that PNE alone is insufficient to reduce catastrophic thinking regarding pain, and supplementary treatment is needed.
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Affiliation(s)
- Anneleen Malfliet
- a Pain in Motion Research Group , University of Antwerp , Antwerp , Belgium.,b Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy , Vrije Universiteit Brussel , Brussels , Belgium.,c Department of Physical Medicine and Physiotherapy , University Hospital Brussels , Brussels , Belgium
| | - Jessica Van Oosterwijck
- a Pain in Motion Research Group , University of Antwerp , Antwerp , Belgium.,b Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy , Vrije Universiteit Brussel , Brussels , Belgium.,d Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium
| | - Mira Meeus
- a Pain in Motion Research Group , University of Antwerp , Antwerp , Belgium.,d Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium.,e Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences , University of Antwerp , Antwerp , Belgium
| | - Barbara Cagnie
- d Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium
| | - Lieven Danneels
- d Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium
| | - Mieke Dolphens
- d Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium
| | - Ronald Buyl
- f Department of Biostatistics and Medical Informatics , Vrije Universiteit Brussel , Brussels , Belgium
| | - Jo Nijs
- a Pain in Motion Research Group , University of Antwerp , Antwerp , Belgium.,b Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy , Vrije Universiteit Brussel , Brussels , Belgium.,c Department of Physical Medicine and Physiotherapy , University Hospital Brussels , Brussels , Belgium
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Fagundes FRC, de Melo do Espírito Santo C, de Luna Teixeira FM, Tonini TV, Cabral CMN. Effectiveness of the addition of therapeutic alliance with minimal intervention in the treatment of patients with chronic, nonspecific low back pain and low risk of involvement of psychosocial factors: a study protocol for a randomized controlled trial (TalkBack trial). Trials 2017; 18:49. [PMID: 28143504 PMCID: PMC5282714 DOI: 10.1186/s13063-017-1784-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/06/2017] [Indexed: 12/30/2022] Open
Abstract
Background The stratified model of care has been an effective approach for the treatment of low back pain. However, the treatment of patients with low risk of psychosocial-factor involvement is unclear. The addition of the therapeutic alliance to a minimal intervention may be an option for the treatment of low back pain. This paper reports on the rationale, design and protocol for a randomized controlled trial with blind assessor to assess the effectiveness of the addition of therapeutic alliance with minimal intervention on pain and disability in patients with chronic, nonspecific low back pain. Methods Two hundred and twenty-two patients with chronic, nonspecific low back pain and low risk of involvement of psychosocial factors will be assessed and randomly allocated into three groups (n = 74 patients per group). The Positive Therapeutic Alliance group will receive counseling and guidance with an emphasis on therapeutic alliance and empathy. The Usual Treatment group will receive the same information and counseling with limited interaction with the therapist. The Control group will not receive any intervention. The treatment will be composed by two intervention sessions with a 1-week interval. A blinded assessor will collect the following outcomes at baseline, 1 month, 6 months and 12 months after randomization: pain intensity (Pain Numerical Rating Scale), specific disability (Patient-specific Functional Scale), general disability (Oswestry Disability Index), global perceived effect (Global Perceived Effect Scale), empathy (Consultation and Relational Empathy Measure), credibility and expectations related to treatment. The analysis will be performed using linear mixed models. Discussion This will be the first study to understand the effect of combining enhanced therapeutic alliance to a treatment based on counseling, information and advice (minimal intervention). The addition of the therapeutic alliance to minimal intervention may improve the treatment of chronic, nonspecific low back pain. Trial registration ClinicalTrials.gov, NCT 02497625. Registered on 10 July 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1784-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felipe Ribeiro Cabral Fagundes
- Master's and Doctoral Programs in Physical Therapy of the Universidade Cidade de Sao Paulo, Rua Cesário Galeno 475, Tatuapé, São Paulo, SP, CEP: 03071-000, Brazil.
| | | | - Francine Mendonça de Luna Teixeira
- Master's and Doctoral Programs in Physical Therapy of the Universidade Cidade de Sao Paulo, Rua Cesário Galeno 475, Tatuapé, São Paulo, SP, CEP: 03071-000, Brazil
| | - Thaís Vanelli Tonini
- Physical Therapy Department of the Universidade de Taubaté, Av. Marechal Arthur Costa e Silva 1055, Centro, Taubaté, SP, Brazil
| | - Cristina Maria Nunes Cabral
- Master's and Doctoral Programs in Physical Therapy of the Universidade Cidade de Sao Paulo, Rua Cesário Galeno 475, Tatuapé, São Paulo, SP, CEP: 03071-000, Brazil
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Louw A, Farrell K, Landers M, Barclay M, Goodman E, Gillund J, McCaffrey S, Timmerman L. The effect of manual therapy and neuroplasticity education on chronic low back pain: a randomized clinical trial. J Man Manip Ther 2016; 25:227-234. [PMID: 29449764 DOI: 10.1080/10669817.2016.1231860] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective To determine if a neuroplasticity educational explanation for a manual therapy technique will produce a different outcome compared to a traditional mechanical explanation. Methods Sixty-two patients with chronic low back pain (CLBP) were recruited for the study. Following consent, demographic data were obtained as well as pain ratings for low back pain (LBP) and leg pain (Numeric Pain Rating Scale), disability (Oswestry Disability Index), fear-avoidance (Fear-Avoidance-Beliefs Questionnaire), forward flexion (fingertips-to-floor), and straight leg raise (SLR) (inclinometer). Patients were then randomly allocated to receive one of two explanations (neuroplasticity or mechanical), a manual therapy technique to their lumbar spine, followed by post-intervention measurements of LBP, leg pain, forward flexion, and SLR. Results Sixty-two patients (female 35 [56.5%]), with a mean age of 60.1 years and mean duration of 9.26 years of CLBP participated in the study. There were no statistically significant interactions for LBP (p = .325), leg pain (p = .172), and trunk flexion (p = .818) between the groups, but SLR showed a significant difference in favor of the neuroplasticity explanation (p = .041). Additionally, the neuroplasticity group were 7.2 times (95% confidence interval = 1.8-28.6) more likely to improve beyond the MDC on the SLR than participants in the mechanical group. Discussion The results of this study show that a neuroplasticity explanation, compared to a traditional biomechanical explanation, resulted in a measureable difference in SLR in patients with CLBP when receiving manual therapy. Future studies need to explore if the increase in SLR correlated to changes in cortical maps of the low back.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA
| | - Kevin Farrell
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Merrill Landers
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Martin Barclay
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Elise Goodman
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Jordan Gillund
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Sara McCaffrey
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Laura Timmerman
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
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Diener I, Kargela M, Louw A. Listening is therapy: Patient interviewing from a pain science perspective. Physiother Theory Pract 2016; 32:356-67. [PMID: 27351690 DOI: 10.1080/09593985.2016.1194648] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The interview of a patient attending physical therapy is the cornerstone of the physical examination, diagnosis, plan of care, prognosis, and overall efficacy of the therapeutic experience. A thorough, skilled interview drives the objective tests and measures chosen, as well as provides context for the interpretation of those tests and measures, during the physical examination. Information from the interview powerfully influences the treatment modalities chosen by the physical therapist (PT) and thus also impacts the overall outcome and prognosis of the therapy sessions. Traditional physical therapy focuses heavily on biomedical information to educate people about their pain, and this predominant model focusing on anatomy, biomechanics, and pathoanatomy permeates the interview and physical examination. Although this model may have a significant effect on people with acute, sub-acute or postoperative pain, this type of examination may not only gather insufficient information regarding the pain experience and suffering, but negatively impact a patient's pain experience. In recent years, physical therapy treatment for pain has increasingly focused on pain science education, with increasing evidence of pain science education positively affecting pain, disability, pain catastrophization, movement limitations, and overall healthcare cost. In line with the ever-increasing focus of pain science in physical therapy, it is time for the examination, both subjective and objective, to embrace a biopsychosocial approach beyond the realm of only a biomedical approach. A patient interview is far more than "just" collecting information. It also is a critical component to establishing an alliance with a patient and a fundamental first step in therapeutic neuroscience education (TNE) for patients in pain. This article highlights the interview process focusing on a pain science perspective as it relates to screening patients, establishing psychosocial barriers to improvement, and pain mechanism assessment.
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Affiliation(s)
- Ina Diener
- a Department of Physical Therapy , Stellenbosch University , Stellenbosch , South Africa
| | - Mark Kargela
- b Department of Physical Medicine and Rehabilitation , Mayo Clinic , Phoenix , AZ , USA
| | - Adriaan Louw
- c International Spine and Pain Institute , Story City , IA , USA
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22
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Louw A, Zimney K, O’Hotto C, Hilton S. The clinical application of teaching people about pain. Physiother Theory Pract 2016; 32:385-95. [DOI: 10.1080/09593985.2016.1194652] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Cox T, Louw A, Puentedura EJ. An abbreviated therapeutic neuroscience education session improves pain knowledge in first-year physical therapy students but does not change attitudes or beliefs. J Man Manip Ther 2016; 25:11-21. [PMID: 28855788 DOI: 10.1080/10669817.2015.1122308] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To determine if a 3-hour therapeutic neuroscience education session alters physical therapy student's knowledge of pain and effects their attitudes and beliefs regarding treating chronic pain. METHODS Seventy-seven entry-level doctoral physical therapy students participated in the study. Following consent, demographic data were obtained and then the subjects completed the Neuroscience of Pain Questionnaire, the Health Care Provider's Pain and Impairment Relationship Scale and an additional questionnaire designed by the researchers. The subjects then received a 3-hour educational session developed by the researchers, focusing on the neurobiology and physiology of pain. The questionnaires were re-administered immediately after the educational session and at 6 months post-education. RESULTS Seventy-seven subjects (mean age = 24.7 years, 57.1% female and 81.8% white) completed the questionnaires pre- and post-educational session with 75 completing the questionnaires at 6 months. To assess the effect of the education on the scores of the questionnaires, a repeated measures ANOVA was conducted. Students demonstrated significantly higher scores on the neuroscience of pain questionnaire (p < 0.001) with no significant effect found on the attitudes and beliefs questionnaire at any of the time points. There were significant differences found on some of the individual questions that were part of the additional questionnaire. DISCUSSION An educational session on the neuroscience of pain is beneficial for educating entry-level doctoral physical therapy students immediately post-education and at 6 months. This educational session had no effect on the student's attitudes and beliefs regarding treating the chronic pain population. There were additional significant findings regarding individual questions posed to the subjects.
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Affiliation(s)
- Terry Cox
- Department of Physical Therapy, Southwest Baptist University, Bolivar, Missouri, USA
| | - Adriaan Louw
- International Spine and Pain Institute, Story City, Iowa, USA
| | - Emilio J Puentedura
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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Valenzuela-Pascual F, Molina F, Corbi F, Blanco-Blanco J, Gil RM, Soler-Gonzalez J. The influence of a biopsychosocial educational internet-based intervention on pain, dysfunction, quality of life, and pain cognition in chronic low back pain patients in primary care: a mixed methods approach. BMC Med Inform Decis Mak 2015; 15:97. [PMID: 26597937 PMCID: PMC4657202 DOI: 10.1186/s12911-015-0220-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/20/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Low back pain is the highest reported musculoskeletal problem worldwide. Up to 90 % of patients with low back pain have no clear explanation for the source and origin of their pain. These individuals commonly receive a diagnosis of non-specific low back pain. Patient education is a way to provide information and advice aimed at changing patients' cognition and knowledge about their chronic state through the reduction of fear of anticipatory outcomes and the resumption of normal activities. Information technology and the expedited communication processes associated with this technology can be used to deliver health care information to patients. Hence, this technology and its ability to deliver life-changing information has grown as a powerful and alternative health promotion tool. Several studies have demonstrated that websites can change and improve chronic patients' knowledge and have a positive impact on patients' attitudes and behaviors. The aim of this project is to identify chronic low back pain patients' beliefs about the origin and meaning of pain to develop a web-based educational tool using different educational formats and gamification techniques. METHODS/DESIGN This study has a mixed-method sequential exploratory design. The participants are chronic low back pain patients between 18-65 years of age who are attending a primary care setting. For the qualitative phase, subjects will be contacted by their family physician and invited to participate in a personal semi-structured interview. The quantitative phase will be a randomized controlled trial. Subjects will be randomly allocated using a simple random sample technique. The intervention group will be provided access to the web site where they will find information related to their chronic low back pain. This information will be provided in different formats. All of this material will be based on the information obtained in the qualitative phase. The control group will follow conventional treatment provided by their family physician. DISCUSSION The main outcome of this project is to identify chronic low back pain patients' beliefs about the origin and meaning of pain to develop a web-based educational tool using different educational formats and gamification techniques. TRIAL REGISTRATION ClinicalTrials.gov NCT02369120 Date: 02/20/2015.
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Affiliation(s)
- Fran Valenzuela-Pascual
- Universidad de Lleida, Facultad de Enfermería y Fisioterapia, Montserrat Roig 2, Lleida, 25198, Spain. .,Grupo de Estudios Sociedad, Salud, Educación y Cultura, Universidad de Lleida, Pl. de Víctor Siurana 1, Lleida, 25003, Spain. .,Grup de Recerca de Cures de Salut, Institut de Recerca Biomèdica, Avda Alcalde Rovira Roure 80, Lleida, 25198, Spain.
| | - Fidel Molina
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, Universidad de Lleida, Pl. de Víctor Siurana 1, Lleida, 25003, Spain.,Universidad de Lleida, Facultad de Educación, Psicología y Trabajo Social, Av. Estudi General 4, Lleida, 25001, Spain
| | - Francisco Corbi
- Universidad de Lleida, Institut Nacional d'Educació Física de Catalunya, Centro de Lleida, Partida Caparrella s/n, Lleida, 25192, Spain
| | - Joan Blanco-Blanco
- Universidad de Lleida, Facultad de Enfermería y Fisioterapia, Montserrat Roig 2, Lleida, 25198, Spain.,Grupo de Estudios Sociedad, Salud, Educación y Cultura, Universidad de Lleida, Pl. de Víctor Siurana 1, Lleida, 25003, Spain.,Grup de Recerca de Cures de Salut, Institut de Recerca Biomèdica, Avda Alcalde Rovira Roure 80, Lleida, 25198, Spain
| | - Rosa M Gil
- Departamento de Informática e Ingeniería Industrial, Universidad de Lleida, Jaume II 69, Lleida, 25001, Spain
| | - Jorge Soler-Gonzalez
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, Universidad de Lleida, Pl. de Víctor Siurana 1, Lleida, 25003, Spain.,Universidad de Lleida, Facultad de Medicina, Montserrat Roig 2, Lleida, 25198, Spain.,Institut Català de la Salut, Rambla de Ferran 44, Lleida, 25007, Spain
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25
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Louw A, Puentedura EJ, Zimney K. A clinical contrast: physical therapists with low back pain treating patients with low back pain. Physiother Theory Pract 2015; 31:562-7. [DOI: 10.3109/09593985.2015.1062944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Louw A, Puentedura EJ, Diener I, Peoples RR. Preoperative therapeutic neuroscience education for lumbar radiculopathy: a single-case fMRI report. Physiother Theory Pract 2015; 31:496-508. [DOI: 10.3109/09593985.2015.1038374] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pragmatic Implementation of a Stratified Primary Care Model for Low Back Pain Management in Outpatient Physical Therapy Settings: Two-Phase, Sequential Preliminary Study. Phys Ther 2015; 95:1120-34. [PMID: 25858972 PMCID: PMC4528015 DOI: 10.2522/ptj.20140418] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 04/02/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The effectiveness of risk stratification for low back pain (LBP) management has not been demonstrated in outpatient physical therapy settings. OBJECTIVE The purposes of this study were: (1) to assess implementation of a stratified care approach for LBP management by evaluating short-term treatment effects and (2) to determine feasibility of conducting a larger-scale study. DESIGN This was a 2-phase, preliminary study. METHODS In phase 1, clinicians were randomly assigned to receive standard (n=6) or stratified care (n=6) training. Stratified care training included 8 hours of content focusing on psychologically informed practice. Changes in LBP attitudes and beliefs were assessed using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS). In phase 2, clinicians receiving the stratified care training were instructed to incorporate those strategies in their practice and 4-week patient outcomes were collected using a numerical pain rating scale (NPRS), and the Oswestry Disability Index (ODI). Study feasibility was assessed to identify potential barriers for completion of a larger-scale study. RESULTS In phase 1, minimal changes were observed for PABS-PT and HC-PAIRS scores for standard care clinicians (Cohen d=0.00-0.28). Decreased biomedical (-4.5±2.5 points, d=1.08) and increased biopsychosocial (+5.5±2.0 points, d=2.86) treatment orientations were observed for stratified care clinicians, with these changes sustained 6 months later on the PABS-PT. In phase 2, patients receiving stratified care (n=67) had greater between-group improvements in NPRS (0.8 points; 95% confidence interval=0.1, 1.5; d=0.40) and ODI (8.9% points; 95% confidence interval=4.1, 13.6; d=0.76) scores compared with patients receiving standard physical therapy care (n=33). LIMITATIONS In phase 2, treatment was not randomly assigned, and therapist adherence to treatment recommendations was not monitored. This study was not adequately powered to conduct subgroup analyses. CONCLUSIONS In physical therapy settings, biomedical orientation can be modified, and risk-stratified care for LBP can be effectively implemented. Findings from this study can be used for planning of larger studies.
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Louw A, Diener I, Puentedura EJ. The short term effects of preoperative neuroscience education for lumbar radiculopathy: A case series. Int J Spine Surg 2015; 9:11. [PMID: 26056626 DOI: 10.14444/2011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Recently a preoperative pain neuroscience education (NE) program was developed for lumbar surgery (LS) for radiculopathy as a means to decrease postoperative pain and disability. This study attempts to determine the short term effects, if any, of providing NE before surgery on patient outcomes. METHODS A case series of 10 patients (female = 7) received preoperative one-on-one educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet, prior to LS for radiculopathy. Post-intervention data was gathered immediately after NE, as well as 1, 3 and 6 months following LS. Primary outcome measures were Pain Catastrophization Scale (PCS), forward flexion, straight leg raise (SLR) and beliefs regarding LS. RESULTS Immediately following NE for LS for radiculopathy, all patients had lower PCS scores, with 5 patients exceeding the MDC score of 9.1 and 8 of the patients had PCS change scores exceeding the MDC by the 1, 3 and 6 month follow ups. Physical changes showed that fingertip-to-floor test in 6 patients had changes in beyond the MDC of 4.5 cm and 6 patients had changes in SLR beyond the MDC of 5.7°. The main finding, however, indicated a positive and more realistic shift in expectations regarding pain after the impending LS by all patients. CONCLUSIONS The results of the case series suggest that immediately after NE, patients scheduled for LS for radiculopathy had meaningful detectable changes in pain catastrophizing, fingertip-to-floor test, passive SLR and positive shifts in their beliefs about LS.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA
| | - Ina Diener
- University Stellenbosch and University Western Cape, Stellenbosch, South Africa
| | - Emilio J Puentedura
- University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy
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McClinton SM, Flynn TW, Heiderscheit BC, McPoil TG, Pinto D, Duffy PA, Bennett JD. Comparison of usual podiatric care and early physical therapy intervention for plantar heel pain: study protocol for a parallel-group randomized clinical trial. Trials 2013; 14:414. [PMID: 24299257 PMCID: PMC3866618 DOI: 10.1186/1745-6215-14-414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 11/18/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A significant number of individuals suffer from plantar heel pain (PHP) and many go on to have chronic symptoms and continued disability. Persistence of symptoms adds to the economic burden of PHP and cost-effective solutions are needed. Currently, there is a wide variation in treatment, cost, and outcomes of care for PHP with limited information on the cost-effectiveness and comparisons of common treatment approaches. Two practice guidelines and recent evidence of effective physical therapy intervention are available to direct treatment but the timing and influence of physical therapy intervention in the multidisciplinary management of PHP is unclear. The purpose of this investigation is to compare the outcomes and costs associated with early physical therapy intervention (ePT) following initial presentation to podiatry versus usual podiatric care (uPOD) in individuals with PHP. METHODS A parallel-group, block-randomized clinical trial will compare ePT and uPOD. Both groups will be seen initially by a podiatrist before allocation to a group that will receive physical therapy intervention consisting primarily of manual therapy, exercise, and modalities, or podiatric care consisting primarily of a stretching handout, medication, injections, and orthotics. Treatment in each group will be directed by practice guidelines and a procedural manual, yet the specific intervention for each participant will be selected by the treating provider. Between-group differences in the Foot and Ankle Ability Measure 6 months following the initial visit will be the primary outcome collected by an independent investigator. In addition, differences in the European Quality of Life--Five Dimensions, Numeric Pain Rating Scale, Global Rating of Change (GROC), health-related costs, and cost-effectiveness at 6 weeks, 6 months, and 1 year will be compared between groups. The association between successful outcomes based on GROC score and participant expectations of recovery generally, and specific to physical therapy and podiatry treatment, will also be analyzed. DISCUSSION This study will be the first pragmatic trial to investigate the clinical outcomes and cost-effectiveness of ePT and uPOD in individuals with PHP. The results will serve to inform clinical practice decisions and management guidelines of multiple disciplines. TRIAL REGISTRATION ClinicalTrials.gov: NCT01865734.
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Affiliation(s)
- Shane M McClinton
- Rocky Mountain University of Health Professions, 561 East 1860 South, Provo, Utah 84606, USA
- Department of Physical Therapy, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA
| | - Timothy W Flynn
- Department of Physical Therapy, Rocky Mountain University of Health Professions, 561 East 1860 South, Provo, Utah 84606, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin – Madison, 1300 University Avenue, Madison, Wisconsin 53706, USA
| | - Thomas G McPoil
- School of Physical Therapy, Rueckert-Hartman College of Health Professions, Regis University, 3333 Regis Boulevard, Denver, Colorado 80221, USA
| | - Daniel Pinto
- Department of Physical Therapy and Human Movement Sciences/Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, Suite 1100, Chicago, Illinois 60611, USA
| | - Pamela A Duffy
- Public Health Program, Des Moines University, 3200 Grand Avenue, Des Moines, Iowa 50312, USA
| | - John D Bennett
- Podiatric Medicine Program, Des Moines University, 3200 Grand Avenue, Des Moines, Iowa 50312, USA
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Zimney K, Louw A, Puentedura EJ. Use of Therapeutic Neuroscience Education to address psychosocial factors associated with acute low back pain: a case report. Physiother Theory Pract 2013; 30:202-9. [DOI: 10.3109/09593985.2013.856508] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Puentedura EJ, Louw A. A neuroscience approach to managing athletes with low back pain. Phys Ther Sport 2012; 13:123-33. [DOI: 10.1016/j.ptsp.2011.12.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 12/01/2011] [Accepted: 12/01/2011] [Indexed: 01/27/2023]
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