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Kristian Johnsen,1 Patrick J Owen,1 Scott D Tagliaferri,1 Jessica Van Oosterwijck,2– 4 Bernadette M Fitzgibbon,5 Jon J Ford,6,7 Daniel L Belavy,1,8 Clint T Miller1 1Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia; 2Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; 3Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; 4Research Foundation – Flanders (FWO), Brussels, Belgium; 5School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; 6Advance HealthCare, Boronia, VIC, Australia; 7Low Back Research Team, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia; 8Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, Bochum, GermanyCorrespondence: Clint T Miller, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia, Tel +61 3 9244 6605, Email c.miller@deakin.edu.auPurpose: This cross-sectional study aimed to investigate whether psychosocial factors were predictive for exercise-induced hypoalgesia (EIH) in pain-free adults.Methods: A sample of 38 pain-free nurses with a mean (SD) age of 26 (6) years were included in this study. Participants completed psychosocial questionnaires prior to physical tests. Pressure pain threshold (PPT) was assessed bilaterally at the calves (local), lower back (semi-local) and forearm (remote) before and immediately after a maximal graded cycling exercise test. Separate linear mixed effects models were used to determine change in PPT before and after cycling exercise (EIH). Multiple linear regression for all psychosocial variables and best subset regression was used to identify predictors of EIH at all locations.Results: The relative mean increase in PPT at the forearm, lumbar, calf, and globally (all sites pooled) was 6.0% (p< 0.001), 10.1% (p< 0.001), 13.9% (p< 0.001), and 10.2% (p=0.013), respectively. Separate best subset multiple linear regression models at the forearm (predictors; Multidimensional Scale of Perceived Social Support (MSPSS) total), lumbar (predictors; MSPSS total, Pain Catastrophizing Scale (PCS) total, Depression Anxiety Stress Scale (DASS) depression), calf (predictors; MSPSS friends, PCS total), and global (predictors; MSPSS friends, PCS total) accounted for 7.5% (p=0.053), 13% (p=0.052), 24% (p=0.003), and 17% (p=0.015) of the variance, respectively.Conclusion: These findings confirm that cycling exercise produced EIH in young nurses and provided preliminary evidence to support the interaction between perceived social support, pain catastrophizing and EIH. Further investigation is required to better understand psychological and social factors that mediate EIH on a larger sample of adults at high risk of developing chronic musculoskeletal pain.Keywords: aerobic exercise, acute exercise, pain pressure threshold, perceived social support, kinesiophobia

The purpose of this paper was first to gain an in-depth understanding of the barriers and facilitators to implementing the BPS model and pain neuroscience education in the current Lebanese physical therapy health care approach and explore its acceptability. A qualitative semi-structured interview using purposive sampling was conducted with eight Lebanese physical therapists practising in different governorates. The transcribed text from the interviews was analyzed using inductive thematic analysis. Two topics were generated and constructed by the researchers: (1) "barriers to the implementation of pain neuroscience education, with subthemes including (a) "current health care approach," (b) "basic curriculum and continuing education," (c) "patients' barriers"; (2) "facilitators to the implementation of pain neuroscience education," with subthemes containing (a) "interest in the BPS model, (b) "therapeutic alliance," and (c) "motivation for future training on BPS approach." The analysis of the results showed that Lebanese physical therapists currently hold a strong biomedical view of chronic pain, assessment, and treatment. However, despite the presence of barriers and challenges, they are aware and open to consider the implementation and future training about the BPS model and pain neuroscience education in their approach. The exploration of potential barriers and facilitators to the bio-psychosocial model and pain neuroscience education implementation may provide an opportunity for better development and design of a culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists. The exploration of barriers and facilitators to the implementation of pain neuroscience education will help to improve pain education and ensure better clinical pain management. The most important barriers were the dominant characteristic of the Lebanese physical therapist's health approach, which is focused on a biomechanically oriented model, and their lack of knowledge to approach chronic pain from a biopsychosocial perspective. [ABSTRACT FROM AUTHOR]

Introduction: Although a positive correlation between patients' expectations and outcome after surgery appears evident, evidence is rather conflicting. This can be attributed to the lack of uniform, validated, and reliable methods to assess patients' expectations. A valid and reliable questionnaire to assess patients' expectations of lumbar spine surgery is not yet available in Dutch. Methods: The forward-backward translation method will be applied to the original Hospital for Special Surgery Lumbar Spine Surgery Expectations Survey [1]. The translations will be revised by an expert committee, including translators, methodologist, spinal surgery experts and psychology experts. The pre-final Dutch survey will be piloted in a sample (n = 50) of patients scheduled for lumbar surgery. Based on these results, the expert committee will improve the survey. The final survey will then be administered in a sample (n = 300) of patients twice before their spinal surgery. Based on the acquired data, validity (i.e. content, construct, and discriminative validity) and reliability (i.e. internal consistency and test-retest reliability) will determined. Results: Not applicable. Discussion: A Dutch validated survey for assessment of expectations of lumbar surgery patients may assist clinicians in determining the quality of spinal surgical care and any discrepancies that might exist between clinician and patient. Researchers will benefit as well, as uniform and valid surveys are essential to unravel the relation between pre-surgical patients' expectations and satisfaction following spinal surgery. Process evaluation: The study is currently in the backward-translation stage. Finding translators with the appropriate requirements according to the WHO guidelines proves to be challenging. [ABSTRACT FROM AUTHOR]

Introduction: Despite the considerable amount of research performed on conditioned pain modulation (CPM), there are still uncertainties concerning the influence of cognitive mechanisms on CPM efficacy.1 This study aimed to investigate whether the CPM effect is influenced by attention and expectations in healthy adults. Methods: Seventy-two healthy pain-free adults participated in this cross-sectional study undergoing CPM evaluation (i.e. pain pressure threshold (PPT) assessment (= test stimulus (TS)) in response to hot water hand submersion (=conditioning stimulus (CS)) during three experimental protocols administered in randomized order, i.e. (1) a sequential 'neutral' protocol, (2) a 'focus' protocol during which attention was focused on the CS, and (3) a 'distraction' protocol during which attention was directed away from the CS using a distraction task. Participants their pain expectations were recorded before each of the three protocols. Results: Compared to the other protocols, focusing the attention on the CS resulted in smaller CPM magnitudes (p < 0.001), and the distraction protocol resulted in lower NRS ratings for the CS (p < 0.001). A priori expectations accounted for 6.6% of the CPM effect of the neutral protocol (p = 0.035), with expectations of analgesia predicting more efficient CPM. Discussion: It is recommended to rate CS-related pain intensity after CS completion rather than during CS to prevent a reduction of the inhibitory effects by the CPM paradigm. Participants' a priori expectations should be registered as these can influence the induced CPM magnitude. Process evaluation: Building the appropriate statistical models, which took into account confounding factors as well as randomization sequence, was challenging. [ABSTRACT FROM AUTHOR]

Introduction: Prayer is the most common therapy used in alternative medicine1. The objective of this study was to explore the effect of prayers on endogenous pain modulation, pain intensity, and sensitivity in healthy religious participants. Methods: Two hundred and eight healthy religious participants were enrolled in this study and randomly distributed into two groups, a prayer group (n = 156) and a poem reading or control group (n = 52). Participants from the prayer group were allocated to either an active prayer group (n = 94) receiving an active type of praying or to a passive prayer group (n = 62) receiving a passive type of praying. Pain assessments were performed prior to and following the prayer or poem reading interventions and included pressure pain threshold assessment, conditioned pain modulation, and a numerical pain rating scale for perceived pain intensity. Results: A significant group-by-time interaction for PPT (p = 0.014) indicated post-intervention increases in PPT in the prayer group but not in the poem reading control group. Also, a significant group-by-time interaction for PPT (p = 0.005) indicated that these effects were greater in the active prayer group than in the passive prayer group. Participants experienced a decrease in CPM efficacy (p = 0.030) and an increase in pain intensity (p < 0.001) following the interventions, independent of their group allocation. Discussion: The results showed that prayer, irrespective to type, can positively affect pain sensitivity and intensity, but does not influence endogenous pain inhibition. Process evaluation: Future research should focus on understanding the mechanism behind "prayer induced analgesia". [ABSTRACT FROM AUTHOR]

Introduction: There is abundant evidence for compromised movement performance in non-specific low back pain (NSLBP)1,2. It has been proposed that not only pain severity, but also cognitive-affective factors such as attention might influence movement3. The objective of this study is to review current knowledge concerning the effects of attention on movement-related outcomes in NSLBP. Methods: A systematic search was performed and reported following the PRISMA-guidelines. A comprehensive search strategy was used by using five electronic databases. Possible risk-of-bias was evaluated by using the adjusted version of the Newcastle-Ottawa Scale. Levels of evidence and conclusion were assigned according to guidelines of the Dutch Institute for Healthcare Improvement. Results: Twenty-two articles were included (ROB 18.2% -72.7%), the majority (77%) performed in chronic LBP.Limited evidence indicated attentional suppression (measured with coping strategy questionnaire) to be negatively associated with activity of the trunk muscles in acute NSLBP. Furthermore, limited evidence indicated that when attention is divided over tasks (i.e. dual-tasks) this results in lower variability of postural strategies in recurrent NSLBP and lower/delayed anticipatory trunk muscle activation in chronic NSLBP. Discussion: Ignoring pain effects trunk muscle activity in acute NSLBP. When attention is divided (i.e. dual-tasks), individuals with recurrent/chronic NSLBP are less capable to control their trunk muscles. Process evaluation: The different possibilities to operationalize 'attention' posed a difficulty. Included studies used two main operationalizations: 'attentional control of pain' (i.e. attention focus, attentional suppression/distraction) and 'attention as a capacity' (i.e. cognitive load of pain competes for available attentional resources for postural control). [ABSTRACT FROM AUTHOR]

Introduction: There is growing acknowledgement of the benefits of incorporating a bio-psychosocial model of understanding pain within physical therapist practice1. Consequently this has led to an increasing interest in interventions such Pain neuroscience education (PNE). However, pain management strategies developed by clinicians in one culture may not necessarily be understood, appropriate, or effective in another culture2 Methods: This study is part of a broader research in the development of culturally sensitive pain neuroscience education for the Lebanese population. Therefore, the purpose of this paper is to first gain an in-depth understanding of the Lebanese physiotherapists' perceptions towards the management of chronic low back pain as well as the knowledge regarding PNE. A qualitative one-to-one semi-structured interviews with 10 practicing physical therapists were conducted. The transcribed text from the interviews was analyzed using inductive thematic analysis. Results: Several themes were generated, identified, and constructed by the researchers: (1) physiotherapists use of a biomechanical approach. (2) Poor knowledge about the bio-psychosocial approach or PNE. (3) Barrier and facilitation for the implementation of PNE. Discussion: The preliminary results showed a limited knowledge of the bio-psychosocial approach, or PNE, and that the Lebanese physical therapist use more a biomechanical approach in the treatment and assessment of people with chronic low back pain. Process evaluation: The results showed that training is needed for physiotherapists to deliver a broader model of care, and that future research should focus on developing a culturally sensitive PNE material. [ABSTRACT FROM AUTHOR]

Introduction: Migraine is conceptualized as a continuum, with at the one hand episodic migraine and at the other hand chronic migraine (CM) which is more frequent1. Recent studies support the presence of central sensitization (CS) in migraine patients2,3, but controversial evidence exists about where in the continuum exactly CS appears and which mechanisms are underlying. Therefore this study aims to determine the occurrence and mechanisms of CS within the migraine continuum. Methods: Self-reported and psychophysiological data will be collected from 30 migraine patients and 30 healthy controls. Pain sensitivity will be evaluated using Quantitative Sensory Testing including mechanical and thermal thresholds. Pain facilitation and inhibition will be assessed by using respectively temporal summation and conditioned pain modulation paradigms. Assessments are performed unilateral at the painful side and interictally. Results: Widespread pain and impaired pain facilitation and inhibition are expected to be more pronounced in patients with more migraine days (further along the continuum) than in those with less migraine days. Discussion: This research will show whether signs of CS are present in migraine patients, where in the migraine continuum these symptoms are appearing, and whether impaired pain inhibition and/or facilitation underlie these symptoms. Process evaluation: Data collection is currently going on. Testing patients with CM interictally is a challenge. [ABSTRACT FROM AUTHOR]

Introduction: Up to 37% of lumbar radiculopathy patients experience residual pain and disability following lumbar discectomy. Although it is assumed that dysfunctional pain processing may play a mechanistic role in symptom persistence, research in this area is lacking. Therefore, this study will evaluate pain processing in lumbar radiculopathy patients prior to and 3 months following lumbar discectomy. Methods: Lumbar radiculopathy patients (n = 122) scheduled for discectomy will be recruited through Flemish hospitals. At follow-up, patients with =1.5/10 average pain intensity on a visual analogue scale and <20% improvement on the Oswestry Disability Index will be categorized as having residual complaints. These will be compared to matched patients without residual complaints and pain-free controls. Pain sensitivity will be evaluated using Quantitative Sensory Testing including thermal, mechanical, and electrical perception and pain thresholds. Spinal modulation will be assessed using nociceptive flexion reflex thresholds; pain facilitation by the presence of psychocognitive factors through questionnaires and temporal summation of mechanical stimuli and the NFR; and pain inhibition using a conditioned pain modulation paradigm. Results: Not applicable. Discussion: We hypothesize that pre-operative pain characteristics are predictive of residual complaints and that patients with residual complaints exhibit dysfunctional pain processing compared to individuals without residual complaints as expressed by impaired pain inhibition and enhanced spinal modulation, pain sensitivity and facilitation. The findings will provide the potential to identify patients at risk of poor surgical outcome and explore treatment strategies according to dysfunctions in pain processing. Process evaluation: Currently recruiting and completing ethical committee applications for multicentric recruitment. [ABSTRACT FROM AUTHOR]

Introduction: Although the cause of persistent non-specific low back pain (NSLBP) remains unknown, structural and functional alterations of the brain1 and paravertebral muscles2 have been proposed as underlying mechanisms. To date, it is unknown if improvements through exercise therapy may be attributed to measurable changes in the muscles and/or adaptations in the brain. Therefore, the objective is to examine short and long-term effects of specific skilled motor control training versus unspecific general exercise training. Methods: In this double-blind, randomized controlled clinical trial, 62 recurrent NSLBP patients will be randomly allocated (1:1) to receive either skilled motor training or general exercise training. The primary outcome is LBP-related disability. Secondary measures include: brain structure, structural/functional connectivity, muscle structure, muscle function, and proprioception. Results: We expect changes only after skilled motor training for: brain function (i.e. increased functional connectivity in default mode network and sensory-motor regions), thoracolumbar dissociation and proprioception. In addition, for brain structure (i.e. changed structural connectivity between parieto-and (pre)motor areas and motor cortex reorganization), muscle function (i.e. timing/amplitude of anticipatory/compensatory postural adjustments) and muscle structure (i.e. muscle/fat index, cross-sectional area) we expect changes for both groups, but more pronounced after skilled motor training. More specifically, we expect that changes in muscle structure are training unspecific for superficial trunk muscles, but more pronounced for deep segmental muscles after skilled motor training. Process evaluation: Learning the necessary skills for MRI acquisition and recognizing artefacts took more time than expected. Several MRI sequence alterations were necessary to ensure sufficient image quality. References: 1. Kregel J, Meeus M, Malfliet A, et al. Structural and functional brain abnormalities in chronic low back pain: A systematic review. Seminars in Arthritis and Rheumatism 2015; 45(2), 229-237. 2. Goubert D, Meeus M. Willems T, et al. The association between back muscle characteristics and pressure pain sensitivity in low back pain patients. Scandinavian Journal of Pain 2018; 18(2), 281-293. Keywords: Low back pain; motor control; exercise; randomized controlled trial; brain 15332500, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/papr.13128 by EBSCO SUBSCRIPTION SERVICES - Journal Digital Lic, Wiley Online Library on [19/10/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License is LBP-related disability. Secondary measures include: brain structure, structural/functional connectivity, muscle structure, muscle function, and proprioception. Results: We expect changes only after skilled motor training for: brain function (i.e. increased functional connectivity in default mode network and sensory-motor regions), thoracolumbar dissociation and proprioception. In addition, for brain structure (i.e. changed structural connectivity between parieto-and (pre)motor areas and motor cortex reorganization), muscle function (i.e. timing/amplitude of anticipatory/compensatory postural adjustments) and muscle structure (i.e. muscle/fat index, cross-sectional area) we expect changes for both groups, but more pronounced after skilled motor training. More specifically, we expect that changes in muscle structure are training unspecific for superficial trunk muscles, but more pronounced for deep segmental muscles after skilled motor training. Process evaluation: Learning the necessary skills for MRI acquisition and recognizing artefacts took more time than expected. Several MRI sequence alterations were necessary to ensure sufficient image quality. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodResultsConclusion\nIMPLICATIONS FOR REHABILITATIONThis paper aims to understand the distinctive biopsychosocial aspects and patient perspectives on chronic low back pain in Lebanon, an Arab country with a unique and rich cultural heritage.Qualitative, semi-structured interviews with 12 Lebanese patients purposefully sampled from various governorates. The interviews included participants from different geographic areas and religions. The data underwent analysis through an inductive thematic approach guided by a bounded relativist ontology, a subjectivist epistemology, and a descriptive phenomenological framework. The coding process was managed by computer-assisted qualitative data analysis software (QSR NVivo version 12.0).The researchers identified and constructed two themes: (1) Chronic low back pain: understanding the impact, coping strategies, and communication patterns in lived experiences within the Lebanese context. This theme sheds light on the complexities of pain management and societal influences in Lebanon. (2) Explanatory model of patients living with chronic low back pain in Lebanon. This theme allowed an exploration of the multifaceted narratives of chronic low back pain.This study found that Lebanese individuals attribute chronic low back pain to biomedical factors despite some recognizing psychosocial elements. It emphasizes the need to educate patients on the biopsychosocial model, facilitate better care, and dispel misconceptions.The exploration of patients’ pain perception may provide an opportunity to better develop and design culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists.The rehabilitation process should incorporate a balanced biopsychosocial approach, addressing both physical and psychosocial elements of pain, to provide more effective care and outcomes for Lebanese patients who predominantly attribute chronic low back pain to biomedical factors.Lebanese healthcare professionals need to improve communication with Lebanese patients regarding the nature of chronic low back pain, using clear communication to help dispel misconceptions and enhance rehabilitation outcomes.The exploration of patients’ pain perception may provide an opportunity to better develop and design culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists.The rehabilitation process should incorporate a balanced biopsychosocial approach, addressing both physical and psychosocial elements of pain, to provide more effective care and outcomes for Lebanese patients who predominantly attribute chronic low back pain to biomedical factors.Lebanese healthcare professionals need to improve communication with Lebanese patients regarding the nature of chronic low back pain, using clear communication to help dispel misconceptions and enhance rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

Conditioned pain modulation (CPM) is a psychophysical experimental measure of endogenous pain inhibition in humans. Within this paradigm, one noxious stimulus, the conditioning stimulus (CS), reduces the pain perception from another heterotopic noxious stimulus, the test stimulus (TS). Cognitive processes are known to influence pain perception and might impact the underlying mechanisms of CPM. This systematic review and meta-analysis synthesizes the existing scientific literature addressing the influence of cognitive factors, namely, expectations and attention on CPM. Four electronic databases were searched to identify relevant literature. Risk of bias and quality of evidence were assessed according to two modified Newcastle-Ottawa Scales and the GRADE approach, respectively. Twenty-four articles were included. Qualitative analysis showed more efficient CPM when pain relief is expected, and an association between intrinsic attention to pain and reduced CPM. Although the evidence is not unanimous, meta-analyses showed that CPM is more efficient when attention is directed towards the CS versus the TS, and is not influenced by distraction. In conclusion, while CPM seems robust to attentional distraction, expectations and attentional focus appear to influence CPM. However, the evidence is limited and conflicting and warrants further study in order to prevent cognitive confounding and enhance mechanistic understanding., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Even in healthy populations, conditioned pain modulation (CPM) magnitude varies. This may be accounted for by (non-)modifiable factors, including physical activity (PA). Yet, little research has thoroughly examined PA and its relation with CPM magnitude in a representative sample. Therefore, the present study investigated the predictive effect of PA on CPM magnitude in 105 healthy adults. PA was assessed during 7 consecutive days by self-report using the International Physical Activity Questionnaire and by monitor-based accelerometry. CPM was examined using a heterotopic noxious-conditioning stimulation protocol during which the effect of a hot water-conditioning stimulus on pressure pain thresholds was evaluated. Comparative, correlation, and hierarchical linear regression analyses were performed. Report-based walking predicts 4.8% of variance in pain-modulatory capacity, moderate PA predicts 10.2% of variance in pain-modulatory capacity, and report-based time spent on total PA predicts 7.0% of variance in pain-modulatory capacity. More metabolic equivalent-minutes/week spent on total PA, including walking and moderate PA, is associated with greater pain-modulatory capacity. The findings of this study add to the limited evidence on the predictive effect of PA on CPM. It urges to consider PA a confounding factor when examining CPM. The current study provides evidence that a physically active lifestyle benefits endogenous pain modulation in healthy adults. Given its potential, walking and moderate-intensity PA might be achievable treatment strategies for pain patients known to have impaired CPM. PERSPECTIVE: The results of this article show that a physically active lifestyle, including larger amounts of walking and moderate activity, predicts greater pain-modulatory capacity. TRIAL REGISTRATION: This study has not been preregistered., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Abstract: The nociceptive withdrawal reflex (NWR) is a spinal withdrawal reflex induced by painful stimulation. It is a measure of spinal hyperexcitability, which is believed to contribute to chronic musculoskeletal pain (MSKP) and headache. Previous syntheses of the evidence for alterations in the NWR in patients with chronic MSKP and headache needed a comprehensive update. This systematic review and meta-analysis was performed after the Preferred Items for Systematic reviews and Meta-Analyses guidelines. Studies examining NWR-related outcome measures in patients with chronic MSKP and headache compared to pain-free controls were identified through electronic database searches and included after screening against predefined eligibility criteria. Standardized mean differences or mean differences and 95% confidence intervals (CI) were calculated. Thirty-one studies were included in the systematic review and 25 in the meta-analysis. Moderate-quality evidence was found indicating lower NWR threshold (-3.68; 95% CI, -4.56 to -2.80; P < 0.001), larger NWR area (standardized mean difference = 0.69; 95% CI, 0.37-1.01; P < 0.001), and shorter NWR latency (mean difference = -13.68; 95% CI, -22.69, -4.67; P = 0.003) in patients compared to controls. These findings remained robust when performing meta-regressions based on subgroups (ie, headache, fibromyalgia, whiplash-associated disorder, and osteoarthritis). Low-quality evidence demonstrated facilitated temporal summation of NWR threshold (-2.48; 95% CI, -3.13 to -1.83; P < 0.001) in patients compared to controls. Spinal hyperexcitability as evidenced by lowered NWR threshold values and temporal summation of the NWR is present in patients with chronic MSKP and headache. No evidence was found for alterations in NWR duration and NWR magnitude. Future research is needed to address the gap in research on NWR-related outcome measures other than NWR threshold., (Copyright © 2024 International Association for the Study of Pain.)

Objective: Previous studies evaluating interdisciplinary multimodal interventions for chronic spinal pain often excluded patients with comorbid mental disorders. This study aims to assess the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program for individuals experiencing co-occurring chronic spinal pain and mental disorders., Methods: Participants were 944 patients with chronic spinal pain and comorbid mental disorders. Primary outcomes were health-related quality of life, assessed using the Research and Development-36 (RAND-36), and pain-related disability, assessed using the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes included pain intensity, pain catastrophizing, kinesiophobia, fatigue, lumbar mobility, and isometric strength. Data were collected during the healthcare program at four time points: pretreatment (T0), midway through 20-week treatment (T1), end of 20-week treatment (T2), and at completion of 12-month relapse prevention program (T3). Multilevel regression analyses were conducted to examine the effects of the healthcare program on primary outcomes over time., Results: The 20-week treatment period yielded significant improvements in both mental ( B = 0.44, t (943) = 19.42, p < .001) and physical component summary scores ( B = 0.45, t (943) = 18.24, p < .001) of the RAND-36, as well as in QBPDS total score ( B = -0.77, t (943) = -26.16 p < .001). Pretreatment scores indicated the presence of problematic fatigue, kinesiophobia, and clinical levels of pain catastrophizing, all of which resolved by the end of the 12-month relapse prevention program., Conclusions: An interdisciplinary multimodal integrative healthcare program seems effective for patients with chronic spinal pain and comorbid mental disorders., (Copyright © 2024 by the American Psychosomatic Society.)

Objective: This study systematically reviewed the literature about sensory retraining effect in comparison to other rehabilitative techniques on cortical reorganization in patients with peripheral neuropathic pain. TYPE: Systematic review., Literature Survey: After an electronic search of PubMed, Web of Science, and Embase, risk of bias was assessed using the revised Cochrane risk of bias tool for randomized controlled trials and the ROBINS-1 (Risk of bias in non-randomized studies-of interventions) for non-randomized studies of intervention., Methodology: The strength of conclusion was determined using the evidence-based guideline development approach., Synthesis: Limited evidence indicates a higher increase in cortical inhibition and a higher reduction in cortical activation during a motor task of the affected hemisphere after graded motor imagery compared to wait-list. Higher reductions in map volume (total excitability of the cortical representation) of the affected hemisphere after peripheral electrical stimulation (PES) were observed when compared to transcranial direct current stimulation (tDCS) or to sham treatment with limited evidence. No other differences in cortical excitability and representation of the affected and non-affected hemisphere were observed when comparing mirror therapy with sham therapy or tDCS, PES with sham therapy or tDCS, and graded motor imagery with wait-list., Conclusions: Graded motor imagery and PES result in higher cortical excitability reductions of the affected hemisphere compared to wait-list, tDCS and sham treatment, respectively., (© 2023 American Academy of Physical Medicine and Rehabilitation.)

Background: Impairments in lumbopelvic sensorimotor control (SMC) are thought to be one of the underlying mechanisms for the recurrence and persistence of low back pain (LBP). As such, lumbopelvic SMC tests are frequently included in the clinical examination of patients with LBP., Objective: To evaluate convergent and known-groups validity of clinically assessed lumbopelvic SMC tests in patients with LBP according to COSMIN guidelines., Design: Systematic review METHODS: Five electronic databases were searched until December 2023. Studies examining convergent or known-groups validity of lumbopelvic SMC tests assessed via inspection or palpation in patients with LBP were included. Known-groups validity had to be assessed between patients with LBP and pain-free persons. Two independent researchers appraised risk of bias and quality of evidence (QoE) using the COSMIN Risk of Bias checklist and modified GRADE approach, respectively. Results for known-groups validity were reported separately for single tests and test-clusters., Results: Twelve studies (946 participants) were included. Three studies investigated convergent validity of three single tests. Regarding known-groups validity, six studies evaluated six single tests and four studies investigated two test-clusters. For only one test, both convergent and known-groups were assessed. The QoE for tests showing sufficient convergent or known-groups validity was (very) low, whereas QoE was moderate for single tests or test-clusters with insufficient known-groups validity., Conclusion: All clinically assessed lumbopelvic SMC tests with sufficient convergent or known-groups validity had (very) low QoE. Therefore, test outcomes should be interpreted cautiously and strong reliance on these outcomes for clinical decision-making can currently not be recommended., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Attention has been proposed to play an important role in persisting pain, with excessive attentional processes towards pain information leading to worse pain outcomes and maladaptive behaviors. Nevertheless, research on somatosensory attending during the anticipation of pain-related movements is still scarce. This study investigated if individuals with chronic and recurrent lower back pain compared to pain-free controls, show enhanced attending to somatosensory information in the back while anticipating back-recruiting movements. 43 healthy control, 33 recurrent (RLBP) and 33 chronic low back (CLBP) pain sufferers were asked to perform back-recruiting movements. Before the movement initiation cue, a task-irrelevant tactile stimulus was administered to participants' lower back to elicit somatosensory evoked potentials (SEPs), used as an index of somatosensory attending. In contrast to our hypothesis, most identified SEP components did not differ across groups. The only exception was the P175 amplitude which was larger for the CLBP group compared to individuals with RLBP and healthy controls. The current study did not find robust evidence of enhanced somatosensory attending to the back in people with persisting lower back pain. The finding that CLBP, but not RLBP individuals, had larger amplitudes to the P175 component, is discussed as possibly reflecting a higher state of emotional arousal in these patients when having to prepare the back-recruiting movements., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Clauwaert et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Pain is one of the most important yet poorly understood complaints in heritable connective tissue disorders (HCTDs) caused by monogenic defects in extracellular matrix molecules. This is particularly the case for the Ehlers-Danlos syndrome (EDS), paradigm collagen-related disorders. This study aimed to identify the pain signature and somatosensory characteristics in the rare classical type of EDS (cEDS) caused by defects in type V or rarely type I collagen. We used static and dynamic quantitative sensory testing and validated questionnaires in 19 individuals with cEDS and 19 matched controls. Individuals with cEDS reported clinically relevant pain/discomfort (Visual Analogue Scale ≥5/10 in 32% for average pain intensity the past month) and worse health-related quality of life. An altered somatosensory profile was found in the cEDS group with higher (P = .04) detection thresholds for vibration stimuli at the lower limb, indicating hypoesthesia, reduced thermal sensitivity with more (P < .001) paradoxical thermal sensations (PTSs), and hyperalgesia with lower pain thresholds to mechanical (P < .001) stimuli at both the upper and lower limbs and cold (P = .005) stimulation at the lower limb. Using a parallel conditioned pain modulation paradigm, the cEDS group showed significantly smaller antinociceptive responses (P-value .005-.046) suggestive of impaired endogenous pain modulation. In conclusion, individuals with cEDS report chronic pain and worse health-related quality of life and present altered somatosensory perception. This study is the first to systematically investigate pain and somatosensory characteristics in a genetically defined HCTD and provides interesting insights into the possible role of the ECM in the development and persistence of pain. PERSPECTIVE: Chronic pain compromises the quality of life in individuals with cEDS. Moreover, an altered somatosensory perception was found in the cEDS group with hypoesthesia for vibration stimuli, more PTSs, hyperalgesia for pressure stimuli, and impaired pain modulation., (Copyright © 2023 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

In patients presenting with low back pain (LBP), once specific causes are excluded (fracture, infection, inflammatory arthritis, cancer, cauda equina and radiculopathy) many clinicians pose a diagnosis of non-specific LBP. Accordingly, current management of non-specific LBP is generic. There is a need for a classification of non-specific LBP that is both data- and evidence-based assessing multi-dimensional pain-related factors in a large sample size. The "PRedictive Evidence Driven Intelligent Classification Tool for Low Back Pain" (PREDICT-LBP) project is a prospective cross-sectional study which will compare 300 women and men with non-specific LBP (aged 18-55 years) with 100 matched referents without a history of LBP. Participants will be recruited from the general public and local medical facilities. Data will be collected on spinal tissue (intervertebral disc composition and morphology, vertebral fat fraction and paraspinal muscle size and composition via magnetic resonance imaging [MRI]), central nervous system adaptation (pain thresholds, temporal summation of pain, brain resting state functional connectivity, structural connectivity and regional volumes via MRI), psychosocial factors (e.g. depression, anxiety) and other musculoskeletal pain symptoms. Dimensionality reduction, cluster validation and fuzzy c-means clustering methods, classification models, and relevant sensitivity analyses, will classify non-specific LBP patients into sub-groups. This project represents a first personalised diagnostic approach to non-specific LBP, with potential for widespread uptake in clinical practice. This project will provide evidence to support clinical trials assessing specific treatments approaches for potential subgroups of patients with non-specific LBP. The classification tool may lead to better patient outcomes and reduction in economic costs., Competing Interests: DLB, ST, MT, LS, SeS, HJW, MA, GT, KE, BF, JVO, CTM, PJO, SB, RD, SK declare no conflicts of interest. BB: declares no conflicts of interest relevant to the current work, but has previously received research support, consultancy fees and/or honoraria from AbbVie, Amgen, Biogen, GE/Lunar, Janssen, Galapagos, Gilead, Medimaps, MSD, Sanofi Genzyme, Theramex, UCB. TS: declares prior consulting fees from Johnson & Johnson, Amgen, Kaia Health Software, SpineArt, Implantcast and speaking and travel arrangements from Johnson & Johnson, ICOTEC, Nuvasive, Ulrichmedical, Silony, Amgen, Kaia Health Software. EE-K has received fees from painCert GmbH, Casquar GmbH and Omega Pharma GmbH, outside the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Belavy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The classification of non-specific chronic low back pain (CLBP) according to multidimensional data could guide clinical management; yet recent systematic reviews show this has not been attempted. This was a prospective cross-sectional study of participants with CLBP (n = 21) and age-, sex- and height-matched pain-free controls (n = 21). Nervous system, lumbar spinal tissue and psychosocial factors were collected. Dimensionality reduction was followed by fuzzy c-means clustering to determine sub-groups. Machine learning models (Support Vector Machine, k-Nearest Neighbour, Naïve Bayes and Random Forest) were used to determine the accuracy of classification to sub-groups. The primary analysis showed that four factors (cognitive function, depressive symptoms, general self-efficacy and anxiety symptoms) and two clusters (normal versus impaired psychosocial profiles) optimally classified participants. The error rates in classification models ranged from 4.2 to 14.2% when only CLBP patients were considered and increased to 24.2 to 37.5% when pain-free controls were added. This data-driven pilot study classified participants with CLBP into sub-groups, primarily based on psychosocial factors. This contributes to the literature as it was the first study to evaluate data-driven machine learning CLBP classification based on nervous system, lumbar spinal tissue and psychosocial factors. Future studies with larger sample sizes should validate these findings., (© 2023. Springer Nature Limited.)

Objective: Although multimodal interventions are recommended in patients with severe depressive and/or anxiety disorders, available evidence is scarce. Therefore, the current study evaluates the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program, delivered within a transdiagnostic framework, for patients with (comorbid) depressive and/or anxiety disorders., Methods: Participants were 3,900 patients diagnosed with a depressive and/or anxiety disorder. The primary outcome was Health-Related Quality of Life (HRQoL) measured with the Research and Development-36 (RAND-36). Secondary outcomes included: (1) current psychological and physical symptoms measured with the Brief Symptom Inventory (BSI) and (2) symptoms of depression, anxiety, and stress measured with the Depression Anxiety Stress Scale (DASS). The healthcare program consisted of two active treatment phases: main 20-week program and a subsequent continuation-phase intervention (i.e., 12-month relapse prevention program). Mixed linear models were used to examine the effects of the healthcare program on primary/secondary outcomes over four time points: before start 20-week program (T0), halfway 20-week program (T1), end of 20-week program (T2) and end of 12-month relapse prevention program (T3)., Results: Results showed significant improvements from T0 to T2 for the primary variable (i.e., RAND-36) and secondary variables (i.e., BSI/DASS). During the 12-month relapse prevention program, further significant improvements were mainly observed for secondary variables (i.e., BSI/DASS) and to a lesser extent for the primary variable (i.e., RAND-36). At the end of the relapse prevention program (i.e., T3), 63% of patients achieved remission of depressive symptoms (i.e., DASS depression score ≤ 9) and 67% of patients achieved remission of anxiety symptoms (i.e., DASS anxiety score ≤ 7)., Conclusion: An interdisciplinary multimodal integrative healthcare program, delivered within a transdiagnostic framework, seems effective for patients suffering from depressive and/or anxiety disorders with regard to HRQoL and symptoms of psychopathology. As reimbursement and funding for interdisciplinary multimodal interventions in this patient group has been under pressure in recent years, this study could add important evidence by reporting on routinely collected outcome data from a large patient group. Future studies should further investigate the long-term stability of treatment outcomes after interdisciplinary multimodal interventions for patients suffering from depressive and/or anxiety disorders., Competing Interests: JW, NG, GH, MP, MG, and JJ are employed by Intergrin Academy. Intergrin Academy evaluates and improves specialized secondary care formats such as offered at ‘PHI’. Intergrin Academy and ‘PHI’ are part of the same overarching organization: Integrative Interventions Group. In addition, JW was a former employee of ‘Het Rughuis’, a mental healthcare facility also part of Integrative Interventions Group., (Copyright © 2023 Wijnen, Gordon, van 't Hullenaar, Pont, Geijselaers, Van Oosterwijck and de Jong.)

Objective: Although multimodal interventions are generally recommended in patients with long-term somatic symptom disorders (SSD), available evidence is limited. The current study evaluates the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program for patients with SSD and predominant (spinal) pain., Method: The healthcare program consisted of two active treatment phases: main 20-week program and a 12-month relapse prevention program. Participants were 4453 patients diagnosed with SSD. The primary outcome was health-related quality of life (HRQoL) assessed using the RAND-36 (i.e., mental/physical component summary) and secondary outcomes included physical and psychological symptoms assessed using the Brief Symptom Inventory (BSI) and RAND-36 subscales. Mixed linear models were used to examine the effects of the multimodal healthcare program on primary/secondary outcomes over four time points: before start 20-week program (T0), halfway 20-week program (T1), end of 20-week program (T2) and end of relapse prevention program (T3)., Results: Significant improvements were found from T0 to T2 for all primary variables (i.e., mental/physical component summary) and secondary variables (i.e., BSI/RAND-36 subscales), which were maintained until the end of the relapse prevention program (T3)., Conclusion: An interdisciplinary multimodal integrative treatment for SSD is effective for improving HRQoL and reducing physical and psychological symptoms.

Prayer is considered to be the most common therapy used in alternative medicine. This study aimed to explore the effect of prayers on endogenous pain modulation, pain intensity, and sensitivity in healthy religious participants. A total of 208 healthy religious participants were enrolled in this study and randomly distributed into two groups, a prayer group (n = 156) and a poem reading or control group (n = 52). Participants from the prayer group were then selectively allocated using the prayer function scale to either an active prayer group (n = 94) receiving an active type of praying or to a passive prayer group (n = 62) receiving a passive type of praying. Pain assessments were performed before and following the interventions and included pressure pain threshold assessment (PPT), conditioned pain modulation (CPM), and a numerical pain rating scale. A significant group-by-time interaction for PPT (p = 0.014) indicated post-intervention increases in PPT in the prayer group but not in the poem reading control group. Participants experienced a decrease in CPM efficacy (p = 0.030) and a reduction in their NPRS (p < 0.001) following the interventions, independent of their group allocation. The results showed that prayer, irrespective of the type, can positively affect pain sensitivity and intensity, but does not influence endogenous pain inhibition during hot water immersion. Future research should focus on understanding the mechanism behind "prayer-induced analgesia.", (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: Although there has been increasing interest in the role of systemic cytokines in chronic spinal pain (CSP), the evidence on their potential contribution is still unclear. Therefore, the current study systematically reviewed the evidence on systemic cytokine level differences between people with CSP compared to healthy controls (HCs) and the potential associations with pain severity., Methods: An electronic search was conducted on PubMed, Web of Science and Embase. All included studies were classified as observational studies, exploring the comparison between a CSP group and a HC group, and the association between systemic cytokine levels and pain severity., Results: Nine articles were included with a total sample of 400 CSP patients suffering from chronic whiplash associated disorder (CWAD) or chronic low back pain (CLBP). In CLBP, moderate evidence was found for elevated tumor necrosis factor (TNF) α, interleukin (IL) 6, IL-1 receptor antagonist (IL-1RA), and soluble TNF receptor (sTNF-R) type 2, for normal interferon (IFN) γ and IL-2 levels, and for reduced IL-10 levels. No association was found between pain severity and these cytokines in CLBP. In CWAD, moderate evidence was found for elevated CRP and evidence for changes in TNF-α was inconclusive. Evidence for the association between pain severity and CRP was limited, and there is probably no association between pain severity and TNF-α with limited evidence in CWAD., Conclusions: Moderate evidence indicates the presence of systemic inflammation in CSP. Evidence regarding the association between pain severity and systemic cytokines is inconclusive and limited., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Theoretical frameworks explain how pain-related psychological factors may influence the physical performance. In this systematic review and meta-analysis, we evaluated the evidence regarding the relationship between the pain-related psychological factors and the maximal physical performance in patients with low back pain (LBP). Pubmed, Embase, CINAHL and Web of Science databases were searched from inception to May 2022. Cross-sectional or longitudinal studies reporting cross-sectional measures of association between at least one pain-related psychological factor and a quantitatively measured outcome of maximal physical performance in patients with LBP were eligible for inclusion. Thirty-eight studies (n = 2,490; 27 cross-sectional studies, n = 1,647 (66%); 11 longitudinal studies, n = 843 (34%)) were included, with 92% of participants (n = 2,284) having chronic LBP. Results showed that pain-related fear, pain catastrophizing, and anticipated pain were consistently and negatively associated with the maximal physical performance in chronic LBP, whereas pain-self efficacy showed positive correlations. Overall, magnitudes of absolute pooled r-values were small (r ≤ 0.25), except for anticipated pain, which was moderately associated with maximal physical performance (r = -0.34 to -0.37). Subanalyses and sensitivity analyses yielded similar pooled correlation coefficients. Certainty of evidence using the GRADE recommendations was very low to moderate for pain-related fear, and very low to low for the other pain-related psychological factors. Prospero registration: CRD42021227486. PERSPECTIVE: Overall, small pooled correlation coefficients were shown between pain-related psychological factors and maximal physical performance in chronic LBP. Certainty of evidence was very low to low for all pain-related psychological factors other than pain-related fear. Future studies taking into account limitations of the current literature may therefore change these conclusions., (Copyright © 2022 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)