Search

Context: Hip muscle imbalance, especially between gluteal muscles and tensor fasciae latae (TFL), is one of the risk factors for developing low back pain which should be considered in rehabilitation programs. This study compared the effect of exercises with gluteal-to-TFL muscle activation index above and below 50 on pain intensity, disability, and lower limbs' range of motion (ROM) in patients with nonspecific chronic low back pain. Design: A semiexperimental intervention study with a pretest and posttest. Methods: A total of 45 patients with nonspecific chronic low back pain were randomly divided into 2 experimental groups of gluteal-to-TFL muscle activation index above 50 (n = 15), below 50 (n = 15), and a control group (n = 15). Pain intensity (visual analog scale), disability (Roland–Morris Disability Questionnaire), and lower limbs' ROM including hip extension, hip abduction, hip external rotation, and knee extension (goniometer) were assessed at pretest and after 8 weeks of intervention. Results: Within-group comparison showed significant improvement of pain, disability, and ROMs in both experimental groups. No significant changes were observed in the control group. In between-group analysis, significant differences were observed in group of gluteal-to-TFL muscle activation index above 50 for only pain (P =.03) and disability (P =.01). For ROMs, although clinical improvement of lower limbs' ROMs was higher in group of gluteal-to-TFL muscle activation index above 50, no statistically significant differences were found between 2 experimental groups. Both experimental groups were superior to the control group for all outcomes. Conclusions: Findings indicate the statistically and clinically superior effectiveness of exercises with a gluteal-to-TFL muscle activation index above 50 in the reduction of pain and disability. Based on the clinical significance of exercises with a gluteal-to-TFL muscle activation index above 50 for improving ROMs, utilizing specific exercises that more activated gluteal muscle compared to TFL is recommended for patient with restricted lower limbs' ROMs. [ABSTRACT FROM AUTHOR]

Introduction: Approximately 75% of caregivers providing unpaid care to family members or friends experience persistent pain. Simultaneously, individuals who require caregiving commonly experience pain. The inherent complexity of pain is enhanced by relationship dynamics of two closely tied individuals (i.e., caregiving dyad = caregivers and care recipients). Currently there are no proven pain interventions that target the caregiving dyad. Thus, the purpose of this pilot study was to assess the feasibility of a new behavioral multimodal intervention, the Merging Yoga and self-management to develop Skills (MY-Skills) intervention. Methods: Each participant was part of a caregiving dyad and all participants had moderate to severe musculoskeletal pain, a score of =4 of 6 on the short minimental status exam, were =18 years old, sedentary, able to speak English, able to stand, and living at home. Participants were randomized to MY-Skills or the control group. MY-Skills was offered twice a week for eight weeks and each two-hour session included yoga and self-management education developed specifically for caregiving dyads experiencing persistent pain. MY-Skills was group based and developed as an in-person intervention. Due to Covid-19, the intervention was moved online and data are presented for in-person and online cohorts. Benchmarks for feasibility were set a priori, addressing: recruitment, attrition, attendance, safety, acceptability/satisfaction, and study completion. Results: Thirteen participants completed the in-person MY-Skills intervention (caregivers n = 7, care-receivers n = 6) and 18 individuals completed the online MY-Skills intervention (9 dyads). Most participants had pain for =10 years. Recruitment and attrition benchmarks for the in-person intervention were not met; yet they were met for the online version. In-person and online MY-Skills intervention attendance, safety, acceptability/satisfaction, and completion exceeded benchmark criteria. Discussion: The MY-Skills intervention appears feasible and acceptable, however changes to recruitment criteria are necessary. Additional testing and larger sample sizes are required to test efficacy. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this systematic review was to synthesise the research identifying possible influences on CBT outcomes in chronic pain. Variations in the effectiveness of psychological therapies, such as CBT, in chronic pain have led to research investigating predictors of improved treatment outcomes. Materials and methods: We identified randomised controlled and cohort studies of CBT for chronic pain, published between 1974 to 2nd August 2023, which identified predictors of CBT outcomes. Results: Nineteen studies were included in the review. Baseline sociodemographic, physical and emotional factors that influence the outcomes of CBT for chronic pain were identified. The most commonly reported predictors of CBT outcome, with medium to large effect sizes, were anxiety, depression and negative cognitions about pain and coping. Sociodemographic predictors of outcomes demonstrated small effects and lacked replicability. Conclusions: There was variability across study designs, CBT delivery and outcomes measures. Further research is needed in chronic pain to identify the predictive factors which influence treatment outcomes, and consistency across study designs and outcome variables is needed to reduce heterogeneity. IMPLICATIONS FOR REHABILITATION: This review synthesised research identifying factors predicting outcomes of Cognitive Behavioural Therapy for chronic pain. The most commonly reported predictors of Cognitive Behavioural Therapy outcome, with medium to large effect sizes, were anxiety, depression, and negative cognitions about pain and coping. sociodemographic predictors of outcomes demonstrated small effects and lacked replicability. There is a move towards more individualised treatments in chronic pain. Our results suggest that decisions regarding Cognitive Behavioural Therapy for chronic pain should carefully consider baseline levels of anxiety, depression, and negative cognitions about pain. [ABSTRACT FROM AUTHOR]

Objective: To investigate potential savings obtained fromrestoring productivity in employees with chronic MSK pain through a digital care program (DCP). Methods: Secondary analysis of a prospective longitudinal study assessing cumulative savings overall or across several industry sectors by analyzing changes inWork Productivity and Activities Impairment (WPAI questionnaire). Results: Employees from 50 U.S. states started the program (n = 5032). Significant improvements in productivity impairment were observed across all industries, yielding median cumulative savings from $151 (95% confidence interval [CI], 128-174) to $294 (95% CI, 286-303) per participant at treatment end. Twelvemonth projections estimatedmedian savings of $2916 (95%CI, 2861-2972). Additionally, significant improvements in non-work-related daily activities were observed. Conclusions: This study underlines the burden of MSK-related productivity loss on employers' financial balance, illustrating the importance of a DCP to assist patients to recover quality of life and succeed professionally. [ABSTRACT FROM AUTHOR]

Background: Chronic painful temporomandibular disorders (TMD), awake bruxism and sleep bruxism are often comorbid with post‐traumatic stress disorder (PTSD), but the implications for treatment are unknown. Objective(s): To explore the effects of PTSD treatment on these conditions. We hypothesized that chronic painful TMD, pain intensity, pain interference, awake bruxism and sleep bruxism would decrease after evidence‐based trauma‐focused treatment and that this decrease would be maintained at the 6‐month follow‐up. Methods: Individuals referred for PTSD treatment were assessed for chronic painful TMD (temporomandibular disorder pain screener), pain intensity, pain interference (Graded Chronic Pain Scale 2.0), awake bruxism and sleep bruxism (oral behaviours checklist) pre‐, post‐treatment and at the 6‐month follow‐up. Hypotheses were tested using the Friedman test, followed by a post hoc Wilcoxon signed‐rank test. Effect sizes (Cohen's r) are reported. Barely any pain interference was reported, therefore these outcomes were not analysed. Results: In individuals with chronic painful TMD (n = 98), pain intensity, awake bruxism and sleep bruxism decreased across the three time points. Post hoc tests showed that chronic painful TMD (r = 0.59), pain intensity (r = 0.28), awake bruxism (r = 0.51) and sleep bruxism (r = 0.35) decreased between pre‐ and post‐treatment. Between pre‐treatment and the 6‐month follow‐up, chronic painful TMD (r = 0.58), awake bruxism (r = 0.30) and sleep bruxism (r = 0.39) decreased as well. Conclusion: The results provide preliminary support for a trauma‐sensitive approach for patients with chronic painful TMD and PTSD and suggest that trauma‐focused treatment may be beneficial for chronic painful TMD, awake bruxism and sleep bruxism in patients with PTSD and chronic painful TMD. [ABSTRACT FROM AUTHOR]

Chronic pain, with its complex and multidimensional nature, poses significant challenges in identifying effective long‐term treatments. There is growing scientific interest in how psychopathological and personality dimensions may influence the maintenance and development of chronic pain. This longitudinal study aimed to investigate whether alexithymia can predict the improvement of pain severity following a treatment‐as‐usual programme for chronic musculoskeletal pain over and above psychological cofactors (emotional distress, catastrophizing, and self‐efficacy). A consecutive sample of 129 patients with diagnosed chronic musculoskeletal pain referred to two tertiary care centres was recruited and treated for 16 weeks. Clinical pain, psychological distress, self‐efficacy, catastrophizing, and alexithymia were assessed with validated self‐report measures at the first medical visit (T0) and at 16‐week follow‐up (T1). Compared with non‐responder patients (n = 72, 55.8%), those who responded (i.e., reduction of >30% in pain severity; n = 57, 44.2%) reported an overall improvement in psychological variables except alexithymia. Alexithymia showed relative stability between baseline and follow‐up within the entire sample and remained a significant predictor of treatment outcome even when other predictive cofactors (i.e., pain interference, depressive symptoms, and catastrophizing) were considered simultaneously. Our results suggest that identifying patients with a co‐occurrence between alexithymia, depressive symptoms, catastrophizing, and the stressful experience of chronic pain can be clinically relevant in pain prevention and intervention programs. [ABSTRACT FROM AUTHOR]

Objective The statistical analysis typically used to compare pain before and after interventions assumes that scores are normally distributed. The present study evaluates whether numeric rating scale (NRS) scores, specifically NRS-11 scores, are indeed normally distributed in a clinically relevant cohort of adults with chronic axial spine pain before and after analgesic intervention. Methods Retrospective review from 4 academic medical centers of prospectively collected data from a uniform pain diary administered to consecutive patients after they had undergone medial branch blocks. The pain diary assessed NRS-11 scores immediately before injection and at 12 different time points after injection up to 48 hours. D'Agostino–Pearson tests were used to test normality at all time points. Results One hundred fifty pain diaries were reviewed, and despite normally distributed pre-injection NRS-11 scores (K 2 = 0.655, P  = .72), all post-injection NRS-11 data were not normally distributed (K 2 = 9.70– 17.62, P  = .0001–.008). Conclusions Although the results of parametric analyses of NRS-11 scores are commonly reported in pain research, some properties of the NRS-11 do not satisfy the assumptions required for these analyses. The data demonstrate non-normal distributions in post-intervention NRS-11 scores, thereby violating a key requisite for parametric analysis. We urge pain researchers to consider appropriate statistical analysis and reporting for non-normally distributed NRS-11 scores to ensure accurate interpretation and communication of these data. Practicing pain physicians should similarly recognize that parametric post-intervention pain score statistics might not accurately describe the data and should expect articles to utilize measures of normality to justify the selected statistical methods. [ABSTRACT FROM AUTHOR]

Background The availability of multidisciplinary care for the management of chronic pain is uncommon outside specialist clinics. The present study aims to determine the physical intervention use of patients participating in an online psychological pain management program and whether exposure to physical interventions in these patients alters treatment outcomes compared with patients who do not access physical interventions. Methods Data were obtained from 2 previously published randomized controlled trials of an online psychological pain management program. Physical intervention exposure (categories: none, 1–3 sessions, 4+ sessions) was assessed at baseline, after treatment, and at 3-month follow-up. Primary outcomes included depression, anxiety, pain intensity, and pain-related disability. Generalized estimating equation models were used to compare treatment outcomes among those with different physical intervention frequencies and periods of exposure. We assessed whether changes in primary outcomes differed (moderated) by the period and category of physical intervention exposure. Results Of the patients (n  = 1074) who completed the baseline questionnaire across both randomized controlled trials, 470 (44%) reported physical intervention use at baseline, 383 (38%) reported physical intervention use after treatment, and 363 (42%) reported physical intervention use at 3-month follow-up. On average, there were moderate–large reductions from baseline to after treatment with respect to all outcomes (Cohen's d  = 0.36–0.82). For all outcomes, the interaction of time by physical intervention exposure was statistically nonsignificant. Conclusion A substantial proportion of patients who participated in a psychologically informed pain management program were establishing, continuing, or stopping additional physical interventions. The frequency of and period of exposure to physical interventions did not appear to moderate treatment outcomes. Clinical trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12613000252718 and ACTRN12615001003561). The website for registration information is https://www.anzctr.org.au [ABSTRACT FROM AUTHOR]

Purpose: To investigate the experience of working age adults living with chronic post-stroke pain in the United Kingdom (UK). Methods: Semi-structured interviews were conducted with eight working age (46–64 years) UK-based stroke survivors who experience chronic post-stroke pain (≥3 months). The interviews were analysed using interpretative phenomenological analysis. Results: The analysis led to three Group Experiential Themes: "The Solitude of the Pain Experience," "Unsatisfactory Healthcare and the Need for Self-Care" and "The Development of Pain Acceptance." Findings suggest that individuals see their post-stroke pain as an invisible disability, which is overlooked and misunderstood by others. Furthermore, in the absence of a differential post-stroke pain diagnosis, clear, accurate information and alternatives to pharmacological treatments, individuals with post-stroke pain invest their own resources in finding answers and a way to live with the pain. Conclusions: The findings suggest the need for further education on post-stroke pain for healthcare professionals, the consideration of pain in post-stroke assessments, the need for clear differential pain diagnoses and the provision of accurate information to patients. Research is needed to establish non-pharmacological evidence-based treatment approaches, such as pain management programmes, peer support and psychological interventions. IMPLICATIONS FOR REHABILITATION: Post-stroke pain is an invisible disability, difficult to describe to others and therefore often overlooked and misunderstood by others. Differential pain diagnoses should be given to patients with clear explanations of the underlying mechanism, characteristics and prognosis. Treatments other than pharmacology, such as a pain management programmes, peer support, family therapy and psychological interventions, should be considered and patients should be supported in finding a way to live a meaningful life despite the pain. Healthcare professionals, particularly in primary healthcare services would benefit from training on post-stroke pain. [ABSTRACT FROM AUTHOR]

The number of low back pain (LBP) cases is projected to increase to more than 800 million by 2050. To address the substantial burden of disease associated with this rise in prevalence, effective treatments are needed. While clinical practice guidelines (CPG) consistently recommend non-pharmacological therapies as first-line treatments, recommendations regarding manual therapy (MT) in treating low back pain vary. The goal of this narrative review was to critically summarize the available evidence for MT behind these recommendations, to scrutinize its mechanisms of action, and propose some actionable steps for clinicians on how this knowledge can be integrated into a person-centered approach. Despite disparate recommendations from CPG, MT is as effective as other available treatments and may be offered to patients with LBP, especially as part of a treatment package with exercise and education. Most of the effects of MT are not specific to the technique. MT and other interventions share several mechanisms of action that mediate treatment success. These mechanisms can encompass patients' expectations, prior experiences, beliefs and convictions, epistemic trust, and nonspecific contextual effects. Although MT is safer than opioids for patients with LBP, this alone is insufficient. Our goal is to encourage clinicians to shift away from outdated and refuted ideas in MT and embrace a person-centered approach rooted in a comprehensive biopsychosocial framework while incorporating patients' beliefs, addressing illness behaviors, and seeking to understand each patient's journey. [ABSTRACT FROM AUTHOR]

Do five baseline moderators identify patients with chronic low back pain who respond best to cognitive functional therapy (CFT) when compared with usual care? Secondary analysis of the RESTORE randomised controlled trial. A total of 492 adults with low back pain for > 3 months with at least moderate pain-related activity limitation. Participants were allocated to CFT alone or CFT plus biofeedback; these two groups were combined for this secondary analysis. The control group was usual care. The outcome was activity limitation measured using the Roland Morris Disability Questionnaire (RMDQ) at 3, 6, 13, 26, 40 and 52 weeks. Investigated effect modifiers were baseline measures of activity limitation, cognitive flexibility, pain intensity, self-efficacy and catastrophising. Baseline levels of activity limitation and, potentially, cognitive flexibility were associated with different effects of CFT treatment, while pain intensity, self-efficacy and catastrophising were not. Patients who had higher baseline activity limitation had greater treatment effects at 13 and 52 weeks. A person with a baseline RMDQ score of 18 (90th percentile) would on average be 6.1 (95% CI 4.8 to 7.4) points better at 13 weeks if they received CFT compared with usual care. However, a person with a baseline score of 7 (10th percentile) would on average be 3.6 (95% CI 2.6 to 4.6) points better at 13 weeks. The finding that CFT is most effective among patients who are most disabled and incur the greatest burden strongly suggests that CFT should be considered as a treatment for this group of patients. ACTRN12618001396213. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of acupuncture in drinkers with chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS). Methods: We conducted a secondary analysis of a randomized controlled trial across multiple centers, involving 224 drinkers. Patients received either acupuncture or sham acupuncture treatment. The primary outcome was the proportion of responders, defined as participants who had a reduction of 6 points or more from baseline in the National Institute of Health—Chronic Prostatitis Symptom Index (NIH-CPSI) total score at weeks 8 and 32. Secondary outcomes measures included the Global Response Assessment (GRA), International Prostate Symptom Score (IPSS) and International Index of Erectile Function 5 (IIEF-5). Results: One hundred and twelve drinkers were included in each group (n = 224 in total). The proportion of responders in terms of NIH-CPSI was 58.9% versus 40.3% in the acupuncture group (AG) and sham acupuncture group (SAG), respectively, with a statistically significant difference of 18.6% (p = 0.002) at week 8. Higher proportions of responders with respect to NIH-CPSI (p < 0.001 at week 32) and GRA (p < 0.001 at week 8 and p = 0.01 at week 32) were observed in the AG compared with the SAG. No between-group differences were found in the changes in IPSS at any assessment time point. Changes in IIEF-5 score were significantly higher in the AG than in the SAG at weeks 20 and 32, while the difference was not statistically significant at week 8. Conclusion: Acupuncture appeared to alleviate the symptoms of pain among drinkers with CP/CPPS and improve their quality of life, but had no demonstrable effect on urinary tract symptoms or erectile function among these patients. Trial registration number: NCT03213938 (ClinicalTrials.gov) [ABSTRACT FROM AUTHOR]

Chronic pain is a debilitating condition frequently observed in the elderly, involving numerous pathological mechanisms within the nervous system. Diminished local blood flow, nerve degeneration, variations in fiber composition, alterations in ion channels and receptors, accompanied by the sustained activation of immune cells and release of pro-inflammatory cytokines, lead to overactivation of the peripheral nervous system. In the central nervous system, chronic pain is strongly associated with the activation of glial cells, which results in central sensitization and increased pain perception. Moreover, agerelated alterations in neural plasticity and disruptions in pain inhibitory pathways can exacerbate chronic pain in older adults. Finally, the environmental influences on the development of chronic pain in the elderly must be considered. An understanding of these mechanisms is essential for developing novel treatments for chronic pain, which can significantly improve the quality of life for this vulnerable population. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this qualitative study was to utilise the recent Theoretical Framework of Acceptability (TFA) to explore participants' acceptability of the mindfulness and exercise interventions in the MOVE-Online pain management programme (PMP) and the programmes' online delivery method. Methods: Online focus groups were carried out following the completion of the PMP. The data were analysed using template analysis in terms of the seven TFA constructs of acceptability [(i) Perceived Effectiveness, (ii) Affective Attitude, (iii) Self-Efficacy, (iv) Ethicality, (v) Burden, (vi) Opportunity Costs and (vii) Intervention Coherence]. Results: Twenty-one participants took part in the focus groups. Five of the seven TFA constructs of acceptability were identified in the analysis. The participants perceived the intervention to have been effective at achieving the goals of the PMP (TFA construct: (i) Perceived Effectiveness), to have supported their emotional management ((ii) Affective Attitude), promoted long term self-directed engagement ((iii) Self-Efficacy), fostered a valued group environment ((iv) Ethicality) and the online delivery of the programme reduced the physical burden associated with participation at an in-person PMP ((v) Burden). Conclusion: The results of the study supports the utility of the TFA as a tool to explore the multi-dimensional construct of acceptability for the participants in the MOVE-Online programme. IMPLICATIONS FOR REHABILITATION: This investigation contributes to the understanding of acceptability as a complex multidimensional construct and emphasises the importance of considering the multiple dimensions when evaluating participants interpretations of novel complex interventions. Results suggest that participants found a pain management programme delivered in a live, online, interactive format to be acceptable, and it may be useful for rehabilitation professionals as an option for chronic pain management. [ABSTRACT FROM AUTHOR]

IntroductionPurposeMethodsResultsDiscussionConclusionEffective treatment for Complex Regional Pain Syndrome (CRPS), a chronic pain condition, is challenging. Cognitive Multisensory Rehabilitation (CMR) is a cognitive and sensorimotor treatment approach aimed at restoring function that targets cognitive, somatosensory, and multisensory functions through sensory discrimination tasks.We aimed to apply CMR to treat CRPS within our clinical practice. Clinically, we have found promising results in reducing pain and other common features of CRPS, such as Body Perception Disturbances (BPD).In this clinical case series, four CRPS patients who participated in a two-week interdisciplinary CRPS rehabilitation program at the National Complex Regional Pain Syndrome Service in Bath, UK received CMR as part of their treatment. A combination of self-reported measures and clinical outcomes were collected pre and post-rehabilitation program.Functional improvements and a reduction on BPD were observed in all clinical cases.We demonstrate how CMR may improve several CRPS-related features that often hinder rehabilitation in people living with CRPS.Research involving larger cohorts are necessary to provide empirical evidence of the application of CMR in treating CRPS. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the efficacy of five analgesic strategies combined with conventional physiotherapy program (CPT) in managing chronic shoulder pain. Methods: Two authors independently screened studies, extracted data using a pre-formatted chart, and assessed bias using the Cochrane Risk of Bias tool. A network meta-analysis was performed by the Stata 17.0 and R 4.3.2 software. Results: A total of 14 studies with 862 subjects were identified. These analgesic strategies included extracorporeal shock wave therapy (ESWT), suprascapular nerve block (SSNB), corticosteroid injection (CSI), hyaluronic acid injection (HAI), and kinesio taping (KT). ESWT plus CPT was the most efficient intervention in alleviating pain intensity and improving physical function. SSNB plus CPT was the optimal intervention in improving shoulder mobility. Compared to CPT alone, CSI + CPT only significantly improved the SPADI total score, but showed no difference in pain intensity or shoulder mobility. HAI + CPT showed no significant difference in improving pain intensity, physical function, or shoulder mobility compared to CPT alone. Adding KT to CPT did not yield additional benefits in improving shoulder mobility. Conclusion: Overall, in managing chronic shoulder pain, ESWT + CPT was the most effective intervention for reducing pain intensity and improving physical function. SSNB + CPT was optimal for enhancing shoulder mobility. Future rigorous clinical trials with larger sample sizes and higher methodological rigor are strongly required to confirm the current results. [ABSTRACT FROM AUTHOR]

Background: Group allied health interventions for people with chronic conditions may be a solution to increasing access to allied health in primary care. This umbrella review aimed to determine the effectiveness of allied health group interventions to improve health-related outcomes for adults with chronic conditions and the applicability of the findings to the Australian primary health care context. Methods: An umbrella review of systematic reviews conducted April-July 2022, searching eight databases. Systematic reviews were eligible if they included randomised controlled trials (RCT) or quasi-RCTs, community dwelling adults aged ≥ 18, at least one chronic condition, group intervention in scope for allied health professionals, and published in English after 2000. Studies were excluded if interventions were conducted in hospital or aged care facilities, out of scope for allied health, or unsupervised. Results: Two thousand three hundred eighty-five systematic reviews were identified: after screening and full text review 154 were included and data extracted from 90. The chronic conditions included: cancer (n = 15), cardiovascular disease (n = 6), mixed chronic conditions (n = 3), kidney disease (n = 1), low back pain (n = 12), respiratory disease (n = 8), diabetes (n = 14), heart failure (n = 9), risk of falls (n = 5), hypertension (n = 4, osteoarthritis (n = 6) and stroke (n = 8). Most group interventions included prescribed exercise and were in scope for physiotherapists and exercise physiologists. Overall, allied health group exercise programs for community dwelling adults improved health outcomes for most chronic conditions. Aggregated data from the systematic reviews suggests programs of 45–60 min per session, 2–3 times per week for 12 weeks. Lifestyle education and support for people with type-2 diabetes improved glycaemic control. Conclusions: Prescribed group exercise delivered by allied health professionals, predominantly by exercise physiologists and physiotherapists, significantly improved health outcomes for community dwelling adults with a broad range of chronic conditions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Among non-pharmacological interventions, Multiwave Locked System (MLS) Laser therapy has been used in patients with several musculoskeletal pathologies and in combination with other therapeutical interventions. The effects of sole MLS therapy on pain and function in patients with chronic non-specific low-back pain are unknown. OBJECTIVE: The objective of this study was to investigate the effects of MLS Laser therapy on pain, function, and disability in patients with chronic non-specific low back pain in comparison to a placebo treatment group. METHODS: Forty-five patients were randomized into two groups: the MLS Laser group and the Sham Laser group, undergoing 8 sessions of either a MLS Laser therapy or a Sham Laser therapy, respectively. At the beginning of the therapy (T0), at the end of the therapy (T1), and 1 month after the end of therapy (T2) patients were assessed for low back pain (by means of a VAS scale), function (by means of kinematic and electromyographic assessment of a forward bending movement) and self-reported disability (by means of the Roland-Morris and Oswestry Disability questionnaires). RESULTS: There was a significant reduction of pain and disability in both groups at T1 and T2 in comparison with T0. At T2 patients in the MLS group showed a significantly lower pain in comparison with patients in the Sham group (VAS = 2.2 ± 2 vs. 3.6 ± 2.4; p < 0.05). No differences between the two groups were found for function and disability. CONCLUSION: Both MLS Laser and Sham Laser therapies lead to a significant and comparable reduction in pain and disability in patients with chronic non-specific low back pain. However, one month after treatment, MLS Laser therapy has been found to be significantly more effective in reducing pain as compared to sham treatment. [ABSTRACT FROM AUTHOR]

The article presents the Best Practice Information Sheet for health professionals which contains a summary of evidence derived from a systematic review published in "JBI Evidence Synthesis" in 2023 regarding experiences and perceptions of participating in a peer-support intervention (PSI) for chronic non-cancer pain adult patients. It offers recommendations for individuals and organizations involved in running PSIs and a background on chronic pain.

Background: Clinicians make clinical decisions using the dual process theory. The dual process theory comprises two approaches, System 1, based on heuristics, and System 2, involving an analytical and effortful thought process. However, there are inherent limitations to the dual process theory, such as relying on inaccurate memory or misinterpreting cues leading to inappropriate clinical management. As a result, clinicians may utilize mental shortcuts, termed heuristics, and be susceptible to clinical errors and biases that may lead to flawed decision making and diagnosis. Methods: This case series describes four clinical cases whereby the clinicians use distinct strategies to assess and manage complex clinical presentations. Discussion: Through the use of self-reflection and acknowledging diagnostic uncertainty, the clinicians were able to reduce common cognitive biases and provide effective and timely patient care. We discuss strategies that clinicians can implement in their daily practice to improve clinical decision-making processes and deliver quality care. [ABSTRACT FROM AUTHOR]

Objectives: This sequential explanatory mixed-method study aimed to explore chiropractic students' attitudes toward incorporating maintenance care (MC) focused evidence. Methods: Attitudes towards using an evidence-based clinical protocol for maintenance care (MC), the MAINTAIN instrument, were assessed via surveys, monologue responses, dialogues, and qualitative feedback. Participants from a single chiropractic educational institution completed questionnaires evaluating their perspectives on patient-centeredness, chronic pain, and evidence incorporation. Descriptive statistics summarized quantitative data, while content analysis was used for qualitative data. Results: 74.4% (n=419) of students participated, mostly male (57.5%), with an average GPA of 3.15 (out of a maximum of 4.0). Qualitative analysis identified the need to clarify MC terminology and factors motivating students to adopt new evidence, such as quality and alignment with healthcare beliefs. Conclusions: This study's findings emphasize the importance of refining healthcare training strategies, including defining terminology and addressing motivators for evidence incorporation, as evidence for MC for low back pain evolves. [ABSTRACT FROM AUTHOR]

Introduction: Traditional, 8-week, mindfulness-based interventions can effectively treat chronic pain, but require a time and resource investment too burdensome for many patients and providers. The solution to this logistical challenge may be to distill the core, therapeutic elements of an efficacious 8-week, mindfulness-based intervention, Mindfulness-Oriented Recovery Enhancement (MORE), into a 2-h, single-session intervention. Methods: In this study, the authors conducted a waitlist-controlled, randomized clinical trial to assess the impact of a 2-h, single-session adaptation of MORE (i.e., One MORE) on chronic pain patients' (N = 40) pain-related outcomes through 3-month follow-up. Results: Results indicated that One MORE significantly improved chronic pain patients' pain catastrophizing (i.e., primary outcome; F = 9.97, p = 0.002), pain intensity (F = 26.58, p < 0.001), pain interference (F = 39.43, p < 0.001), physical function (F = 16.29, p < 0.001), sleep (F = 16.66, p < 0.001), anxiety (F = 12.54, p < 0.001), and depression (F = 17.48, p < 0.001). One MORE also significantly increased theoretically indicated therapeutic mechanisms through the 3-month follow-up: mindfulness, positive reappraisal, savoring, self-transcendence. Discussion: Study results are promising, and if replicated, would suggest that One MORE is a highly scalable, low-cost (e.g., sustainable), nonpharmacologic treatment for chronic pain. Clinical Trial Registration: NCT05194241. [ABSTRACT FROM AUTHOR]

The Global Task Force on Chronic Pain in HIV published seven research priorities in the field of HIV-associated chronic pain in 2019: (1) causes; (2) management; (3) treatment individualization and integration with addiction treatment; (4) mental and social health factors; (5) prevalence; (6) treatment cost effectiveness; and (7) prevention. The current study used a web-based survey to determine whether the research topics were aligned with the priorities of adults with lived experiences of HIV and chronic pain. We also collected information about respondents' own pain and treatment experiences. We received 311 survey responses from mostly US-based respondents. Most respondents reported longstanding, moderate to severe, multisite pain, commonly accompanied by symptoms of anxiety and/or depression. The median number of pain treatments tried was 10 (IQR = 8, 13), with medications and exercise being the most common modalities, and opioids being viewed as the most helpful. Over 80% of respondents considered all research topics either "extremely important" or "very important". Research topic #2, which focused on optimizing management of pain in people with HIV, was accorded the greatest importance by respondents. These findings suggest good alignment between the priorities of researchers and US-based people with lived experience of HIV-associated chronic pain. [ABSTRACT FROM AUTHOR]

Background. Chronic pain has been investigated in pathophysiology and different mechanisms underlying this condition has been described. Despite the plentiful literature regarding this topic and the different pharmacological treatments proposed, patients often referred inadequate relief from medication. The aim of this narrative review was to investigate the different rehabilitative approach in the management of chronic pain and their efficacy. Methods. A systematic narrative review has been conducted considering randomize controlled trials and systematic reviews published within the past 5 years. Results. 13 papers on chronic pain and 6 papers on nociplastic pain has been described in the main aspects analyzed. Conclusions. No one treatment appears to be more effective than another but often it is the combination of several treatments that gives the best results. More studies, evaluating in particular specific exercises with clear proprioceptive elements, should be conducted to best analyzed their role in the management of chronic pain. Clin Ter 2024; 175 (5):337-345 doi: 10.7417/CT.2024.5139 [ABSTRACT FROM AUTHOR]

The article highlights the impact of wound pain on patients with hard-to-heal wounds, noting that it can lead to physical, psychological, and social challenges, ultimately affecting treatment adherence and quality of life. Topics include the benefits of microcurrent electrical stimulation therapy (EST) as a non-pharmacological approach to reduce pain and promote healing, the challenges in managing chronic wounds and the importance of addressing both budgetary and compliance issues.

(1) Background: This cohort study aimed to evaluate the effect of patients' treatment expectations on pain perception changes following manual therapy cervical manipulations in individuals with chronic mechanical neck pain. (2) Methods: Demographic data were collected by 56 subjects who were asked to fill out the Neck Disability Index (NDI) and the Expectations for Treatment Scale (ETS). All patients received one single cervical manipulation, and pressure pain thresholds (PPTs) were measured before and immediately after the manipulation with a digital algometer. (3) Results: A total of 56 patients participated. Most subjects (62.5%) had high treatment expectations according to the ETS scale. Statistically significant increases in PPTs were noted both locally and in remote areas (p < 0.05), with 37.5–48.2% of participants showing clinically significant changes in pain perception. However, no statistically significant correlation was found between high treatment expectations and increased PPTs (p > 0.05). (4) Conclusions: Although a significant reduction in pain perception was observed, it did not correlate with patients' treatment expectations. Future research for further investigation of this hypothesis by comparing real versus sham treatment and exploring additional mechanisms affecting changes in PPTs after cervical manipulations in this population will contribute to a better understanding of the research question. [ABSTRACT FROM AUTHOR]

Background/Objective: Pain is one of the most common chronic conditions in the US, estimated to affect 20.9% of the population (51.6 million people). We evaluated the Partners Aligned in Transformative Healing (PATH) program at University Medical Center's Comprehensive Pain Program clinic. Feasibility, initial clinical and financial results were assessed to inform payers' support for PATH, an integrative transdisciplinary program within a bundled payment format. Methods: Participants completed a multi-week program including integrative therapies, with empirically validated assessment surveys administered at the beginning and end of the program. Insurance claims data were analyzed 12 months pre- and post-program. Statistical significance of pre-post differences was assessed by paired T-tests with P < 0.05. Results: Between June 2019 and August 2022, 170 individuals enrolled in PATH, 151 (88.8%) completed the program, and 121 participants completed outcome surveys. Participants were predominately White, non-Hispanic (98%), female (76%), with an average age of 49.8. All participant-reported clinical outcomes (PROs) showed statistically significant improvement from baseline to final assessment, and some but not all were clinically significant. PEG subscale of average pain interference, enjoyment of life, and interference with general activity each decreased. The T-scores for the following domains of PROMIS-29 decreased: Pain interference; fatigue; sleep disturbance; anxiety, and depression. The PROMIS-29 domains of overall physical function and social roles and activities mean T-scores increased. Per Member Per Month (PMPM) total cost of care decreased by $462 (18%). Emergency room utilization for all diagnoses decreased by 457 visits/1000 patients (65%), and for pain-related diagnoses by 194 visits/1000 patients (67%) during the observation period. Conclusions: Results suggest that the PATH Program is a feasible and acceptable model that shows initial effectiveness relative to short-term patient-reported clinical outcomes and shows signs of durability in both utilization and financial outcomes at 1 year. The results support continued study including a multi-site RCT. [ABSTRACT FROM AUTHOR]

Background: Approximately one-half of all adults with HIV experience chronic pain. Needed are nonpharmacological approaches to improve pain management in this population. Methods: For this study, we conducted in-depth qualitative interviews (n = 20) with thirteen adults with HIV and 7 HIV care providers regarding their perceptions of Tai Chi for chronic pain management. The interviews were audio recorded, transcribed, double-coded, and analyzed using applied thematic analysis. Results: HIV patients had limited prior exposure to Tai Chi and had not previously considered this practice for pain management. However, after viewing a brief video demonstration of Tai Chi, patients recognized potential benefits, including relaxation, stress reduction, and pain lessening. Patients were surprised by the gentle nature of Tai Chi and expressed enthusiasm to learn more about Tai Chi. HIV healthcare providers similarly had limited knowledge of Tai Chi for pain management. HIV care providers shared several helpful insights on the potential implementation of Tai Chi with this population. Conclusions: Adults with HIV and healthcare providers were optimistic that Tai Chi would reduce stress and ease chronic pain. These data suggest that Tai Chi would be of interest to HIV patients and care providers as a novel pain management strategy. [ABSTRACT FROM AUTHOR]

This paper presents a case of a 35-year-old female patient diagnosed with Complex Regional Pain Syndrome (CRPS) type I and treated over a two-month period with a novel low-frequency sound-transduced focal pulsed stimulus. The patient received 21 treatments consisting of focally applied sound sweeps in the 15–100 Hz range. Outcome measures included the Visual Analogue Scale for pain, five physical assessment parameters, medication, and the Pain Catastrophizing Scale. A follow-up was conducted at six months. The results show that the patient's low-back pain level was substantially reduced after treatment and after six months. CRPS-related peripheral pain was strongly reduced but had some rebound after six months. The low-frequency sound-transduced focal pulsed stimulus shows potential as a non-invasive treatment for CRPS and deserves controlled clinical trials. [ABSTRACT FROM AUTHOR]

Chronic pain is a complex condition that significantly impacts patients' quality of life and presents a substantial burden on healthcare systems. This paper reviews innovative approaches to chronic pain management, addressing existing pharmacological options and integrating therapies. In the context of emerging pharmacological treatments, including biologics and novel analgesics, targeted pain pathways are evaluated for their potential to provide more effective and reliable pain relief. Additionally, advancements in neuromodulation techniques, such as sleep-inducer rope provocation and Transcutaneous Electrical Nerve Stimulation (TENS), are explored for their role in modulating pain signals and reducing reliance on opioids. The integration of behavioral health sciences through mobile technology and wearable devices is examined for their ability to enhance patient self-management and facilitate real-time pain monitoring. Furthermore, this paper discusses the importance of combining various branches of care models that integrate medical, psychological, and physical therapy approaches to address the multifactorial nature of chronic pain. Case studies and objective challenges are reviewed to highlight the effectiveness and obstacles of these innovative approaches. By adopting a holistic and patient-centered perspective, this paper aims to provide a comprehensive understanding of future directions in chronic pain management, emphasizing the need for ongoing research and collaboration with healthcare professionals to improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

This field report describes the accessibility and perceived effectiveness of a free acupuncture program among a group of predominantly low-income Hispanic/Latino adults. Surveys, developed based on the Levesque Conceptual Framework of Access to Health Care, were administered to clients. Baseline (n = 245) and 6-week follow-up (n = 79) surveys were analyzed to document early program findings. A majority of clients were Hispanic/Latino (72.7%) and female (73.1%). Most reported their original pain complaint was treated very well/well (98.7%). Clients reported an average 1.2 points pain level decrease (scale 1–10) at follow-up (p < 0.0001). Early program results suggest this acupuncture program was accessible and well received by low-income Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

Background and Aims: Opioid use disorder often co‐occurs with chronic pain but assessment and treatment of these co‐occurring disorders is complex. This review aims to identify current treatments and delivery models for co‐occurring chronic pain and opioid use disorder (OUD) documented in the scientific literature. Design: Scoping review. Methods: The review was conducted in six databases in June 2022 (no time limit): CINAHL, PsycINFO, Web of Science, Cochrane, PubMed and Embase. The PRISMA‐ScR checklist was used to guide reporting. Results: Forty‐seven publications addressing the issue of co‐occurring chronic pain and OUD management were included. Randomized controlled trials provide evidence for the effectiveness of opioid agonist treatments (OAT) such as methadone or buprenorphine/naloxone, as well as for combining OAT with Mindfulness‐Oriented Recovery Enhancement or cognitive behavioural therapy. A number of other pharmacological treatments (opioid and nonopioid), nonpharmacological treatments (e.g. physiotherapy) and service delivery models (e.g. simultaneous treatment of comorbidities, interdisciplinary and interprofessional collaboration) are also underlined. In most cases, authors recommend a combination of strategies to meet patient needs. Conclusions: The scoping review reveals gaps in evidence‐based knowledge to effectively care for co‐occurring chronic pain and OUD, but several experts recommend the uptake of known 'best' practices such as integrated treatment of the multiple biopsychosocial dimensions of the co‐occurring disorders as well as collaborative interdisciplinary work. Clinical Relevance: Improving services is dependent on alleviating barriers such as working in silos, the costs associated with nonpharmacological treatments, and the double stigma associated with pain in people with a substance use disorder. [ABSTRACT FROM AUTHOR]

Background Several factors seem to be related to the use of healthcare services, and chronic pain (CP) is among these characteristics. The objective is to describe the number of visits to a doctor's surgery or emergency rooms, and the periods of hospitalization; to identify characteristics associated with frequent healthcare use, including disabling chronic pain (DCP) and non-disabling chronic pain (n-DCP). Methods Representative population-based cross-sectional study of 6569 people older than 16 years from southern Spain was collected. The frequency of visits to a doctor's surgery or emergency rooms and periods of hospitalization were defined as at or above the 90th percentile. Binary logistic regression analyses were conducted separately on women and men to identify characteristics associated with being frequent visitors. Results People with DCP are more frequent visitors to a doctor's surgery and emergency rooms and endure longer periods of hospitalization compared to people with n-DCP and without pain. In logistic regression models, people with DCP are twice as likely to over-visit a doctor's surgery; to endure longer periods of hospitalization and more visits to an emergency room service. No relationship was found in n-DCP. Conclusions Disability seems to modulate a greater use of health services among the population with CP, doubling it when compared to n-DCP and n-CP, both in women and men. Understanding the role of disability in the use of healthcare services for individuals with CP allows for the identification of needs and strategies to optimize resources. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to understand the impact of pain management programmes, focusing on the unwanted effects and their influence on patients' long-term use of self-management strategies. Design: Qualitative study. Setting: Specialist musculoskeletal hospital in North London, England. Participants: Patients with chronic musculoskeletal pain that have completed a pain management programme. Intervention: Multidisciplinary pain management programmes. Main measures: Data were collected regarding patients' experiences and unwanted effects from the pain management programme using semi-structured interviews. Data were analysed using thematic analysis. Results: Fourteen participant interviews were included in the analysis (median age 54 years, 12 females). Four themes were generated from the data: Benefits and burdens, Pain management programme and real life, Social support and Healthcare interventions. Unwanted effects included heightened anxiety related to negative interactions with peers, being in a new environment, worries about ability to cope with the programme, social anxiety from being in a group, the strain on families due to participants being away from home and a sense of abandonment at end of the programme. Burdens associated with implementing pain management strategies were identified, including the emotional burden of imposing their self-management on close family and competing demands with time and energy spent on self-management at the expense of work or home commitments. Conclusions: Pain management programmes have an important role in helping patients to learn how to self-manage chronic pain. Their unwanted effects and the treatment burdens associated with long-term self-management may be an important consideration in improving the longevity of their beneficial effects. [ABSTRACT FROM AUTHOR]

Objective: To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-specific low back pain. Design: Randomised placebo-controlled study with three intervention groups. Setting: The patients recruited for this study were sent for physiotherapy treatment at primary care between May and July 2022. Participants: Eighty-one patients with chronic non-specific low back pain aged 18–80 years with pain for ≥3 months and pain intensity ≥3 were randomly recruited for the study. Intervention: The patients received a single intervention of radial shockwave therapy with 2000 discharges at 100 mJ energy and 5 Hz frequency using concave or convex tips or placebo treatment. Main measures: The primary outcome was pain intensity immediately post-intervention. The secondary outcomes were pressure pain threshold, temporal summation of pain, and functional performance. Data were collected at baseline and post-intervention. Results: The post-intervention pain intensity in the concave tip group is an average of two points lower (95% CI = −3.6, −0.4; p < 0.01) than that in the placebo group. The post-intervention pressure pain threshold for the concave tip group was an average of 62.8 kPa higher (95% CI = 0.4, 125.1; p < 0.05) than for the convex tip group and 76.4 kPa higher (95% CI = 14, 138.7; p < 0.01) than in the placebo group. Conclusion: The concave tip shockwave therapy is effective in reducing pain and local hyperalgesia in patients with chronic non-specific low back pain. [ABSTRACT FROM AUTHOR]

Chronic pain syndromes affect over one-third of the US adult population and often lead to significant disability and a reduced quality of life. Despite their high prevalence, causal links between chronic pain syndromes and anatomic abnormalities are often not apparent. Most current chronic pain treatments provide modest, if any, relief. Thus, there is a pressing need to understand the causal mechanisms implicated in chronic pain as a means to develop more targeted interventions for improvement in clinical outcomes and reduction in morbidity and financial burden. In the present manuscript, we summarize the current literature on treatment for chronic pain, and hypothesize that nonspecific chronic back pain (without a clear organic etiology, such as tumors, infections or fractures) is of psychophysiologic origin. Based on this hypothesis, we developed Psychophysiologic Symptom Relief Therapy (PSRT), a novel pain reduction intervention for understanding and treating chronic pain. In this manuscript, we provide the rationale for PSRT, which we have tested in a pilot trial with a subsequent larger randomized trial underway. In the proposed trial, we will evaluate whether non-specific chronic back pain can be treated by addressing the underlying stressors and psychological underpinnings without specific physical interventions. [ABSTRACT FROM AUTHOR]

Background and purpose. Low back pain (LBP) is a common health problem that hinders patients' daily activities. During hip physical examination on LBP patients, gluteus medius (GMed) weakness and tenderness were found. Therefore, in patients with non-specific chronic low back pain (NSCLBP), this study examined the effect of adding specific GMed strengthening to the APTA-guided program on pain, back disability, GMed macromorphology, strength, and functional performance. Methods. This study is a randomized controlled trial involving 58 patients with NSCLBP aged between 20 and 45 years. The pain was measured by a numerical pain rating scale, functional disability was estimated by the Oswestry disability index, and Ultrasonography evaluated GMed thickness. A hand-held dynamometer measured GMed strength, and its functional performance was assessed by a single-leg squat test (SLST). Patients were randomly assigned to group A received the APTA program and group B received the same program plus selected GMed strengthening. Results. For groups A and B, the percentage of change in pain was 40%, and 66.67% and that of disability level was 45.24%, and 61.5%, in favor of group B. The between-group comparison revealed significant differences for pain (p = 0.001) but not for functional disability (p = 0.12). There was a significant difference in GMed thickness for average relaxed (p = 0.009), and average contracted (p = 0.043) in both groups post-treatment but not for activation (p = 0.063). GMed strength changed by 13.1% and 21.8% in groups A and B respectively but no significant differences were observed between groups (p = 0.44). The percentage of change in the SLST was 20.6% and 58.8% for Groups A and B respectively, with a significant between-group comparison (p = 0.04). Conclusions. GMed strengthening exercises improved GMed macromorphology, reduced disability, and pain, and enhanced functional performance. It may therefore be advised that patients with NSCLBP incorporate strengthening of the GMed muscle in their treatment program. Study registration. This study was registered in ClinicalTrials.gov (NCT05521165). [ABSTRACT FROM AUTHOR]

Objective: The Non-Opioid Pain Alleviation Information Network (NOPAINMN) project was designed to identify, consolidate, and map evidence-based non-opioid and non-pharmacological pain management complementary and integrative health (CIH) modalities for chronic pain management across Minnesota into a searchable and informational website (www.nopainmn.org ). Methods: The Academic Consortium for Integrative Medicine & Health's Pain Task Force White Paper identifying evidence-based research of non-pharmacological pain practice (NPPC) was reviewed and referenced. National and state certifying boards and accrediting organizations for NPPC modalities were accessed to identify Minnesota-based NPPC providers' name, business/health-system affiliation, address, contact information, and credentials. The NOPAINMN website displays these data in a consumer-facing website with searchable fields such as NPPC modality type, and location with varying distances. The website was β-tested by practitioners and stakeholders for optimization. Eight main NPPC modalities and their respective subcategories were identified and mapped: Acupuncture; Integrative Medical Care (Functional medicine consultation and Integrative medicine consultation); Massage Therapy; Mind–Body Therapies (Biofeedback, Clinical Hypnosis, Mindfulness-Based Stress Reduction, and Music Therapy); Movement Therapies (Tai Chi, qigong, and Yoga Therapy); Psychology (Cognitive Behavioral Therapy); Rehabilitative Therapies (Physical and Occupational Therapy); and Spinal Manipulation. Results: All information compiled resulted in 17,155 providers/practitioners. Physical Therapy had the greatest number of reported providers (n = 5224), followed by Occupational Therapy (n = 3792), Psychology (n = 3324), Chiropractic (n = 3033), Acupuncture (n = 591), and Massage Therapy (n = 544). The Resource Map included 56 major health systems, 686 facilities, 2651 solo or private group practices, and 14 academic training schools. With web-based cross-referencing, providers and facilities were affiliated and linked with health systems to produce an interconnected mapping system. β-Testing with patients found that the website was reported as relatively easy to use and informative. Conclusion: The website was created to assist individuals, health care providers, insurance carriers, and health care facilities in finding evidence-based information and resources on NPPC to guide, support, and proactively manage and engage chronic pain patients across Minnesota. [ABSTRACT FROM AUTHOR]

Background: Aberrant movement in chronic low back pain (CLBP) is associated with a deficit in the lumbar multifidus (LM) and changes in cortical topography. Anodal transcranial direct current stimulation (a‐tDCS) can be used to enhance cortical excitability by priming the neuromuscular system for motor control exercise (MCE), thereby enhancing LM activation and movement control. This study aimed to determine the effects of a 6‐week MCE program combined with a‐tDCS on cortical topography, LM activation, movement patterns, and clinical outcomes in individuals with CLBP. Methods: Twenty‐two individuals with CLBP were randomly allocated to the a‐tDCS group (a‐tDCS; n = 12) or sham‐tDCS group (s‐tDCS; n = 10). Both groups received 20 min of tDCS followed by 30 min of MCE. The LM and erector spinae (ES) cortical topography, LM activation, movement control battery tests, and clinical outcomes (disability and quality of life) were measured pre‐ and post‐intervention. Results: Significant interaction (group × time; p < 0.01) was found in the distance between LM and ES cortical locations. The a‐tDCS group demonstrated significantly fewer discrete peaks (p < 0.05) in both ES and LM and significant improvements (p < 0.05) in clinical outcomes post‐intervention. The s‐tDCS group demonstrated a significant increase (p < 0.05) in the number of discrete peaks in the LM cortical topography. No significant changes (p > 0.05) in LM activation were observed in either group; however, both groups demonstrated improved movement patterns. Discussion: Our findings suggest that combined a‐tDCS with MCE can separate LM and ES locations over time while s‐tDCS (MCE alone) reduces the distance. Our study did not find superior benefits of adding a‐tDCS before MCE for LM activation, movement patterns, or clinical outcomes. [ABSTRACT FROM AUTHOR]

The onset of the coronavirus disease 2019 (COVID-19) necessitated a rapid transition to virtual care for chronic pain treatment. This study examined experiences of patients and caregivers who received virtual multidisciplinary pain treatment (MDT) for pediatric chronic pain between March 2020 and August 2021. A mixed methods design was implemented using qualitative interviews and quantitative satisfaction surveys. Satisfaction surveys were administered to a convenience sample of patients (aged 8 to 18; N = 20) and their caregivers (N = 20) who received MDT through an outpatient hospital pediatric chronic pain program. Interviews were conducted with a subset of these patients and their caregivers (n = 6). Analysis of interviews revealed four themes: 1) benefits of virtual care; 2) challenges of virtual care; 3) recommendations and evaluation of virtual care; and 4) patient preferences. Analysis of the satisfaction survey data revealed that while patients and caregivers were satisfied with many aspects of virtual care, 65% (n = 13) of patients reported a preference for in-person appointments, with caregivers showing equal preference for in-person and virtual appointments, though this was a non-significant difference (p =.37). Overall, both patients and caregivers stated a stronger preference for in-person physiotherapy sessions but were willing to have psychology sessions provided virtually. Finally, the most reported preference was for a hybrid model of care incorporating at least some in-person contact with providers. This study provides a rich exploration of virtual care for multidisciplinary pediatric chronic pain treatment. The current results may inform the future development of guidelines for virtual care delivery with pediatric chronic pain populations. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) and chronic low back pain (CLBP) are frequently co-morbid. Some research suggests that PTSD and CLBP may share common neurobiological mechanisms related to stress. Traditional biomedical education may be ineffective for PTSD and CLBP, especially when co-morbid. The purpose of this study is to determine if pain neuroscience education (PNE) is more effective than traditional education in reducing PTSD, disability, pain, and maladaptive beliefs in patients with CLBP. Participants with CLBP and possible PTSD/PTSD-symptoms were recruited for this study. Participants were randomly allocated to a PNE group or a traditional education group. The intervention included 30 minutes of education followed by a standardized exercise program once a week for 4-weeks with a 4 and 8-week follow-up and healthcare utilization assessed at 12-months. Forty-eight participants consented for this research study with 39 allocated to treatment (PNE n = 18, traditional n = 21). PNE participants were more likely to achieve a clinically meaningful reduction in PTSD symptoms and disability at short-term follow-up. At 12-months, the PNE group utilized healthcare with 76% lower costs. In participants with CLBP, PNE may reduce hypervigilance toward pain and improve PTSD symptoms. Participants who received PNE were more confident body-tissues were safe to exercise. These beliefs about pain could contribute to a decrease in perceived disability and healthcare consumption for CLBP. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to understand connections between pain, caregiving, physical and behavioral health treatment needs, and motivations for prescription opioid use among child caregiving women with chronic pain. Methods: We conducted in-depth, semi-structured interviews with 12 women (average age 48 years; 58% Black) in child caregiving roles, including women who were pregnant or trying to become pregnant and were caring for children or grandchildren < 18 years, and who received treatment at an outpatient pain management clinic. We used thematic text analysis to identify qualitative themes related to caregiving, pain, treatment, substance use, coping strategies, and sources of support. Results: A diverse sample of women reported high levels of stress and pain, substance use, interpersonal violence, depression, and financial strain. Most described difficulties at work, interacting with children or grandchildren, and engaging routine, daily activities due to their pain. Most indicated that they spent less time with family and friends due to their pain and had limited sources of support to help them navigate both caregiving and pain. Many described barriers to receiving appropriate healthcare, including prescription opioids, due to stigma or logistics, though most also reported positive healthcare experiences. Women also reported added daily-life, physical, mental health, and interpersonal stressors and difficulty navigating the healthcare system to receive needed care. Discussion: For women with chronic pain in child caregiver roles, results highlight the importance of care tailored to the physical needs of child caregiving and of trauma-informed approaches given the prevalence of comorbid conditions and trauma. Significance: What is already known on this subject?: There are complex associations between chronic pain, trauma, mental health, and opioid and other substance use which may be exacerbated in the context of child caregiving. What this study adds?: Few studies have obtained women's own perspectives on their experiences and needs in the context of child caregiving and chronic pain which is critical to informing treatment options and intervention priorities. Qualitative interviews revealed unique and combined impacts of child caregiving and chronic pain on mental health, relationship quality, coping capabilities and strategies, prescription opioid misuse and the overlap of traumatic experiences with each of the themes. [ABSTRACT FROM AUTHOR]

Background Chronic hip pain is one of the most common and difficult-to-treat causes of disability. Our study's primary aim was to investigate the effects of ultrasound and fluoroscopy-guided radiofrequency thermocoagulation of the femoral and obturator nerve articular branches on chronic hip pain, and the secondary aim was to determine its effects on hip function and quality of life. Methods Fifty-three patients with hip pain lasting more than three months were enrolled in the study. VPS scale and WOMAC, SF-12 questionnaires were applied to the patients before and in the first, third, and sixth months following the procedure. Results Of the patients, 60.4% were female, and 39.6% were male. Hip pain was caused by osteoarthritis in 77.1%, postoperative hip pain in 12.5%, malignancy in 8.3%, and avascular necrosis in 2.1%. The VPS scores were 8.9 ± 1.1 (mean±SD) in the baseline period, 2.4 ± 2.5 in the first postoperative week, 3.8 ± 2.5 in the first month, 5.1 ± 2.8 in the third month, and 5.8 ± 2.7 in the sixth month, with a significant decrease in VPS score (P  < .001). One patient developed a motor deficit that improved spontaneously. Conclusions We concluded that radiofrequency thermocoagulation application to the articular branches of the femoral and obturator nerves provides pain relief, hip function improvement, and better quality of life (better physical component scores but no improvement in mental component scores in SF-12) for up to 6 months in chronic hip pain. [ABSTRACT FROM AUTHOR]

BACKGROUND: Specific stabilisation exercises (SSE) can combat the debilitating effects of chronic non-specific low back pain (CLBP), improve disability, pain and fear-avoidance beliefs (FAB). OBJECTIVE: To elicit the determinants of outcome in patients with CLBP with associated FABs after treatment with SSE. METHOD: Twenty-nine patients (20 females) with CLBP were classified using FAB questionnaire into high or low Work and Physical Activity (PA) subscales. After 4-week treatment, evaluations were done for pain, disability and lumbar spine active range of motion (AROM). Data was analysed exploratory-descriptively with a significance level set at p < 0.05. RESULTS: Participants were aged 55.24 ± 11.91 years. They scored 19 (65.5%) and 5 (17.2%) respectively on Work and PA subscales. The post-intervention evaluation showed significant differences in all outcomes, but no significant difference between patients with high or low FAB scores for both subscales. PA scores correlated significantly with pain while work scores correlated significantly with disability. Participants' gender predicted disability, pain and AROM with moderate to large effect sizes. CONCLUSION: SSE can potentially improve disability, pain and range of motion for patients with chronic low back pain regardless of FABQ status. Gender and baseline patient status are potential determinants of outcome of treatment using SSE. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tools, such as the STarTBack Screening Tool (SBT), have been developed to identify risks of progressing to chronic disability in low back pain (LBP) patients in the primary care population. However, less is known about predictors of change in function after treatment in the specialty care population. OBJECTIVE: We pursued a retrospective observational cohort study involving LBP patients seen in a multidisciplinary specialty clinic to assess which features can predict change in function at follow-up. METHODS: The SBT was administered at initial visit, and a variety of patient characteristics were available in the chart including the presence of chronic overlapping pain conditions (COPCs). Patient Reported Outcomes Measurement Information System-10 (PROMIS-10) global physical health (PH) and global mental health (MH) were measured at baseline and at pragmatic time points during follow-up. Linear regression was used to estimate adjusted associations between available features and changes in PROMIS scores. RESULTS: 241 patients were followed for a mean of 17.0 ± 7.5 months. Mean baseline pain was 6.7 (SD 2.1), PROMIS-10 global MH score was 44.8 (SD 9.3), and PH score was 39.4 (SD 8.6). 29.7% were low-risk on the SBT, 41.8% were medium-risk, and 28.5% were high-risk. Mean change in MH and PH scores from baseline to the follow-up questionnaire were 0.86 (SD 8.11) and 2.39 (SD 7.52), respectively. Compared to low-risk patients, high-risk patients had a mean 4.35 points greater improvement in their MH score (p = 0.004) and a mean 3.54 points greater improvement in PH score (p = 0.006). Fewer COPCs also predicted greater improvement in MH and PH. CONCLUSIONS: SBT and the presence of COPC, which can be assessed at initial presentation to a specialty clinic, can predict change in PROMIS following treatment. Effort is needed to identify other factors that can help predict change in function after treatment in the specialty care setting. [ABSTRACT FROM AUTHOR]

Previous research supports music therapy's benefits for addressing acute pain intensity in various populations. However, few studies have investigated music therapy's impact on clinically relevant patient-reported outcomes (PROs) among individuals with chronic pain. Authors held multiple meetings focused on existing theoretical frameworks, published recommendations regarding core outcomes, and their own clinical practice and research among individuals with chronic pain. Recommendations are presented using sickle cell disease (SCD) as an exemplar condition. Music therapists working in hospitals that serve individuals with SCD have a unique opportunity to build therapeutic relationships over multiple hospitalizations and help these individuals develop self-management strategies for addressing chronic pain and improving quality of life. To assess the impact of their interventions, music therapists working with people with chronic pain conditions may benefit from using PROs focused on pain interference, self-efficacy, pain catastrophizing, and physical, emotional, and social functioning. PRO selection should ensure that measures are (a) relevant to the population's specific needs; (b) appropriate to individuals' developmental and health literacy levels; (c) appropriate to individuals' culture, environment, and socio-economic status; and (d) not overly burdensome. According to the Theory of Self-Care Management for SCD, music therapy can serve as a self-care management resource for improving self-efficacy and mediating the relationship between vulnerability factors and health outcomes. Accordingly, it is important for appropriate PROs to be used within practice and research to capture these important domains and improve our understanding of how music therapy can help individuals with chronic pain achieve meaningful outcomes. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is persistent or recurrent pain lasting longer than 3 months. The experience of temporomandibular disorder (TMD)‐related pain is modulated by emotional and social factors, with mindfulness encapsulating these aspects. Objective: To investigate the association between cognitive‐behavioural‐emotional characteristics, mindfulness and the painful experience in women with chronic pain‐related TMD. Methods: A cross‐sectional study was conducted, including 90 women aged between 18 and 61 years old, diagnosed with chronic pain‐related TMD according to the Diagnostic Criteria for Temporomandibular Disorder, considering both temporomandibular joint and muscle pain. Specific instruments were employed to assess cognitive‐behavioural‐emotional aspects. The Mindful Attention Awareness Scale and the Five Facets of Mindfulness Questionnaire scales evaluated the level and construct of mindfulness. The relationship between variables was analysed using bivariate association tests (.05 > p <.20), followed by multiple regression tests (p <.05). Results: The heightened experience of pain correlated with increasing age, a low level of education, the attribution of the locus of control by chance, and lower levels of mindfulness (p <.05). The heightened experience of pain was negatively influenced by mindfulness levels (p <.05). On the other hand, the painful experience was mainly influenced by facets describing negative formulation, distraction, non‐reactivity and non‐judgement (p <.05). Conclusion: Demographic, cognitive‐behavioural‐emotional data and levels of mindfulness and its facets presented different influence weights on the painful experience. These findings provide support for future studies focusing on mindfulness strategies, education and pain management in women with chronic pain‐related TMD. [ABSTRACT FROM AUTHOR]

Purpose: The viewpoint essay focusses on the significance of integrated care (IC) for chronic pain in India, in an attempt to reflect on how pain management and care can be made more accessible and available to patients. Design/methodology/approach: This reflective essay invites looking at chronic pain beyond biomedical perspectives. Insights from the medical humanities and the social sciences are used to emphasise chronic pain as a psychosocial and socio-political phenomenon and not just a biomedical category. Findings: The essay argues that there are several challenges and barriers to the recognition and validation of chronic pain as a speciality. Originality/value: IC has not received sufficient attention in the Indian context, where medical curricula and training do not sufficiently include an understanding of the multi-faceted aspects surrounding chronic pain. By highlighting the role of humanistic approaches to effectively bridge the gap, this viewpoint essay illustrates the significance of drawing on an integrated or holistic healthcare framework. [ABSTRACT FROM AUTHOR]

(1) Background: Acute pain in hospitalized children remains under-recognized and under-treated. Our objective is to benchmark pain assessment, documentation, treatment, and patient experience in children admitted to a US children's hospital. (2) Methods: A cross-sectional, mixed-method survey of pain for children hospitalized ≥24 h. Charts were reviewed for modalities of pain assessment and treatment for all inpatients. If pain was documented, patients/caregivers were surveyed regarding their experience with pain and its management. (3) Results: Chart review: All 107 patients had ≥1 pain score documented. A total of 47 patients had a pain score ≥0, 35 (74.5%) of whom had ≥1 moderate-severe score. Seventy (65.4%) patients received ≥1 intervention for pain, including medications from ≥1 class (e.g., opioids) (n = 55, 51.4%) and/or integrative/non-pharmacologic intervention(s) (n = 39, 36.4%). There were assessment and documentation gaps. Patient survey: A total of 39 (83.0%) interviews were attempted; 25 (53.2%) were completed. The worst pain was mostly caused by acute illness (n = 13, 52%) and painful procedures (n = 10, 40%). Suggestions for improvement included increasing the use of integrative modalities and optimizing patient–clinician communication. (4) Conclusions: All patients admitted ≥24 h had ≥1 pain score documented; however, gaps in documentation were common. Multimodal treatment and integrative modalities were underutilized. Procedures were a frequent cause of under-treated pain, prompting an institution-wide quality improvement project. [ABSTRACT FROM AUTHOR]