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Background: The association between home mindfulness practice quantity in standard length mindfulness-based interventions (MBIs) and chronic pain outcomes is variable. Few studies focus on abbreviated MBIs (< 8 weeks) and distinguish between formal guided practices and informal practices in daily life. Objectives: To characterize home mindfulness practice and explore associations between home practice quantity and pre-to-post-outcome changes after an MBI for chronic pain. Methods: In this single-arm study, 21 adults with chronic pain (mean age = 54 years, 81% White, mean pain duration = 7 years) completed an MBI with four weekly group sessions. Pre and post self-report measures of pain intensity/interference, physical function, depression, anxiety, positive affect, sleep disturbance (all PROMIS measures), and pain acceptance, catastrophizing, perceived stress and mindfulness were completed, along with daily surveys of formal (mindfulness of breath, body scan) and informal (breathing space, mindfulness of daily activities) practice. Bivariate correlations and multivariable regression models were used to assess the association between days and minutes of practice and change in outcomes. Results: On average, formal practice was completed on 4.3 days per week and 13.5 minutes per day. Informal practice was completed on 3.5 days per week and 8.6 minutes per day. Formal practice was not significantly correlated with outcomes (Spearman's ρ = |.01|-|.32|), whereas informal practice was correlated with multiple outcomes (ρ = |.04|-|.66|). Number of days practiced informally was associated with improved pain interference, physical function, sleep disturbance, and catastrophizing (p 's ≤.05). Number of minutes practiced informally was associated with improved pain interference, anxiety, positive affect, and catastrophizing (p 's ≤.05). Conclusion: Informal home practice quantity, but not formal practice quantity, is associated with improved outcomes during an abbreviated MBI for chronic pain. For these MBIs, it is important to evaluate the distinct roles of formal and informal practice. ClinicalTrials.gov Registration: NCT03495856. [ABSTRACT FROM AUTHOR]

Background: Menopause is a stage in a woman's physiology where several chronic illnesses begin to appear, compromising both the quality and quantity of their life. It has been postulated that a decrease in estrogen levels in women may be important for accelerated disc degeneration in postmenopausal women. The overall prevalence of LBP is 52% higher in perimenopausal women with osteoporosis which is considered to be one of the predominant factors for low back pain in women. There are many modalities like Interferential therapy, ultrasound therapy, and transcutaneous electrical nerve stimulation, that treat nonspecific back pain with varying results, some advanced electrotherapy modalities like shockwave, low-level laser therapy, Matrix Rhythm Therapy (MaRhyThe) also proved to be effective in reducing the nonspecific chronic low back pain. Matrix Rhythm Therapy was invented by Dr. Med. Ulrich Randoll (1987–1999) at the University of Erlangen, Germany. Matrix Rhythm Therapy includes a wand with a resonating head that oscillates at the frequency of 8-–12 Hz and is connected to the machine with a connecting cable (U.G Randoll p18 The Principles of Matrix Rhythm Therapy – MaRhyThe 3rd edition 2015). Objective: The main objective of this survey study is to investigate awareness among physiotherapists in the use of Matrix Rhythm Therapy in treating chronic low back pain in post-menopausal women. Methods: For this study, Google Forms were distributed to physiotherapists of diverse area specializations through social media. The survey was carried out between 16th December 2022 to 18th April 2023. Results: Out of 103 responses which is 10% of the total sample size, 69.9% of the physiotherapists were aware of Matrix Rhythm Therapy whereas 30.1% were not aware of the same. Meanwhile, when it comes to treating chronic low back pain in post-menopausal women, only 49.5% of the physiotherapists say that the condition can be treated with Matrix Rhythm Therapy, the rest of the 28.2% are not aware and 11.7% are not sure if the condition can be treated with the same. Conclusion: In conclusion, these findings show that implementing or using Matrix Rhythm Therapy as a physical therapy intervention in treating chronic low back pain is woefully inadequate, despite Physical therapists and clinicians recognizing the need for or usage of matrix rhythm therapy, they also must maintain a consistent interest and commitment to effectively employ Matrix Rhythm Therapy for clinical conditions and active research. [ABSTRACT FROM AUTHOR]

Persistent pain (PP) is a complex mechanism affecting 35% to 51.3% of adults in the United Kingdom and is associated with significant reductions in quality of life. Understanding of PP and how best to treat it has developed over the past 50 years, but there is still a vacuum of research to inform novel applications for self-management. Mindfulness techniques and nature exposure have separately been found to have beneficial effects on general well-being and health. The integration of the two could produce much needed self-management strategies, improving quality of life in this patient group. To determine if nature-based mindfulness (NBM) interventions improve pain and quality of life in adults with PP. Systematic literature review. Seven electronic databases were searched to identify quantitative papers investigating nature-based mindfulness and persistent pain. Included articles were appraised using the PEDro tool. A total of 362 studies were identified. Of these, three were included in the final review. All studies reported statistically significant improvements in self-reported scores for pain (p ≤ 0.001–0.006) and depression (p ≤ 0.001–0.000). Other outcomes, such as stress and fatigue produced mixed results. Despite showing statistical significance in multiple outcomes, the minimal clinically important difference was not reached across all measures. Heterogeneity of interventions and outcomes, as well as methodological issues of internal and external validity, preclude definitive conclusions. Further research is required, employing explicit mindfulness interventions and outcome measures with greater relevance and specificity, as well as further investigation of theoretical mechanisms. [ABSTRACT FROM AUTHOR]

Objectives: The COVID‐19 pandemic has had substantial impacts for both people using pain services and healthcare professionals delivering them. While the effects on service users have been studied, less is known about the effects for service providers. This study aimed to assess the impact of the pandemic on providers and the evolving role of telemedicine in treatment. Design & Methods: An electronic survey was distributed to the professional membership of the European Pain Federation (EFIC). The survey evaluated impact and adjustment to the COVID‐19 pandemic separately across two pandemic years (March 2020–February 2021 and March 2021 to February 2022) and assessed worry about COVID‐19, disruption and adjustment of pain services, and use of telehealth services. The change between the first and second pandemic years and the degree to which telehealth services were adopted was evaluated. Results: From 149 respondents, 131 (88%) participants provided sufficient data to be included in the analysis. Both providers worry about the pandemic and service disruption decreased significantly from the first to the second year of the pandemic. Prior to the pandemic, only 30% of providers offered telehealth appointments but this increased to 64% and 83%, respectively, in the first and second years of the pandemic. Conclusions: Although provider worry and disruption to delivery of pain services decreased during the second year of COVID‐19 pandemic, waiting times for appointments continued to lengthen. The pandemic has hastened the adoption of telemedicine in pain services and plans to continue telehealth services seem common. [ABSTRACT FROM AUTHOR]

Background: Mechanical neck pain (MNP) affects all age groups, it has a substantial physical, psychological, and economic impact, especially in elderly. This study aimed to evaluate effect of addition of magnetic therapy (MT) to exercise versus exercise therapy alone on neck pain (NP), proprioception, and balance in elderly patients with chronic MNP. Materials & Methods: 50 elderly patients with chronic MNP were assigned to magnetic group (25 patients who practiced exercise program for 35-40 minutes/session three sessions per week for four weeks in addition exposure to MT for 20 minutes each session three sessions per week for four weeks) and control group (25 patients who practiced only the exercise program). The severity of pain, cervical joint position sense (JPS) and balance performance were measured by using the visual analogue scale (VAS) goniometer and the both single-leg stance time (SLST), and timed up and go (TUG) tests, respectively. ANOVA and Independent t-tests were used to determine significant differences within and between two groups for normal variables, whereas the Mann-Whitney and Kruskal-Wallis tests were used for not normal variables. Results: The results show significant improvements in VAS, SLST (with open and closed eyes), TUG, and JPS after interventions in both groups, p-value <0.05, while addition of MT to exercise program induced only significant differences in VAS, SLST (with open & closed eyes), TUG, except JPS, p-value = 0.002, 0.047 & 0.037, 0.001, and 0.928 respectively, in favor to the magnetic group. Conclusions: Multi-dimensional exercise program is effective in relieving NP and improving balance in elderly with MNP, addition of MT to exercise program could induce superior effects only on pain and balance for elderly patients with MNP. [ABSTRACT FROM AUTHOR]

Background Virtual psychotherapy for chronic pain (CP) has been shown to be feasible, efficacious, and acceptable; however, little is known about how virtual delivery of group psychotherapy affects participants' experiences. This study aimed to explore the impact of a virtual medium during the coronavirus disease 2019 (COVID-19) pandemic on social interactions and therapeutic processes in the context of group psychotherapy for CP management. Methods This qualitative, interview-based study collected data on 18 individuals who participated in virtual group psychotherapy in a tertiary care pain management unit. Results Results of the thematic analysis showed 4 themes. First, the ability to participate and connect was modified by not meeting in person. Connections also occurred differently as the usual patterns of interactions changed. Participants described important shifts in how emotions are communicated and subsequent experience of empathy. Finally, the commonality of chronic pain experience was identified as a central driver of connection between participants. Conclusions Mixed impacts of the virtual medium on group psychotherapy dynamics and processes were found. Future research could explore ways to mitigate the negative impacts. [ABSTRACT FROM AUTHOR]

Objective To identify and synthesize patient-related barriers to and enablers of the implementation of high-value physiotherapy (HVP) for chronic pain. Furthermore, to review what patient-related interventions have been used to facilitate the implementation of HVP for chronic pain, as well as their efficacy. Methods We systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain. We used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized. Results Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient's understanding of exercise benefits. Other barriers included fear of movement, fragmented care, and cost. Ten studies explored interventions, 9 of which aimed to improve exercise adherence. Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls. Conclusion Patients with chronic pain experience barriers to HVP, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. Our findings suggest that interventions seeking to enhance implementation of HVP need to consider the multifactorial barriers experienced by patients with chronic pain. Study registration Open Science Framework (https://doi.org/10.17605/OSF.IO/AYGZV). [ABSTRACT FROM AUTHOR]

Objective This case series retrospectively reviewed the outcomes in patients implanted with combined, synchronous dorsal root ganglion stimulation (DRGS) and spinal cord stimulation (SCS) connected to a single implantable pulse generator (IPG) in a tertiary referral neuromodulation centre in the United Kingdom. Methods Twenty-six patients underwent a trial of DRGS+SCS for treating focal neuropathic pain between January 2016 and December 2019, with a follow-up in February 2022. A Transgrade approach was employed for DRGS. Patients were provided with 3 possible stimulation programs: DRGS-only, SCS-only, or DRGS+SCS. Patients were assessed for pain intensity, patients' global impression of change (PGIC), preferred lead(s) and complications. Results Twenty patients were successful and went on for full implantation. The most common diagnosis was Complex Regional Pain Syndrome. After an average of 3.1 years follow-up, 1 patient was lost to follow-up, and 2 were non-responders. Of the remaining 17 patients, 16 (94%) continued to report a PGIC of 7. The average pain intensity at Baseline was 8.5 on an NRS scale of 0–10. At the last follow-up, the average NRS reduction overall was 78.9% with no statistical difference between those preferring DRGS+SCS (n  = 9), SCS-only (n  = 3) and DRGS-only (n  = 5). The combination of DRGS+SCS was preferred by 53% at the last follow-up. There were no serious neurological complications. Conclusions This retrospective case series demonstrates the potential effectiveness of combined DRGS+SCS with sustained analgesia observed at an average follow-up of over 3 years. Implanting combined DRGS+SCS may provide programming flexibility and therapeutic alternatives. [ABSTRACT FROM AUTHOR]

Objective: To examine the value of including an open label phase after a clinical trial of pain treatments by examining participant characteristics and potential benefits. Method: Secondary data analysis. Veterans with chronic pain who completed a randomized controlled trial (RCT) comparing hypnosis, mindfulness meditation, and pain education were invited to participate in an open label phase. Average and worst pain intensities, pain interference, and depression were assessed pre- and postopen label phase; global impressions of change and treatment satisfaction were assessed at postopen label phase only. Results: Of those who were offered the open label phase, 40% (n = 68) enrolled. Enrollees were likely to be older, to have attended more sessions in the RCT, to be satisfied with their first treatment, and to perceive improvement in their ability to manage pain after the RCT. In the open label phase, depression and worst pain decreased across all three treatment conditions. No other improvements were observed. However, most Veterans perceived improvements in pain intensity, ability to manage pain, and pain interference, and were satisfied with the second intervention. Conclusions: There appears to be some value to adding an open label phase to the end of a trial of pain treatments. A substantial portion of study participants elected to participate and reported it to be beneficial. Exploring data from an open label phase can illuminate important aspects of patient experience, barriers to and facilitators of care, as well as treatment preferences. Impact and Implications: Effective pain management requires a biopsychosocial approach that includes engagement in multiple treatments including complementary and integrative health (CIH) approaches (e.g., mindfulness meditation). Little is known about who is likely to participate in multiple treatments and whether multiple treatments are beneficial. Following a study that compared the effectiveness of hypnosis, mindfulness meditation, and pain education in Veterans with chronic pain, participants were invited to enroll in a second intervention of their choosing (i.e., one of the study interventions to which they were not randomized). Almost half of the Veterans (40%) enrolled in a second treatment; these Veterans were more likely to be older and to perceive the first treatment as beneficial. Veterans reported less depression and lower worst pain intensity following the second treatment, and they thought that the second treatment was helpful in managing their chronic pain. This is one of the first studies to provide evidence that many individuals with chronic pain are interested in participating in multiple pain treatments and that these second treatments confer benefits. Future work is needed to investigate how to combine multiple treatments to optimize pain care. [ABSTRACT FROM AUTHOR]

Background: Daith piercing is a special ear‐piercing method that punctures the crus of the helix. The penetrated site at the ear's innermost point is assumed to stimulate a pressure point associated with the vagus nerve. It has been reported that the pierced spot relieves migraine and tension‐type headaches by activating vagal afferents, leading to the inhibition of neurons in the caudal trigeminal nucleus via the nucleus tractus solitarii. Objective: The objective of this narrative literature review is to summarize the current state of knowledge concerning daith piercing for the treatment of migraine and tension‐type headaches from the perspectives of the Chinese and Western auricular systems. Methods: PubMed and China National Knowledge Infrastructure databases were searched using the keywords "daith piercing," "auricular points," "headache," and "acupuncture" from database inception to September 1, 2023. Only studies on humans were eligible; otherwise, no further restrictions were applied to the study designs, type of headache, or patient population of the identified articles. Bibliographies of all eligible studies were screened for further eligible studies. The main outcome of interest was a quantitative measure of pain relief by daith piercing. Secondary outcomes were relapse time of headache and further outcomes related to daith piercing, if available. Results: From a total of 186 identified articles, one retrospective study and three case reports fulfilled the inclusion criteria. No clinical trial was identified. The obtained studies describe patients experiencing chronic headaches undergoing daith piercing without changing or reducing their usual medication. In all case studies and the retrospective study, patients reported substantial reductions in pain immediately after daith piercing; however, headache symptoms recurred several weeks to months thereafter. From the perspective of the Chinese and Western auricular systems, no sufficient explanation for the described treatment effect of daith piercing was found. Conclusion: The available literature, combined with the reported recurrence of pain as well as the associated side effects of daith piercing, indicate that current evidence does not support daith piercing for the treatment of migraine, tension‐type headaches, or other headache disorders. Plain Language Summary: This paper summarizes what we know about Daith piercing (DP) for chronic migraine and tension‐type headache and discusses how DP might work. Current evidence does not support DP as an effective treatment of chronic migraine and tension‐type headache. These findings might assist clinicians in discussing this subject with patients as well as guide future research. Plain Language Summary: This paper summarizes what we know about Daith piercing (DP) for migraine and tension‐type headache and discusses how DP might work. Current evidence does not support DP as an effective treatment of migraine and tension‐type headache. These findings might assist clinicians in discussing this subject with patients as well as guide future research. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to evaluate the feasibility of a randomized controlled trial investigating the effectiveness of a multimodal program (PAT-Back) compared to best practice advice on pain and disability in older adults with chronic low back pain (LBP) in primary care. Methods This feasibility study took place in Fortaleza, Northeast Brazil. The PAT-Back intervention consisted of a program including exercises, pain education, and motivational text messages for the in-home component. The control group received an evidence-based educational booklet. Feasibility outcomes were recruitment, adherence and retention rates, level of difficulty of the education and intervention content, perception of utility of mobile technology, and adverse events. The feasibility criteria were previously defined. Results A total of 248 people were screened, of which 46 older adults were eligible. The retention rate was high (100% in the PAT-Back group and 95% in the control group). The adherence rate to intervention was partially met (60%), whereas the adherence rate to unsupervised exercises was adequate (75%), and perception about safety to perform home exercise was partially acceptable (70%) in the PAT-Back group. In addition, 100% of older adults reported which text messages motivated them to perform the exercises in the PAT-Back group. Difficulty reported by participants in understanding and performing the intervention was small in both groups. Six participants reported transient adverse events in both groups. Conclusion Older adults accepted both interventions. Results demonstrated that the program is feasible, although minor changes targeting adherence and safety in home exercise are needed. Impact This feasibility study supports progression to a full trial investigating the effectiveness of a multimodal program (PAT-Back) on pain and disability in older adults with chronic LBP within a primary health care setting in low to middle income countries where such data from the older population are scarce and the burden of LBP is increasing. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the prevalence and risks associated with transgender and gender diverse (TGD) persons' misuse of prescription pain relievers (PPRs). This study explores the relationship between PPR misuse and various sociodemographic identities and experiences of discrimination in health care among TGD adults. Methods: TGD participants (n=595) were recruited in 2018 to participate in a cross-sectional statewide trans health survey through convenience sampling. Chi-square tests of independence and logistic regressions were conducted to explore associations between sociodemographics and experiences of discrimination among persons who had ever misused PPRs, or who had misused PPRs in the past year. Results: Sociodemographics such as gender identity (odds ratio [OR]=0.44, p=0.01), race/ethnicity (OR=0.14, p<0.001), and sexual orientation influence TGD individuals likeliness of misusing PPRs (OR=0.40, p<0.001). Notably, those who were ever diagnosed with anxiety had a higher likeliness of having lifetime PPR misuse compared with those who were never diagnosed (OR=2.05, p=0.05), and those reporting past-year discrimination within the mental health care setting because of their gender identity were more than twice as likely to report past-year misuse than those who reported not experiencing it (OR=2.43, p=0.004). Conclusion: Certain subpopulations of TGD individuals may be at elevated risk of PPR misuse. It is imperative to acknowledge the impact of multimarginalized identities as well as differences across various identities and experiences within the TGD community while working to address non-PPR misuse. [ABSTRACT FROM AUTHOR]

Background: Pain is a major clinical problem across all ages with serious social and economic consequences and a great negative impact on quality of life. Brain entrainment using binaural beats is a non-pharmaceutical intervention that is claimed to have analgesic effects in acute and chronic pain. We aimed to systematically review the available randomized clinical trials on the efficacy of binaural auditory beats in reducing adults' pain perception in acute and chronic pain. A systematic search in electronic databases including Medline (via PubMed), Web of Science, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase was performed. The search was completed through Google Scholar and a manual search of the reference lists of all included studies. Randomized clinical trials with full text available in English that investigated the effect of binaural auditory beats on pain perception in acute and chronic pain in adults were included. The risk of bias was assessed by the revised Cochrane risk-of-bias (RoB 2) tool. Furthermore, The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the quality of the evidence. Sixteen studies (three on chronic pain and thirteen on acute pain perception) fulfilled the eligibility criteria. Because of substantial heterogeneity of the studies, a meta-analysis was inappropriate and this review focused on the narrative interpretation of the results. The risk of bias in most studies was high and the quality of evidence was low to very low. Although the effects of binaural beats on pain perception seem to be influenced by the etiology of pain or medical procedures, our review identifies alpha or a combination of tones in the range of delta to alpha as a potential non-pharmacological intervention in reducing acute pain. However, drawing a conclusion regarding the efficacy of binaural beats for chronic pain requires more high-quality studies. Registration: The protocol of this review was registered in PROSPERO (No. CRD42023425091). [ABSTRACT FROM AUTHOR]

Background: Chronic neck pain is known to be caused by the weakness of the deep neck flexors and disturbances in the mechanoreceptors and the proprioceptors of the cervical spine. Proprioceptive neuromuscular facilitation (PNF) is hypothesized to balance the relative stiffness and weakness of the muscles and activate the mechanoreceptors and proprioceptors. Objective: To investigate PNF techniques and the craniocervical flexor training (CCFT) techniques for pain and function in chronic neck pain. Methods: A randomized clinical trial was conducted on 66 chronic mechanical neck pain patients randomly assigned to either the PNF or CCFT groups using block randomization for a duration of 4 weeks. Numerical Pain Rating Scale (NPRS), Neck disability Index (NDI) and Active cervical range of motion (ACROM) were measured at baseline and after 4 weeks of intervention. Data were analysed using independent t test and MANOVA. Results: The mean difference scores for NPRS and NDI were 2.18 and 15.72 in PNF group and 2.26 and 15.76 in the CCFT groups, respectively. Both the groups showed a change that was statistically significant. Also, the mean differences for the ACROM in all the planes in both the groups were statistically significant. However, the between group changes did not reveal any statistical significance in this study except for the right rotation in the CCFT group (p = 0.01). Conclusions: This study concluded that the PNF treatment is also beneficial to pain and function in treating chronic mechanical neck pain patients as its results stand similar to the CCFT treatment, which is already established to be a reliable tool to treat this condition. [ABSTRACT FROM AUTHOR]

Introduction: Neuromodulation has emerged as a promising therapy for the management of chronic pain, movement disorders, and other neurological conditions. Spinal cord stimulation (SCS) is a widely used form of neuromodulation that involves the delivery of electrical impulses to the spinal cord to modulate the transmission of pain signals to the brain. In recent years, there has been increasing interest in the use of automation systems to improve the efficacy and safety of SCS. This narrative review summarizes the status of Food and Drug Administration‐approved autonomous neuromodulation devices including closed loop, feedforward, and feedback systems. The review discusses the advantages and disadvantages of each system and focuses specifically on the use of these systems for SCS. It is important for clinicians to understand the expanding role of automation in neuromodulation in order to select appropriate therapies founded on automation systems to the specific needs of the patient and the underlying condition. Conclusion: The review also provides insights into the current state of the art in neuromodulation automation systems and discusses potential future directions for research in this field. [ABSTRACT FROM AUTHOR]

Background: A better insight in how the biopsychosocial factors influence patient outcome(s) may provide information that helps selecting the optimal pain management for a specific group. Methods: Categorization was made in the prospective DATAPAIN registry, in which patients with pain severity (Numeric Rating Scale [NRS]: 7–10), depression or anxiety (Hospital Anxiety and Depression Scale: > 10), and pain catastrophizing (Pain Catastrophizing Scale: > 31) were identified as complex cases. Patient outcomes; treatment satisfaction on the Patient Global Impression of Change (PGIC), pain relief (NRS), pain interference on the Brief Pain Inventory (BPI) and quality of life indicator General Perceived Health (GPH) were evaluated. Logistic regression analyzed if belonging to the complex cases showed modification in the outcome of the PGIC and GPH. Linear regression was observed if complex cases differed in average reduction in pain relief and interference compared to non‐complex cases. Results: 1637 patients were included, of which 345 (21.08%) were considered complex cases. The changes in scores of pain relief and BPI active subscale were not significantly different between groups. The BPI affective subscale had a different change in score (−0.509; p: 0.002). The complex cases had an odds ratio (OR) of 0.59 (95% confidence interval [CI]: 0.36–0.77) on treatment satisfaction compared to non‐complex cases, and an OR of 0.28 (95% CI: 0.11–0.56) on the GPH. Conclusion: When treating patients with complex cases, desired treatment outcome(s) should be recognized by specialists and patients, as these may be less likely to occur. [ABSTRACT FROM AUTHOR]

This study determined whether the combined application of sling exercises (SE) with targeted vibration and oscillations using a device called the Vibraoscillator (VO) is effective in reducing pain intensity, increasing range of motion (ROM), and enhancing back-related functions in patients with chronic nonspecific low back pain (CNLBP). Thirty-six participants were randomized into experimental (SE + VO) and control (SE) groups. Both groups received the intervention twice a week for 4 weeks. The pain was assessed using the Numerical Rating Scale (NRS), ROM was measured using the Modified-Modified Schober's Test (MMST), and the level of disability was evaluated using the Oswestry Disability Scale (ODI). In addition, the global perceived effect (GPE) was determined. NRS and ODI scores significantly improved after the intervention in the experimental group. Only lumbar spine extension improved significantly in the case of ROM. The GPE satisfaction rate was 14.5% higher in the experimental group than in the control group. Based on the findings obtained in this study, the combined use of VO and SE in patients with CNLBP was effective in reducing pain, improving ROM, and reducing physical disability in comparison with the treatment of only SE. Chronic nonspecific low back pain is a major public health problem because it affects almost every person at least once in their lifetime. A new device called a Vibraoscillator generates horizontal vibrations and vertical oscillation movements targeted to a specific area of treatment to promote the neurofacilitation of the targeted zone, aiming for a more focused treatment than general vibrations. This device, in combination with sling exercises, is hypothesized to reduce pain and increase the mobility of the targeted zone and back-related functions in these patients. Based on our findings, the combined use of these interventions twice a week for 4 weeks was effective in reducing pain and improving the range of movement, which consequently reduced physical disability in patients with chronic nonspecific low back pain. [ABSTRACT FROM AUTHOR]

Treating chronic illness requires ongoing patient-provider cooperation, but individual differences in patients' negative perceptions of care can undermine this cooperation. Research suggests people high on borderline personality disorder (BPD) features may react negatively to and comply less with mental health and medical treatment. This might be particularly problematic in chronic pain treatment, where BPD features are over-represented and the dysregulation typifying BPD likely undermines consistent care. In a sample of 147 chronic pain patients, we investigated whether higher levels of BPD features – both in general and by specific facets – predicted worse perceptions of treatment and lower patient-reported compliance with treatment recommendations. Participants higher (vs. lower) on borderline features viewed treatment more negatively but did not report complying less with recommendations. We found evidence that this may reflect the unstable relationships facet of BPD. Our results indicate that, consistent with other treatment settings, BPD features may undermine care for chronic pain. Furthermore, our results highlight the importance of collaborative provider-patient relationships and patient agreement with the treatment of chronic pain, particularly among individuals higher on BPD features. [ABSTRACT FROM AUTHOR]

This study aimed to systematically review and synthesize evidence (i.e., active [land-based training] and nonactive controls [e.g., receiving usual care]) regarding the effects of water-based training on patients with nonspecific chronic low-back pain (NSCLBP). Web of Science (WOS), PubMed (MEDLINE), EMBASE, EBSCO (SPORTDiscus; CINAHL), and PEDro were searched, with no date restrictions, until October 2021. The included studies satisfied the following criteria: (a) NSCLBP ($12 weeks) patients, (b) water-based intervention, (c) control group (land-based trained; nonactive group), and (d) outcomes related to pain, disability, quality of life, or flexibility. The main outcome analyzed in the meta-analysis was pain intensity. Secondary outcomes included disability, body mass index, and flexibility. The random-effects model was used, and effect size (ES) values are presented with 95% confidence intervals (CIs). The impact of heterogeneity was assessed (I2 statistic), with values of, 25%, 25-75%, and .75% representing low, moderate, and high levels, respectively. Alpha was set at p, 0.05. In conclusion, 15 studies (n 5 524) were meta-analyzed. After intervention, pain intensity was reduced compared with nonactive controls (ES523.61; p, 0.001) and a similar reduction was noted when compared with land-based trained group (ES520.14; p50.359). Greater decrease in disability (ES52.15; p < 0.001) and greater increase in sitand-reach (i.e., flexibility; ES522.44; p < 0.001) were noted after intervention compared with the nonactive group. In conclusion, water-based exercise therapy reduces pain intensity, disability, and increases flexibility in NSCLBP compared with nonactive subjects and was equally effective compared with land-based exercise to reduce pain. Favorable effects may be expected at #8 weeks. However, due to several methodological issues (e.g., high heterogeneity), for the improvement of most outcomes, we are unable to provide other than a weak recommendation in favor of intervention compared with control treatment. [ABSTRACT FROM AUTHOR]

In 2022, the CDC released an updated clinical practice guideline for prescribing opioids and managing pain in the outpatient setting. Th is article synthesizes the guideline recommendations and implementation considerations for clinical NP practice. [ABSTRACT FROM AUTHOR]

Chronic low back pain is characterised by multiple and overlapping biological, psychological, social and broader dimensions, affecting individuals' lives. Multidisciplinary pain services have been considered optimal settings to account for the multidimensionality of chronic low back pain but have largely focused on cognitive and behavioural aspects of individuals' pain. Social dimensions are usually underexplored, considered outside or beyond healthcare professionals' scope of practice. Employing Actor Network Theorist Mol's concept multiplicity, our aim in this paper is to explore how a pain service's practices bring to the fore the social dimensions of individuals living with low back pain. Drawing on 32 ethnographic observations and four group exchanges with the service's clinicians, findings suggest that practices produced multiple enactments of an individual with low back pain. Although individuals' social context was present and manifested during consultations at the pain service (first enactment: 'the person'), it was often disconnected from care and overlooked in 'treatment/management' (second enactment: 'the patient'). In contrast, certain practices at the pain service not only provided acknowledgement of, but actions towards enhancing, individuals' social contexts by adapting rules and habits, providing assistance outside the service and shifting power relations during consultations (third enactment: 'the patient-person'). We therefore argue that different practices enact different versions of an individual with low back pain in pain services, and that engagement with individuals' social contexts can be part of a service's agenda. [ABSTRACT FROM AUTHOR]

Psychological flexibility is a model of human performance and well-being. It essentially entails an approach to life circumstances that includes openness, awareness, and engagement. It has roots in behavior analysis, and it is linked to a philosophy of science called functional contextualism and to a specific therapy approach called Acceptance and Commitment Therapy. One of the earliest and most developed research areas in which this model and therapy have been applied is chronic pain. This review describes psychological flexibility and its facets in more detail, sets them in a context of relevant psychological models, and examines related assessment and treatment methods. It also examines evidence, current challenges, and future directions. It is proposed that psychological flexibility, or an expanded model very much like it, could provide a basis for integrating current research and treatment approaches in chronic pain and health generally. This, in turn, could produce improved treatments for people with chronic pain and other conditions. [ABSTRACT FROM AUTHOR]

Objective This study aimed to estimate the proportion of exercise interventions tested in clinical trials of people with chronic low back pain (CLBP) that meet the World Health Organization's (WHO) physical activity guidelines. Methods A secondary analysis of the 2021 Cochrane review of exercise therapy for CLBP was performed. Data from each study were extracted by 1 reviewer and were checked by a second reviewer. Data extracted related to the frequency, duration and intensity of each exercise intervention, and the proportion of exercise interventions that met the WHO's physical activity guidelines (aerobic, muscle strengthening, or both) were determined. Results The 249 included trials comprised 426 exercise interventions. Few interventions reported an exercise type and dose consistent with the WHO guidelines (aerobic: 1.6%, muscle strengthening: 5.6%, both: 1.6%). Poor reporting of exercise intensity limited our ability to determine whether interventions met the guidelines. Conclusion Few interventions tested in clinical trials for people with CLBP prescribe an exercise type and dose consistent with the WHO guidelines. Therefore, they do not appear sufficiently dosed to achieve broader health outcomes. Future trials should investigate the effect of WHO guideline-recommended exercise interventions on patient-reported outcomes (pain and disability) as well as health-related outcomes in people with CLBP. Impact This exploratory analysis showed the lack of exercise interventions in the CLBP literature that meet the WHO's physical activity guidelines. With people in chronic pain groups, such as people with CLBP, being at higher risk for noncommunicable disease, it appears this is a key consideration for exercise practitioners when designing interventions for people with CLBP. [ABSTRACT FROM AUTHOR]

Objective Our aim was to investigate whether cognitive functional therapy (CFT) was more effective than core exercises and manual therapy (CORE-MT) in improving pain and function for patients with chronic low back pain after spinal surgery. Methods This study was a randomized controlled superiority trial in a university hospital and a private physical therapist clinic in Santa Catarina, Brazil. Eighty participants who were 18 to 75 years old and had chronic low back pain after spinal surgery received 4 to 12 treatment sessions of CFT or CORE-MT once per week for a maximum period of 12 weeks. Primary outcomes were pain intensity (numeric pain rating scale, scored from 0 to 10) and function (Patient-Specific Functional Scale, scored from 0 to 10) after intervention. Results We obtained primary outcome data for 75 participants (93.7%). CFT was more effective, with a large effect size, than CORE-MT in reducing pain intensity (mean difference [MD] = 2.42; 95% CI = 1.69–3.14; effect size [ d ] = 0.85) and improving function (MD = −2.47; 95% CI = −3.08 to −1.87; effect size = 0.95) after intervention (mean = 10.4 weeks [standard deviation = 2.17] after the beginning of treatment). The differences were maintained at 22 weeks for pain intensity (MD = 1.64; 95% CI = 0.98–2.3; effect size = 0.68) and function (MD = −2.01; 95% CI = −2.6 to −1.41; effect size = 0.81). Conclusion CFT was more effective than CORE-MT, with large effect sizes, and may be an option for patients with chronic low back pain after spinal surgery. Impact CFT reduces pain and improves function, with large effect sizes, compared with CORE-MT. The difference between CFT and CORE-MT was sustained at the midterm follow-up. Treatment with CFT may be an option for patients with chronic low back pain after spinal surgery. [ABSTRACT FROM AUTHOR]

Background Implicit motor learning has been shown to be effective for learning sports-related motor skills. It facilitates automaticity of movements and thereby improves performance in multitasking and high-pressure environments. Motor learning to develop motor skills and neuroplastic capacities is not sufficiently incorporated in musculoskeletal rehabilitation. Especially in patients with chronic pain conditions like shoulder pain this approach might benefit over traditional exercise programs. Purpose/hypothesis The aim of this study was to investigate the feasibility and clinical outcome of a new implicit motor learning exercise program in a group of patients with chronic shoulder pain. Study design Pilot and feasibility cohort study Methods Twenty-six patients with chronic shoulder pain performed a 6-week home exercise program with weekly remote follow up by a physiotherapist. The program comprised five exercises designed to challenge overall body balance, simultaneously engaging the upper limbs in a range of reaching tasks. The tasks included reaching above the head, at and below waist level, in various directions. No instructions on correct performance were provided to foster external focus. Feasibility was assessed by (1) recruitment rate, (2) follow up rate, (3) subjective experience, (4) self-reported adverse events and (5) self-reported adherence of subjects. Clinical effects of the program were assessed with (1) the Shoulder Pain and Disability Index (SPADI), (2) the Auto-Constant score, (3) the numeric rating scale (NRS) at rest and at night, (4) the patient specific functional scale (PSFS), (5) the avoidance endurance questionnaire (AEQ), (6) patient acceptable symptom state (PASS) and (7) a global rating of change (GROC). Results The study protocol was feasible in terms of follow up rate (16w for 28 patients), exercise adherence (77.1%± 29.41), and adverse events (no serious, 5 light adverse events). Statistically significant improvements were observed for SPADI (p<0.001), NRS at rest (p=0.033), at night (p=0.29), PSFS (p<0.001) and PASS (p<0.001) after only six weeks training. Conclusion This study reveals promising results of another way of looking at exercise for patients with chronic shoulder pain. Both feasibility and clinical effects of the program on pain and function was acceptable. Future studies should incorporate a control group, provide longer follow up and include objective measurements. Level of evidence 2b [ABSTRACT FROM AUTHOR]

The aims of this qualitative research were (1) to gain more insight in the diagnostic and treatment history of patients with chronic temporomandibular disorder (TMD) pain; (2) to get a deeper understanding of possible factors that are involved in the possible delay in setting a TMD-pain diagnosis and receiving appropriate treatment; and (3) to get a deeper understanding of the perspectives and experiences of chronic TMD-pain patients on the possible improvement of various aspects of their diagnostic and treatment journey. Methods In this narrative research, semi-structured interviews took place with patients who experienced chronic orofacial pain (OFP) for at least three years before getting diagnosed with, and treated for, TMD pain by an OFP specialist in an interprofessional setting. Results In total, ten patients were interviewed in-depth. Patients experienced their chronic OFP in different ways, but all reported a significant impact of their pain on their quality of life. All patients visited numerous health care professionals before their TMD diagnosis was set. Among others, they underwent anti-neuropathic pain medication therapies and invasive surgeries, which did not significantly reduce their chronic OFP. The interprofessional TMD-pain treatment reduced the suffering of the chronic OFP substantially, also 6 months after the start of therapy, and improved the quality of life for all patients. In most of them, the OFP intensity was also decreased. Conclusion Chronic TMD-pain patients with a history of neuropathic pain treatment may experience a long journey until receiving the appropriate diagnosis and treatment. This stresses the need to improve the implementation of chronic TMD-pain guidelines. [ABSTRACT FROM AUTHOR]

Chronic myalgias and arthralgias occur after Chikungunya virus infections (pCHIKV- M&A). We report details of treating a 6-years lasting CHIKV-M&A pains with a combination of medications and interventions. The patient had severe pain in bilateral shoulders and elbows; right thumb and back. Response to steroids, sulphasalazine and methotrexate was poor. Examination revealed M&A pains. Medications initiated included Pregabalin, Paracetamol, Tramadol and vitamin D. At two weeks, despite improvement, there were residual pains in bilateral shoulders and elbows. Four weekly sessions (two on each side), of ultrasound-guided dry needling (USGDN) of all muscles of the upper limb was done. Patient reassessment revealed moderate, residual pains at bilateral supraspinatus muscles, bicipital tendons and radio-humeral joints. These pains were addressed by USG guided steroid injection of bilateral- suprascapular nerves, bicipital tendons and radio-humeral joints. Medications reduced pains especially of back and thumb. USGDN of muscles further reduced it by 60%. The interventions at the nerves, entheses and joints gave 90%-100% relief. The pre-intervention Disability of Arm, Shoulder and Hand (DASH) score of 52.7 reduced to 5.4. At fifth month follow-up, the DASH was15.8, but patient reported satisfaction over pain relief, improvement in daily activities and quality-of-life. There are no evidence-based treatment guidelines or corroborative evidence for rheumatic pathology (most times) for persistent CHIKV-M&A pains. This case-report highlights the successful management of CHIKV-M&A pains by multi-modal approach. USGDN and steroids have neuro-modulatory effects. We have proposed that USGDN aids pain relief by an integrative role with the biologically inherent “chaos theory.” [ABSTRACT FROM AUTHOR]

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Purpose: Chronic non-specific low back pain (CNSLBP) is a common health issue caused by a mix of biological, psychological, and social factors. Cognitive functional therapy (CFT) is a comprehensive way to treat CNSLBP that focuses on changing negative thoughts and unhelpful habits through relaxation techniques. Since the evidence on the efficacy of CFT is still limited, it is essential to conduct clinical trials aimed at the effectiveness of CFT in the treatment of CNSLBP. This study aims to examine the effect of cognitive functional therapy on psychological variables in women with CNSLBP. Methods: Thirty women with CNSLBP were recruited for the clinical trial. They were randomly divided into two experimental and control groups (15 patients in each group). Our experimental group will have 18 individualized CFT sessions, each lasting an hour, over two months. The control group received no intervention. Pain intensity, disability, and kinesiophobia were assessed via the visual analog scale, Oswestry, and Tampa scale, respectively. Two-way repeated measures analysis of variance (ANOVA) was used to compare results between groups. Results: Two-way repeated measures ANOVA results showed that the experimental group compared to the control group in reducing pain (P=0.000, p 2=0.787), disability (P=0.005, p 2=0.457) and Kinesiophobia (P=0.000, p 2=0.561) had a significant difference. Conclusion: CFT reduced pain, disability, and kinesiophobia in patients with CNSLBP. Further evaluation of the efficacy of CFT in high-quality randomized clinical trials among patients with CNSLBP is recommended. [ABSTRACT FROM AUTHOR]

Emotional Awareness and Expression Therapy (EAET) targets trauma and emotional conflict to reduce or eliminate chronic pain, but video telehealth administration is untested. This uncontrolled pilot assessed acceptability, feasibility, and preliminary efficacy of group-based video telehealth EAET (vEAET) for older veterans with chronic musculoskeletal pain. Twenty veterans were screened, and 16 initiated vEAET, delivered as one 60-minute individual session and eight 90-minute group sessions. Veterans completed posttreatment satisfaction ratings and pain severity (primary outcome), pain interference, anxiety, depression, functioning, social connectedness, shame, and anger questionnaires at baseline, posttreatment, and 2-month follow-up. Satisfaction was high, and veterans attended 7.4 (SD = 0.6) of 8 group sessions; none discontinued treatment. Veterans attained significant, large reductions in pain severity from baseline to posttreatment (p <.001, Hedges' g = −1.54) and follow-up (p <.001, g = −1.20); 14 of 16 achieved clinically significant (≥ 30%) pain reduction, and 3 achieved 90–100% pain reduction. Secondary outcomes demonstrated significant, medium-to-large improvements. In this small sample, vEAET produced better attendance, similar benefits, and fewer dropouts than in-person EAET in prior studies. Larger, controlled trials are needed. Group vEAET appears feasible and highly effective for older veterans with chronic pain. [ABSTRACT FROM AUTHOR]

This study was conducted to determine the effect of muscle energy technique (MET) on pelvic alignment, leg length, pain, and fatigue in chronic low back pain (CLBP) patients with leg length discrepancy (LLD). Forty-two CLBP patients with LLD volunteered to participate and were randomly assigned to the MET group (n = 21) and placebo group (n = 21). The intervention group performed three METs with 5 s of isometric contraction and 30 s of rest once, and the placebo group performed three times the placebo-MET, maintaining the same posture as the MET group without muscle isometric contraction. X-ray equipment, tape measure, and visual analog scale were used to evaluate pelvic alignment, leg length, pain, and fatigue before and after each intervention. In comparison pre- and postintervention, only the MET group showed significant changes in pelvic alignment, leg length, pain, and fatigue (p < 0.05). In comparison between groups, there were significant differences in all variables (pelvic alignment, leg length, pain, fatigue) (p < 0.05). The results of this study confirmed the therapeutic effect of MET for improving pelvic alignment, functional LLD, pain, and fatigue in CLBP patients with functional LLD. Future research is needed to evaluate the long-term effect on more chronic low back pain patients. [ABSTRACT FROM AUTHOR]

Neurodynamic exercise is a specific type of exercise used as a neural treatment that focuses on restoring altered homeostasis in the neuroimmune system by mobilising the nervous system and other structures. A prospective, randomized clinical trial was performed to evaluate the effect of neurodynamic exercises on disability and neck pain in elderly women over four weeks. Participants were randomized into two groups: a neurodynamic (NM) group (n = 28) and a non-specific exercise (NSE) group (n = 28). Inclusion criteria were women over 65 years of age who subjectively admitted to having mechanical neck pain for more than six months. Results showed that specific neurodynamic exercises can improve pain and disability in older women with chronic mechanical neck pain. Improvements were observed in all variables (p < 0.05). Significant between-group differences in favour of the NM group were only found for neck pressure pain thresholds and both tibialis anterior muscles. Larger effect sizes were obtained in favour of the NM group, especially for pain, disability, neck extension and inclination and pressure pain thresholds. Neurodynamic exercises have been shown to be more clinically relevant in disability and neck pain in older women. [ABSTRACT FROM AUTHOR]

Hyperbaric oxygen therapy (HBOT) is an adjunctive treatment for chronic pain. The current study aimed to perform a systematic evaluation and meta-analysis of randomised controlled trials (RCTs) to assess the clinical efficacy and safety of HBOT for pain reduction in fibromyalgia (FM) patients compared to conventional therapy. A systematic search of medical subject headings and keywords associated with HBOT for FM patients was conducted using electronic databases: MEDLINE/ PubMed, Web of Science, Cochrane Library Central Register of Controlled Trials, and Scopus. Google Scholar was also combed to detect likely non-indexed available studies. We also searched manually through reference lists of identified original articles or reviews for relevant articles. The http://www.clinicaltrial.gov was examined for all research protocols being conducted/ planned. The Cochrane Collaboration tool and Higgins and Thompson’s I2 method determined the risk of bias and heterogeneity. The primary outcome was the effect of HBOT on pain; secondary outcomes included adverse effects of HBOT, assessment of the quality of life, functional impairment, psychological symptoms, and sleep quality. The overall quality of evidence was assessed with the GRADE approach. Cochrane RevMan software (version 5.4) was used for data analysis. Results were synthesised through a general summary of the characteristics and findings of each study. We also analysed different HBOT protocols and their outcomes across the studies. Five RCTs enrolling 91 and 89 patients in FM and control groups were included in the present study. HBOT results in decreased tender points (-6.23 (95 % CI: -7.76, -4.71) P < 0.0001), increased pain threshold ( 0.57 (95% CI: 0.3, 0.83) P < 0.00001) and a decreased Visual Analog scale (VAS) score for pain (-5.31(95 % CI: -8.17, -2.45)). Quality of life, sleep, functional impairment, etc., also improved after HBOT. HBOT is effective in pain and other associated outcomes in FM patients. In FM patients, high-quality evidence in favour of HBOT to improve pain, fatigue, quality of life, sleep, psychological outcomes, etc., is required. [ABSTRACT FROM AUTHOR]

Background: Nursing professionals relentlessly promote health around the world but do not utilize self-care themselves, leaving them to experience chronic pain and stress, which impacts their personal and professional lives. Nurses report a lack of time to practice consistent self-care; however, micro-practices performed throughout the day were statistically significant between pre and post for chronic pain, stress, self-compassion, care-providing, and pulse rate. Aim: To evaluate the feasibility and acceptability of conducting a study on the effectiveness of loving kindness micro practices compared to an active-controlled group on outcomes of chronic pain, stress, pulse rate, analgesic intake, self-compassion, professional caring, as-needed over-the-counter pain medication, and serum cortisol among nurses. Methods: Asynchronized, three-week, online, double-blind, randomized controlled pilot study with 40 United States nurses based on theories of Watson's Caring Science, Neff s Self-Compassion, Positive Psychology, Donabedian's Model, Adult Education, and Neuroplasticity. Results: Results from the analysis of covariance suggested that there were not statistically significant differences between groups; however, self-reports noted improvements in pain, anxiety, sleep, and stress reduction. Paired samples t-tests showed a mean difference that were statistically significant difference between pre-and post-intervention means: chronic pain (p = .002), stress (p <.001),), self-compassion (p <.001), care-providing (p = 0.19), pulse rate (p = .003). The mean differences between pre and post-measures of cortisol (p = .058) and as-needed medications (p =.693) were not statistically significant. Conclusions: Results suggest conducting this complex study online was feasible and acceptable to nurses, inviting further exploration into loving-kindness micro-practices to help chronic pain and stress outcomes for nurses. [ABSTRACT FROM AUTHOR]

Background: Low back pain is the most common type of musculoskeletal pain and various treatments are given to treat it. Mobilization and aerobic exercise has very good effect in relieving pain and disability. This study focuses to evaluate the combined effect of mobilization and aerobic exercise program in patient with chronic LBP. Methods: The study designed used was a pretest and post test experimental study. Samples are taken with convenient sample method. N=10 with a duration of 12 weeks. Posterioanterior mobilization and high intensity exercises where given and data's were calculated and the results were obtained by two outcome tools --VAS and OSW questionnaire. the data colected from (12/01/2023 to 10/03/2023) with gardern city university physiotherapy out patient department. Results: The pre test mean value of VAS is 7.1 and the post test mean value is 5.8.The mean difference of pre test and post test value of VAS measurement is 1.9.The pre test mean value of OSW questionnaire is 41% and the post test mean value is 21%. The mean difference of pre test and post test value of OSW questionnaire is 20%. Conclusion: Maitland mobilization with high intensity aerobic exercise was effective in reducing pain and disability and also in the improvement of range of motion for low back pain. This study can be used as treatment protocol in the field of physiotherapy to treat the patient with chronic low back pain [ABSTRACT FROM AUTHOR]

There is limited understanding of attrition (premature treatment withdrawal and non-completion) from pediatric chronic pain services. This narrative review aimed to summarize attrition prevalence from face-to-face pediatric outpatient chronic pain interventions, identify associated factors and develop a theoretical model to account for attrition in this setting. A comprehensive search of the published literature revealed massive variability (0–100%) in the reported attrition rates from pediatric chronic pain interventions that varied in type and format (individual vs. group, single discipline vs. interdisciplinary, psychological only vs. multiple combined interventions, of different durations). The factors associated with attrition from pediatric chronic pain programs varied between the studies: some have assessed patient sex, psychological and other comorbidities, avoidance strategies, missed schooling, family composition/tensions, caregiver catastrophizing, scheduling, caregiver leave and clinic access. A theoretical model is presented depicting youth, caregiver and service factors that may impact attrition from pediatric chronic pain interventions. Where available, literature is drawn from the pediatric chronic pain context, but also from adult chronic pain and pediatric weight management fields. The implications for research and clinical practice are discussed, including improved reporting, patient screening and targeted supports to promote intervention completion. This review contributes to a better understanding of attrition, which is crucial for optimizing pediatric chronic pain service outcomes. [ABSTRACT FROM AUTHOR]

Paediatric chronic pancreatitis (CP) is a rare and debilitating pathology that often requires invasive diagnostics and therapeutic interventions either to address a primary cause such as a pancreaticobiliary malunion or to deal with secondary complications such as chronic pain. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are two endoscopic modalities that have an established diagnostic role in paediatric CP, and their therapeutic utilisation is increasing in popularity. Surgical decompression of the obstructed and dilated pancreatic duct plays a role in alleviating pancreatic duct hypertension, a common association in CP. Surgery equally has a role in certain anatomical abnormalities of the pancreaticobiliary draining system, or occasionally in some CP complications such as drainage of a symptomatic pancreatic pseudocyst. [ABSTRACT FROM AUTHOR]

The article offers information on the use of virtual reality (VR) for pain therapy and the challenges associated with VR-induced cybersickness. Topics include the growing interest in VR for pain management, highlighting its potential to immerse patients in a computer-generated world to distract them from pain.

This article discusses the use of non-invasive and minimally invasive vagus nerve stimulation for chronic pain. Chronic pain affects a significant portion of the population and better techniques are needed to manage pain and restore function without the risks of addiction or overdose. Non-invasive vagus nerve stimulation has shown effectiveness in treating pain and comorbid conditions such as mood and substance use disorders. The article explores the use of vagus nerve stimulation in various conditions, including functional abdominal pain, primary headache disorders, and opioid use disorder. Further research is needed to fully understand the mechanisms and efficacy of this treatment. [Extracted from the article]

Purpose: This study aims to explore how people with chronic pain explain their use or non-use of painrelated healthcare services and their expectations of the healthcare provider, and explore how explanations and expectations vary between different levels of pain-related healthcare use. Materials and methods: We conducted 20 individual semi-structured interviews with purposely sampled adults between 39 and 77 years of age with chronic pain. All interviews were audio-recorded, transcribed and analysed using a thematical template analysis approach. Results: Four key drivers for pain-related healthcare use were identified: (1) the healthcare system facilitates clinical pathways, (2) appraisal of pain-related healthcare initiatives influences future use, (3) autonomy, beliefs and values determine healthcare behaviour, and (4) recommendations from others impact healthcare behaviour. Comparing explanations across different pain-related healthcare user groups (high, medium and low) showed that perceived needs, beliefs and values, and appraisal of previous healthcare experiences differed between these groups. Conclusions: Beliefs, pain characteristics, recommendations, and the search for a diagnostic label, often initiate pain-related healthcare use. Healthcare is modified by two interconnected systems: (1) perceived needs, beliefs and values and (2) previous healthcare experiences. Differences related to these systems could explain some of the variance in pain-related healthcare use. [ABSTRACT FROM AUTHOR]

Self-care programs for chronic neck pain are relevant to everyday life and can lead to long- term improvement. More studies on their effectiveness, key components and appropriate duration are needed. The aim of this study was to determine the effectiveness of self-care programs for patients with chronic neck pain. A systematic review and meta-analysis of randomized controlled trials was conducted according to the PRISMA guidelines. After searching in PubMed, Web of Science, Scopus and ScienceDirect, eleven studies met the inclusion criteria. Self-care education interventions typically consisted of education (i.e., pain neuro-science education or general educational concepts) accompanied by exercise or manual therapy. The most frequent components were addressing physical and psychological symptoms and engaging in self-care strategies. The least frequent ones were monitoring and recording symptoms and discussing with providers of medical care. The duration of the interventions ranged from three sessions to six months. Finally, individual and supervised modalities were the most frequent. After pooling the data, a meta-analysis was carried out according to four variables (i.e., pain, disability, kinesiophobia and catastrophization) and showed significant results (p < 0.05) in favor of self-care interventions. This systematic review and meta-analysis suggests that self-education interventions improve pain, psychological pain-related variables and disability in patients with chronic neck pain. The most frequently used components were addressing physical and psychological symptoms and engaging in self-care strategies. Future trials should focus on including other components, such as discussing symptoms with providers of medical care or self-monitoring symptoms. Additional areas of focus include more homogeneous doses and comparator treatments, as well as studies with better evidence to reach more solid conclusions. [ABSTRACT FROM AUTHOR]

The most prevalent metabolic bone disease, osteoporosis, is characterized by a decrease in bone mineral density and alterations to the bone's microstructure, both of which can result in fragility fractures. It affects a significant section of the population. Acute or chronic pain from these fractures is typical in elderly adults with other coexisting conditions. Since the antiresorptive medication only partially reduces pain, other analgesics are required for effective pain management. NSAIDs or selective COX-2 inhibitors can reduce acute pain, but persistent neuropathic pain is difficult to manage with these drugs. Opioids have their adverse effects and safety concerns, although they can be used to address acute or chronic pain. Hence, a multifaceted approach is to be implemented, including pharmacological and nonpharmacological therapy and surgical treatment in a selected number of cases. This chapter briefly describes the etiology of pain, its mechanism, and pain management in osteoporotic patients. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain (CPP) is a complex and debilitating condition affecting a significant portion of the global population, predominantly women. This review dwells on various interventions to alleviate the burden of CPP and improve patients' quality of life. Traditional approaches have included patient education, pharmacotherapy, physical therapy, and cognitive behavioral therapy. However, the limited efficacy and potential side effects of long-term medications necessitate a multidisciplinary approach. The review lists a comprehensive tabulation of results from systematic reviews and meta-analyses on CPP interventions published in the past 5 years. [ABSTRACT FROM AUTHOR]

Introduction: The Department of Veterans Affairs (VA) launched a Whole Health System pilot program in 18 VA "Flagship" medical centers in 2018 in part to expand the provision of complementary and integrative health (CIH) therapies. Materials and methods: A longitudinal quasi-experimental design was used to examine Veterans' use of at least 1 of 12 CIH therapies 2 years after initiation of the Flagship pilot program compared with the year before the program started. The sample included Veterans with chronic musculoskeletal pain with at least one visit to a VA primary care, mental health care, or pain clinic in each of the 3 study years. A population-average logit model was used to measure changes in the percentage of Veterans using at least one the CIH therapies over time. Results: Among Veterans with chronic musculoskeletal pain receiving health care at Flagship sites, 9.7% used a CIH therapy before the Flagship program initiation, whereas 14.2% used a therapy in the second year of the program (46.0% increase). In comparison, CIH therapy use among Veterans at non-Flagship sites increased from 10.3% to 12.0% over the same period (16.5% increase). Results from the population-average logit model show that Veterans at Flagship sites were significantly more likely to be CIH therapy users in the first (p < 0.001) and second (p < 0.001) years of the implementation compared with non-Flagship sites. Discussion: The Flagship pilot program was successful in terms of increasing the use of CIH therapies among Veterans with chronic musculoskeletal pain compared with non-Flagship sites. Conclusions: The Whole Health System implementation that included financial incentives, education, and other support to 18 VA "Flagship" medical centers helped to increase the use of CIH therapies in the VA. Future research should examine which of these efforts were most effective in expanding CIH therapy provision. [ABSTRACT FROM AUTHOR]

Chronic postoperative pain (also known as chronic postsurgical pain) is pain that occurs post-surgery and extends beyond the tissue-healing process, lasting for at least 3 months. Risk factors for the development of chronic postoperative pain include demographic/lifestyle, genetic, psychologic, and clinical factors (comorbidities, surgical factors, anesthesia/analgesia factors), as well as perioperative pain (preoperative and postoperative pain). In addition, there are several conditions that occur postoperatively leading to propagation of chronic postoperative pain, such as anterior cutaneous nerve entrapment, incisional neuromas, pudendal neuralgia, and ilioinguinal neuralgia. Clinicians should focus on identifying risk factors and mitigating them to decrease the incidence of chronic postoperative pain. (J GYNECOL SURG 39:262) [ABSTRACT FROM AUTHOR]