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(1) Background: The aims of this study are to explore what beliefs children and adolescents manifest about the cause of the pain they describe, to compare whether there are differences between beliefs by age and the persistence of pain, and to relate the explanations of the cause of pain with current scientific evidence. (2) Methods: a cross-sectional qualitative study was used. The primary endpoint of the study was obtaining explanations of the cause of pain recorded by means of an open-ended question. The participants were school-age children attending a charted school in the province of Barcelona. (3) Results: The children and adolescents proposed a diverse range of explanations for the cause of pain that they reported in their responses. The most frequent explanation for the cause of pain were pathologies and injuries (45.95%), ergonomic issues (22.60%) and psychological issues (15.95%). (4) Conclusions: There is a lot of variety in the explanations that young people give about the cause of their pain in schoolchildren aged between 10 and 16 years old. There exists a high prevalence of explanations non-associated with tissue damage (ENAD) concerning the causes of pain described. It is necessary that future health prevention programs dedicated to early ages consider which beliefs about the cause of pain are the most frequent in the pediatric population.

(1) Background: The aim of the present study was to establish ankle joint dorsiflexion reference values among youth federated basketball players. (2) Methods: Cross-sectional study. The participants were basketball players who belonged to youth basketball developmental teams (female and male) from under-12 (U12) to under-17 (U17) categories. Ankle joint dorsiflexion range of motion was evaluated with the weight-bearing lunge test through the Leg Motion system. The distance achieved was recorded in centimeters. (3) Results: 693 basketball players who met the eligibility criteria and volunteered to participate were included in the study. The mean (SD) of ankle joint dorsiflexion was 10.68 (2.44) cm and the reference values were: excessive hypomobility < 6.09 (0.54) cm; hypomobility 6.09 (0.88) cm-8.43 (0.77) cm; normal 8.44 (0.77)-13.11 (0.79) cm; hypermobility 13.11 (0.74)-15.44 (0.86) cm; and excessive hypermobility >15.44 (0.86) cm. (4) Conclusions: This study provides ankle joint dorsiflexion reference values in youth basketball players from 12 to under 17 years old.

(1) Background: The aim of the present study was to evaluate and to detect neuromuscular deficiencies in static and dynamic tests among federated youth basketball players. (2) Methods: Cross-sectional study with 778 basketball players. Specific tests and trials were conducted to evaluate members of teams from several clubs in male and female from under 12 (U12) to under 17 (U17) categories. The evaluations consisted of static physical measurements and dynamic measurements. (3) Results: 575 players were included in this study. A total of 95% of participants are unable to keep their ankle stable in monopodial loading; 86% present dynamic lower extremity valgus with statistically significant differences between categories ( p = 0.004); 94% are unable to keep the pelvis stable when performing a single-leg squat; 93% are unable to keep their trunk stable when performing the same movement. During landing, 96% present dynamic lower extremity valgus. The thighs of 92% do not reach parallel (peak of jump). (4) Conclusions: The most frequent neuromuscular deficits in federated youth basketball players are related to instability, the most frequent being ankle instability, followed by lumbo-pelvic instability, dynamic postural instability and dynamic knee valgus. Deficits in jumping/landing technique are also very frequent in all the items analyzed (jumping, landing and plyometrics). The performed tests, which mostly showed a poor performance by the sample, can be indicative of injury probability.

(1) Background: Research has shown that thoughts about pain are important for the management of chronic pain in children. In order to monitor changes in thoughts about pain over time and evaluate the efficacy of treatments, we need valid and reliable measures. The aims of this study were to develop a questionnaire to assess a child's concept of pain and to evaluate its psychometric properties; (2) Methods: This is a cross-sectional, two-phase, mixed-method study. A total of 324 individuals aged 8 to 17 years old responded to the newly created questionnaire. The Conceptualization of Pain Questionnaire (COPAQ) was calibrated using the Rasch model. The chi-square test was used for the fit statistics. Underfit and overfit of the model were determined and a descriptive analysis of infit and outfit was conducted to identify who responded erratically. Internal consistency was measured using the Person Separation Index (PSI); (3) Results: Fit to the Rasch model was good. Suitable targeting indicated which items were simple to answer; Person Fit identified 9.56% children who responded erratically; PSI = 0.814; (4) Conclusions: The findings suggest that COPAQ is a measure of a child's concept of pain that is easy to administer and respond to. It has a good fit and a good internal consistency.

Objective: To assess the content, quality and readability of websites with information on fibromyalgia in Spanish., Methods: Websites were retrieved entering the keyword 'fibromyalgia' in Google, Yahoo! and Bing, and by searching records of patients associations in Spain and Latin America. The Bermúdez-Tamayo and DISCERN questionnaires were employed for evaluating quality and content, and INFLESZ for readability. Statistical analysis was conducted using IBM SPSSV.24 (Chicago, USA)., Results: Three hundred and five websites were found. After applying the exclusion criteria, 73 websites were analysed. Websites retrieved by search engines obtained median scores of 27.0 (interquartile interval (IQI): 24.5-32.0) with DISCERN, 35.0 (IQI: 31.0-40.5) with Bermúdez-Tamayo and 53.7 (IQI: 47.4-56.2) with INFLESZ, whereas those from patients associations scored 21.0 (IQI: 19.2-23.8), 26.0 (IQI: 25.0-31.0) and 51.7 (IQI: 47.9-55.1), respectively. In general, content was not up-to-date., Conclusions: Overall quality was medium-low, content quality was very low and readability was poor. Further effort is needed to guarantee meeting quality criteria and accessing updated, relevant, and legible information.This study exposes the quality and readability of websites on fibromyalgia in Spanish, which can help healthcare workers to better appraise this resource and its potential influence on the development of the pathology., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Back pain in children is a reality and various factors are involved in its etiology. The study's aim was to analyze the relationship between the use and type of backpack and pain in children. An analytical observational cross-sectional study was conducted among 123 schoolchildren between 8-10 years. Data on the participants' weight and height and their backpacks were collected, as well as the way of travel to school and their physical activity during the week. The results indicated that all backpacks were large because the backpack's height is longer than torso length. Participants who studied in a traditional educational system (62.60%) carried backpacks that exceeded 10% of their body weight. Additionally, 31.7% of the students presented pain. There is no significant correlation between the weight or type of backpack and the pressure pain threshold collected from shoulders muscles. Participants who carried backpacks heavier than 10% of their body weight did not have more musculoskeletal pain or a lower pressure pain threshold than the others, although they did report greater fatigue. All these topics should be debated considering the student's social environment and the backpack's discomfort to the children, even though no relationship was found between musculoskeletal pain and backpack weight., Competing Interests: The authors declare no conflict of interest.

Background: Pain management is a challenge and effective treatment requires professionals to collaborate if they are to address the needs of patients with pain. Comprehensive education and training is key to helping skilled professionals provide the best pain care possible. The objective of this work was to study the content of the pain education provided to undergraduates in healthcare and veterinary programs in Spain., Methods: A survey was developed on the basis of previous surveys that had been used in the field. The final version included 31 questions about different issues on pain education, including, type of subject, number of pain mandatory/elective hours, and specific content covered. The survey was sent to all course leaders for all subjects on the undergraduate programs in Dentistry, Human Nutrition and Dietetics, Medicine, Nursing, Occupational Therapy, Pharmacy, Physiotherapy, Podiatry, Psychology, and Veterinary Science, in Catalonia, Spain. The survey was conducted from January to June, 2018. Students' t-test were used to study mean differences in responses., Results: A total of 550 course leaders from all healthcare undergraduate programs in Catalan universities took part. There were considerable differences in the number of pain-related hours among disciplines: Nursing reported the highest number of hours, and Psychology the lowest. The area least covered by all the disciplines was the "Management of pain", and particularly the content related to the most vulnerable members of society (i.e., youths, the elderly and special populations). No interprofessional educational program on pain was identified., Conclusions: Pain is not such a large component of the undergraduate healthcare curriculum in Spain as could be expected given the extent of pain and its impact. Curricula need to be changed so that the problems all stakeholders have with pain care can be addressed.

Introduction: Reorganized force control may be an important adaptation following painful traumas. In this study, force control adaptations were assessed in elbow pain patients. Increasing the contraction demand may overcome pain interference on the motor control and as such act as an internal control. It was hypothesized that elbow pain patients compared with controls would present greater change in the direction of force when increasing the demand of the motor task., Methods: Elbow pain patients (n=19) and asymptomatic participants (n=21) performed isometric wrist extensions at 5% to 70% of maximum voluntary contraction. Pressure pain thresholds were recorded at the lateral epicondyle and tibialis anterior muscle. Contraction force was recorded using a 3-directional force transducer. Participants performed contractions according to visual feedback of the task-related force intensity (main direction of wrist extension) and another set of contractions with feedback of the 3 force directions. Going from the simple to the detailed force feedback will increase the demand of the motor task. Force steadiness in all 3 dimensions and force directions were extracted., Results: Compared with controls, elbow pain patients presented lower pressure pain thresholds at both sites (P<0.05). Force steadiness was not significantly different between groups or feedback methods. The change in force direction when providing simple visual feedback in contrast with feedback of all force components at all contraction levels was greater for patients compared with controls (P<0.05)., Conclusion: The larger change in force direction in pain patients implies redistribution of loads across the arm as an associated effect of pain.

Background: A key tool for use in approaching chronic pain treatment is educating patients to reconceptualize pain. Thus, health professionals are fundamental to the transmission of pain information to patients. Because their understanding of pain is acquired during the educational process, the aim of this study was to compare the knowledge about pain neurophysiology in first and final-year students from three different health science programs at a single University to determine their gain in knowledge using a well-known questionnaire designed to evaluate the understanding of pain., Methods: The Neurophysiology of Pain Questionnaire (19 closed-ended questions) was administered to students in their first and final years of study in Medicine, Physiotherapy, or Nutrition. The percentage of correct responses was determined and comparisons of the results were analyzed between the programs as well as between the first and final years of study within each program. For all tests, p-values were two-sided, and results with p-values below 0.05 were considered statistically significant., Results: The participation rate was greater than 51% (n = 285). The mean percentage of correct responses, reported as mean (SD), among the first year students was 42.14 (12.23), without significant statistical differences detected between the programs. The mean percentages of correct responses for students in their final year were as follows: Medicine, 54.38 (13.87); Physiotherapy, 68.92 (16.22); Nutrition, 42.34 (10.11). We found statistically significant differences among all three programs and between the first and final years in Medicine and Physiotherapy. A question-by-question analysis showed that the percentage of correct responses for questions related to the biopsychosocial aspects of pain was higher for students in Physiotherapy than those in Medicine., Conclusions: Students in their final years of Medicine and Physiotherapy programs know more about the neurophysiology of pain than students in their first years of these programs, however there are some questions where first years students have better results. Physiotherapy students have greater knowledge of neurophysiology of pain than Medicine students, especially the biopsychosocial aspects. Even so, their understanding may not be sufficient and does not guarantee an approach to chronic pain that will help patients reconceptualize their pain.

Objective: Multidisciplinary treatments of fibromyalgia (FM) have demonstrated efficacy. Nevertheless, they have been criticized for not maintaining their benefits and for not being studied for specific populations. Our objectives were to determine the efficacy of a multidisciplinary treatment for FM adapted for patients with low educational levels and to determine the maintenance of its therapeutic benefits during a long-term followup period., Methods: Inclusion criteria consisted of female sex, a diagnosis of FM (using American College of Rheumatology criteria), age between 18 and 60 years, and between 3 and 8 years of schooling. Patients were randomly assigned to 1 of the 2 treatment conditions: conventional pharmacologic treatment or multidisciplinary treatment. Outcome measures were functionality, sleep disturbances, pain intensity, catastrophizing, and psychological distress. Analysis was by intent-to-treat and missing data were replaced following the baseline observation carried forward method., Results: One hundred fifty-five participants were recruited. No statistically significant differences regarding pretreatment measures were found between the 2 experimental groups. Overall statistics comparison showed a significant difference between the 2 groups in all of the variables studied (P < 0.0001). Mixed linear model analysis demonstrated the superiority of the multidisciplinary treatment in all of the studied variables at posttreatment. The differences were maintained at 12-month followup in sleep disturbances (P < 0.0001), catastrophizing (P < 0.0001), and psychological distress (P < 0.01)., Conclusion: Multidisciplinary treatment adapted for individuals with low educational levels is effective in reducing key symptoms of FM. Some improvements were maintained 1 year after completing the multidisciplinary treatment., (Copyright © 2013 by the American College of Rheumatology.)

The aim of this study was to determine whether the dry needling of myofascial trigger points (MTrPs) is superior to placebo in the prevention of pain after total knee arthroplasty. Forty subjects were randomised to a true dry needling group (T) or to a sham group (S). All were examined for MTrPs by an experienced physical therapist 4-5 hours before surgery. Immediately following anesthesiology and before surgery started, subjects in the T group were dry needled in all previously diagnosed MTrPs, while the S group received no treatment in their MTrPs. Subjects were blinded to group allocation as well as the examiner in presurgical and follow-up examinations performed 1, 3, and 6 months after arthroplasty. Subjects in the T group had less pain after intervention, with statistically significant differences in the variation rate of the visual analogue scale (VAS) measurements 1 month after intervention and in the need for immediate postsurgery analgesics. Differences were not significant at 3- and 6-month follow-up examinations. In conclusion, a single dry needling treatment of MTrP under anaesthesia reduced pain in the first month after knee arthroplasty, when pain was the most severe. Results show a superiority of dry needling versus placebo. An interesting novel placebo methodology for dry needling, with a real blinding procedure, is presented.

Background: Taping is a common technique to treat inversion ankle sprains, but the effects of tape on proprioception are still not clear. The purpose of this study was to establish whether proprioception would be modified by the use of ankle tape. To do so we studied joint position sense (JPS) in healthy volunteers using three-dimensional (3D) movement analysis systems., Material and Methods: Forty healthy volunteers (mean age and SD = 23.2 ± 4.2) were asked to actively reproduce four different ankle positions: 10 degrees of dorsiflexion, neutral, 10 degrees and 20 degrees of plantarflexion. The absolute difference between the estimated angle and the target angle was used to assess JPS. This difference was named Error. Subjects were randomly assigned to the control (n = 21) or the intervention (n = 19) groups. Members of the intervention group received ankle tape for a lateral ligament sprain in the non-dominant leg. A t-test was used to evaluate the results., Results: Tape significantly improved JPS for the dorsiflexion position (p = 0.038). Neutral was the most accurately reproduced position, and the remaining positions were overestimated for both groups., Conclusion: Taping improved proprioception in healthy volunteers, and 3D movement analysis was a useful method to accurately quantify joint position sense., Clinical Relevance: Because ankle proprioception is critical to the functional success of surgical and rehabilitation treatments, these results regarding proprioception are of particular importance because ankle taping is often used in preventing ankle sprains and it is a common treatment after ankle injuries.