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Introduction: Persistent pelvic pain is a prevalent condition that negatively impacts one's physical, psychological, social, and sexual wellbeing. Pain science education (PSE) involves learning about the biology of pain and is commonly integrated into the management of persistent pain. However, PSE is yet to be thoroughly investigated for persistent pelvic pain potentially due to the lack of targeted curricula, including learning concepts. The aim of this study was to gain consensus on PSE learning concepts important for persistent pelvic pain according to expert clinicians. Methods: A three-round e-Delphi survey was conducted to generate and gain consensus on important PSE learning concepts for female persistent pelvic pain among 20 international, multidisciplinary expert clinicians (e.g., physiotherapists, gynaecologists, psychologists). Learning concepts generated by clinicians were rated by importance using a six-point Likert scale. Consensus on importance rating was considered reached for items with an IQR <1.0. Results: The expert clinicians generated 125 PSE learning concepts that were considered important for persistent pelvic pain; 92 (73.6%) learning concepts reached consensus on their importance rating. Of the 125 learning concepts, 102 were generated for persistent pelvic pain in general, and were categorised into 13 overarching PSE concepts (e.g., persistent pelvic pain involves changes to the brain and nervous system). Sixteen PSE concepts were generated for specific pelvic pain conditions (e.g., endometriosis) and seven concepts for specific life stages (e.g., adolescence). Discussion: This study provides the first list of key PSE concepts tailored for persistent pelvic pain developed by expert clinicians. These concepts provide a framework for developing and implementing PSE curricula for persistent pelvic pain in research and clinical settings. [ABSTRACT FROM AUTHOR]

We developed a realist program theory describing factors that affect healthcare professionals' delivery of guideline-based pain care in rural Australia as part of a realist-informed needs assessment. To our knowledge, this project is the first to apply a realist research approach to conducting a needs assessment. We conducted and analysed realist informed teacher-learner cycle interviews with rural healthcare professionals to inform our program theory. In these interviews, we presented participants with a summary of guideline recommendations for the assessment and management of chronic pain. We asked participants which recommendations they found easy and challenging to implement in their local setting, and discussed why, how, and in what circumstances this was the case. We detail how we analysed interview transcripts retroductively in NVivo and how the authorship team abstracted from the clinical scenarios provided by interviewees to generate theories at a 'middle level' of abstraction. Our discussion details lessons learned from the utilised methods with recommendations for how we would adapt these methods in the future. [ABSTRACT FROM AUTHOR]

Introduction: People with persistent pain experience problems modifying their cognition and behaviours when task or environmental demands change – abilities otherwise known as cognitive flexibility. However, limitations and inconsistent results of previous studies raise concerns over the quality of that evidence. We aimed to determine whether people with and without persistent pain differ on two assessments that are commonly used to assess cognitive flexibility. We also examined the relationship between the two assessments and explored whether people with and without persistent pain are distinguishable based on their scores on these assessments. Methods: Participant demographics and symptoms of anxiety and depression were assessed. Participants completed the Cognitive Flexibility Inventory (CFI) and the Wisconsin Card Sorting Test (WCST). Multiple linear regression on the two outcome variables: CFI (total score) and WCST (% perseverative responses) was applied using backward stepwise selection. Both outcomes were calculated as a standardised proportion of the outcome scale and log-odds transformed to meet the model assumptions. Correlation analysis and logistic regression were used to investigate our secondary and exploratory aims. Results: Data were available from 128 participants with persistent pain and 68 pain-free controls. After adjusting for covariates, no differences were found between people with and without persistent pain on either assessment of cognitive flexibility. No significant correlations were detected between the two assessments in either group. The probability of having persistent pain was also not associated with scores on either or both assessments. Conclusion: 'Cognitive flexibility' appears similar in people with and without persistent pain. [ABSTRACT FROM AUTHOR]

To review clinical practice guidelines (CPGs) and recent literature to identify common recommendations guiding "best practice" pain care for adults with spinal cord injury (SCI). We searched four scientific databases and four guideline repositories from January 2010 to February 2022 for CPGs relating to the management of pain following SCI. We excluded guidelines that related to a single treatment modality, complementary medicines, specific disease processes, and guidelines that were not freely available. We identified 1373 records from which 11 met all eligibility criteria. Seven were classified as "tier 1" and were used to generate 46 care components related to neuropathic pain management. We organised these into three themes: screening and assessment, principles of evaluation and management, and management recommendations; and seven subthemes: screening, assessment and diagnosis, addressing complex care needs, ongoing evaluation, management – interventional, management – pharmacological, and management – non-pharmacological. Four CPGs were classified as "tier 2" and were used to provide supporting evidence. We identified 12 recommendations related to the management of nociceptive pain. This synthesis of recommendations can guide consumers, clinicians, researchers, and policy makers to inform understanding and clinical implementation of evidence-based "best practice" management of pain in adults with SCI. Persistent pain is a frequent problem for individuals following spinal cord injury and its effective management is challenging for clinicians. High-quality clinical practice guidelines that are up-to-date and readily accessible have the potential to enhance care quality and outcomes. This synthesis of 58 key care recommendations can guide consumers, clinicians, researchers, and policy makers towards improving pain care for adults with spinal cord injuries. [ABSTRACT FROM AUTHOR]

There is a high prevalence of persistent pain following SCI yet insights into its impact and the quality of pain care are limited. We aimed to explore, in-depth, the problem of persistent pain in Australian community-dwelling adults with a spinal cord injury (SCI). Our objectives were to investigate (i) how individuals experience persistent pain, (ii) how they experience pain care and (iii) the concordance between clinical practice guidelines for managing pain and reported care practices. We conducted a mixed-methods convergent parallel study. Adults with SCI and persistent pain completed a survey (n = 43); a subset of participants completed interviews (n = 10). We analysed the data from each method separately and then integrated the findings. Results indicated that the life impact of persistent pain is variable but it can be more disabling than physical impairments and compound a sense of isolation and despair. Community-based management was reported to predominantly have a pharmacological focus, with occurrences of opioid misuse apparent in the data. Access to expert, comprehensive and individualised care was frequently reported as inadequate. While some people with SCI and persistent pain can effectively self-manage their pain, for others the impact on quality of life is profound and complex care needs are commonly unmet. Persistent pain is a common consequence of SCI and profoundly impacts quality of life. Complex pain care needs are commonly unmet. Individuals require regular, comprehensive, biopsychosocial assessment. The effectiveness of pain management strategies must be monitored on an ongoing basis. Opportunities for personal self-management support must be available long-term. [ABSTRACT FROM AUTHOR]

Introduction: Clinician time and resources may be underutilised if the treatment they offer does not match patient expectations and attitudes. We developed a questionnaire (AxEL-Q) to guide clinicians toward elements of first-line care that are pertinent to their patients with low back pain.Methods: We used guidance from the COSMIN consortium to develop the questionnaire and evaluated it in a sample of people with low back pain of any duration. Participants were recruited from the community, were over 18 years and fluent in English. Statements that represented first-line care were identified. Semantic scales were used to measure attitude towards these statements. These items were combined to develop the questionnaire draft. Construct validity was evaluated with exploratory factor analysis and hypotheses testing, comparing to the Back Beliefs Questionnaire and modified Pain Self-Efficacy Questionnaire. Reliability was evaluated and floor and ceiling effects calculated.Results: We recruited 345 participants, and had complete data for analysis for 313 participants. The questionnaire draft was reduced to a 3-Factor questionnaire through exploratory factor analysis. Factor 1 comprised 9 items and evaluated Attitude toward staying active, Factor 2 comprised 4 items and evaluated Attitude toward low back pain being rarely caused by a serious health problem, Factor 3 comprised 4 items and evaluated Attitude toward not needing to know the cause of back pain to manage it effectively. There was a strong inverse association between each factor and the Back Beliefs Questionnaire and a moderate positive association with the modified Pain Self-Efficacy Questionnaire. Each independent factor demonstrated acceptable internal consistency; Cronbach α Factor 1 = 0.92, Factor 2 = 0.91, Factor 3 = 0.90 and adequate interclass correlation coefficients; Factor 1 = 0.71, Factor 2 = 0.73, Factor 3 = 0.79.Conclusion: This study demonstrates acceptable construct validity and reliability of the AxEL-Q, providing clinicians with an insight into the likelihood of patients following first-line care at the outset. [ABSTRACT FROM AUTHOR]

Purpose: To develop and test a standardised method of interpreting spinal imaging findings in a manner designed to reassure patients with low back pain and promote engagement in an active recovery.Methods: A five-phase development and testing process involved collaborative working party contributions, informal and formal appraisal of the intervention content by clinicians and consumers, a two-stage online evaluation of the take-home patient resource, and onsite testing.Results: A total of 12 health professionals and 77 consumers were included in formal evaluative processes at various stages of the development and testing process. Consumers assessed the revised iteration of the take-home resource to be clearer and easier to understand than the original version. We integrated all feedback and evaluation outcomes to develop the final intervention content, which was approved by experienced clinicians and considered safe. We devised a framework to guide delivery of the low-cost clinical intervention and a 10-15-min timeframe was demonstrated to be realistic.Conclusions: We have developed, modified, and tested a pragmatic framework for a brief, psychoeducational intervention. We have established face validity and acceptability from key stakeholders and engaged clinicians and are ready to proceed with a pilot feasibility trial. [ABSTRACT FROM AUTHOR]