1
|
Ferraro MC, O'Connell NE, Sommer C, Goebel A, Bultitude JH, Cashin AG, Moseley GL, McAuley JH. Complex regional pain syndrome: advances in epidemiology, pathophysiology, diagnosis, and treatment. Lancet Neurol 2024; 23:522-533. [PMID: 38631768 DOI: 10.1016/s1474-4422(24)00076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 04/19/2024]
Abstract
Complex regional pain syndrome (CRPS) is a rare pain disorder that usually occurs in a limb after trauma. The features of this disorder include severe pain and sensory, autonomic, motor, and trophic abnormalities. Research from the past decade has offered new insights into CRPS epidemiology, pathophysiology, diagnosis, and treatment. Early identification of individuals at high risk of CRPS is improving, with several risk factors established and some others identified in prospective studies during the past 5 years. Better understanding of the pathophysiological mechanisms of CRPS has led to its classification as a chronic primary pain disorder, and subtypes of CRPS have been updated. Procedures for diagnosis have also been clarified. Although effective treatment of CRPS remains a challenge, evidence-based integrated management approaches provide new opportunities to improve patient care. Further advances in diagnosis and treatment of CRPS will require coordinated, international multicentre initiatives.
Collapse
Affiliation(s)
- Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
| | - Claudia Sommer
- University Hospital Würzburg, Department of Neurology, Würzburg, Germany
| | - Andreas Goebel
- Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, and Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Janet H Bultitude
- Centre for Pain Research, Department of Psychology, University of Bath, Bath, UK
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - G Lorimer Moseley
- IMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
| |
Collapse
|
2
|
Wallwork SB, Nichols S, Jordan A, Noel M, Madden VJ, Lorimer Moseley G. Harnessing children's picture books to socialize children about pain and injury: a qualitative study. J Pain 2024:S1526-5900(24)00440-1. [PMID: 38580100 DOI: 10.1016/j.jpain.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024]
Abstract
Pain experiences are common during childhood (e.g., 'everyday' pain, vaccine injections) and are powerful opportunities for children to learn about pain and injury. These experiences likely inform fundamental and life-long beliefs about pain. There is scant research investigating the sociocultural contexts in which children learn about pain and injury. One unexplored context is shared reading of picture books (e.g., between parents/caregivers and children). In this study, we investigated whether shared reading of picture books that included depictions of pain and/or injury prompted parent/caregiver-child interactions. If interactions were observed, we explored what those interactions entailed. Twenty parent/caregivers (8 men, 12 women) and their children (n=27; 10 boys, 17 girls) were recruited from libraries in South Australia. Parent/caregiver-child families chose from 8 books (7 fiction, 1 non-fiction) with varying amounts of pain/injury-related content. Shared reading interactions were video recorded, transcribed, and analysed alongside analysis of the picture books using reflexive thematic analysis. Pain/injury-related interactions were observed between parents/caregivers and children during shared reading of picture books. Qualitative analyses generated one main theme and three sub-themes. Findings identified that shared reading presented an opportunity for children's understanding of pain and injury to be socialized through discussion of characters' experiences. This included teaching children about pain and injury, as well as promoting empathy and emotional attunement towards characters who were depicted as being in pain. Finally, parents/caregivers often responded with observable/expressed amusement if pain/injury was depicted in a light-hearted or unrealistic way. Overall, shared reading of picture books presents an untapped opportunity to socialize children about pain and injury. PERSPECTIVE: Shared reading of picture books that have depictions of pain and/or injury can prompt parent/caregiver-child interactions about pain and injury. These interactions present critical opportunities that can be harnessed to promote children's learning of adaptive pain-related concepts and behaviours during a critical developmental period.
Collapse
Affiliation(s)
- Sarah B Wallwork
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia.
| | - Sue Nichols
- Education Futures, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Abbie Jordan
- Centre for Pain Research & Department of Psychology, University of Bath, Bath, United Kingdom
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Victoria J Madden
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia; Pain Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa; HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - G Lorimer Moseley
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| |
Collapse
|
3
|
Ryan CG, Karran EL, Wallwork SB, Pate JW, O'Keeffe M, Fullen BM, Livadas N, Jones N, Toumbourou JW, Gilchrist P, Cameron PA, Fatoye F, Ravindran D, Lorimer Moseley G. We Are All in This Together-Whole of Community Pain Science Education Campaigns to Promote Better Management of Persistent Pain. J Pain 2024; 25:902-917. [PMID: 37918470 DOI: 10.1016/j.jpain.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/02/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
Persistent pain is a major public health issue-estimated to affect a quarter of the world's population. Public understanding of persistent pain is based on outdated biomedical models, laden with misconceptions that are contrary to best evidence. This understanding is a barrier to effective pain management. Thus, there have been calls for public health-based interventions to address these misconceptions. Previous pain-focussed public education campaigns have targeted pain beliefs and behaviours that are thought to promote recovery, such as staying active. However, prevailing pain-related misconceptions render many of these approaches counter-intuitive, at best. Pain Science Education improves understanding of 'how pain works' and has been demonstrated to improve pain and disability outcomes. Extending Pain Science Education beyond the clinic to the wider community seems warranted. Learning from previous back pain-focussed and other public health educational campaigns could optimise the potential benefit of such a Pain Science Education campaign. Pain Science Education-grounded campaigns have been delivered in Australia and the UK and show promise, but robust evaluations are needed before any firm conclusions on their population impact can be made. Several challenges exist going forward. Not least is the need to ensure all stakeholders are involved in the development and implementation of Pain Science Education public messaging campaigns. Furthermore, it is crucial that campaigns are undertaken through a health equity lens, incorporating underrepresented communities to ensure that any intervention does not widen existing health inequalities associated with persistent pain. PERSPECTIVE: Public misconceptions about pain are a significant public health challenge and a viable intervention target to reduce the personal, social, and economic burden of persistent pain. Adaptation of Pain Science Education, which improves misconceptions in a clinical setting, into the public health setting seems a promising approach to explore.
Collapse
Affiliation(s)
- Cormac G Ryan
- Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK
| | - Emma L Karran
- Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Sarah B Wallwork
- Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Joshua W Pate
- Pain Education Team to Advance Learning (PETAL) Collaboration; Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Mary O'Keeffe
- Pain Education Team to Advance Learning (PETAL) Collaboration; Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, University of Sydney, Australia
| | - Brona M Fullen
- Pain Education Team to Advance Learning (PETAL) Collaboration; UCD School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | - Nick Livadas
- Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK
| | - Niki Jones
- Pain Education Team to Advance Learning (PETAL) Collaboration
| | - John W Toumbourou
- Pain Education Team to Advance Learning (PETAL) Collaboration; Deakin University, School of Psychology and Centre for Social and Early Emotional Development, Geelong, Australia
| | - Peter Gilchrist
- Pain Education Team to Advance Learning (PETAL) Collaboration; The University of Adelaide Rural Clinical School, Rural Generalist Program, South Australia
| | - Paul A Cameron
- Pain Education Team to Advance Learning (PETAL) Collaboration; Fife Health & Social Care Partnership, Scotland, UK; School of Medicine, Cardiff University, UK
| | - Francis Fatoye
- Pain Education Team to Advance Learning (PETAL) Collaboration; Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, UK; Lifestyle Disease Entity, North-West University, South Africa
| | - Deepak Ravindran
- Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK; Department of Pain Medicine, Royal Berkshire NHS Foundation Trust, UK
| | - G Lorimer Moseley
- Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| |
Collapse
|
4
|
Mardon AK, Chalmers KJ, Heathcote LC, Curtis LA, Freedman L, Malani R, Parker R, Neumann PB, Moseley GL, Leake HB. "I wish I knew then what I know now" - pain science education concepts important for female persistent pelvic pain: a reflexive thematic analysis. Pain 2024:00006396-990000000-00547. [PMID: 38452219 DOI: 10.1097/j.pain.0000000000003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/18/2024] [Indexed: 03/09/2024]
Abstract
ABSTRACT Pain science education (PSE) provides people with an understanding of "how pain works" grounded in the biopsychosocial model of pain; it has been demonstrated to improve outcomes in musculoskeletal pain conditions. Preliminary evidence suggests PSE may be effective for female individuals with persistent pelvic pain, but how the content of PSE needs to be modified for this group remains to be determined. A reflexive thematic analysis of qualitative data was performed to identify PSE concepts that female individuals with persistent pelvic pain consider important and why. Twenty individual, semistructured interviews were conducted with adult females who had engaged with PSE and had self-identified as having "improved" pelvic pain. Most participants had been diagnosed with endometriosis (n = 16). Four themes were generated capturing PSE concepts considered important by female individuals with "improved" pelvic pain: (1) "A sensitised nervous system leads to overprotective pain" validated their pelvic pain as being real; (2) "Pain does not have to mean the body is damaged (although sometimes it does)" provided reassurance that pelvic pain does not mean their condition is worsening; (3) "How I think, feel, and 'see' my pain can make it worse" enabled participants to find optimal ways to manage their pain; and (4) "I can change my pain… slowly" provided hope that pelvic pain can improve and empowered them to pursue pain improvement as a viable goal. This study generated 4 PSE learning concepts that were important to female individuals with improved pelvic pain and may be incorporated into PSE curricula for female individuals with pelvic pain.
Collapse
Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - K Jane Chalmers
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Lauren C Heathcote
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lee-Anne Curtis
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | | | - Rinkle Malani
- MGM School of Physiotherapy, Aurangabad, A Constituent Unit of MGMIHS, Maharashtra, India
| | - Romy Parker
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Patricia B Neumann
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Hayley B Leake
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| |
Collapse
|
5
|
English C, Simpson DB, Billinger SA, Churilov L, Coupland KG, Drummond A, Kuppuswamy A, Kutlubaev MA, Lerdal A, Mahmood A, Moseley GL, Pittman QJ, Riley EA, Sutherland BA, Wong CHY, Corbett D, Mead G. A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2024; 19:133-144. [PMID: 37424273 PMCID: PMC10811972 DOI: 10.1177/17474930231189135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
RATIONALE Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. METHODS We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. RESULTS We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool. CONCLUSIONS By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.
Collapse
Affiliation(s)
- Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Dawn B Simpson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Sandra A Billinger
- Department of Neurology, University of Kansas Medical Centre, University of Kansas Alzheimer’s Disease Research Centre, Kansas City, KS, USA
| | - Leonid Churilov
- Department of Medicine (RMH), University of Melbourne, Heidelberg, VIC, Australia
| | - Kirsten G Coupland
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Amreen Mahmood
- Faculty of Health, Health and Education, Manchester Metropolitan University, Manchester, UK
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Quentin J Pittman
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ellyn A Riley
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, NY, USA
| | - Brad A Sutherland
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Connie HY Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa Roger Guindon Hall, Ottawa, ON, Canada
| | - Gillian Mead
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
6
|
Wallwork SB, Braithwaite FA, O'Keeffe M, Travers MJ, Summers SJ, Lange B, Hince DA, Costa LOP, Menezes Costa LDC, Chiera B, Moseley GL. The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis. CMAJ 2024; 196:E29-E46. [PMID: 38253366 PMCID: PMC10805138 DOI: 10.1503/cmaj.230542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Understanding the clinical course of low back pain is essential to informing treatment recommendations and patient stratification. Our aim was to update our previous systematic review and meta-analysis to gain a better understanding of the clinical course of acute, subacute and persistent low back pain. METHODS To update our 2012 systematic review and meta-analysis, we searched the Embase, MEDLINE and CINAHL databases from 2011 until January 2023, using our previous search strategy. We included prospective inception cohort studies if they reported on participants with acute (< 6 wk), subacute (6 to less than 12 wk) or persistent (12 to less than 52 wk) nonspecific low back pain at study entry. Primary outcome measures included pain and disability (0-100 scale). We assessed risk of bias of included studies using a modified tool and assessed the level of confidence in pooled estimates using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. We used a mixed model design to calculate pooled estimates (mean, 95% confidence interval [CI]) of pain and disability at 0, 6, 12, 26 and 52 weeks. We treated time in 2 ways: time since study entry (inception time uncorrected) and time since pain onset (inception time corrected). We transformed the latter by adding the mean inception time to the time of study entry. RESULTS We included 95 studies, with 60 separate cohorts in the systematic review (n = 17 974) and 47 cohorts (n = 9224) in the meta-analysis. Risk of bias of included studies was variable, with poor study attrition and follow-up, and most studies did not select participants as consecutive cases. For the acute pain cohort, the estimated mean pain score with inception time uncorrected was 56 (95% CI 49-62) at baseline, 26 (95% CI 21-31) at 6 weeks, 22 (95% CI 18-26) at 26 weeks and 21 (95% CI 17-25) at 52 weeks (moderate-certainty evidence). For the subacute pain cohort, the mean pain score was 63 (95% CI 55-71) at baseline, 29 (95% CI 22-37) at 6 weeks, 29 (95% CI 22-36) at 26 weeks and 31 (95% 23-39) at 52 weeks (moderate-certainty evidence). For the persistent pain cohort, the mean pain score was 56 (95% CI 37-74) at baseline, 48 (95% CI 32-64) at 6 weeks, 43 (95% CI 29-57) at 26 weeks and 40 (95% CI 27-54) at 52 weeks (very low-certainty evidence). The clinical course of disability was slightly more favourable than the clinical course of pain. INTERPRETATION Participants with acute and subacute low back pain had substantial improvements in levels of pain and disability within the first 6 weeks ( moderate-certainty evidence); however, participants with persistent low back pain had high levels of pain and disability with minimal improvements over time (very low-certainty evidence). Identifying and escalating care in individuals with subacute low back pain who are recovering slowly could be a focus of intervention to reduce the likelihood of transition into persistent low back pain. PROTOCOL REGISTRATION PROSPERO - CRD42020207442.
Collapse
Affiliation(s)
- Sarah B Wallwork
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Felicity A Braithwaite
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Mary O'Keeffe
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Mervyn J Travers
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Simon J Summers
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Belinda Lange
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Dana A Hince
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Leonardo O P Costa
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Luciola da C Menezes Costa
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Belinda Chiera
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| |
Collapse
|
7
|
Madden VJ, Kamerman P, Leake HB, Catley MJ, Heathcote LC, Moseley GL. The Sensation and Pain Rating Scale: easy to use, clear to interpret, and responsive to clinical change. medRxiv 2024:2023.09.08.23295128. [PMID: 37732279 PMCID: PMC10508797 DOI: 10.1101/2023.09.08.23295128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Background The Sensation and Pain Rating Scale (SPARS) allows rating of non-painful as well as painful percepts. While it performs well in the experimental context, its clinical utility is untested. This prospective, repeated-measures study mixed qualitative and quantitative methods to examine the utility and performance of the SPARS in a clinical context, and to compare it with the widely used 11-point NRS for pain. Methods People presenting for outpatient physiotherapy (n = 121) provided ratings on the SPARS and NRS at first consultation, before and after sham and active clinical interventions, and at follow-up consultation. Clinicians (n = 9) reported each scale's usability and interpretability using Likert-type scales and free text, and answered additional questions with free text. Each data type was initially analysed separately: quantitative data were visualised and the ES II metric was used to estimate SPARS internal responsiveness; qualitative data were analysed with a reflexive inductive thematic approach. Data types were then integrated for triangulation and complementarity. Results The SPARS was well received and considered easy to use, after initial familiarisation. Clinicians favoured the SPARS over the NRS for clarity of interpretation and inter-rater reliability. SPARS sensitivity to change was good (ESII=0.9; 95%CI: 0.75-1.10). The greater perceptual range of the SPARS was deemed especially relevant in the later phases of recovery, when pain may recede into discomfort that still warrants clinical attention. Conclusion The SPARS is a promising tool for assessing patient percept, with strong endorsement from clinicians for its clarity and superior perceptual scope.
Collapse
Affiliation(s)
- Victoria J Madden
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town. IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Peter Kamerman
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Hayley B Leake
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, SA, Australia
| | - Mark J Catley
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, SA, Australia
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College London
| | - G Lorimer Moseley
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, SA, Australia
| |
Collapse
|
8
|
English C, Simpson DB, Billinger SA, Churilov L, Coupland KG, Drummond A, Kuppuswamy A, Kutlubaev MA, Lerdal A, Mahmood A, Moseley GL, Pittman QJ, Riley EA, Sutherland BA, Wong CHY, Corbett D, Mead G. A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2024; 38:7-18. [PMID: 37837346 PMCID: PMC10798034 DOI: 10.1177/15459683231209170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
RATIONALE Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. METHODS We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. RESULTS We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool. CONCLUSIONS By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.
Collapse
Affiliation(s)
- Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Dawn B Simpson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Sandra A Billinger
- Department of Neurology, University of Kansas Medical Centre, University of Kansas Alzheimer’s Disease Research Centre, Kansas City, KS, USA
| | - Leonid Churilov
- Department of Medicine (RMH), University of Melbourne, Heidelberg, VIC, Australia
| | - Kirsten G Coupland
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Amreen Mahmood
- Faculty of Health, Health and Education, Manchester Metropolitan University, Manchester, UK
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Quentin J Pittman
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ellyn A Riley
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, NY, USA
| | - Brad A Sutherland
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Connie HY Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa Roger Guindon Hall, Ottawa, ON, Canada
| | - Gillian Mead
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
9
|
Howlett CA, Miles S, Berryman C, Phillipou A, Moseley GL. Conflation between self-report and neurocognitive assessments of cognitive flexibility: a critical review of the Jingle Fallacy. Australian Journal of Psychology 2023. [DOI: 10.1080/00049530.2023.2174684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- Caitlin A. Howlett
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Stephanie Miles
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Carolyn Berryman
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Brain Stimulation, Imaging and Cognition Research Group, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Department of Mental Health, St Vincent’s Hospital, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Department of Mental Health, Austin Health, Melbourne, Australia
| | - G. Lorimer Moseley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| |
Collapse
|
10
|
Mardon AK, Leake HB, Szeto K, Moseley GL, Chalmers KJ. Recommendations for patient education in the management of persistent pelvic pain: a systematic review of clinical practice guidelines. Pain 2023:00006396-990000000-00478. [PMID: 38112691 DOI: 10.1097/j.pain.0000000000003137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/01/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Patient education has a critical role in the management of pain. There is considerable heterogeneity in patient education for females with persistent pelvic pain (PPP), and it remains unclear what is considered best clinical practice. Therefore, this systematic review identified and summarised recommendations for patient education in the management of benign gynaecological and urological conditions associated with PPP, as endorsed by international guidelines. Academic and relevant guideline databases were searched from inception to May 2022. Included guidelines were those for the management of benign gynaecological and urological conditions associated with PPP in adult females published in English, of any publication date, and endorsed by a professional organisation or society. Two independent reviewers screened 3097 records; 17 guidelines were included in the review. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. Recommendations were pooled using descriptive synthesis. Persistent pelvic pain guideline quality was generally poor. Three guidelines were classified as "excellent" (The NICE, RANZCOG, and ESHRE endometriosis guidelines) and therefore recommended for use. Eleven guidelines (64.7%) recommended patient education for females with PPP. Recommendations for education content were variable, however most frequently covered treatment strategies and pelvic pain diagnoses. For education delivery, the most frequent recommendations were for support groups and written/printed materials. Further research into tailored education interventions is needed for females with PPP.
Collapse
Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Kimberley Szeto
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Alliance for Research in Exercise, Nutrition and Activity, Kaurna Country, University of South Australia, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Western Sydney University, Campbelltown, Australia
| |
Collapse
|
11
|
De Groef A, Meeus M, Heathcote LC, Wiles L, Catley M, Vogelzang A, Olver I, Runciman WB, Hibbert P, Dams L, Morlion B, Moseley GL. Treating persistent pain after breast cancer: practice gaps and future directions. J Cancer Surviv 2023; 17:1698-1707. [PMID: 35275361 PMCID: PMC8914454 DOI: 10.1007/s11764-022-01194-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/29/2022]
Abstract
This paper discusses the growing problem of persisting pain after successful treatment of breast cancer and presents recommendations for improving pain-related outcomes for this group. We discuss the dominant treatment approach for persisting pain post-breast cancer treatment and draw contrasts with contemporary treatment approaches to persistent pain in non-cancer-related populations. We discuss modern application of the biopsychosocial model of pain and the notion of variable sensitivity within the pain system, moment by moment and over time. We present the implications of increasing sensitivity over time for treatment selection and implementation. By drawing on transformative changes in treatment approaches to persistent non-cancer-related pain, we describe the potentially powerful role that an intervention called pain science education, which is now recommended in clinical guidelines for musculoskeletal pain, may play in improving pain and disability outcomes after successful breast cancer treatment. Finally, we present several research recommendations that centre around adaptation of the content and delivery models of contemporary pain science education, to the post-breast cancer context.
Collapse
Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Campus Drie Eiken, Room R3.08, Universiteitsplein 1, 2610, Wilrijk Antwerp, Belgium.
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Campus Drie Eiken, Room R3.08, Universiteitsplein 1, 2610, Wilrijk Antwerp, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Louise Wiles
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Mark Catley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Anna Vogelzang
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Ian Olver
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - William B Runciman
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Peter Hibbert
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Lore Dams
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Campus Drie Eiken, Room R3.08, Universiteitsplein 1, 2610, Wilrijk Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Bart Morlion
- Section Anesthesiology and Algology, Department of Cardiovascular Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - G Lorimer Moseley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| |
Collapse
|
12
|
Cashin AG, Lee H, Wand BM, Bagg MK, O'Hagan ET, Rizzo RRN, Stanton TR, Moseley GL, McAuley JH. Mechanisms of education and graded sensorimotor retraining in people with chronic low back pain: a mediation analysis. Pain 2023; 164:2792-2800. [PMID: 37366598 DOI: 10.1097/j.pain.0000000000002978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/14/2023] [Indexed: 06/28/2023]
Abstract
ABSTRACT An improved understanding of the biopsychosocial influences that contribute to and maintain pain has promoted the development of new efficacious treatments for chronic low back pain (CLBP). This study aimed to investigate the mechanisms of a new treatment-education and graded sensorimotor retraining-on pain and disability. We conducted a preplanned causal mediation analysis of a randomized clinical trial which allocated 276 participants with CLBP to 12 weekly clinical sessions of education and graded sensorimotor retraining (n = 138) or a sham and attention control (n = 138). Outcomes were pain intensity and disability, both assessed at 18 weeks. Hypothesized mediators included tactile acuity, motor coordination, back self-perception, beliefs about the consequences of back pain, kinesiophobia, pain self-efficacy, and pain catastrophizing, all assessed at the end of treatment (12 weeks). Four of 7 mechanisms (57%) mediated the intervention effect on pain; the largest mediated effects were for beliefs about back pain consequences (-0.96 [-1.47 to -0.64]), pain catastrophizing (-0.49 [-0.61 to -0.24]), and pain self-efficacy (-0.37 [-0.66 to -0.22]). Five of 7 mechanisms (71%) mediated the intervention effect on disability; the largest mediated effects were for beliefs about back pain consequences (-1.66 [-2.62 to -0.87]), pain catastrophizing (-1.06 [-1.79 to -0.53]), and pain self-efficacy (-0.84 [-1.89 to -0.45]). When all 7 mechanisms were considered simultaneously, the joint mediation effect explained most of the intervention effect for both pain and disability. Optimizing interventions to target beliefs about the consequences of back pain, pain catastrophizing, and pain self-efficacy is likely to lead to improved outcomes for people with CLBP.
Collapse
Affiliation(s)
- Aidan G Cashin
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Benedict M Wand
- Faculty of Medicine, Nursing and Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Edel T O'Hagan
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- Westmead Applied Research Centre, The University of Sydney, Sydney, Australia
| | - Rodrigo R N Rizzo
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Tasha R Stanton
- IIMPACT (Innovation, IMPlementation And Clinical Translation) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT (Innovation, IMPlementation And Clinical Translation) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - James H McAuley
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| |
Collapse
|
13
|
Lorimer Moseley G, Leake HB, Beetsma AJ, Watson JA, Butler DS, van der Mee A, Stinson JN, Harvie D, Palermo TM, Meeus M, Ryan CG. Teaching Patients About Pain: The Emergence of Pain Science Education, its Learning Frameworks and Delivery Strategies. J Pain 2023:104425. [PMID: 37984510 DOI: 10.1016/j.jpain.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
Since it emerged in the early 2000's, intensive education about 'how pain works', widely known as pain neuroscience education or explaining pain, has evolved into a new educational approach, with new content and new strategies. The substantial differences from the original have led the PETAL collaboration to call the current iteration 'Pain Science Education'. This review presents a brief historical context for Pain Science Education, the clinical trials, consumer perspective, and real-world clinical data that have pushed the field to update both content and method. We describe the key role of educational psychology in driving this change, the central role of constructivism, and the constructivist learning frameworks around which Pain Science Education is now planned and delivered. We integrate terminology and concepts from the learning frameworks currently being used across the PETAL collaboration in both research and practice-the Interactive, Constructive, Active, Passive framework, transformative learning theory, and dynamic model of conceptual change. We then discuss strategies that are being used to enhance learning within clinical encounters, which focus on the skill, will, and thrill of learning. Finally, we provide practical examples of these strategies so as to assist the reader to drive their own patient pain education offerings towards more effective learning. PERSPECTIVE: Rapid progress in several fields and research groups has led to the emergence 'Pain Science Education'. This PETAL review describes challenges that have spurred the field forward, the learning frameworks and educational strategies that are addressing those challenges, and some easy wins to implement and mistakes to avoid.
Collapse
Affiliation(s)
- G Lorimer Moseley
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia.
| | - Hayley B Leake
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Anneke J Beetsma
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, the Netherlands
| | - James A Watson
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK; Integrated Musculoskeletal Service, Community Pain Management, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - David S Butler
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Annika van der Mee
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Consumer Representative, Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, the Netherlands
| | - Jennifer N Stinson
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Child Health Evaluative Sciences, The Research Institute, The Hospital for Sick Children and Lawrence S. Bloomberg, Faculty of Nursing, The University of Toronto, Toronto, Ontario, Canada
| | - Daniel Harvie
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Tonya M Palermo
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Mira Meeus
- The Pain Education Team to Advance Learning (PETAL) Collaboration; MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Cormac G Ryan
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| |
Collapse
|
14
|
Karran EL, Cashin AG, Barker T, Boyd MA, Chiarotto A, Dewidar O, Mohabir V, Petkovic J, Sharma S, Tejani S, Tugwell P, Moseley GL. Using PROGRESS-plus to identify current approaches to the collection and reporting of equity-relevant data: a scoping review. J Clin Epidemiol 2023; 163:70-78. [PMID: 37802205 DOI: 10.1016/j.jclinepi.2023.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/27/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES Our objectives were to identify what and how data relating to the social determinants of health are collected and reported in equity-relevant studies and map these data to the PROGRESS-Plus framework. STUDY DESIGN AND SETTING We performed a scoping review. We ran two systematic searches of MEDLINE and Embase for equity-relevant studies published during 2021. We included studies in any language without limitations to participant characteristics. Included studies were required to have collected and reported at least two participant variables relevant to evaluating individual-level social determinants of health. We applied the PROGRESS-Plus framework to identify and organize these data. RESULTS We extracted data from 200 equity-relevant studies, providing 962 items defined by PROGRESS-Plus. A median of 4 (interquartile range = 2) PROGRESS-Plus items were reported in the included studies. 92% of studies reported age; 78% reported sex/gender; 65% reported educational attainment; 49% reported socioeconomic status; 45% reported race; 44% reported social capital; 33% reported occupation; 14% reported place and 9% reported religion. CONCLUSION Our synthesis demonstrated that researchers currently collect a limited range of equity-relevant data, but usefully provides a range of examples spanning PROGRESS-Plus to inform the development of improved, standardized practices.
Collapse
Affiliation(s)
- Emma L Karran
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia.
| | - Aidan G Cashin
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Trevor Barker
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Mark A Boyd
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Alessandro Chiarotto
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Omar Dewidar
- Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vina Mohabir
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Petkovic
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Saurab Sharma
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Sinan Tejani
- InBalance Physiotherapy, Launceston, Tasmania, Australia
| | - Peter Tugwell
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Department of Medicine and School of Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
| | - G Lorimer Moseley
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| |
Collapse
|
15
|
Roose E, Nijs J, Moseley GL. Striving for better outcomes of treating chronic pain: integrating behavioural change strategies before, during, and after modern pain science education. Braz J Phys Ther 2023; 27:100578. [PMID: 38096753 PMCID: PMC10727936 DOI: 10.1016/j.bjpt.2023.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/22/2023] Open
Affiliation(s)
- Eva Roose
- Pain in Motion Research Group (PAIN), Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physical Therapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium; Rehabilitation Research Group, Department of Physical Therapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; REVAL, Universiteit Hasselt, Agoralaan-gebouw A, 3590 Diepenbeek, Belgium
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physical Therapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physical Therapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Huvudbyggnad Vasaparken, Universitetsplatsen 1, 41345 Gothenburg, Sweden.
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country GPO Box 2471, Adelaide, South Australia 5001, Australia; The Pain Education Team to Advance Learning (PETAL) Collaboration, Australia
| |
Collapse
|
16
|
Mouatt B, Leake HB, Stanton TR, Moseley GL, Simons LE, Braithwaite FA. A single-item mood question adequately discriminates moderately severe to severe depression in individuals with persistent pain: preliminary validation. Br J Anaesth 2023; 131:e137-e139. [PMID: 37587007 DOI: 10.1016/j.bja.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023] Open
Affiliation(s)
- Brendan Mouatt
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA, Australia
| | - Tasha R Stanton
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA, Australia
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Felicity A Braithwaite
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| |
Collapse
|
17
|
Pulling BW, Braithwaite FA, Butler DS, Vogelzang AR, Moseley GL, Catley MJ, Murray CM, Stanton TR. Item development and pre-testing of an Osteoarthritis Conceptualisation Questionnaire to assess knowledge and beliefs in people with knee pain. PLoS One 2023; 18:e0286114. [PMID: 37773973 PMCID: PMC10540977 DOI: 10.1371/journal.pone.0286114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/09/2023] [Indexed: 10/01/2023] Open
Abstract
Many people with osteoarthritis hold beliefs that physical activity is unhelpful or dangerous for their joints, despite high-level evidence suggesting otherwise. Recent advances in scientific understanding of osteoarthritis have led to new treatments that target an individual's understanding both of their condition and the importance of best-practice management strategies, such as physical activity. Conceptual change has been proposed as an important mechanism by which cognitive interventions, such as pain science education, may reduce pain and improve function. There are currently no specific assessments of osteoarthritis conceptualisation to determine the effectiveness of cognitive interventions in effecting conceptual change in people with knee osteoarthritis. Therefore, we aimed to develop an item bank, as the first phase of developing a questionnaire to assess people's conceptualisations about their knee osteoarthritis and the role of physical activity in managing their osteoarthritis. Using a guideline-informed mixed method design, a panel of experts identified domains relevant to conceptualisation about knee osteoarthritis and physical activity (knowledge, beliefs, understanding) based upon available evidence. The panel created 33 provisional items. Qualitative and quantitative pretesting were used to explore how people with knee osteoarthritis understood the provisional items. Eighteen people with knee osteoarthritis completed cognitive interviews about their comprehension of the wording/grammar of each provisional item. The provisional item bank was field tested with 100 people with knee osteoarthritis. Readability was adequate with a Flesch reading ease score of 57.7. Although 14.7% used the 'Strongly agree' response option, only 3.4% of responses used the 'Strongly disagree' option, suggesting possible response bias. Predictive quality testing identified relevant modifications to the questionnaire instructions. The panel of experts appraised the qualitative data to assess whether and how items should be modified to address the problems identified, resulting in a final item bank of 45 items that can be evaluated for psychometric properties in future research.
Collapse
Affiliation(s)
- Brian W. Pulling
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Felicity A. Braithwaite
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - David S. Butler
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Anna R. Vogelzang
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - G. Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Mark J. Catley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Carolyn M. Murray
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Tasha R. Stanton
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| |
Collapse
|
18
|
Ferraro MC, Cashin AG, Wand BM, Smart KM, Berryman C, Marston L, Moseley GL, McAuley JH, O'Connell NE. Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews. Cochrane Database Syst Rev 2023; 6:CD009416. [PMID: 37306570 PMCID: PMC10259367 DOI: 10.1002/14651858.cd009416.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a chronic pain condition that usually occurs in a limb following trauma or surgery. It is characterised by persisting pain that is disproportionate in magnitude or duration to the typical course of pain after similar injury. There is currently no consensus regarding the optimal management of CRPS, although a broad range of interventions have been described and are commonly used. This is the first update of the original Cochrane review published in Issue 4, 2013. OBJECTIVES To summarise the evidence from Cochrane and non-Cochrane systematic reviews of the efficacy, effectiveness, and safety of any intervention used to reduce pain, disability, or both, in adults with CRPS. METHODS We identified Cochrane reviews and non-Cochrane reviews through a systematic search of Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, CINAHL, PEDro, LILACS and Epistemonikos from inception to October 2022, with no language restrictions. We included systematic reviews of randomised controlled trials that included adults (≥18 years) diagnosed with CRPS, using any diagnostic criteria. Two overview authors independently assessed eligibility, extracted data, and assessed the quality of the reviews and certainty of the evidence using the AMSTAR 2 and GRADE tools respectively. We extracted data for the primary outcomes pain, disability and adverse events, and the secondary outcomes quality of life, emotional well-being, and participants' ratings of satisfaction or improvement with treatment. MAIN RESULTS: We included six Cochrane and 13 non-Cochrane systematic reviews in the previous version of this overview and five Cochrane and 12 non-Cochrane reviews in the current version. Using the AMSTAR 2 tool, we judged Cochrane reviews to have higher methodological quality than non-Cochrane reviews. The studies in the included reviews were typically small and mostly at high risk of bias or of low methodological quality. We found no high-certainty evidence for any comparison. There was low-certainty evidence that bisphosphonates may reduce pain intensity post-intervention (standardised mean difference (SMD) -2.6, 95% confidence interval (CI) -1.8 to -3.4, P = 0.001; I2 = 81%; 4 trials, n = 181) and moderate-certainty evidence that they are probably associated with increased adverse events of any nature (risk ratio (RR) 2.10, 95% CI 1.27 to 3.47; number needed to treat for an additional harmful outcome (NNTH) 4.6, 95% CI 2.4 to 168.0; 4 trials, n = 181). There was moderate-certainty evidence that lidocaine local anaesthetic sympathetic blockade probably does not reduce pain intensity compared with placebo, and low-certainty evidence that it may not reduce pain intensity compared with ultrasound of the stellate ganglion. No effect size was reported for either comparison. There was low-certainty evidence that topical dimethyl sulfoxide may not reduce pain intensity compared with oral N-acetylcysteine, but no effect size was reported. There was low-certainty evidence that continuous bupivacaine brachial plexus block may reduce pain intensity compared with continuous bupivacaine stellate ganglion block, but no effect size was reported. For a wide range of other commonly used interventions, the certainty in the evidence was very low and provides insufficient evidence to either support or refute their use. Comparisons with low- and very low-certainty evidence should be treated with substantial caution. We did not identify any RCT evidence for routinely used pharmacological interventions for CRPS such as tricyclic antidepressants or opioids. AUTHORS' CONCLUSIONS Despite a considerable increase in included evidence compared with the previous version of this overview, we identified no high-certainty evidence for the effectiveness of any therapy for CRPS. Until larger, high-quality trials are undertaken, formulating an evidence-based approach to managing CRPS will remain difficult. Current non-Cochrane systematic reviews of interventions for CRPS are of low methodological quality and should not be relied upon to provide an accurate and comprehensive summary of the evidence.
Collapse
Affiliation(s)
- Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Benedict M Wand
- The School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Keith M Smart
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Physiotherapy Department, St Vincent's University Hospital, Dublin, Ireland
| | - Carolyn Berryman
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- School of Biomedicine, The University of Adelaide, Kaurna Country, Adelaide, Australia
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
| |
Collapse
|
19
|
Rizzo RRN, Wand BM, Leake HB, O'Hagan ET, Bagg MK, Bunzli S, Traeger AC, Gustin SM, Moseley GL, Sharma S, Cashin AG, McAuley JH. "My Back is Fit for Movement": A Qualitative Study Alongside a Randomized Controlled Trial for Chronic Low Back Pain. J Pain 2023; 24:824-839. [PMID: 36577460 DOI: 10.1016/j.jpain.2022.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
A new wave of treatments has emerged to target nervous system alterations and maladaptive conceptualizations about pain for chronic low back pain. The acceptability of these treatments is still uncertain. We conducted a qualitative study alongside a randomized controlled trial to identify perceptions of facilitators or barriers to participation in a non-pharmacological intervention that resulted in clinically meaningful reductions across 12 months for disability compared to a sham intervention. We conducted semi-structured interviews with participants from the trial's active arm after they completed the 12-week program. We included a purposeful sample (baseline and clinical characteristics) (n = 20). We used reflexive thematic analysis informed by the Theoretical Framework of Acceptability for health care interventions. We identified positive and negative emotional/cognitive responses associated with treatment acceptability and potential efficacy, including emotional support, cognitive empowerment, readiness for self-management, and acceptance of face-to-face and online components designed to target the brain. These findings suggest the importance of psychoeducation and behavior change techniques to create a positive attitude towards movement and increase the perception of pain control; systematic approaches to monitor and target misconceptions about the interventions during treatment; and psychoeducation and behavior change techniques to maintain the improvements after the cessation of formal care. PERSPECTIVE: This article presents the experiences of people with chronic low back pain participating in a new non-pharmacological brain-targeted treatment that includes face-to-face and self-directed approaches. The facilitators and barriers of the interventions could potentially inform adaptations and optimization of treatments designed to target the brain to treat chronic low back pain.
Collapse
Affiliation(s)
- Rodrigo R N Rizzo
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia.
| | - Benedict M Wand
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Hayley B Leake
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Edel T O'Hagan
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia. Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Queensland, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Adrian C Traeger
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| |
Collapse
|
20
|
Karran EL, Grant AR, Lee H, Kamper SJ, Williams CM, Wiles LK, Shala R, Poddar CV, Astill T, Moseley GL. Do health education initiatives assist socioeconomically disadvantaged populations? A systematic review and meta-analyses. BMC Public Health 2023; 23:453. [PMID: 36890466 PMCID: PMC9996883 DOI: 10.1186/s12889-023-15329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Health education interventions are considered critical for the prevention and management of conditions of public health concern. Although the burden of these conditions is often greatest in socio-economically disadvantaged populations, the effectiveness of interventions that target these groups is unknown. We aimed to identify and synthesize evidence of the effectiveness of health-related educational interventions in adult disadvantaged populations. METHODS We pre-registered the study on Open Science Framework https://osf.io/ek5yg/ . We searched Medline, Embase, Emcare, and the Cochrane Register from inception to 5/04/2022 to identify studies evaluating the effectiveness of health-related educational interventions delivered to adults in socio-economically disadvantaged populations. Our primary outcome was health related behaviour and our secondary outcome was a relevant biomarker. Two reviewers screened studies, extracted data and evaluated risk of bias. Our synthesis strategy involved random-effects meta-analyses and vote-counting. RESULTS We identified 8618 unique records, 96 met our criteria for inclusion - involving more than 57,000 participants from 22 countries. All studies had high or unclear risk of bias. For our primary outcome of behaviour, meta-analyses found a standardised mean effect of education on physical activity of 0.05 (95% confidence interval (CI) = -0.09-0.19), (5 studies, n = 1330) and on cancer screening of 0.29 (95% CI = 0.05-0.52), (5 studies, n = 2388). Considerable statistical heterogeneity was present. Sixty-seven of 81 studies with behavioural outcomes had point estimates favouring the intervention (83% (95% CI = 73%-90%), p < 0.001); 21 of 28 studies with biomarker outcomes showed benefit (75% (95%CI = 56%-88%), p = 0.002). When effectiveness was determined based on conclusions in the included studies, 47% of interventions were effective on behavioural outcomes, and 27% on biomarkers. CONCLUSIONS Evidence does not demonstrate consistent, positive impacts of educational interventions on health behaviours or biomarkers in socio-economically disadvantaged populations. Continued investment in targeted approaches, coinciding with development of greater understanding of factors determining successful implementation and evaluation, are important to reduce inequalities in health.
Collapse
Affiliation(s)
- E L Karran
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
| | - A R Grant
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - H Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal, Sciences, University of Oxford, Oxford, UK.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - S J Kamper
- School of Health Sciences, University of Sydney, Sydney, NSW, Australia.,Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - C M Williams
- University of Newcastle, Sydney, NSW, Australia.,Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - L K Wiles
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - R Shala
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.,Department of Physiotherapy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - C V Poddar
- Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - T Astill
- Western Sydney University, Sydney, NSW, Australia
| | - G L Moseley
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| |
Collapse
|
21
|
Post AA, Rio EK, Sluka KA, Moseley GL, Bayman EO, Hall MM, de Cesar Netto C, Wilken JM, Danielson J, Chimenti RL. Efficacy of Telehealth for Movement-Evoked Pain in People With Chronic Achilles Tendinopathy: A Noninferiority Analysis. Phys Ther 2023; 103:pzac171. [PMID: 37172125 PMCID: PMC10071585 DOI: 10.1093/ptj/pzac171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the efficacy of physical therapy delivered via an all telehealth or hybrid format with an all in-person format on movement-evoked pain for individuals with chronic Achilles tendinopathy (AT). METHODS Sixty-six individuals with chronic AT participated (age, 43.4 [SD = 15.4] years; 56% female; body mass index, 29.9 [SD = 7.7] kg/m2). Participants completed all in-person visits from the initiation of recruitment in September 2019 to March 16, 2020 (in-person group). From March 17 to July 15, 2020, participants completed all telehealth visits (telehealth group). From July 16, 2020, to enrollment completion in December 2020, participants could complete visits all in-person, all telehealth, or a combination of in-person and telehealth (hybrid group) based on their preference. A physical therapist provided 6 to 7 visits, including an exercise program and patient education. Noninferiority analyses of the telehealth and hybrid groups compared with the in-person group were completed for the primary outcome of movement-evoked pain during single-limb heel raises. RESULTS All groups demonstrated decreases in movement-evoked pain beyond the minimal clinically important difference from baseline to 8 weeks (2 out of 10 on a numeric pain rating scale). Lower bounds of the 95% CIs for mean differences between groups did not surpass the preestablished noninferiority margin (2 out of 10) for movement-evoked pain in both the telehealth and hybrid groups (telehealth vs in-person: 0.45 [-1.1 to 2.0]; hybrid vs in-person: 0.48 [-1.0 to 1.9]). CONCLUSION Individuals with chronic AT who completed a tendon-loading program with patient education through a telehealth or hybrid format had no worse outcomes for pain than those who received the same intervention through in-person visits. IMPACT Physical therapist-directed patient care delivered via telehealth may enhance accessibility to best practice AT rehabilitation, including exercise and education. Use of telehealth technology may also provide an opportunity to prioritize patient preference for physical therapy visit format. LAY SUMMARY If you are a patient with chronic AT, physical therapist-directed patient care delivered via telehealth may improve your accessibility to best practice AT rehabilitation, including exercise and education. Use of telehealth technology may also prioritize your preferences regarding the format of the physical therapy visit.
Collapse
Affiliation(s)
- Andrew A Post
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Ebonie K Rio
- La Trobe Sport and Exercise Medicine Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - G Lorimer Moseley
- University of South Australia, IMPACT in Health, Kaurna Country, Adelaide, Australia
| | - Emine O Bayman
- Department of Biostatistics, The University of Iowa, Iowa City, Iowa, USA
- Department of Anesthesia, The University of Iowa, Iowa City, Iowa, USA
| | - Mederic M Hall
- University of Iowa Sports Medicine, Department of Orthopaedics and Rehabilitation, The University of Iowa, Iowa City, Iowa, USA
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, The University of Iowa, Iowa City, Iowa, USA
| | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Jessica Danielson
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa, USA
| | - Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
22
|
Leake HB, Moseley GL, Murphy LK, Murray CB, Palermo TM, Heathcote LC. How does pain work? A qualitative analysis of how young adults with chronic pain conceptualize the biology of pain. Eur J Pain 2023; 27:424-437. [PMID: 36527324 PMCID: PMC10947129 DOI: 10.1002/ejp.2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pain science education (PSE) is commonly integrated into treatments for childhood-onset chronic pain. A core component of PSE is learning about, and often reconceptualizing, the biology of chronic pain. Yet, few interventions have been developed specifically for young adults and little is known about how young adults conceptualize the biology of pain. This study used a qualitative methodology to examine how young adults with childhood-onset chronic pain understand the biology of pain, and the language they use in this meaning-making process, which may inform future interventions tailored to this age group. METHODS We identified a cohort of young adults with childhood onset chronic pain, and a subset of 17 young adults with continuing chronic pain completed individual, semi-structured interviews. Telephone interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. RESULTS We generated four themes that capture participants' conceptualizations of the biology of pain: (1) Something is wrong with the body, (2) An injury has not healed, (3) Nerves fire when they should not, (4) An overactive stress system. CONCLUSION These conceptualizations, and the language used by young adults with childhood-onset chronic pain to describe them are discussed. Recommendations are provided for how PSE interventions can be tailored for young adults. SIGNIFICANCE This study provides new qualitative insights reflecting a variety of ways that young adults with childhood-onset chronic pain conceptualize pain. Some conceptualizations of pain align with modern pain science principles (altered function of nervous and endocrine systems) while others conflict (unhealed injury). Health professionals can use these findings to tailor their pain education interventions by leveraging concepts that 'stick' for youth, being aware of, and interrogating, common misconceptions, and offering language and metaphors familiar to youth.
Collapse
Affiliation(s)
- Hayley B. Leake
- IIMPACT in HealthUniversity of South Australia, Kaurna CountryAdelaideSouth AustraliaAustralia
- Centre for IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
| | - G. Lorimer Moseley
- IIMPACT in HealthUniversity of South Australia, Kaurna CountryAdelaideSouth AustraliaAustralia
| | - Lexa K. Murphy
- Department of PsychologySeattle UniversitySeattleWashingtonUSA
| | - Caitlin B. Murray
- Center for Child Health, Behavior & DevelopmentSeattle Children's Research InstituteSeattleWashingtonUSA
- Department of Anesthesiology and Pain MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Tonya M. Palermo
- Center for Child Health, Behavior & DevelopmentSeattle Children's Research InstituteSeattleWashingtonUSA
- Department of Anesthesiology and Pain MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Lauren C. Heathcote
- Health Psychology Section, Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| |
Collapse
|
23
|
Karran EL, Fryer CE, Middleton JW, Moseley GL. Pain and pain management experiences following spinal cord injury - a mixed methods study of Australian community-dwelling adults. Disabil Rehabil 2023; 45:455-468. [PMID: 35156498 DOI: 10.1080/09638288.2022.2034994] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE There is a high prevalence of persistent pain following SCI yet insights into its impact and the quality of pain care are limited. We aimed to explore, in-depth, the problem of persistent pain in Australian community-dwelling adults with a spinal cord injury (SCI). Our objectives were to investigate (i) how individuals experience persistent pain, (ii) how they experience pain care and (iii) the concordance between clinical practice guidelines for managing pain and reported care practices. METHODS We conducted a mixed-methods convergent parallel study. Adults with SCI and persistent pain completed a survey (n = 43); a subset of participants completed interviews (n = 10). We analysed the data from each method separately and then integrated the findings. RESULTS Results indicated that the life impact of persistent pain is variable but it can be more disabling than physical impairments and compound a sense of isolation and despair. Community-based management was reported to predominantly have a pharmacological focus, with occurrences of opioid misuse apparent in the data. Access to expert, comprehensive and individualised care was frequently reported as inadequate. CONCLUSION While some people with SCI and persistent pain can effectively self-manage their pain, for others the impact on quality of life is profound and complex care needs are commonly unmet.IMPLICATIONS FOR REHABILITATIONPersistent pain is a common consequence of SCI and profoundly impacts quality of life.Complex pain care needs are commonly unmet.Individuals require regular, comprehensive, biopsychosocial assessment.The effectiveness of pain management strategies must be monitored on an ongoing basis.Opportunities for personal self-management support must be available long-term.
Collapse
Affiliation(s)
- Emma L Karran
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | - Caroline E Fryer
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | - James W Middleton
- State Spinal Cord Injury Service, NSW Agency for Clinical Innovation, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Royal North Shore Hospital, St Leonards, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - G Lorimer Moseley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| |
Collapse
|
24
|
Mardon AK, Leake HB, Hayles C, Henry ML, Neumann PB, Moseley GL, Chalmers KJ. The Efficacy of Self-Management Strategies for Females with Endometriosis: a Systematic Review. Reprod Sci 2023; 30:390-407. [PMID: 35488093 PMCID: PMC9988721 DOI: 10.1007/s43032-022-00952-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
Self-management is critical for the care of endometriosis. Females with endometriosis frequently use self-management strategies to manage associated symptoms; however, the efficacy of such strategies is unknown. The aim of this review was to systematically appraise the evidence concerning efficacy of self-management strategies for endometriosis symptoms. Electronic databases, including Medline, Embase, Emcare, Web of Science Core Collection, Scopus, and the Cochrane Central Register of Controlled Trials, were searched from inception to March 2021. We included peer-reviewed experimental studies published in English evaluating the efficacy of self-management strategies in human females laparoscopically diagnosed with endometriosis. Studies underwent screening, data extraction, and risk of bias appraisal (randomised studies: Risk of Bias 2 tool; non-randomised studies: Risk Of Bias In Non-randomized Studies - of Interventions tool). Of the fifteen studies included, 10 evaluated dietary supplements, three evaluated dietary modifications, one evaluated over-the-counter medication, and one evaluated exercise. Most studies had a high-critical risk of bias. Many self-management strategies were not more effective at reducing endometriosis symptoms compared to placebo or hormonal therapies. Where studies suggest efficacy for self-management strategies, no recommendations can be made due to the poor quality and heterogeneity of evidence. High-quality empirical evidence is required to investigate the efficacy of self-management strategies for females with endometriosis.
Collapse
Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
- Centre for IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Cathy Hayles
- University of South Australia, Adelaide, SA, Australia
| | - Michael L Henry
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | | | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.
- Western Sydney University, Campbelltown, NSW, Australia.
| |
Collapse
|
25
|
Pate JW, Harrison LE, Hess CW, Moseley GL, Rush G, Heathcote LC, Simons LE. Targeting Pain Science Education in Youth With Chronic Pain: What Are the Sticking Points for Youth and Their Parents? Clin J Pain 2023; 39:60-67. [PMID: 36453624 DOI: 10.1097/ajp.0000000000001088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/12/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES An important part of providing pain science education is to first assess baseline knowledge and beliefs about pain, thereby identifying misconceptions and establishing individually-tailored learning objectives. The Concept of Pain Inventory (COPI) was developed to support this need. This study aimed to characterize the concept of pain in care-seeking youth and their parents, to examine its clinical and demographic correlates, and to identify conceptual gaps. MATERIALS AND METHODS Following an initial interdisciplinary evaluation, a cohort of 127 youth aged 8 to 18 years, and their parents, completed a series of questionnaires. RESULTS Parents had slightly higher COPI scores than youth did, reflecting parents' greater alignment with contemporary pain science. The moderate positive association with older age among youth ( r =.32) suggests that COPI is sensitive to cognitive development and life experiences. Youth and parent COPI responses were weakly associated ( r =0.24), highlighting the importance of targeting the concept of pain in both groups. For both parents and youth, 'Learning about pain can help you feel less pain' was the least endorsed concept. This conceptual 'gap' is a key point of intervention that could potentially lead to greater engagement with multidisciplinary pain treatment. DISCUSSION The COPI appears useful for identifying conceptual gaps or 'sticking points'; this may be an important step to pre-emptively address misconceptions about pain through pain science education. Future research should determine the utility of COPI in assessing and treating youth seeking care for pain. The COPI may be a useful tool for tailoring pain science education to youth and their parents.
Collapse
Affiliation(s)
- Joshua W Pate
- Graduate School of Health, University of Technology Sydney, Sydney, NSW
| | - Lauren E Harrison
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - Courtney W Hess
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - G Lorimer Moseley
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gillian Rush
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Laura E Simons
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| |
Collapse
|
26
|
De Groef A, Evenepoel M, Van Dijck S, Dams L, Haenen V, Wiles L, Catley M, Vogelzang A, Olver I, Hibbert P, Morlion B, Moseley GL, Heathcote LC, Meeus M. Feasibility and pilot testing of a personalized eHealth intervention for pain science education and self-management for breast cancer survivors with persistent pain: a mixed-method study. Support Care Cancer 2023; 31:119. [PMID: 36645526 DOI: 10.1007/s00520-022-07557-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Here, we describe the development and pilot study of a personalized eHealth intervention containing a pain science education program and self-management support strategies regarding pain and pain-related functioning in female survivors of breast cancer. First, we aimed to evaluate the eHealth intervention's acceptability, comprehensibility, and satisfaction; second, we aimed to assess its preliminary efficacy. METHODS A mixed-method study design was used. Breast cancer survivors with persistent pain were recruited. After 6 weeks of engagement with the eHealth intervention, acceptability, comprehensibility, and satisfaction were measured quantitatively with a self-constructed questionnaire and described qualitatively using focus groups. A joint display was used to present the meta-interferences between data. Efficacy was assessed via mixed effects models with repeated measures (outcomes assessed at baseline, 6 weeks, and 12 weeks). RESULTS Twenty-nine women with persistent pain after breast cancer surgery participated. Overall, the eHealth program was well received and experienced as easy to use and helpful. The eHealth intervention seems useful as an adjunct to comprehensive cancer aftercare. Efficacy estimates suggested a significant improvement in pain-related functioning, physical functioning, and quality of life. CONCLUSION A personalized eHealth intervention appears valuable for persistent pain management after breast cancer surgery. A large controlled clinical trial to determine effectiveness, and a full process evaluation, seems warranted.
Collapse
Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT Research Group, University of Antwerp, Universiteitsplein 1, Antwerp, Belgium.
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.
- Pain in Motion International Research Group, Brussels, Belgium.
| | - Margaux Evenepoel
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Sophie Van Dijck
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT Research Group, University of Antwerp, Universiteitsplein 1, Antwerp, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT Research Group, University of Antwerp, Universiteitsplein 1, Antwerp, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Vincent Haenen
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT Research Group, University of Antwerp, Universiteitsplein 1, Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Louise Wiles
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Mark Catley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Anna Vogelzang
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Ian Olver
- Department of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Hibbert
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Bart Morlion
- Department of Cardiovascular Sciences, Section Anesthesiology and Algology, University of Leuven, Leuven, Belgium
| | - G Lorimer Moseley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT Research Group, University of Antwerp, Universiteitsplein 1, Antwerp, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| |
Collapse
|
27
|
Karran EL, G. Cashin A, Barker T, A. Boyd M, Chiarotto A, Dewidar O, Petkovic J, Sharma S, Tugwell P, Moseley GL. The ' what' and ' how' of screening for social needs in healthcare settings: a scoping review. PeerJ 2023; 11:e15263. [PMID: 37101795 PMCID: PMC10124546 DOI: 10.7717/peerj.15263] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023] Open
Abstract
Background Adverse social determinants of health give rise to individual-level social needs that have the potential to negatively impact health. Screening patients to identify unmet social needs is becoming more widespread. A review of the content of currently available screening tools is warranted. The aim of this scoping review was to determine what social needs categories are included in published Social Needs Screening Tools that have been developed for use in primary care settings, and how these social needs are screened. Methods We pre-registered the study on the Open Science Framework (https://osf.io/dqan2/). We searched MEDLINE and Embase from 01/01/2010 to 3/05/2022 to identify eligible studies reporting tools designed for use in primary healthcare settings. Two reviewers independently screened studies, a single reviewer extracted data. We summarised the characteristics of included studies descriptively and calculated the number of studies that collected data relevant to specific social needs categories. We identified sub-categories to classify the types of questions relevant to each of the main categories. Results We identified 420 unique citations, and 27 were included. Nine additional studies were retrieved by searching for tools that were used or referred to in excluded studies. Questions relating to food insecurity and the physical environment in which a person lives were the most frequently included items (92-94% of tools), followed by questions relating to economic stability and aspects of social and community context (81%). Seventy-five percent of the screening tools included items that evaluated five or more social needs categories (mean 6.5; standard deviation 1.75). One study reported that the tool had been 'validated'; 16 reported 'partial' validation; 12 reported that the tool was 'not validated' and seven studies did not report validation processes or outcomes.
Collapse
Affiliation(s)
- Emma L. Karran
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Aidan G. Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health and Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Trevor Barker
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Mark A. Boyd
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus University/Rotterdam, Rotterdam, Netherlands
| | - Omar Dewidar
- Bruyere Research Institute, University of Ottawa, Ottawa, Canada
| | | | - Saurab Sharma
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health and Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter Tugwell
- Department of Medicine and School of Epidemiology, University of Ottawa, Ottawa, Canada
| | - G. Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | | |
Collapse
|
28
|
Chimenti RL, Post AA, Rio EK, Moseley GL, Dao M, Mosby H, Hall M, de Cesar Netto C, Wilken JM, Danielson J, Bayman EO, Sluka KA. The effects of pain science education plus exercise on pain and function in chronic Achilles tendinopathy: a blinded, placebo-controlled, explanatory, randomized trial. Pain 2023; 164:e47-e65. [PMID: 36095045 PMCID: PMC10016230 DOI: 10.1097/j.pain.0000000000002720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/14/2022] [Indexed: 01/09/2023]
Abstract
ABSTRACT Exercise is the standard of care for Achilles tendinopathy (AT), but 20% to 50% of patients continue to have pain following rehabilitation. The addition of pain science education (PSE) to an exercise program may enhance clinical outcomes, yet this has not been examined in patients with AT. Furthermore, little is known about how rehabilitation for AT alters the fear of movement and central nervous system nociceptive processing. Participants with chronic AT (N = 66) were randomized to receive education about AT either from a biopsychosocial (PSE) or from a biomedical (pathoanatomical education [PAE]) perspective. Simultaneously, all participants completed an exercise program over 8 weeks. Linear mixed models indicated that there were no differences between groups in (1) movement-evoked pain with both groups achieving a clinically meaningful reduction (mean change [95% CI], PSE: -3.0 [-3.8 to -2.2], PAE = -3.6 [-4.4 to -2.8]) and (2) self-reported function, with neither group achieving a clinically meaningful improvement (Patient-Reported Outcomes Measurement Information System Physical Function-PSE: 1.8 [0.3-3.4], PAE: 2.5 [0.8-4.2]). After rehabilitation, performance-based function improved (number of heel raises: 5.2 [1.6-8.8]), central nervous system nociceptive processing remained the same (conditioned pain modulation: -11.4% [0.2 to -17.3]), and fear of movement decreased (Tampa Scale of Kinesiophobia, TSK-17: -6.5 [-4.4 to -8.6]). Linear regression models indicated that baseline levels of pain and function along with improvements in self-efficacy and knowledge gain were associated with a greater improvement in pain and function, respectively. Thus, acquiring skills for symptom self-management and the process of learning may be more important than the specific educational approach for short-term clinical outcomes in patients with AT.
Collapse
Affiliation(s)
- Ruth L. Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Andrew A. Post
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Ebonie K. Rio
- Physiotherapy, School of Allied Health, La Trobe University, Bundoora, Australia
| | - G. Lorimer Moseley
- IIMPACT in Health, Allied Health & Human Performance, Physiotherapy, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Megan Dao
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Hadley Mosby
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Mederic Hall
- University of Iowa Sports Medicine, University of Iowa, Iowa City, IA, United States
- Department of Orthopaedics & Rehabilitation, University of Iowa, Iowa City, IA, United States
| | - Cesar de Cesar Netto
- Department of Orthopaedics & Rehabilitation, University of Iowa, Iowa City, IA, United States
| | - Jason M. Wilken
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Jessica Danielson
- Institute for Clinical and Translational Science, Clinical Research Support, University of Iowa Hospital and Clinica, Iowa City, IA, United States
| | - Emine O. Bayman
- Department of Biostatistics and Department of Anesthesia, University of Iowa, Iowa City, IA, United States
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| |
Collapse
|
29
|
Wand BM, Cashin AG, McAuley JH, Bagg MK, Orange GM, Moseley GL. The Fit-for-Purpose Model: Conceptualizing and Managing Chronic Nonspecific Low Back Pain as an Information Problem. Phys Ther 2022; 103:6785992. [PMID: 36317747 DOI: 10.1093/ptj/pzac151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/06/2022] [Accepted: 08/20/2022] [Indexed: 11/05/2022]
Abstract
Chronic nonspecific low back pain (CNSLBP) is a complex and multifaceted problem. The following Perspective Piece tries to help make sense of this complexity by describing a model for the development and maintenance of persistent low back pain that integrates modifiable factors across the biopsychosocial spectrum. The Fit-for-Purpose model (FFPM) posits the view that chronic nonspecific low back pain represents a state in which the person in pain holds strong and relatively intransient internal models of an immutably damaged, fragile, and unhealthy back, and information that supports these models is more available and trustworthy than information that counters them. This Perspective proposes a corresponding treatment framework for persistent pain that aims to shift internal models of a fragile, damaged, unhealthy, and unchangeable self toward the formulation of the back as healthy, strong, adaptable and fit-for-purpose and to provide the system with precise and trustworthy evidence that supports this supposition while minimizing information that works against it.
Collapse
Affiliation(s)
- Benedict M Wand
- Faculty of Medicine, Nursing & Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.,Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Gemma M Orange
- Faculty of Medicine, Nursing & Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| |
Collapse
|
30
|
Parkitny L, McAuley JH, Herbert RD, Di Pietro F, Cashin AG, Ferraro MC, Moseley GL. Post-fracture serum cytokine levels are not associated with a later diagnosis of complex regional pain syndrome: a case-control study nested in a prospective cohort study. BMC Neurol 2022; 22:385. [PMID: 36224537 PMCID: PMC9555076 DOI: 10.1186/s12883-022-02910-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/01/2022] [Accepted: 09/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Complex Regional Pain Syndrome (CRPS) is a disabling pain disorder that is most common after a distal limb fracture. While the acute systemic immune response to the injury is thought to play a role in the development of CRPS, this hypothesis has never been tested directly. Thus, we evaluated whether elevated levels of circulating pro-inflammatory cytokines early after a fracture were associated with the development of CRPS. Methods We conducted a case-control study nested within a prospective cohort study. Individuals with wrist and/or hand fractures were recruited from specialist hand units. Baseline clinical data were obtained from participants within 28 days of fracture. CRPS status was determined 16 weeks after the fracture using a two-stage diagnostic process. Cytokine assays were obtained from all cases (defined using the Budapest criteria) and a random sample of those who did not have CRPS at 16 weeks. We calculated odds ratios with 95% confidence intervals to determine the risk of CRPS associated with the expression of each of 25 cytokines. Results Baseline data were collected for 702 consenting participants, of whom 535 provided blood samples. Follow-up at 16 weeks was 97.2%. 15 (2.2% of the cohort) met the Budapest CRPS criteria and 69 (including those who met the Budapest criteria; 9.8%) met the International Association for the Study of Pain (IASP) CRPS criteria. In all of the primary analyses (using Budapest criteria) and 49/50 secondary analyses (using IASP criteria), 95% confidence intervals for the association between cytokine levels and the risk of subsequently developing CRPS included the null value (OR = 1). However, the confidence intervals were wide. Conclusion There was no evidence that early post-injury expression of systemic cytokines was associated with a CRPS diagnosis 16 weeks after injury. This study does not provide support for the hypothesis that innate immune activation has a determinative role in the development of CRPS. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02910-z.
Collapse
Affiliation(s)
- Luke Parkitny
- Departments of Pediatrics-Neurology, Baylor College of Medicine, Houston, TX, USA. .,Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX, USA. .,Centre for Pain IMPACT Neuroscience Research Australia, University of New South Wales, Sydney, Australia.
| | - James H McAuley
- Centre for Pain IMPACT Neuroscience Research Australia, University of New South Wales, Sydney, Australia.,School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Robert D Herbert
- Centre for Pain IMPACT Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Flavia Di Pietro
- Curtin Medical School, Curtin University, Bentley Campus, Bentley, Australia.,Curtin Health Innovation Centre (CHIRI), Curtin University, Bentley, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT Neuroscience Research Australia, University of New South Wales, Sydney, Australia.,School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Michael C Ferraro
- Centre for Pain IMPACT Neuroscience Research Australia, University of New South Wales, Sydney, Australia.,School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | |
Collapse
|
31
|
Wilson D, Mackintosh S, Nicholas MK, Moseley GL, Costa D, Ashton-James C. Are group identity and sense of belonging relevant for group pain management programmes? An exploratory pilot study. Br J Pain 2022; 16:528-537. [PMID: 36389006 PMCID: PMC9644103 DOI: 10.1177/20494637221098941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Introduction Cognitive Behaviour Therapy (CBT)-based programmes for chronic pain are often conducted in groups, most likely for time and cost efficiencies. However, there has been very little investigation of the role that the group itself, and particularly the processes occurring within the group, may play in individual outcomes. The objective of this study was to explore whether social group processes were relevant to key treatment outcomes of group CBT for chronic pain. Method Data were collected from 15 groups (N = 118) undertaking a pain management programme in a tertiary setting. Intraclass correlations were computed to determine any clustering of outcomes in groups, and linear mixed modelling analysis explored pre-registered hypotheses of associations between treatment outcomes and the social group processes of Group Identification and Sense of Belonging. Results A weak association between early identification with the group and changes in pain-related disability was shown. In addition, an enhanced global Sense of Belonging was associated with increased pain self-efficacy. Conclusion These associations, in a programme that had not been designed to address group processes, suggest that their relevance is worth further investigation, particularly in group programmes that do focus on the social consequences of chronic pain. Future studies should investigate whether manipulation of social group processes within a CBT-based pain programme enhances pain-related outcomes and improves the overall well-being of people with chronic pain.
Collapse
Affiliation(s)
- Dianne Wilson
- IIMPACT in Health, Allied Health
and Human Performance, University of South
Australia, Adelaide, SA, Australia
| | - Shylie Mackintosh
- IIMPACT in Health, Allied Health
and Human Performance, University of South
Australia, Adelaide, SA, Australia
| | - Michael K Nicholas
- Pain Management Research Institute, University of Sydney, Sydney, NSW, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, Allied Health
and Human Performance, University of South
Australia, Adelaide, SA, Australia
| | - Daniel Costa
- Pain Management Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Claire Ashton-James
- Pain Management Research Institute, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
32
|
Haslam BS, Butler DS, Moseley GL, Kim AS, Carey LM. "My Hand Is Different": Altered Body Perception in Stroke Survivors with Chronic Pain. Brain Sci 2022; 12:brainsci12101331. [PMID: 36291266 PMCID: PMC9599659 DOI: 10.3390/brainsci12101331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic pain and body perception disturbance are common following stroke. It is possible that an interaction exists between pain and body perception disturbance, and that a change in one may influence the other. We therefore investigated the presence of body perception disturbance in individuals with stroke, aiming to determine if a perceived change in hand size contralateral to the stroke lesion is more common in those with chronic pain than in those without. METHODS Stroke survivors (N = 523) completed an online survey that included: stroke details, pain features, and any difference in perceived hand size post-stroke. RESULTS Individuals with stroke who experienced chronic pain were almost three times as likely as those without chronic pain to perceive their hand as now being a different size (OR = 2.895; 95%CI 1.844, 4.547). Further, those with chronic pain whose pain included the hand were almost twice as likely to perceive altered hand size than those whose pain did not include the hand (OR = 1.862; 95%CI 1.170, 2.962). This was not influenced by hemisphere of lesion (p = 0.190). CONCLUSIONS The results point to a new characteristic of chronic pain in stroke, raising the possibility of body perception disturbance being a rehabilitation target to improve function and pain-related outcomes for stroke survivors.
Collapse
Affiliation(s)
- Brendon S. Haslam
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3010, Australia
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia
- Correspondence:
| | - David S. Butler
- IMPACT in Health, University of South Australia, Kaurna Country, Adelaide 5001, Australia
- Neuro-Orthopaedic Institute, Adelaide 5001, Australia
| | - G. Lorimer Moseley
- IMPACT in Health, University of South Australia, Kaurna Country, Adelaide 5001, Australia
- Neuro-Orthopaedic Institute, Adelaide 5001, Australia
| | - Anthony S. Kim
- Weil Institute of Neurosciences, Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Leeanne M. Carey
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3010, Australia
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia
| |
Collapse
|
33
|
Leake HB, Mardon A, Stanton TR, Harvie DS, Butler DS, Karran EL, Wilson D, Booth J, Barker T, Wood P, Fried K, Hayes C, Taylor L, Macoun M, Simister A, Moseley GL, Berryman C. Key Learning Statements for persistent pain education: an iterative analysis of consumer, clinician and researcher perspectives and development of public messaging. J Pain 2022; 23:1989-2001. [PMID: 35934276 DOI: 10.1016/j.jpain.2022.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/05/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
Abstract
Over the last decade, the content, delivery and media of pain education have been adjusted in line with scientific discovery in pain and educational sciences, and in line with consumer perspectives. This paper describes a decade-long process of exploring consumer perspectives on pain science education concepts to inform clinician-derived educational updates (undertaken by the authors). Data were collected as part of a quality audit via a series of online surveys in which consent (non-specific) was obtained from consumers for their data to be used in published research. Consumers who presented for care for a persistent pain condition and were treated with a pain science education informed approach were invited to provide anonymous feedback about their current health status and pain journey experience 6, 12 or 18 months after initial assessment. Two-hundred eighteen consumers reported improvement in health status at follow-up. Results of the surveys from three cohorts of consumers that reported improvement were used to generate iterative versions of 'Key Learning Statements'. Early iteration of these Key Learning Statements was used to inform the development of Target Concepts and associated community-targeted pain education resources for use in public health and health professional workforce capacity building initiatives. Perspective This paper reflects an explicit interest in the insights of people who have been challenged by persistent pain and then recovered, to improve pain care. Identifying pain science concepts that consumers valued learning provided valuable information to inform resources for clinical interactions and community-targeted pain education campaigns.
Collapse
Affiliation(s)
- Hayley B Leake
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia; Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia; Centre for Impact, Neuroscience Research Australia, Sydney, Australia
| | - Amelia Mardon
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | - Tasha R Stanton
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia; Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia
| | - Daniel S Harvie
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia; Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia
| | - David S Butler
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia; Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia
| | - Emma L Karran
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia; Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia
| | - Dianne Wilson
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia; Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia
| | - John Booth
- Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia; Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Trevor Barker
- Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia; Lived experience advocate, Yorta Yorta Land, Australia
| | - Pene Wood
- Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia; School of Molecular Sciences, College of Science, Health & Engineering, La Trobe University, Bendigo, Victoria
| | - Kal Fried
- Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia; Rehabilitation Medicine Group, Boonwurrung Land, Melbourne, Australia
| | - Chris Hayes
- Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia; Hunter Integrated Pain Service, Awabakal Land, John Hunter Hospital, New Lambton Heights, Australia
| | - Lissanthea Taylor
- Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia; Brain Changer, Canberra, Australia; Parkway Health, Shanghai, China
| | - Melanie Macoun
- Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia; Australian Capital Territory Pain Centre, Ngunnawal Country, Canberra, Australia
| | - Amanda Simister
- Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia; Persistent Pain Clinic, Shoalhaven District Memorial Hospital, Nowra, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia; Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia
| | - Carolyn Berryman
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia; Pain Revolution, Kaurna Country, University of South Australia, Adelaide, Australia; School of Biomedicine, Kaurna Country, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
34
|
Bagg MK, Wand BM, Cashin AG, Lee H, Hübscher M, Stanton TR, O’Connell NE, O’Hagan ET, Rizzo RRN, Wewege MA, Rabey M, Goodall S, Saing S, Lo SN, Luomajoki H, Herbert RD, Maher CG, Moseley GL, McAuley JH. Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA 2022; 328:430-439. [PMID: 35916848 PMCID: PMC9346551 DOI: 10.1001/jama.2022.9930] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE The effects of altered neural processing, defined as altering neural networks responsible for perceptions of pain and function, on chronic pain remains unclear. OBJECTIVE To estimate the effect of a graded sensorimotor retraining intervention (RESOLVE) on pain intensity in people with chronic low back pain. DESIGN, SETTING, AND PARTICIPANTS This parallel, 2-group, randomized clinical trial recruited participants with chronic (>3 months) nonspecific low back pain from primary care and community settings. A total of 276 adults were randomized (in a 1:1 ratio) to the intervention or sham procedure and attention control groups delivered by clinicians at a medical research institute in Sydney, Australia. The first participant was randomized on December 10, 2015, and the last was randomized on July 25, 2019. Follow-up was completed on February 3, 2020. INTERVENTIONS Participants randomized to the intervention group (n = 138) were asked to participate in 12 weekly clinical sessions and home training designed to educate them about and assist them with movement and physical activity while experiencing lower back pain. Participants randomized to the control group (n = 138) were asked to participate in 12 weekly clinical sessions and home training that required similar time as the intervention but did not focus on education, movement, and physical activity. The control group included sham laser and shortwave diathermy applied to the back and sham noninvasive brain stimulation. MAIN OUTCOMES AND MEASURES The primary outcome was pain intensity at 18 weeks, measured on an 11-point numerical rating scale (range, 0 [no pain] to 10 [worst pain imaginable]) for which the between-group minimum clinically important difference is 1.0 point. RESULTS Among 276 randomized patients (mean [SD] age, 46 [14.3] years; 138 [50%] women), 261 (95%) completed follow-up at 18 weeks. The mean pain intensity was 5.6 at baseline and 3.1 at 18 weeks in the intervention group and 5.8 at baseline and 4.0 at 18 weeks in the control group, with an estimated between-group mean difference at 18 weeks of -1.0 point ([95% CI, -1.5 to -0.4]; P = .001), favoring the intervention group. CONCLUSIONS AND RELEVANCE In this randomized clinical trial conducted at a single center among patients with chronic low back pain, graded sensorimotor retraining, compared with a sham procedure and attention control, significantly improved pain intensity at 18 weeks. The improvements in pain intensity were small, and further research is needed to understand the generalizability of the findings. TRIAL REGISTRATION ANZCTR Identifier: ACTRN12615000610538.
Collapse
Affiliation(s)
- Matthew K. Bagg
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Benedict M. Wand
- Faculty of Medicine, Nursing and Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
| | - Aidan G. Cashin
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Markus Hübscher
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| | - Tasha R. Stanton
- IIMPACT (Innovation, IMPlementation And Clinical Translation) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Neil E. O’Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, United Kingdom
| | - Edel T. O’Hagan
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Rodrigo R. N. Rizzo
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Michael A. Wewege
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Martin Rabey
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Sopany Saing
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Serigne N. Lo
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
- Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hannu Luomajoki
- School of Health Professions, Zurich University of Applied Sciences, Institute of Physiotherapy, Winterthur, Switzerland
| | | | - Chris G. Maher
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - G. Lorimer Moseley
- IIMPACT (Innovation, IMPlementation And Clinical Translation) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - James H. McAuley
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| |
Collapse
|
35
|
Wallwork SB, Noel M, Moseley GL. Communicating with children about 'everyday' pain and injury: A Delphi study. Eur J Pain 2022; 26:1863-1872. [PMID: 35829711 PMCID: PMC9545644 DOI: 10.1002/ejp.2008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/29/2022] [Accepted: 07/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND 'Everyday' pain experiences are potentially critical in shaping our beliefs and behaviours around injury and pain. Influenced by social, cultural and environmental contexts, they form the foundation of one's understanding of pain and injury that is taken into adulthood. How to best communicate to young children about their everyday pain experiences, in order to foster adaptive beliefs and behaviours, is unknown. METHODS In this Delphi survey, we sought expert opinion on the key messages and strategies that parents/caregivers can consider when communicating with young children (aged 2-7 years) about 'everyday' pain that is most likely to promote recovery, resilience and adaptive pain behaviours. Eighteen experts participated including specialists in paediatric pain, trauma, child development, and psychology; educators and parents. The survey included three rounds. RESULTS Response rate was over 88%. Two hundred fifty-three items were raised; 187 reached 'consensus' (≥80% agreement among experts). Key messages that the experts agreed to be 'very important' were aligned with current evidence-based understandings of pain and injury. Strategies to communicate messages included parent/caregiver role-modelling, responses to child pain, and discussion during and/or after a painful experience. Other key themes included promoting emotional development, empowering children to use active coping strategies, and resilience building. CONCLUSIONS This diverse set of childhood, pain and parenting experts reached consensus on 187 items, yielding 12 key themes to consider when using everyday pain experiences to promote adaptive pain beliefs and behaviours in young children.
Collapse
Affiliation(s)
- S B Wallwork
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - M Noel
- Department of Psychology, University of Calgary, Calgary, Canada
| | - G L Moseley
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| |
Collapse
|
36
|
Karran EL, Wiles LK, Wilson DJ, Moseley GL. Best practice care for persistent pain in adults with spinal cord injuries: a systematic review and narrative synthesis of clinical practice guideline recommendations. Disabil Rehabil 2022:1-10. [DOI: 10.1080/09638288.2022.2093998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Emma L. Karran
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - Louise K. Wiles
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - Dianne J. Wilson
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - G. Lorimer Moseley
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| |
Collapse
|
37
|
Pulling BW, Braithwaite FA, Moseley GL, Jensen MP, Burke ALJ, Collins KL, Hull MJ, Jones HG, Cyna AM, Ferencz N, Stanton TR. Suggestions in Hypnosis to Aid Pain Education (SHAPE) in People with Chronic Low-Back Pain: A Pilot Feasibility Randomized, Controlled Trial. Int J Clin Exp Hypn 2022; 70:251-276. [PMID: 35969169 DOI: 10.1080/00207144.2022.2105147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic low back pain (CLBP) is a debilitating and burdensome condition, and new treatment strategies are needed. This study aimed to evaluate (1) the feasibility of undertaking a controlled clinical trial investigating a novel intervention for people with CLBP: hypnotically reinforced pain science education, and (2) the acceptability of the intervention as rated by participants. A priori feasibility and intervention acceptability criteria were set. Twenty participants with CLBP were recruited and randomized to receive: (1) hypnotically delivered pain science education that utilizes hypnotic suggestions to enhance uptake of pain science concepts; or (2) pain science education with progressive muscle relaxation as an attention control. Twenty participants were recruited, however, not solely from the hospital waitlist as intended; community sampling was required (13 hospital, 7 community). Most criteria were met in the community sample but not the hospital sample. Protocol modifications are needed before progressing to a full scale randomized controlled trial for hypnotically reinforced pain science education. Improvements in relevant secondary outcomes paired with moderate-high treatment acceptability ratings are promising.
Collapse
Affiliation(s)
- Brian W Pulling
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide
| | - Felicity A Braithwaite
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide
| | - G Lorimer Moseley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Anne L J Burke
- Psychology Department, Central Adelaide Local Health Network, South Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia
| | - Kathryn L Collins
- Psychology Department, Central Adelaide Local Health Network, South Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia
| | - Melissa J Hull
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Adelaide
| | - Hannah G Jones
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide.,Institute of Psychiatry, Psychology & Neuroscience, Kings College London, England, United Kingdom
| | - Allan M Cyna
- Department of Women's Anaesthesia, Women's and Children's Hospital, Adelaide, South Australia
| | - Nicki Ferencz
- Paediatric Chronic Pain Service, Women's and Children's Hospital, Adelaide, South Australia
| | - Tasha R Stanton
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide
| |
Collapse
|
38
|
Gerges AN, Hordacre B, Pietro FD, Moseley GL, Berryman C. Do Adults with Stroke have Altered Interhemispheric Inhibition? A Systematic Review with Meta-Analysis. J Stroke Cerebrovasc Dis 2022; 31:106494. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022] Open
|
39
|
Bedwell GJ, Louw C, Parker R, van den Broeke E, Vlaeyen JW, Moseley GL, Madden VJ. The influence of a manipulation of threat on experimentally-induced secondary hyperalgesia. PeerJ 2022; 10:e13512. [PMID: 35757170 PMCID: PMC9220919 DOI: 10.7717/peerj.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/07/2022] [Indexed: 01/17/2023] Open
Abstract
Pain is thought to be influenced by the threat value of the particular context in which it occurs. However, the mechanisms by which a threat achieves this influence on pain are unclear. Here, we explore how threat influences experimentally-induced secondary hyperalgesia, which is thought to be a manifestation of central sensitization. We developed an experimental study to investigate the effect of a manipulation of threat on experimentally-induced secondary hyperalgesia in 26 healthy human adults (16 identifying as female; 10 as male). We induced secondary hyperalgesia at both forearms using high-frequency electrical stimulation. Prior to the induction, we used a previously successful method to manipulate threat of tissue damage at one forearm (threat site). The effect of the threat manipulation was determined by comparing participant-rated anxiety, perceived threat, and pain during the experimental induction of secondary hyperalgesia, between the threat and control sites. We hypothesized that the threat site would show greater secondary hyperalgesia (primary outcome) and greater surface area (secondary outcome) of induced secondary hyperalgesia than the control site. Despite a thorough piloting procedure to test the threat manipulation, our data showed no main effect of site on pain, anxiety, or threat ratings during high-frequency electrical stimulation. In the light of no difference in threat between sites, the primary and secondary hypotheses cannot be tested. We discuss reasons why we were unable to replicate the efficacy of this established threat manipulation in our sample, including: (1) competition between threats, (2) generalization of learned threat value, (3) safety cues, (4) trust, and requirements for participant safety, (5) sampling bias, (6) sample-specific habituation to threat, and (7) implausibility of (sham) skin examination and report. Better strategies to manipulate threat are required for further research on the mechanisms by which threat influences pain.
Collapse
Affiliation(s)
- Gillian J. Bedwell
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, Western Cape, South Africa,Pain Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Caron Louw
- Pain Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Romy Parker
- Pain Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Emanuel van den Broeke
- Institute of Neuroscience, Division Cognitive and Systems, UC Louvain, Brussels, Belgium
| | - Johan W. Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium,Experimental Health Psychology, University of Maastricht, Maastricht, Netherlands
| | | | - Victoria J. Madden
- Pain Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa,Research Group Health Psychology, KU Leuven, Leuven, Belgium,IIMPACT in Health, University of South Australia, Adelaide, Australia,Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| |
Collapse
|
40
|
Abstract
BACKGROUND Behavioural activation (BA) is an effective treatment for depression; however, it is unclear if it can be used to manage pain. OBJECTIVES To conduct a scoping review of primary research that reported using BA to support people living with chronic pain to understand how BA had been used in relation to pain. In addition, we wanted to understand whether there were any reported changes in that pain, and how and who delivered BA. ELIGIBILITY CRITERIA Primary research published in English. SOURCES OF EVIDENCE We searched seven databases MEDLINE, Ovid Embase, Ovid Emcare, PsycINFO, CINAHL, Scopus and Web of Science, for primary research. No initial date limit was used with the date the searches were conducted used as the end date limit (1 July 2021). CHARTING METHODS A customised data extraction table was developed, piloted and used. RESULTS 551 papers were screened for inclusion, with 15 papers included in our review. Studies were conducted in North America and in Canada. These included three case studies, nine uncontrolled trials and three randomised controlled trials. Only two studies reported pain as the primary outcome. BA was applied across a range of pain related conditions. The dose of BA ranged from 3 to 16 sessions. Duration of treatment was 3 weeks to 12 months. Most studies reported reductions in pain following exposure to BA. CONCLUSION BA has the potential to reduce pain. Caution needs to be exercised in the interpretation of these findings as a high risk of bias was observed in most studies. High-quality research is required to test if BA is an effective intervention for chronic pain.
Collapse
Affiliation(s)
- Sandra Walsh
- Department of Rural Health, University of South Australian - Whyalla Campus, Whyalla Norrie, Barngarla Country, South Australia, Australia
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Richard John Gray
- School of Nursing, La Trobe University, Bundoora, Victoria, Australia
- Department of Rural Health, University of South Australia, Mt Barker, South Australia, Australia
| | - Marianne Gillam
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Department of Rural Health, University of South Australia, Mt Barker, South Australia, Australia
| | - Kate M Gunn
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Trevor Barker
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Kham Tran
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Tesfahun Eshetie
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Martin Jones
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Department of Rural Health, University of South Australia, Mt Barker, South Australia, Australia
| |
Collapse
|
41
|
Pavlova M, Mueri K, Kennedy M, Wallwork S, Moseley GL, Jordan A, Noel M. Portrayals of Pain in Children's Popular Media: Mothers' and Fathers' Beliefs and Attitudes. Front Pain Res 2022; 3:898855. [PMID: 35599967 PMCID: PMC9122327 DOI: 10.3389/fpain.2022.898855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/14/2022] [Indexed: 12/03/2022] Open
Abstract
Evidence suggests that children's popular media may model maladaptive and distorted experiences of pain to young children. In a recent study, pain depicted in popular media targeting 4–6-year-olds was frequently and unrealistically portrayed, evoked little response or empathy from observing characters, and perpetuated unhelpful gender stereotypes. Parents play a critical role in both children's pain experiences and children's media consumption. Yet, no study to date has examined parents' beliefs and attitudes regarding how pain is portrayed in media for young children. The present study aimed to fill this gap by examining how parents perceive and appraise painful instances depicted in children's popular media. Sixty parents (48% fathers) of children aged 4 to 6 years completed a semi-structured interview to assess their general beliefs and attitudes toward how pain is portrayed in children's media. Inductive reflexive thematic analysis was conducted to identify and analyze key patterns in the data. Qualitative analyses generated two major themes representing parental beliefs regarding pain that is portrayed in children's media: “entertaining pain” and “valuable lessons”. Findings reveal that parents believe that pain portrayed in popular media serves either a function of entertaining and amusing children or can provide valuable lessons about appropriate emotional responses and empathic reactions. Further, pain portrayals could also instill valuable lessons and provide children with a point of reference and language for their own painful experiences. Parents serve as a primary socialization agent for young children; thus, it is important that parents remain aware of underlying messages about how pain is portrayed in children's popular media so that they can optimally discuss these portrayals, promote their children's pain education and understanding and positively impact future pain experiences.
Collapse
Affiliation(s)
- Maria Pavlova
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Kendra Mueri
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Madison Kennedy
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sarah Wallwork
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - G. Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
- *Correspondence: Melanie Noel
| |
Collapse
|
42
|
Yap ZL, Summers SJ, Grant AR, Moseley GL, Karran EL. The role of the social determinants of health in outcomes of surgery for low back pain: a systematic review and narrative synthesis. Spine J 2022; 22:793-809. [PMID: 34848343 DOI: 10.1016/j.spinee.2021.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain is a major cause of morbidity and disability worldwide and is responsible for vast societal impact. Rates of surgical intervention for lumbar spine disorders continue to rise but poor outcomes remain common. Understanding how the social determinants of health (SDH) influence spinal surgical outcomes stands to inform appropriately tailored care practices and lead to better patient outcomes. PURPOSE To determine the relationships between the SDH and pain, opioid use, disability and work absenteeism following lumbar spine surgery. STUDY DESIGN Systematic review and narrative synthesis. METHODS We searched Embase, the Cochrane Library, Medline, and Web of Science from inception to April 21, 2020. Studies eligible for inclusion involved participants receiving lumbar spine surgery and investigated the relationship between at least one SDH and post-surgical pain, opioid use, disability or work absenteeism. We evaluated the risk of bias of included studies and used the PROGRESS-Plus framework to organize a narrative synthesis of findings. RESULTS Relevant data was extracted from twenty-three studies involving 30,987 adults from 12 countries. A total of 107 relationships between the SDH and post-surgical outcomes were evaluated, 67 in multivariate analyses. Education was investigated in 23 analyses (14 studies): 70% revealed significant independent relationships between lower education and poorer outcomes. Socioeconomic status was investigated in nine analyses (four studies): 67% revealed independent relationships between lower socioeconomic status and poorer outcomes. Gender was investigated in 40 analyses (22 studies): indications that male versus female sex was associated with poorer outcomes were equivocal. Place of residence, race/ethnicity, and social capital were infrequently investigated. CONCLUSIONS Low educational attainment and low-income status are clear independent contributors to poorer outcomes following lumbar spine surgery. Occupational factors and work context are likely to be influential. Further research is critical to guide best-practice spinal surgery through a health equity lens. STUDY REGISTRATION PROSPERO registration number CRD42015015778.
Collapse
Affiliation(s)
- Zen L Yap
- Australasian Faculty of Occupational and Environmental Medicine, Royal Australasian College of Physicians, Level 2, 257, Melbourne Street, North Adelaide, 5006, Australia
| | - Simon J Summers
- Biology Teaching and Learning Centre, Australian National University, 46 Sullivans Creek Road, Canberra, Australian Capital Territory, 2600, Australia; Discipline of Sport and Exercise Science, Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, Australian Capital Territory, 2617, Australia
| | - Ashley R Grant
- Innovation Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Emma L Karran
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
| |
Collapse
|
43
|
Lotze M, Moseley GL. Clinical and Neurophysiological Effects of Progressive Movement Imagery Training for Pathological Pain. J Pain 2022; 23:1480-1491. [PMID: 35504569 DOI: 10.1016/j.jpain.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/17/2022] [Accepted: 04/11/2022] [Indexed: 01/04/2023]
Abstract
Movement limitation is a common characteristic of chronic pain such that pain prevents the very movement and activity that is most likely to promote recovery. This is particularly the case for pathological pain states such as complex regional pain syndrome (CRPS). One clinical approach to CRPS that has growing evidence of efficacy involves progressive movement imagery training. Graded Motor Imagery (GMI) targets clinical and neurophysiological effects through a stepwise progression through implicit and explicit movement imagery training, mirror therapy and then functional tasks. Here we review experiences from over 20 years of clinical and research experience with GMI. We situate GMI in terms of its historical underpinnings, the benefits and outstanding challenges of its implementation, its potential application beyond CRPS. We then review the neuropathological targets of GMI and current thought on its effects on neurophysiological biomarkers. Perspective This article provides an overview of our experiences with graded motor imagery training over the last 20 years focussing on the treatment of CRPS. It does both cover the theoretical underpinnings for this treatment approach, biomarkers which indicate potential changes driven by GMI, and experiences for achieving optimal treatment results.
Collapse
Affiliation(s)
- Martin Lotze
- Functional Imaging Unit. Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| |
Collapse
|
44
|
Karran EL, Fryer CE, Middleton JW, Moseley GL. Exploring the Social Determinants of Health Outcomes for Adults with Low Back Pain or Spinal Cord Injury and Persistent Pain: A Mixed Methods Study. J Pain 2022; 23:1461-1479. [PMID: 35429673 DOI: 10.1016/j.jpain.2022.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
Developing a greater understanding of the social and environmental factors that are related to differential outcomes for individuals who experience persistent pain and disability is important for achieving health equity. In this study, we aimed to develop insights into the role of the social determinants of health (SDH) in care experiences and health status for socio-economically disadvantaged adults who experience persistent low back pain or persistent pain following spinal cord injury. Our objectives were to investigate 1) relationships between the SDH and health outcomes, 2) care experiences, and 3) perceived barriers and facilitators to optimal pain care. We conducted a mixed-methods convergent parallel study involving an online survey and semistructured interviews. We analyzed the data from each method separately and integrated the findings. One hundred sixty-four adults completed the survey and 17 adults completed the semistructured interviews. We found large or moderate-sized correlations between greater selfreported social isolation and poorer health outcomes. Experiencing a higher number of adverse SDH was moderately correlated with lower quality of life and was significantly correlated with all other outcomes. We generated 5 themes from the qualitative analysis: active strategies are important for well-being; low agency; facilitators of optimal care; barriers to optimal care; and health inequities, and derived meta-inferences that highlight the complex inter-relationships between the SDH and health outcomes in this cohort. The findings of our study can importantly inform endeavors to improve equity of pain care for adults with low back pain or spinal cord injury and persistent pain. PERSPECTIVE: This study illustrates the complex interplay between adverse social determinants of health and poorer health status for adults with persistent pain and provides evidence to support the important role of social isolation. Developing an understanding of the life-contexts of those seeking care is a vital step towards addressing health inequities.
Collapse
Affiliation(s)
- Emma L Karran
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, Kaurna Country, University of South Australia, Adelaide, South Australia, Australia..
| | - Caroline E Fryer
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, Kaurna Country, University of South Australia, Adelaide, South Australia, Australia
| | - James W Middleton
- State Spinal Cord Injury Service, NSW Agency for Clinical Innovation, Sydney, Australia.; John Walsh Centre for Rehabilitation Research, Kolling Institute, Royal North Shore Hospital Sydney, Australia.; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - G Lorimer Moseley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, Kaurna Country, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
45
|
Howlett CA, Wewege MA, Berryman C, Oldach A, Jennings E, Moore E, Karran EL, Szeto K, Pronk L, Miles S, Moseley GL. Back to the drawing board-The relationship between self-report and neuropsychological tests of cognitive flexibility in clinical cohorts: A systematic review and meta-analysis. Neuropsychology 2022; 36:347-372. [PMID: 35389719 DOI: 10.1037/neu0000796] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Cognitive flexibility has been previously described as the ability to adjust cognitive and behavioral strategies in response to changing contextual demands. Cognitive flexibility is typically assessed via self-report questionnaires and performance on neuropsychological tests in research and clinical practice. A common assumption among researchers and clinicians is that self-report and neuropsychological tests of cognitive flexibility assess the same or similar constructs, but the extent of the relationship between these two assessment approaches in clinical cohorts remains unknown. We undertook a systematic review and meta-analysis to determine the relationship between self-report and neuropsychological tests of cognitive flexibility in clinical samples. METHOD We searched 10 databases and relevant gray literature (e.g., other databases and pearling) from inception to October 2020 and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Eleven articles including 405 participants satisfied our eligibility criteria. RESULTS A multilevel random-effects meta-analysis revealed no relationship between self-report and neuropsychological tests of cognitive flexibility (0.01, 95% CI [-0.16 to 0.18]). Individual random-effects meta-analyses between 12 different tests pairs also found no relationship. CONCLUSION Based on our results, it is clear that the two assessment approaches of cognitive flexibility provide independent information-they do not assess the same construct. These findings have important ramifications for future research and clinical practice-there is a need to reconsider what constructs self-report and neuropsychological tests of "cognitive flexibility" actually assess, and avoid the interchangeable use of these assessments in clinical samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
- Caitlin A Howlett
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health
| | | | - Carolyn Berryman
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health
| | | | | | - Emily Moore
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health
| | - Emma L Karran
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health
| | - Kimberley Szeto
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health
| | - Leander Pronk
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health
| | | | - G Lorimer Moseley
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health
| |
Collapse
|
46
|
Chimenti RL, Post AA, Silbernagel KG, Hadlandsmyth K, Sluka KA, Moseley GL, Rio E. Kinesiophobia Severity Categories and Clinically Meaningful Symptom Change in Persons With Achilles Tendinopathy in a Cross-Sectional Study: Implications for Assessment and Willingness to Exercise. Front Pain Res (Lausanne) 2022; 2:739051. [PMID: 35295417 PMCID: PMC8915659 DOI: 10.3389/fpain.2021.739051] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/10/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: (1) Validate thresholds for minimal, low, moderate, and high fear of movement on the 11-item Tampa Scale of Kinesiophobia (TSK-11), and (2) Establish a patient-driven minimal clinically important difference (MCID) for Achilles tendinopathy (AT) symptoms of pain with heel raises and tendon stiffness. Methods: Four hundred and forty-two adults with chronic AT responded to an online survey, including psychosocial questionnaires and symptom-related questions (severity and willingness to complete heel raises and hops). Kinesiophobia subgroups (Minimal ≤ 22, Low 23–28, Moderate 29–35, High ≥ 36 scores on the TSK-11), pain MCID subgroups (10-, 20-, 30-, >30-points on a 0- to 100-point scale), and stiffness MCID subgroups (5, 10, 20, >20 min) were described as median [interquartile range] and compared using non-parametric statistics. Results: Subgroups with higher kinesiophobia reported were less likely to complete three heel raises (Minimal = 93%, Low = 74%, Moderate = 58%, High = 24%). Higher kinesiophobia was associated with higher expected pain (Minimal = 20.0 [9.3–40.0], Low = 43.0 [20.0–60.0], Moderate = 50.0 [24.0–64.0], High = 60.5 [41.3–71.0]) yet not with movement-evoked pain (Minimal = 25.0 [5.0–43.0], Low = 31.0 [18.0–59.0], Moderate = 35.0 [20.0–60.0], High = 43.0 [24.0–65.3]). The most common pain MCID was 10 points (39% of respondents). Half of respondents considered a 5-min (35% of sample) or 10-min (16%) decrease in morning stiffness as clinically meaningful. Conclusions: Convergent validity of TSK-11 thresholds was supported by association with pain catastrophizing, severity of expected pain with movement, and willingness to complete tendon loading exercises. Most participants indicated that reducing their pain severity to the mild range would be clinically meaningful.
Collapse
Affiliation(s)
- Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Andrew A Post
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | | | - Katherine Hadlandsmyth
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - G Lorimer Moseley
- Sansom Institute for Health Research, IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Ebonie Rio
- School of Allied Health, LaTrobe Sport and Exercise Medicine Research Center, La Trobe University, Bundoora, VIC, Australia
| |
Collapse
|
47
|
Caneiro JP, Smith A, Bunzli S, Linton S, Moseley GL, O'Sullivan P. From Fear to Safety: A Roadmap to Recovery From Musculoskeletal Pain. Phys Ther 2022; 102:6480889. [PMID: 34971393 DOI: 10.1093/ptj/pzab271] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 11/12/2022]
Abstract
Contemporary conceptualizations of pain emphasize its protective function. The meaning assigned to pain drives cognitive, emotional, and behavioral responses. When pain is threatening and a person lacks control over their pain experience, it can become distressing, self-perpetuating, and disabling. Although the pathway to disability is well established, the pathway to recovery is less researched and understood. This Perspective draws on recent data on the lived experience of people with pain-related fear to discuss both fear and safety-learning processes and their implications for recovery for people living with pain. Recovery is here defined as achievement of control over pain as well as improvement in functional capacity and quality of life. Based on the common-sense model, this Perspective proposes a framework utilizing Cognitive Functional Therapy to promote safety learning. A process is described in which experiential learning combined with "sense making" disrupts a person's unhelpful cognitive representation and behavioral and emotional response to pain, leading them on a journey to recovery. This framework incorporates principles of inhibitory processing that are fundamental to pain-related fear and safety learning.
Collapse
Affiliation(s)
- J P Caneiro
- Curtin University, School of Allied Health, Faculty of Health Sciences, Perth, Western Australia, Australia.,Body Logic Physiotherapy Perth, Western Australia, Australia
| | - Anne Smith
- Curtin University, School of Allied Health, Faculty of Health Sciences, Perth, Western Australia, Australia
| | - Samantha Bunzli
- University of Melbourne Department Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Steven Linton
- Örebro University, Center for Health and Medical Psychology (CHAMP), Örebro, Sweden
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Peter O'Sullivan
- Curtin University, School of Allied Health, Faculty of Health Sciences, Perth, Western Australia, Australia.,Body Logic Physiotherapy Perth, Western Australia, Australia
| |
Collapse
|
48
|
Mardon AK, Leake HB, Szeto K, Astill T, Hilton S, Moseley GL, Chalmers KJ. Treatment recommendations for the management of persistent pelvic pain: A systematic review of international clinical practice guidelines. BJOG 2021; 129:1248-1260. [PMID: 34919325 DOI: 10.1111/1471-0528.17064] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/30/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Females with persistent pelvic pain (PPP) report great variability in treatments they are recommended despite the availability of clinical practice guidelines (CPGs) that aim to standardise care. A clear consensus for the best practice care for PPP is required. OBJECTIVE Identify and summarise treatment recommendations across CPGs for the management of PPP, and appraise their quality. SEARCH STRATEGY MEDLINE, CENTRAL, EMBASE, EmCare, SCOPUS, the Cochrane Database of Systematic Reviews, Web of Science Core Collection, and relevant guideline databases were searched from their inception to June 2021. SELECTION CRITERIA Included CPGs were those for the management of urogynaecological conditions in adult females published in English, of any publication date, and endorsed by a professional organisation or society. DATA COLLECTION AND ANALYSIS We screened 1,379 records and included 20 CPGs. CPG quality was assessed using The Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. Descriptive synthesis compiled treatment recommendations across CPGs. MAIN RESULTS CPGs for seven conditions provided 281 individual recommendations. On quality appraisal, guidelines on average scored 'excellent' for the domains 'scope and purpose' (80.6%, SD=13.3) and 'clarity and presentation' (74.4%, SD=12.0); for other domains, average scores were satisfactory or poor. Four guidelines (Endometriosis, NICE, RANZCOG, ESHRE; PCOS, Teede et al. 2018) were deemed recommended for use. Recommendations were most frequent for pharmaceutical and surgical interventions. Recommendations were variable for psychological, physiotherapy, and other conservative interventions. CONCLUSIONS The quality of CPGs for PPP is generally poor. Several CPGs endorse the consideration of biopsychosocial elements of PPP. Yet most recommend pharmaceutical, surgical, and other biomedical interventions.
Collapse
Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.,Centre for IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Kimberley Szeto
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.,Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, SA, Australia
| | - Thomas Astill
- Brain Stimulation and Rehabilitation (BrainSTAR) Lab, Western Sydney University, Campbelltown, NSW, Australia
| | | | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.,Western Sydney University, Campbelltown, NSW, Australia
| |
Collapse
|
49
|
Moore E, Stanton TR, Traeger A, Moseley GL, Berryman C. Determining the credibility, accuracy and comprehensiveness of websites educating consumers on complex regional pain syndrome accessible in Australia: a systematic review. Aust J Prim Health 2021; 27:485-495. [PMID: 34814978 DOI: 10.1071/py21066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/03/2021] [Indexed: 01/20/2023]
Abstract
Complex regional pain syndrome (CRPS) is a distressing and disabling pain condition. Many people with CRPS and the health professionals who treat them seek information about the condition via the Internet. The credibility, accuracy and comprehensiveness of online CRPS information remains unknown. The aim of this study was to determine the credibility, accuracy and comprehensiveness of information presented on freely accessible websites that aim to educate people about CRPS. Keyword searches were conducted on the Australian Google site, with 'trustworthy' websites included and critically appraised. Primary outcomes were recognised metrics of credibility (JAMA benchmark credibility criteria) and website accuracy (according to European CRPS guidelines). Comprehensiveness was assessed using the proportion of European CRPS guidelines covered by the websites. In all, 30 websites with 819 recommendations were critically appraised. Five (17%) websites met all credibility criteria; of the recommendations, 349 (43%) were accurate, 252 (31%) were inaccurate and 218 (26%) were unclear. For comprehensiveness, an average of 17% of general guidelines, 15% of therapeutic guidelines and 6% of medication/supplement guidelines were covered. Online information about CRPS available to Australians has low credibility, accuracy and comprehensiveness. Many website recommendations are inaccurate or unclear, and many websites endorse inappropriate treatments. There is an urgent need for accurate and comprehensive sources of CRPS information online.
Collapse
Affiliation(s)
- Emily Moore
- IIMPACT in Health, The University of South Australia, Adelaide, SA 5001, Australia
| | - Tasha R Stanton
- IIMPACT in Health, The University of South Australia, Adelaide, SA 5001, Australia; and Institute for Musculoskeletal Health, Camperdown, NSW 2050, Australia
| | - Adrian Traeger
- Institute for Musculoskeletal Health, Camperdown, NSW 2050, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, The University of South Australia, Adelaide, SA 5001, Australia; and Neuroscience Research Australia, Randwick, NSW 2031, Australia
| | - Carolyn Berryman
- IIMPACT in Health, The University of South Australia, Adelaide, SA 5001, Australia; and School of Biomedicine, The University of Adelaide, Adelaide, SA 5005, Australia; and South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; and Corresponding author.
| |
Collapse
|
50
|
Olthof NA, Coppieters MW, Moseley GL, Sterling M, Chippindall DJ, Harvie DS. Modernising tactile acuity assessment; clinimetrics of semi-automated tests and effects of age, sex and anthropometry on performance. PeerJ 2021; 9:e12192. [PMID: 35070517 PMCID: PMC8759376 DOI: 10.7717/peerj.12192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background Reduced tactile acuity has been observed in several chronic pain conditions and has been proposed as a clinical indicator of somatosensory impairments related to the condition. As some interventions targeting these impairments have resulted in pain reduction, assessing tactile acuity may have significant clinical potential. While two-point discrimination threshold (TPDT) is a popular method of assessing tactile acuity, large measurement error has been observed (impeding responsiveness) and its validity has been questioned. The recently developed semi-automated ‘imprint Tactile Acuity Device’ (iTAD) may improve tactile acuity assessment, but clinimetric properties of its scores (accuracy score, response time and rate correct score) need further examination. Aims Experiment 1: To determine inter-rater reliability and measurement error of TPDT and iTAD assessments. Experiment 2: To determine internal consistencies and floor or ceiling effects of iTAD scores, and investigate effects of age, sex, and anthropometry on performance. Methods Experiment 1: To assess inter-rater reliability (ICC(2,1)) and measurement error (coefficient of variation (CoV)), three assessors each performed TPDT and iTAD assessments at the neck in forty healthy participants. Experiment 2: To assess internal consistency (ICC(2,k)) and floor or ceiling effects (skewness z-scores), one hundred healthy participants performed the iTAD’s localisation and orientation tests. Balanced for sex, participants were equally divided over five age brackets (18–30, 31–40, 41–50, 51–60 and 61–70). Age, sex, body mass index (BMI) and neck surface area were assessed to examine their direct (using multiple linear regression analysis) and indirect (using sequential mediation analysis) relationship with iTAD scores. Results Mean ICC(2,1) was moderate for TPDT (0.70) and moderate-to-good for the various iTAD scores (0.65–0.86). The CoV was 25.3% for TPDT and ranged from 6.1% to 16.5% for iTAD scores. Internal consistency was high for both iTAD accuracy scores (ICC(2,6) = 0.84; ICC(2,4) = 0.86). No overt floor or ceiling effects were detected (all skewness z-scores < 3.29). Accuracy scores were only directly related to age (decreasing with increasing age) and sex (higher for men). Discussion Although reliability was similar, iTAD scores demonstrated less measurement error than TPDT indicating a potential for better responsiveness to treatment effects. Further, unlike previously reported for TPDT, iTAD scores appeared independent of anthropometry, which simplifies interpretation. Additionally, the iTAD assesses multiple aspects of tactile processing which may provide a more comprehensive evaluation of tactile acuity. Taken together, the iTAD shows promise in measuring tactile acuity, but patient studies are needed to verify clinical relevance.
Collapse
Affiliation(s)
- Nick A. Olthof
- School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
| | - Michel W. Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, QLD, Australia
| | - Dylan J. Chippindall
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
| | - Daniel S. Harvie
- School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA, Australia
| |
Collapse
|