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Background: The chronic musculoskeletal pain (CMP) epidemic occurs concurrently during historical mass population movements and significant income inequities. Epidemiological studies indicate CMP may occur disproportionately in marginalized populations. Nationalistic rhetoric has arisen, in part, due to perceived concerns over access to healthcare. Political policies directly and indirectly impact healthcare. Objectives: To explore 1) how potential historical, societal, and political factors may contribute to the clinical conversation of pain; 2) the impact ineffective clinical conversations may have on the CMP experience. Methods: Literature Review. Major Findings: CMP is an invisible disease decoupled from normal tissue healing. The clinical conversation is increasingly recognized to impact treatment outcomes. The clinician and the patient bring differing histories, values, and interpretations to clinic visits. Systemic healthcare racism, implicit biases, incongruent provider/patient assessment of pain, and provider stigmatization contribute to olgioanalgesia. As healthcare professional groups become more politically active, providers bring that political experience into the clinic. Marginalized populations, at risk for greater stress, discrimination, and fear bring their own intensified political perceptions into the clinic. We suggest that poor management and discordant clinical conversation may be adversely influenced by the current political climate. Conclusion: Identifying contributing factors to ineffective clinical conversations is important to improve CMP outcomes and to minimize inequities in CMP management. We hope to identify populations that may be more vulnerable to political biases, understand factors in the clinical conversation that are important to patients, and to build opportunities to educate providers and patients on these forces impacting the clinical conversation. [ABSTRACT FROM AUTHOR]

Background: The incidence and severity of phantom limb pain (PLP) does not differ much between the extremities of amputation. However, its impact on functional ability and quality of life in lower limb amputation may be different, as prosthetic weight bearing is a key component in the movement and functional rehabilitation of individuals with a lower limb amputation. Objective: To evaluate the evidence for effectiveness or efficacy of non-pharmacological interventions in the management of PLP in adults with lower limb amputation. Methods: A comprehensive literature search conducted on 11 electronic databases, from their inception to 25 March 2016 identified 626 potentially relevant articles. Full-text randomised controlled trials in English which examined any form of non-pharmacologic intervention for managing PLP in lower limb amputees were included. The data with regard to characteristics of the studies, participants, intervention and outcome measures and overall statistical result were extracted. The Cochrane ‘Risk of bias assessment tool’ was used to assess the bias of all included articles. Results: Four studies met the final criteria to be included in the review. Four treatment techniques had been used in the treatment of 204 patients with lower limb amputation. Two trials showed a positive impact of intervention on PLP compared to control group. Risk of bias varied across studies, and only one included study was assessed as having a low risk of bias. Conclusion: The review identified lack of evidence to support non-pharmacological interventions in the management of PLP. Adequately powered high-quality trials are needed in this area to inform rehabilitation. [ABSTRACT FROM AUTHOR]