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Purpose: This study aims to explore the meaningful contributions of rehabilitation for participants living with persistent pain. Materials and methods: A phenomenological methodology was used. Thirteen purposefully selected participants, who self-identified as substantially improved from persistent pain due to rehabilitation, were interviewed in-depth. Data were analyzed using reflexive thematic analyses. Results: Participants included three men and ten women, age ranging from 22–69 years, pain duration was 2–30 years. Seven interconnected themes were developed: 1) indication of negative pain and health care experiences, 2) supporting working alliance with healthcare professionals, 3) Pain Dialogue, 4) improved self-awareness and self-regulation, 5) different view on pain, 6) autonomy and personal growth and 7) hope and new perspective. Integration of these themes provided a framework for understanding meaningful contributions of rehabilitation from the participants' perspective. Conclusions: The study identified seven interconnected themes enhancing meaningful contributions of rehabilitation for participants who have substantially improved from persistent pain. These findings provide a novel conceptual understanding of how rehabilitation can foster recovery. The themes strongly support person-centred care, an understanding of Pain Dialogue and personal growth through the lens of the lived experience. The quality of the therapeutic relationship is considered a central vehicle for improved health outcomes. IMPLICATIONS FOR REHABILITATION: A rehabilitation participant perspective can contribute to better outcomes in pain rehabilitation. A shift from a pain-centred to a person-centred approach should be considered to enhance meaningful contributions of rehabilitation. Pain Education should be reconceptualized into Pain Dialogue. The quality of the therapeutic relationship can be regarded as a key driver for the effectiveness of person-centred care and Pain Dialogue. [ABSTRACT FROM AUTHOR]

Purpose: To describe the outcomes of an interdisciplinary multimodal pain treatment (IMPT) for chronic musculoskeletal pain (CMP) patients up until 12 months post-treatment. Materials and Methods: Data were gathered during routine clinical practice during a 3-year period (2019–2021) at six Dutch rehabilitation centres. Assessments included patient-reported outcome measures for multiple domains including disability, pain and fatigue. Longitudinal data were analysed using repeated-measures models and by quantifying responder rates. Results: Included were 2309 patients with a mean age of 43.7 (SD 12.9) years, of which 73% female. All outcomes showed significant improvements at each timepoint. At discharge, large effect sizes were found for disability, average and worst pain, fatigue and health-related quality of life. Improvements were largely sustained at 12-months. Relatively large proportions of patients had clinically relevant improvements after treatment (pain-related disability: 60%; average pain: 52%; worst pain: 37.4%; work capacity: 50%; concentration: 50%; fatigue: 46%). Patients who received a treatment extension showed further improvements for all outcome measures, except average pain. Conclusions: At group level, all outcomes significantly improved with mainly large effect sizes. The results were mostly sustained. The proportion of patients showing clinically relevant improvements tends to be larger than previously reported for mixed CMP patients. IMPLICATIONS FOR REHABILITATION: Chronic musculoskeletal pain can be very disabling and impacting participation and quality of life. Often several psychosocial factors contribute to the maintenance of pain and its evolving consequences. In this study, a 61 hours highly individualized interdisciplinary multimodal pain treatment resulted in significant improvements with moderate to very large effect sizes for all important domains like pain, fatigue, disability, work capacity, and quality of life. Care providers as well as health insurers should acknowledge the interdisciplinary multimodal pain programme as an effective treatment in their clinical decision making. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to describe chronic pain patients' perception of their physical function and treatment factors for improving or maintaining physical function long-term after the completion of an Interdisciplinary Pain Rehabilitation Program (IPRP) and to compare physical function before, directly after and at long-term follow-up (16–20 months after treatment). Materials and methods: Patients with severe nonmalignant chronic pain, participating in an IPRP at a specialist clinic, were eligible for inclusion in a convergent mixed methods study. Quantitative data included aerobic capacity, level of physical activity (PA) and self-efficacy for exercise. Qualitative data were collected through semi-structured interviews. Results: The qualitative analysis resulted in one theme: Orientation change and two categories: Permission to feel self-worth and Reclaiming life, which illuminated factors that enabled a sustained increase in PA. The quantitative data (n = 11) showed a significantly increased maximal oxygen uptake (VO2max) from 2.46 l/min (SD = 0.9) at baseline to 2.63 l/min (SD = 0.9, p =.03) on completion of the program. VO2max was sustained at long-term follow-up (2.56 l/min (SD = 1.0, p =.24). Conclusion: This study indicates that an orientation change process through an IPRP can lead to increased physical function and a sustainable level of PA. Furthermore, it highlights the importance of a person-centered approach to enable sustainable change in patients with chronic pain. [ABSTRACT FROM AUTHOR]

Fibromyalgia is characterized by widespread chronic pain and multiple additional symptoms which may result in significant disability. Recent studies have demonstrated disturbances in body image and body schema in people affected by this condition. Importantly, it affects a heterogenous population in which distinct profiles can be identified based on physiological and/or psychological characteristics. The objective of our study was to explore individual differences in experiencing one's own body in fibromyalgia. We applied a mixed methods design and included data from 28 women diagnosed with fibromyalgia. We measured symptom intensity (Fibromyalgia Impact Questionnaire, part 1), disturbances in body schema (adapted Fremantle Back Awareness Questionnaire) and body image (Body Esteem Scale, Multidimensional Assessment of Interoceptive Awareness). Additionally, participants drew their bodies and how they experienced them (Body Drawing task). Next, we asked five experts in chronic pain treatment to evaluate the drawings on a specially designed scale and indicate what kind of emotions these drawings expressed. We found evidence of disturbed body experiences and large individual differences in each of the measured variables which allowed for clustering participants into three groups, named 'Connected body', 'Conflicted body', and 'Disconnected body'. These preliminary results suggest patients with fibromyalgia may have both qualitatively and quantitatively distinct disrupted body experience. [ABSTRACT FROM AUTHOR]

\nPlain Language SummaryElectromagnetic transduction therapy (EMTT) is a non-invasive magnetic therapy with high oscillating electromagnetic field power. This pilot randomised controlled trial (ChiCTR1900021031) evaluated EMTT’s potential efficacy in relieving pain and other non-symptomatic aspects of chronic myofascial pain (CMP). Forty patients with moderate-to-severe CMP were randomised into treatment (real-EMTT) or control (sham-EMTT) group, and received eight sessions of 20-minute real or sham EMTT over four weeks. Generalised estimating equation was used to estimate changes in outcomes, including Numerical Rating Scale (NRS), Brief Pain Inventory Interference Scale (BPI-IS), Beck Depression Inventory (BDI), and Patient Global Impression of Change scale (PGIC) before and up to 6 months after treatment. Recruitment and compliance rates (95% confidence interval) were 39.6% (30.0%–49.8%) and 87.5% (73.2%–95.8%), respectively. There were no significant changes in NRS, BPI-IS and BDI over time (group*time p = 0.929, p = 0.949 and p = 0.608, respectively), and PGIC also did not differ between groups over time (all p > 0.050). Based on the variability of the NRS and non-compliance rate of the patients included in this pilot trial, a total sample size of 148 is required to achieve 80% power if a clinically meaningful reduction in NRS after EMTT treatment is 1.0 (with a superiority margin of 0.3).Electromagnetic transduction therapy (EMTT) is a non-invasive magnetic therapy with high oscillating electromagnetic field power. Previous studies suggested that this therapy may be useful in treating different musculoskeletal conditions. Chronic myofascial pain is a long-lasting condition that causes pain in the musculoskeletal system. In this pilot randomised trial, we assessed the responses of patients with chronic myofascial pain to EMTT, real or sham EMTT (20 minutes/session), over a four-week period. We interviewed 101 patients and successfully recruited 40 patients (recruitment rate: 40%). Thirty-five patients completed the whole treatment series and follow-ups (compliance rate: 88%). The changes in pain intensity, activity interference and severity of depression over time between two groups were not different. Adverse events related to EMTT were rare; only one patient in the treatment group reporting a transient increase in pain after therapy. Based on the non-compliance rate and variability of the pain scores, a sample size of approximately four times of the present pilot study is needed to confirm the efficacy of EMTT for chronic myofascial pain. [ABSTRACT FROM AUTHOR]

A survey examined the relationship between pain science continuing education (PSCE) and practice patterns among pediatric physical therapists (PTs) treating patients with chronic pain. Seventy-nine PTs reported on their methods, confidence, and satisfaction. Those with 20+ hours of PSCE were significantly more likely to use desensitization, nerve glides, and Pain Neuroscience Education, and expressed higher confidence. However, there was no difference in satisfaction with patient outcomes across education levels. The study reveals insights into pediatric PT practices and identifies opportunities to better align clinical approaches with current evidence, emphasizing the importance of ongoing education in pain management techniques. [ABSTRACT FROM AUTHOR]

BackgroundObjectivesMethodsResultsConclusionsClinical trials registration noIndividuals with low back pain (LBP) often exhibit weakness and the presence of trigger points in their Gluteus Medius (GMe) muscle.To examine the effectiveness of adding dry needling (DN) for the GMe to standard care of active physical therapy in patients with chronic nonspecific LBP.A randomized, prospective, sham-controlled trial was conducted. Participants with chronic nonspecific LBP (N = 22, age range: 31–55 years) were randomly divided into intervention and control groups. Both groups received active physical therapy including exercises for 6 treatments. In addition, at each session, the intervention group received deep DN to their GMe muscle, and the control group received sham needling. Outcome measures included level of pain (using VAS scale), function (Oswestry disability index ODI), low back range of motion (ROM) (forward flexion and schober tests), and global rating of change. The research group was further divided into moderate and minimal disability according to the ODI.The research group showed greater improvement in pain level compared with control (p = 0.01). The change in ODI was higher in the moderate LBP group compared with the control group (B = 5.25, p < 0.05). The change in forward flexion distance test was higher in the moderate disability LBP group compared with the control group (B = 6.31, p < 0.01). Simple mean analysis also revealed a significant difference between the moderate and minimal disability groups (B = 6.16, p = 0.01)Incorporating DN into physical therapy treatments for chronic nonspecific low back pain, can improve pain level and function.NCT04498572 (clinicaltrial.gov). [ABSTRACT FROM AUTHOR]

Purpose: Chronic pain assessment tools exist for children, but may not be valid, reliable, and feasible for populations with functional, cognitive or communication limitations, for example, cerebral palsy (CP). This study aimed to (i) identify chronic pain assessment tools used with children and young people and rate their measurement properties; (ii) develop a CP specific feasibility rating tool to assess the feasibility of tools in CP; and (iii) categorise tools according to reporting method. Materials and methods: Assessment tools were identified by literature review. Their measurement properties were rated using the COnsensus based standards for the Selection of health Measurement INstruments. The CP specific Feasibility Rating Tool was developed and used to rate the tools. Results: Fifty-seven chronic pain assessment tools were identified. Six have content validity for CP, four of these use proxy-report. Forty-two tools were considered feasible for people with CP; 24 self report and 18 observational/proxy-report. Only the Paediatric Pain Profile has content validity and feasibility for people with CP unable to self-report. Conclusions: There are few valid, reliable and feasible tools to assess chronic pain in CP. Further research is required to modify tools to enable people with cognitive limitations and/or complex communication to self-report pain. IMPLICATIONS FOR REHABILITATION: Few of the existing chronic pain assessment tools are feasible or valid to use with all young people with cerebral palsy (CP). Modifications to self-report tools are needed to improve access for young people who have cognitive impairment or use alternative and augmentative communication. The pain assessment tool with the strongest feasibility and measurement properties for young people who cannot self-report is the Paediatric Pain Profile. Clinicians will need to consider a range of chronic pain assessment tools to assess the biopsychosocial domains important to young people with cerebral palsy. [ABSTRACT FROM AUTHOR]

Athletes ‘learn’ to conform to the extensive pressures and expectations within the culture of sport; however, an understanding of the process by which athletes learn to conform to the sport ethic is not well known. As high performing athletes’ over-conformity to traditional sport values has been linked to negative health consequences (e.g. overtraining, playing while injured, disordered eating, engagement in hazing, chronic pain management, performance-enhancing substance abuse and risk for maltreatment), it is crucial that we better understand the process by which athletes learn to conform to these extreme expectations within sport. Therefore, the aim of this study was to examine high-performance athletes’ experiences of conforming to the sport ethic and the process by which they adhere to these dominant sport values. A total of 13 retired, competitive, women athletes from a variety of sports participated in this study and engaged in a 1-to-2-hour semi-structured interview. Data were analysed thematically. Generated themes include the development of athletes’ conformity to the sport ethic through their initial sport engagement, modelling and observing, positive reinforcement and fear of repercussion. Additionally, athletes experienced both maladaptive and adaptive long-term outcomes stemming from their learned sport ethic which stuck with them post-sport involvement. Findings are interpreted using Bandura’s theoretical perspective of observational learning and future directions are recommended. [ABSTRACT FROM AUTHOR]

BackgroundObjectiveMethodResultsConclusionPain Science Education (PSE) has been shown to reduce pain and disability in chronic low back pain (CLBP), a prevalent and disabling condition. PSE helps reconceptualize pain using aids like pictures, metaphors, and stories, and supports pain self-management. Due to variations in pain beliefs across different cultures, the PSE resources need to be customized to accommodate respective literacy levels, cultures and languages.This study aimed to develop PSE booklets in three Indian languages: Bengali, Hindi and Kannada.Thirty chronic pain experts (i.e. physiotherapists, pain physicians, psychiatrists, psychologists, public health professionals, nurses) independently examined the PSE booklet’s content and rated it under: (1) Content adequacy, (2) Simplicity and clarity, (3) Topical flow, (4) Metaphors’ appropriateness (5) Illustration suitability (6) Color scheme and (7) Culture-specific content. Five people with lived CLBP experience contributed. The content validity ratio (CVR) was used to rate the content of the PSE booklet in seven domains (e.g. cultural relevance). A priori criterion for acceptance of the content was set at 70%.Five booklet chapters were developed and were deemed acceptable. Cultural relevance domain received the highest score.This is the first study to develop culturally relevant PSE booklets in Bengali, Hindi, and Kannada, which are likely to be useful in educating patients with CLBP. The new intervention needs to be tested for effectiveness in respective language-speaking samples. [ABSTRACT FROM AUTHOR]

AbstractTreatment of chronic, non-cancer pain can be challenging in the presence of long-term opioid therapy (LTOT). Buprenorphine products can provide a unique option for chronic pain treatment due to the improved safety profile with a ceiling effect on respiratory depression. Drug manufacturers provide recommendations for conversion from full mu agonist to buprenorphine which typically includes tapering to lower morphine equivalent doses (MEDD). This study will attempt to compare if there is a difference in the ability of achieving buprenorphine maintenance therapy for chronic pain based on the starting opioid MEDD. This study’s primary endpoint is the difference in ability to achieve buprenorphine maintenance therapy for chronic, non-cancer pain based on baseline MEDD (i.e., ≤30 MEDD vs >30 MEDD). Secondary endpoints will describe method of conversion to buprenorphine, difference in frequency of follow up and average time to achieve maintenance doses. There was no difference in ability to achieve buprenorphine maintenance doses between either group. Approximately 40% of patients in each group achieved maintenance doses regardless of baseline MEDD. Patients on higher MEDDs had the same likelihood of achieving buprenorphine maintenance therapy for chronic pain as those were at 30 MEDD and can be considered for buprenorphine therapy without tapering first. [ABSTRACT FROM AUTHOR]

AbstractThe purpose of this study was to better characterize morphine equivalent daily dose (MEDD) equivalencies with buccal buprenorphine, and identify real-world efficacy and safety outcomes associated with the use of buccal buprenorphine for chronic pain at a local VA Medical Center. This study was a retrospective chart review of Computerized Patient Record System (CPRS) patient records with outpatient prescriptions for buccal buprenorphine (Belbuca®). Overall, there was a high discontinuation rate of Belbuca®: being 60% or greater across all different patient groups. These high attrition rates may potentially be result of failure to titrate to an optimal dose of Belbuca® needed for adequate analgesia. Those fully rotated fared marginally better than those partially rotated in that those fully rotated discontinued at a lesser rate and less quickly than those who were partially rotated. From the results of this study, a local dosing scheme for Belbuca® based on baseline MEDD was created for facility level guidance. The exact MEDD conversion ratio, however, for individual buprenorphine products as well as MEDD contributed by these products on a patient’s overall opioid related risk compared to other full agonist opioids still remains unclear and further studies are warranted. [ABSTRACT FROM AUTHOR]

AbstractBuprenorphine can be an effective and safe option for patients with chronic pain. We describe a case in which a patient on long-term full opioid agonists for chronic non-cancer pain was safely transitioned from methadone to buprenorphine in the outpatient setting using a low dose buprenorphine initiation protocol. One month after the opioid rotation, the patient reported adequate analgesic effect from the buprenorphine regimen. Further studies are warranted to better guide prescribing of buprenorphine for chronic nonmalignant pain. [ABSTRACT FROM AUTHOR]

Background: Chronic stress and chronic pain are closely linked by the capacity to exacerbate each other, sharing common roots in the brain and in the gut. The strict intersection between these two neurological diseases makes important to have a therapeutic strategy aimed at preventing both to maintain mental health in patients. Diet is an modifiable lifestyle factor associated with gut-brain axis diseases and there is growing interest in its use as adjuvant to main therapies. Several evidence attest the impact of specific diets or nutrients on chronic stress-related disorders and pain with a good degree of certainty. A daily adequate intake of foods containing micronutrients such as amino acids, minerals and vitamins, as well as the reduction in the consumption of processed food products can have a positive impact on microbiota and gut health. Many nutrients are endowed of prebiotic, anti-inflammatory, immunomodulatory and neuroprotective potential which make them useful tools helping the management of chronic stress and pain in patients. Dietary regimes, as intermittent fasting or caloric restriction, are promising, although further studies are needed to optimize protocols according to patient's medical history, age and sex. Moreover, by supporting gut microbiota health with diet is possible to attenuate comorbidities such as obesity, gastrointestinal dysfunction and mood disorders, thus reducing healthcare costs related to chronic stress or pain. Objective: This review summarize the most recent evidence on the microbiota-mediated beneficial effects of macro- and micronutrients, dietary-related factors, specific nutritional regimens and dietary intervention on these pathological conditions. [ABSTRACT FROM AUTHOR]

Introduction: Acute lower back pain can lead to neuroplastic changes in the central nervous system, and symptoms of central sensitization after 12 weeks. While sensory sensitivity has been shown to predict symptoms of central sensitization, trait sensory profiles may be prognostic in the persistence of central sensitization symptoms in low back pain over time. Objective: To examine sensory profiles as prognostic symptoms of central sensitization in people with acute low back pain. Methods: A longitudinal type 2 prognostic factor research study was performed according to the PROGRESS framework. Baseline and 12-week follow-up measures were taken using the Adolescent/Adult Sensory Profile and the Central Sensitization Inventory measures. Study participants were consecutively included from primary care physiotherapy practices. Univariable, and multivariable regression analyses were performed to adjust sensory profiles based on previous history of low back pain, baseline Central Sensitization Inventory scores, level of pain, disability, age, and duration of low back pain. Results: After adjustment, the sensory profiles of Low Registration B = 0.44, 95%CI (0.18, 0.70), Sensation Seeking B = 0.38, 95%CI (0.19, 0.57), Sensory Sensitive B = 0.49, 95%CI (0.25, 0.74), Sensation Avoiding B = 0.40, 95% CI (0.15, 0.65) was significantly associated with the persistence of central sensitization symptoms (N = 103). Conclusion: Sensory profiles may predict symptoms of central sensitization after 12 weeks in people with acute low back pain. [ABSTRACT FROM AUTHOR]

Background: The US National Institutes of Health (NIH) has produced a minimal data set to promote more accurate and consistent reporting of clinical trials, facilitating easier comparison of research on low back pain patients worldwide. The NIH-minimal dataset has not been previously translated into Turkish, and its features are currently unknown. This study aimed to adapt the NIH-Minimal Data Set into Turkish and investigate its validity and reliability in Turkish-speaking patients with chronic low back pain (CLBP). Methods: In the study, 245 patients with CLBP were included. Test-retest and internal consistency analyzes were performed to evaluate the reliability of the NIH-minimal dataset. The intraclass correlation coefficient (ICC2,1) value was used to assess test-retest analysis. Cronbach's alpha value was calculated for internal consistency. Total impact scores of the NIH-minimal dataset were compared with total scores of the Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) to assess construct validity. The minimal detectable change (MDC95) was calculated based on the standard error of measurement (SEM95). Results: The NIH-Minimal Data Set was found to have high test-retest reliability (ICC2,1 = 0.928) and high internal consistency (Cronbach α = 0.905). The NIH-minimal dataset correlated well with RMDQ and ODI (r = 0.750 and 0.810, respectively). There were no floor or ceiling effects. Also, SEM95 and MDC95 for the total score were 4.57 and 12.55, respectively. Conclusion: Considering all these data, it was concluded that the Turkish version of the NIH-minimal dataset is a valid and reliable outcome measure for evaluating patients with CLBP. [ABSTRACT FROM AUTHOR]

Purpose: Pain is a complex, intimate, and subjective experience influenced by biological, psychological, and social factors. This case report investigates the effectiveness of a multidisciplinary team approach in addressing chronic pain and pain-related fear. Case description: The case report describes a 22-year-old female who experienced anterior knee pain for seven years, despite undergoing two knee surgeries and physiotherapy without improvement. Following a comprehensive assessment, which included a detailed medical history, clinical examination, and thoughtful clinical analysis, a multidisciplinary approach was recommended. Employing an evidence-based methodology that integrated neurocognitive rehabilitation techniques, including Pain Neuroscience Education, Graded Motor Imagery, and Tactile Discrimination Training, alongside psychological rehabilitation strategies such as Mindfulness, Acceptance and Commitment Therapy, and Problem-Solving Therapy, the report presents a comprehensive in-depth rehabilitation plan exemplifying the application of this multimodal approach within a clinical setting in a patient with chronic pain. This approach is designed not to address the biomechanical aspects but to delve into the cognitive facets associated with pain perception and avoidance, as well as potential psychological factors that may be influencing the onset and persistence of symptoms. Outcomes: The scores from the rating scales provided valuable insights into patient progress in pain management, functional improvement, fear of movement, and overall physical, psychological, and emotional well-being, at six months. Conclusion: This case report offers valuable insights into the usefulness of this multidisciplinary and multimodal approach, highlighting its potential as an avenue in the management of chronic pain and pain-related fear. [ABSTRACT FROM AUTHOR]

Background: A link between pronated feet (PF) and chronic low back pain (CLBP) has been reported in the literature. However, physical interventions (PI) like physiotherapy and orthotics mainly target the lower back, neglecting the broader biomechanical impacts of PF that affect the feet, ankles, and overall posture. Currently, there is a lack of comprehensive meta-analyses or systematic reviews on this subject. Objectives: This systematic review with a meta-analysis aimed to evaluate the effects of PI on pain and disability in patients having CLBP with PF. Methods: From inception until October 15, 2023, Medline/PubMed, Web of Science, and Scopus databases were searched using the desired keywords for randomized control trials (RCTs). The quality of the RCTs was evaluated using the PEDro scale and risk of bias tool. Results: Four studies involving 268 patients were identified, two compared custom-made foot orthoses to non-biomechanical foot insoles, while the other two used exercises. The meta-analysis included four studies for pain and three for disability. The results showed a significant change in pain [−2.43 (95% CI −2.73 to −2.13, p <.001)] and disability of −6.69 (95% CI −8.04 to −5.33, p <.001)]. Conclusions: This systematic review and meta-analysis of four RCTs elucidates that PI, specifically targeting PF, significantly alleviate pain and reduce disability in patients having CLBP with PF. These findings advocate for integrating foot-based PI within the treatment protocols for patients suffering from CLBP accompanied by PF. [ABSTRACT FROM AUTHOR]

Introduction: A higher prevalence of knee pain in Southeast Asian countries, compared with non-Asian countries, is an established fact. This article hypothesizes that this fact, combined with personal, cultural, and environmental factors, may influence attitudes toward illness and treatment-seeking behavior and adherence. Objective: This study aimed to determine current attitudes, stigma, and barriers of women to the management of chronic knee pain and treatment in two Southeast Asian countries. Methods: Fourteen semi-structured interviews explored female lived perceptions of chronic knee pain in Southeast Asia. Using a phenomenological reduction process, open-ended questions allowed participants to voice their perceptions of their experience of this knee condition. Particular foci were potential stigma associated with the perceptions of others, health-seeking attitudes, and attitudes toward exercise. Results: The shared experiences of managing chronic knee pain revealed the impact of their condition on participants' normality of life and their struggles with pain, limitations, and fear for the future. Key individual, interpersonal, organizational and community barriers and facilitators impacted the health seeking attitudes and engagement with conservative rehabilitation programmes. Conclusion: Improved socio-cultural competency and consideration for an individuals' intersectional identity and interpersonal relationships are key to designing rehabilitation and conservative management solutions. Co-creating alternative pathways for rehabilitation for individuals that are more distant from health facilities may help reduce socio-cultural barriers at a community level. [ABSTRACT FROM AUTHOR]

Objectives: Most patients seen in physical therapy (PT) clinics for low back pain (LBP) are treated for chronic low back pain (CLBP), yet PT interventions suggest minimal effectiveness. The Cochrane Back Review Group proposed 'Holy Grail' questions, one being: 'What are the most important (preventable) predictors of chronicity' for patients with LBP? Subsequently, prognostic factors influencing outcomes for CLBP have been described, however results remain conflicting due to methodological weaknesses. Methods: This retrospective observational cohort study examined prognostic risk factors for PT outcomes in CLBP treatment using a sub-type of AI. Bootstrap random forest supervised machine learning analysis was employed to identify the outcomes-associated variables. Results: The top variables identified as predictive were: FOTO™ predicted functional status (FS) change score; FOTO™ predicted number of visits; initial FS score, age; history of jogging/walking, obesity, and previous treatments; provider education level; medication use; gender. Conclusion: This article presents how AI can be used to predict risk prognostic factors in healthcare research. Improving predictive accuracy helps clinicians predict outcomes and determine most appropriate plans of care and may impact research attrition rates. [ABSTRACT FROM AUTHOR]

Purpose: Chronic whiplash-associated disorders (WAD) is a heterogeneous condition with limited effective treatment options available. This study evaluated the efficacy of multimodal physiotherapy and usual care in chronic WAD with facet-mediated pain receiving platelet-rich plasma (PRP) injections to determine if pain interference and confidence completing activities in the presence of neck pain could be improved. Materials and methods: A multiple-baseline, single-case experimental design was used to evaluate the 6-week effect of physiotherapy or usual care in two groups of three participants each. Results: All six participants demonstrated a significant reduction in pain interference, and three participants showed improved confidence to perform daily activities when in pain. Weighted Tau-U demonstrated a significant reduction of pain interference with large to very large effect sizes (> 0.75) for both interventions in all participants irrespective of treatment allocation with no significant group difference demonstrated. Similar effects were demonstrated for the confidence to perform daily activities with neck pain (ES > 0.46), although this was only evident in three participants (two PT and one UC). Generalisation measures also showed improvements in pain and disability, psychological and quality of life outcomes. No adverse events were reported. Conclusions: Both physiotherapy and usual care demonstrated improvements in pain interference and confidence to perform activities of daily living with neck pain in people with chronic WAD following cervical facet joint PRP. Trial Registration: The trial was registered with ClinicalTrials.gov (Protocol Number: NCT03949959). [ABSTRACT FROM AUTHOR]

Objective: Mixed Martial Arts (MMA) is a relatively young combat sport. In contrast to classic boxing, MMA combines techniques of grappling and striking. However, characteristic long-term effects of MMA on the wrist are discussed controversially. Aim of this study was to elucidate characteristic degenerative changes of the wrist from MMA fighters in comparison to classic boxers. Methods: In this study, eleven professional MMA fighters and ten professional boxers with chronic wrist pain were examined and compared. Age, weight, number of fights and weekly hours of training were recorded. Wrist and hand of each fighter were examined using a 3T-MR scanner. Degenerations of the radial, central and ulnar column were analyzed according to Navarro's three-column theory and degenerative changes were categorized based on the classification of Fredericson. Results: There was no significant difference of age, weight and number of fights between MMA fighters and boxers (p > 0.15). However, MMA fighters practiced significantly more hours per week (19.5 (MMA) vs. 8.5 (boxing) hours/week, p < 0.001). No significant associations were found between different training times per Week in terms of degenerative changes of the wrist in MMA and boxing based on the three column theory. The comparison of degenerative changes in the columns between MMA and boxing showed no significant differences. The MRI showed a significantly higher degeneration in the radial column compared to the central column among MMA fighters for ligaments (p = 0.01) and bones (p = 0.03). Conclusion: Due to different fighting techniques, different physical traumas, including falls, pattern of degenerations of the wrist between MMA fighters and boxers are different. MMA fighters suffer of a highly degenerative radial column and boxers suffer of a homogeneous degeneration of all three columns. [ABSTRACT FROM AUTHOR]

Background: Fast-acting Sub-perception Therapy (FAST) is a novel spinal cord stimulation (SCS) modality delivering paresthesia-free pain relief. Our study evaluated the longer-term, real-world impact of FAST on chronic pain. Research design and methods: As part of a multicenter, real-world, consecutive case series, we retrospectively identified patients who used FAST-SCS and analyzed their data. The numerical rating scale (NRS) was used to evaluate the overall pain. Results: Data from 315 patients were analyzed at baseline and their last available follow-up (median 6.8 months after SCS implantation). At the time of the analysis, 12-, 18-, and 24-month data were available for 112, 86, and 50 patients, respectively. At the last follow-up, NRS pain score was reduced by 5.5 ± 2.5 compared to baseline (from 7.8 ± 1.7 to 2.3 ± 2.0; p < 0.0001). Interim long-term analysis showed that results were sustained for up to 2 years, with 64% of patients reporting a minimal overall pain score (NRS ≤2/10). Conclusion: This ongoing, real-world, multicenter study showed that FAST-SCS achieved significant paresthesia-free pain relief, while long-term interim analysis suggests that outcomes could be sustained for up to 2 years. Our data provide preliminary insights into the potential utility of this low-frequency sub-perception SCS paradigm using a biphasic active recharge pulse shape. Trial registration: ClinicalTrials.gov (CT.gov identifier: NCT01550575). Plain Language Summary: Unlike conventional spinal cord stimulation (SCS) – which relies on a tingling sensation to replace the sensation of pain (paresthesia) – a novel SCS modality called Fast-Acting, Sub-perception Therapy (FAST) uses supra-threshold, biphasic, low-frequency pulses with an active recharge pattern as a guidance strategy to optimize targeting of dorsal column fibers. Once the painful region has been precisely covered with paresthesia, the stimulation amplitude is reduced, and the therapy is applied at a paresthesia-free dose. Recent pre-clinical and computational models provide a plausible framework supporting the working hypothesis under which FAST stimulation settings are believed to enhance inhibitory mechanisms of action in the dorsal horn pain processing network; these suggest that pain relief may be mediated by the preferential activation of surround receptive field fibers in the dorsal column. A recent clinical report found that when programming FAST sub-perception settings, patients with SCS experienced pain relief within minutes with no sensation of paresthesia. Our real-world, multicenter study identified patients using FAST-SCS to manage their chronic pain of the lower back and/or limbs. We found that patients reported a significant reduction in their overall pain, from 7.8 ± 1.7 at baseline to 2.3 ± 2.0 at the last follow-up (median 6.8 months), corresponding to a 5.5-point improvement in their pain (p < 0.0001, n = 315). The responder rate was 82% (258/315), and 61% of the patients (193/315) reported overall NRS pain scores ≤2. To date, 112, 86, and 50 patients have been assessed at 12-, 18-, and 24-months follow-up, respectively. Interim analysis of this preliminary long-term data showed that results were sustained for up to 2 years, with around 85% of patients who experienced ≥50% reduction in overall pain and 64% of patients who reported minimal overall pain scores (NRS ≤ 2). This multicenter, real-world, ongoing study demonstrates that FAST can deliver significant paresthesia-free pain relief for SCS-implanted patients and suggests that these results could be sustained over time. Future studies with prospective and comparative designs are required to confirm these preliminary findings and gather more evidence related to the functional impact, safety, and cost-effectiveness profile of this novel sub-threshold SCS paradigm. [ABSTRACT FROM AUTHOR]

AbstractBackgroundObjectiveMethodsResultsConclusionChronic neck pain associated with reduced cervical range of motion, necessitating accurate and reliable assessment for effective rehabilitation. The ActivForce 2 electronic goniometer is a user-friendly tool with potential applicability in both clinical and research settings.This study evaluated the intra- and inter-rater reliability of the ActivForce 2 electronic goniometer in measuring cervical range of motion in patients with chronic neck pain.Thirty-one patients (21 women, 10 men; mean age ± standard deviation: 38.74 ± 11.08 years) were assessed over two sessions, one week apart. Two data collectors measured cervical movements, with three repetitions per movement. Intra-rater reliability was evaluated by having each collector assess participants in both sessions, while inter-rater reliability was tested by comparing measurements between collectors. Reliability was evaluated using the Intraclass Correlation Coefficient, Standard Error of Measurement, Minimum Detectable Change, Bland-Altman plots and linear regression.The electronic goniometer demonstrated excellent reliability, with ICC values ranging from 0.980-0.999 (intra-rater) and 0.954-1.00 (inter-rater). Low SEM and narrow Bland-Altman limits supported the precision of measurements.The ActivForce 2 electronic goniometer is a reliable tool for assessing cervical spine movements in chronic neck pain patients. [ABSTRACT FROM AUTHOR]

BackgroundPurposeMethodResultsConclusionPersistent pain is increasingly recognized as a growing issue among adolescents worldwide, with an estimated prevalence of 10–30%. Physical therapy is a recommended treatment modality for managing this kind of pain. Yet, there is still limited knowledge regarding how physiotherapists experience, manage, and follow up this patient population.This qualitative study aimed to explore the experiences of physiotherapists in Norwegian primary healthcare working with adolescents experiencing persistent pain. The study examined the resources the therapists make use of, and the challenges they encounter.Four focus group interviews were conducted with a total of 13 Norwegian physiotherapists experienced in treating adolescents with persistent pain. The interviews explored the physiotherapists’ experiences of working with adolescents with persistent pain. A reflexive thematic analysis was conducted to analyze the data.Three main themes were identified from the data analysis: (1) Relationship building as the foundation of the intervention. (2) Accompanying the adolescents into their everyday life. (3) Challenging cases that are also rewarding to work with.This study sheds light on the importance of sufficient and multifaceted clinical competence among physiotherapists to enable them to work effectively with adolescents experiencing persistent pain, and their families. The experiences of physiotherapists show the importance of a strong therapeutic alliance and individualized treatment approaches, based on shared decision-making and age-appropriate communication and interventions. The therapists in our study emphasized the need to integrate interventions into the adolescents’ everyday lives, tailoring treatments to the unique life of each individual. Physiotherapists must navigate the complexities of meeting individual patient needs and adapting to challenges beyond traditional practice. To support this patient group effectively, ongoing professional development is recommended, either through continued education or colleague guidance from other experienced physiotherapists. [ABSTRACT FROM AUTHOR]

AbstractPurpose of the articleMaterials and MethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONWalking disorders are a significant issue for patients with low back pain. The aim of clinical trials is to compare the effects of cognitive functional therapy (CFT) and neurofeedback training (NFBT) on gait kinetics in chronic non-specific low back pain (CNSLBP) patients.Sixty females with chronic non-specific low back pain were recruitment for clinical trials. They were randomly divided into experimental and one control groups (Each group 20 patients). The experimental group received the relevant interventions for eight weeks. The primary outcome was pain, kinesiophobia and disability. The secondary outcome was vertical ground reaction force (VGRF) parameters. Two-Way Repeated Measures ANOVA statistical method was used for data analysis.Within-group comparisons showed that neurofeedback training and cognitive functional therapy groups experienced significant improvement in pain intensity, disability and kinesiophobia after eight-week (p < 0.05). However, the cognitive functional therapy group improved the vertical ground reaction force parameters better than the neurofeedback training group (p < 0.05).cognitive functional therapy intervention had a greater effect on the vertical ground reaction force parameters. The reason for the greater effect of cognitive functional therapy intervention on vertical ground reaction force parameters can be partially explained due to the multimodal therapy used through cognitive exercises and motor control.Cognitive functional therapy and neurofeedback training was shown to reduce pain intensity, disability, and kinesiophobia, Consequently improving vertical ground reaction force parameters in patients with Chronic non-specific low back pain.Among the psychological interventions used, the cognitive functional therapy significantly showed more effectiveness in improving the vertical ground reaction force parameters of patients with chronic non-specific low back pain.Our research may inform clinical decision-making and guide the development of therapeutic interventions for patients with chronic non-specific low back pain.Cognitive functional therapy and neurofeedback training was shown to reduce pain intensity, disability, and kinesiophobia, Consequently improving vertical ground reaction force parameters in patients with Chronic non-specific low back pain.Among the psychological interventions used, the cognitive functional therapy significantly showed more effectiveness in improving the vertical ground reaction force parameters of patients with chronic non-specific low back pain.Our research may inform clinical decision-making and guide the development of therapeutic interventions for patients with chronic non-specific low back pain. [ABSTRACT FROM AUTHOR]

AbstractNaltrexone is an opioid antagonist approved by the Food and Drug Administration (FDA) for alcohol use disorder and opioid use disorder. More recently, naltrexone has been used off-label at low doses of 4.5 mg daily for chronic pain due to fibromyalgia, neuropathy, complex regional pain syndrome, and multiple sclerosis. While several studies show the promise of low-dose naltrexone in treating chronic pain, most had small sample sizes and short-term follow up, which warrants additional investigation into the effectiveness of low-dose naltrexone. This medication use evaluation aimed to evaluate the effectiveness of low-dose naltrexone for chronic pain in Veterans through retrospective chart review. The average duration of low-dose naltrexone therapy was 123 days with approximately half of Veterans still taking it at the time of chart review. The average change in pain score from initiation to most recent visit was −0.83. Low-dose naltrexone was generally well-tolerated with 32% (13 of 41) of Veterans reporting adverse effects including vivid dreams, drowsiness, dizziness, and nausea. Low-dose naltrexone resulted in a small decrease in pain, although may be considered after a patient has failed multiple lines of therapy for additional pain control after a risk versus benefits discussion. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMethodsResultsConclusionsKnee pain increases the risk of developing chronic widespread pain (CWP) and knee osteoarthritis (KOA). The prevalence of CWP and KOA has increased, and there is a need for early prevention. Therefore, the aim was to examine the associations of health-related quality of life (HRQoL) and lifestyle habits with chronic pain at a two-year follow-up in individuals with knee pain.A two-year longitudinal cohort study including 251 individuals aged 30–60 years reporting knee pain at baseline. HRQoL was measured via the Short-Form General Health Survey (SF-36), and lifestyle habits included questions on overweight, physical activity, diet, alcohol and tobacco use. Pain was assessed with a pain mannequin. Differences in health status and lifestyle habits over time in groups with unchanged no chronic pain (NCP), transitioned to less and more pain, and unchanged CWP were analysed using Wilcoxon’s, McNemar’s and Friedman’s tests. Multinominal regression analysis was performed to study associations with reporting chronic pain at follow-up.Reporting better HRQoL across various SF-36 concepts and normal weight at baseline was associated with reporting NCP after two years. A few changes were made regarding HRQoL and lifestyle habits over the course of two years, but an increase in general health was associated with transitioning to less pain.During primary care visits for knee pain with a combination of overweight or lower HRQoL, individuals should receive comprehensive attention to prevent the development of CWP. Future studies should investigate the associations further. [ABSTRACT FROM AUTHOR]

AbstractUndergraduates’ health and wellness is a critical focus in higher education, yet there remains a paucity of research exploring first-generation to college (FGC) undergraduates with chronic pain (CP). Examining 116 first-year, FGC undergraduates, this quantitative study sought to understand the impact of CP on pain acceptance for FGC undergraduates at a midwestern Predominately White Institution (PWI). Students were primarily White, self-identified female, domestic, and traditional first-year students, most of whom reported experiencing pain some to most days over the last 3 months. Using the Psychosociocultural Model, results revealed group differences by CP identity and onset. Regression analysis indicated adjustment and identity positively predicted wellness. Further, pain/pain impact partially mediated the relationship between identity and wellness. An ongoing, multidimensional examination in addressing pain acceptance for first-year, FGC undergraduates with CP is suggested, as it is not enough to just explore pain in and of itself. [ABSTRACT FROM AUTHOR]

Purpose: Hypermobile Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorder (HSD) are painful, chronic and multi-systemic conditions. No online pain management programs for hEDS/HSD currently exist. We aimed to develop one by exploring what people with hEDS/HSD want in such programs. Materials and methods: A Delphi was conducted via online surveys of stakeholders: participants with hEDS/HSD and healthcare professionals (HCP). In survey 1, participants were asked if a hEDS/HSD-specific online pain management program was important, listing up to 20 topics important to know about pain. In survey 2, participants rated the importance of those topics. Consensus was set as ≥75% rating of at least "important". Using topics that reached consensus, the online program was developed. Usability testing was performed using the Systems Usability Scale (SUS). Results: 396 hEDS/HSD and 29 HCP completed survey 1; 151 hEDS/HSD and 12 HCP completed survey 2. 81% of hEDS/HSD and 69% of HCP rated a hEDS/HSD-specific program as at least "important". Thirty-five topics reached consensus to guide content for the HOPE program (Hypermobile Online Pain managemEnt). SUS score was 82.5, corresponding to "high acceptability". Conclusions: A hEDS/HSD-specific online pain management program is important to stakeholders. Utilising a Delphi approach to incorporate stakeholder input, an evidence-informed and user appropriate program was developed. IMPLICATIONS FOR REHABILITATION: Pain is one of the most common and impactful symptom affecting those with Hypermobile Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorder (HSD). Online pain management programs are effective in other chronic conditions such as Fibromyalgia and Rheumatoid Arthritis, but there are no programs specific for hEDS/HSD. People with hEDS or HSD and healthcare professionals with experience in these conditions feel that an online pain management program specific to their condition is important; consensus revealed thirty-five key topics important to these stakeholders. The first hEDS/HSD-specific online pain management program, called HOPE, was developed with stakeholder input and usability tested, ready for clinical trial testing. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this review was to assess the effectiveness of multidisciplinary, activity-based interventions on adults with chronic musculoskeletal or widespread pain who identify as ethnoculturally diverse (ECD) compared to adults belonging to the predominant culture of the host country. Methods: Online databases Medline, CINAHL, AMED, Psych Info and PubMed were searched from the earliest date available until April 2023. The quality of the included studies were assessed against the Risk of Bias in Non Randomized Studies of Interventions (ROBINS-I). Postintervention data were analyzed using meta-analyses and the certainty of evidence determined using the Grading of Recommendation, Assessment, Development and Evaluation approach (GRADE). Results: Nine cohort studies with 3467 participants living in America and north-western European countries were included. ECD adults had higher pain intensity (SMD 1.36, 95%CI 0.29 to 2.35, p = 0.03), higher levels of depression (SMD 0.96, 95%CI 0.40 to 1.52, p < 0.01) and a nonsignificant difference in pain-related disability (SMD −1.45, 95%CI −3.28 to 0.39, p = 0.12) following multidisciplinary pain intervention compared to adults of the predominant culture. Conclusion: Adults from ECD backgrounds in Western nations have poorer outcomes after multidisciplinary, activity-based chronic pain interventions compared to adults from predominant cultural groups in these countries suggesting program adaptations may be required. IMPLICATIONS FOR REHABILITATION: Adults from ethnoculturally diverse backgrounds in Western nations have poorer outcomes after chronic pain interventions suggesting different approaches to management are needed. Programs can be adapted to reflect culture-specific beliefs, metaphors, language and concepts in their content to better address pain and improve outcomes among ethnoculturally diverse communities. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONThis study aimed to investigate the effectiveness of Manual Lymphatic Drainage (MLD) on the pain intensity, impact of the disease, and health-related quality of life among women diagnosed with Fibromyalgia syndrome (FMS).The study was designed as a single-center, double-blind, randomized, and sham-controlled trial. Twenty women with FMS were included and randomized into intervention (n = 11) and sham control (n = 9) groups. In the intervention group, MLD was applied in addition to medical treatment, whereas the sham control group received sham MLD along with medical care over a period of 3 weeks. The Visual Analog Scale (VAS), Fibromyalgia Impact Questionnaire (FIQ-R), and 12-item Short Form Survey (SF-12) were used to measure outcomes. Participants were assessed baseline, immediately after the treatment, at 12 weeks, and at 24 weeks.The VAS score, the FIQ-R symptom and FIQ-R overall scores, and SF-12 score showed a statistically significant time effect (p < 0.05) in intervention group. No significant main effects in any parameters for any time interval were observed in the sham group (p > 0.05).MLD added to medical treatment may be an effective alternative method that could be used in the treatment of FMS to reduce pain intensity and improve impact of disease.Fibromyalgia syndrome (FMS) is a chronic pain condition causing widespread pain, primarily affecting women.Manual Lymphatic Drainage (MLD) is a therapy technique that uses slow, rhythmic, superficial, and repetitive movements to stimulate lymphatic and parasympathetic systems, alleviate pain, aid immune system regulation, and remove waste.The results of this study suggest that MLD added to medical treatment may be an effective alternative method that could be used in the treatment of FMS to reduce pain intensity and improve impact of disease.Fibromyalgia syndrome (FMS) is a chronic pain condition causing widespread pain, primarily affecting women.Manual Lymphatic Drainage (MLD) is a therapy technique that uses slow, rhythmic, superficial, and repetitive movements to stimulate lymphatic and parasympathetic systems, alleviate pain, aid immune system regulation, and remove waste.The results of this study suggest that MLD added to medical treatment may be an effective alternative method that could be used in the treatment of FMS to reduce pain intensity and improve impact of disease. [ABSTRACT FROM AUTHOR]

Objectives: Recognizing the limitations of the current pain therapies, the study aimed to explore the unique needs and obstacles related to pain management in Breast Cancer Survivors (BCs) with Chronic Pain (CP). Methods: 4 focus groups were conducted involving 17 BCs with CP (Mage = 51, SD = 7.99) with varying pain intensities. Thematic analysis was applied to transcribed discussions. Findings: Three key themes emerged: (1) Challenges to pain management, including "Doctor-patients communications barriers" and "Contextual and societal barriers"; (2) Self-management needs, encompassing "Psycho-social support," "Care-related needs," and "Shared decision-making"; (3) Treatment preferences and perceptions of pain management, with subthemes like "Treatment preferences," "Institution preference," and "Decision role perception." Conclusions: This study emphasizes tailored support systems targeting patient hesitancy, countering pain normalization, and addressing healthcare providers' attitudes. It underscores the importance of integrating caregiver and peer support. Findings advocate refining healthcare provider education, adopting a comprehensive multidisciplinary approach, and strategically incorporating eHealth tools into such care. [ABSTRACT FROM AUTHOR]

Background: Patients with fibromyalgia experience chronic, widespread pain. It remains a misunderstood disorder with multimodal treatments providing mixed results. Objectives: To examine the effects of radial shockwave therapy (RSWT) compared to placebo on pain, pain catastrophizing, psychological indices, blood markers, and neuroimaging. Study-related experiences were also explored qualitatively. Methods: Quantitative sensory testing (QST), Visual Analog Scale (VAS), Beighton Scoring Screen (BSS), Pain Catastrophizing Scale (PCS), blood biomarker (Interleukin (IL)-6 and IL-10), and brain fMRI were measured pre- and post-treatment along with a post-treatment survey. The RSWT group received five treatments (one week apart over five-week period) to the three most painful areas (500 shocks at 1.5 bar and 15 Hz, then 1000 shocks at 2 bar and 8 Hz, and finally 500 shocks at 1.5 bar and 15 Hz) versus sham treatment for the placebo group. Results: There were no statistically significant differences in the BSS for hypermobility (p =.21; d =.74), PCS (p =.70; d =.22), VAS (p =.17–.61; d =.20–.83) scores, QST for skin temperature and stimuli (p =.14–.65; d =.25–.88), and for the pressure pain threshold (p =.71–.93; d =.05–.21). The VAS scores had clinically significant changes (MCID greater than 13.90) with improved pain scores in the RSWT group. Neuroimaging scans revealed no cortical thickness changes. Post-treatment surveys revealed pain and symptom improvements and offered hope to individuals. Conclusion: RSWT was implemented safely, without any negative treatment effects reported, and acted as a pain modulator to reduce sensitivity. Clinical Trials Registration: ClinicalTrials.gov identification number NCT02760212 [ABSTRACT FROM AUTHOR]

Background: Previous studies have evaluated the implementation of behavioral approaches in individuals with chronic temporomandibular disorders (TMDs). Objective: To evaluate the benefits of a behavioral approach to craniofacial pain. Second, we assessed the benefits of kinesiophobia, catastrophizing, mouth opening without pain, and forward head posture. Methods: Individuals with chronic TMDs were treated for five weeks. The intervention group (n = 17) underwent pain neuroscience education, manual therapy, and therapeutic exercise, whereas the control group (n = 17) underwent manual therapy only. Outcomes were evaluated immediately, at seven and 19 weeks follow-up. The assessment tools used were the Craniofacial Pain Disability Inventory, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Mandibular Range of Motion Scale, and Cervical Range of Motion Tool. Results: The interventions did not influence the differences in the improvements between the groups observed for craniofacial pain disability (inter-subject p 0.4). The intervention had a moderate influence on the improvement of kinesiophobia and catastrophizing (Inter-subject p 0.09 and 0.1 respectively) with a clinically significant effect size (Estimated mean (EM) −8.6 standard deviation (SD) ±3.48 p 0.019; and EM −7.6 SD ± 5.11 p 0.15 respectively). Conclusion: The behavioral approach improved catastrophizing and kinesiophobia outcomes in individuals with chronic TMDs. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the psychometric properties of the Silhouettes Fatigue Scale (SFS) when used to assess fatigue in undergraduates and middle-aged adults with chronic pain. Materials and methods: A total of 426 undergraduates and 207 middle-aged individuals with chronic pain participated in this study. Participants were asked to respond to a survey including the SFS as well as another validated measure of fatigue, questionnaires about pain catastrophizing and pain interference, and questions about pain (i.e., location, duration, and intensity). Convergent, discriminant, criterion and known-groups validity were evaluated. Results: Convergent validity was supported by a strong association between the two scales measuring fatigue. Discriminant validity was supported by stronger associations between the two fatigue scales scores compared to those between the SFS and pain catastrophizing scores. Criterion validity was supported by moderate associations between the SFS and measures of pain intensity and pain interference. Finally, known-groups validity was supported by significant differences in the SFS scores between students without chronic pain, students with chronic pain, and middle-aged individuals with chronic pain. Conclusions: The findings support the validity of the SFS scores when used to assess fatigue in undergraduates and middle-aged adults with chronic pain. IMPLICATIONS FOR REHABILITATION: Fatigue is a significant problem among people with chronic pain that can lead to disability. Assessing and treating fatigue in people with pain is essential. The Silhouettes Fatigue Scale (SFS) is a new single-item self-report of fatigue, fast and easy to use. Results support convergent and discriminant validity as well as sensibility to detect differences in fatigue between groups. [ABSTRACT FROM AUTHOR]

Central pain sensitivity (CS) is defined as an increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold inputs. The main aim of this paper is to investigate if and how specific psychological constructs are related with CS burden in patients with chronic headache (CH). Specifically, research question 1 explores the association of temperament, personality, childhood adversities, defense mechanisms and mental pain with CS burden. Research question 2 aims to test the role of the best predictors of CS burden in affecting the quality of life (QoL) using path analysis. A total of 508 women with CH completed a psycho-diagnostic survey. Results showed that higher levels of low sensory threshold (β = 0.200), bodily threat traumatic experiences (β = 0.156), neurotic defenses (β = 0.109) and mental pain (β = 0.343) emerged as the best predictors of higher CS burden. The model presented demonstrated a satisfactory fit (GFI = 0.984; NFI = 0.966; CFI = 0.979; RMSEA = 0.056 [95% CI 0.028–0.085]) with large and medium effect sizes on physical (−0.654) and psychological QoL (−0.246). The study showed a key role of psychological dimensions in CS burden levels and their relationships with QoL in CH patients. From a clinical perspective, these results suggest the importance of evaluating the level of CS burden during the clinical assessment for chronic pain conditions such as CH, since it may contribute to guide patients to tailored psychological and medical treatments, thereby saving time and costs on diagnostic procedures for chronic pain. [ABSTRACT FROM AUTHOR]

Background: Central sensitization is an important mechanism underlying many chronic pain conditions. Chronic pain and alcohol use disorder (AUD) are highly comorbid. Despite great scientific interest in brain mechanisms linking chronic pain and AUD, progress has been impeded by difficulty assessing central sensitization in AUD. Objective: The present study is the first to employ a validated surrogate measure to describe central sensitization in a clinical sample with AUD. Methods: Participants with AUD (n = 99) were recruited from an academic addiction treatment center. A well-established surrogate measure of central sensitization, The American College of Rheumatology Fibromyalgia Survey Criteria (ACRFMS) was administered. Participants also responded to questions about quality of life (RAND-36), and AUD. Descriptive analyses and Spearman's rho correlations were performed. Results: Chronic pain and evidence of central sensitization were prevalent. Greater central sensitization was associated with worse health-related quality of life. Participants higher in central sensitization expressed greater endorsement of pain as a reason for AUD onset, maintenance, escalation, treatment delay, and relapse. Conclusion: The present study bolsters prior assertions that AUD and chronic pain might compound one another via progressive sensitization of shared brain circuitry. These results may inform future mechanistic research and precision AUD treatment. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is an important medical problem that is associated with significant negative effects in many aspects of life. Based on prior studies, certain religious behaviors and having religion-based beliefs help coping with chronic diseases. this research aimed to investigate the effectiveness of Islamic spiritual therapy on the perception of pain intensity and catastrophizing of pain in patients with pain. Methods: The research population included all female patients suffering from chronic pain who referred to physiotherapy and pain clinics in Shiraz in 2022; finally, 30 female patients were selected from 3 clinics using available sampling method. After meeting the inclusion criteria, they entered into the treatment process. In the pretest stage, research questionnaires including Pain catastrophizing questionnaire (pcs) (1995) and Pain Intensity Perception Questionnaire were completed and randomly assigned. The participants underwent 10 sessions of Islamic spirituality therapy, each lasted 45 min; during this time, the control group did not receive any intervention. After the end of the treatment program, the questionnaires were administered again to both groups in the form of a post-test. The data were analyzed using multivariate analysis of covariance (MANCOVA) in SPSS version 22. Result: the average values of pain intensity and pain catastrophizing exhibited a reduction in the post-assessment in contrast to the pre-assessment. This disparity demonstrated statistical significance within the experimental cohort, whereas the difference between the mean values of the pre- and post-assessment in the control group were not statistically significant. It affirmed the efficacy of the intervention on the experimental group. Conclusions: Based on the findings of this study, Islamic spiritual therapy approaches decrease pain intensity and pain catastrophizing in women with chronic pain and represents new horizons in clinical interventions and thus could be used as an effective interventional method to reduce psychosocial problem and increase pain tolerance. [ABSTRACT FROM AUTHOR]

Objective: Pain catastrophizing has dimensions of magnification, rumination, and helplessness, being an important evaluator of chronic pain. Studies with mindfulness intervention point to a possible modulation of chronic pain catastrophizing behavior. However, how these facets of mindfulness are associated with the catastrophizing subscales is uncertain. The scope of this study is to verify how the association of mindfulness facets and catastrophizing subdimensions occurs. Methods: Women with chronic TMD answered the Pain Catastrophizing Scale (PCS) and Five Facets of Mindfulness Questionnaire (FFMQ). Results: Magnification was inversely correlated with "not reacting," "not judging," and the total FFMQ score. Total PCS was also inversely correlated with "not reacting." Conclusion: It is necessary to consider such possible correlations between mindfulness facets and the catastrophizing subdimensions in mindfulness-based interventions for this population. [ABSTRACT FROM AUTHOR]

Background: Cannabis-based medicinal products (CBMPs) are increasingly demonstrating effectiveness in treating a wide range of conditions, with a relatively high safety profile in clinical usage compared to other prescription pain medications and few contraindications. Consultation and other prescription-related costs are, at present, higher for CBMPs than for some other treatment options, leading to some concern around wider prescribing. Research design and Methods: An early cost-effectiveness model was developed to estimate the impact of prescribing CBMPs alone and/or in addition to analgesics, physiotherapy, and cognitive behavioral therapy for chronic pain in the UK for 1 year. Results: Due to their comparative effectiveness, CBMPs were found to be cost saving. Various scenarios were model tested; in all scenarios where CBMPs decrease pain-level states, less resource use is required. Increased efficacy of 5% was conservatively assumed based on current Real-World Evidence. In this scenario, CBMPs were significantly more cost-effective, and as costs relating to the prescribing of these continue to fall, relative savings are predicted to increase. Conclusion: These findings highlight the substantial cost saving that CBMPs may represent for the treatment of chronic pain patients, and the benefits for healthcare providers as a treatment for this often hard-to-treat population. [ABSTRACT FROM AUTHOR]

Objective: This study examines the efficacy of positive psychology interventions (PPIs) for patients with chronic pain through a systematic review and meta-analysis. PPIs are defined as strategies that involve focusing on positive emotions, thoughts, and behaviors that improve mental health by increasing mental well-being and reducing psychological distress. Design: The search was conducted using the PubMed, Scopus, PsycINFO, and Cochrane Library databases. Main Outcome Measures: Subjective, psychological, and social well-being were used as indicators of mental well-being, and depression, anxiety, and stress symptoms were used as indicators of psychological distress. Results: Nine studies were included. Eight studies evaluated subjective well-being, seven evaluated depression, and three evaluated anxiety symptoms. No studies examined psychological well-being, social well-being, or stress. PPIs were found to be effective in promoting subjective well-being post-treatment (Hedges' g = 0.40; 95% CI [0.06, 0.73]) and reducing anxiety (Hedges' g = −0.32, 95% CI [-0.59, −0.06]), but no significant results were found for depression (Hedges' g = −0.23, 95% CI [-0.50, 0.04]). Conclusion: The included investigations, while limited, suggest the utility of PPIs in mitigating the psychological consequences of chronic pain. Researchers and practitioners are encouraged to implement PPI practices. [ABSTRACT FROM AUTHOR]

Background: Research suggests that individuals who experience four or more adverse childhood experiences (ACEs) have increased rates of cannabis use. However, most prior research does not separate recreational and medical usage. Medical cannabis is used legally in many states to treat a variety of health conditions, many of which are also associated with ACEs. Objectives: Therefore, we explore the extent to which medical cannabis users differ from recreational cannabis users and whether medical use is associated with ACEs, poor health, or disability. Accordingly, we ask the following questions: Are ACEs associated with any cannabis use when controlling for measures of poor health and disability? Are ACEs associated with medical cannabis use? Are associations between ACEs and medical cannabis use explained by poor health and/or disability? Results: Using 2019 BRFSS data, we find that ACEs are significantly associated with cannabis use, but that disability and poor health fully account for the effect of ACEs on medical cannabis use. Conclusions: We conclude that practitioners screen for ACEs and disability status when prescribing medical cannabis. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsConclusionImpactTo compare the effect of Neuromuscular Exercise (NME) plus Pain Science Education (PSE), Isolated NME, and usual care on brain function measured by electroencephalography (EEG), clinical, and psychosocial outcomes in patients with chronic pain due to knee osteoarthritis (KOA).A three-arm randomised controlled trial will be conducted. Fifty-seven participants with KOA will be recruited in a 1:1:1 ratio. Outcome assessor, and statistician will be blinded to group allocation. One experimental group (n = 19) will receive NME plus PSE (24 sessions, 60-90 min each), the other experimental group (n = 19) will receive isolated NME (24 sessions, 60-90 min each) and the control group (n = 19) will continue with usual care. The PSE will be adapted to the context of the participants. Primary outcome measures will be brain activity, and secondary outcomes will be pressure pain threshold, pain intensity, disability, fear-avoidance beliefs, self-efficacy, and pain catastrophizing. Outcome measures will be evaluated pre-intervention, immediately post-intervention, and four-month post-intervention.The NME plus PSE intervention approach proposed in this trial could expand multimodal intervention strategies for patients with KOA.NME plus PSE applied by a physical therapist could be essential in improving brain function, clinical, and psychosocial outcomes of patients with KOA. This could have a positive impact on the use of these therapeutic modalities from a multidimensional approach, and this combined protocol could potentially be a guide for health professionals. [ABSTRACT FROM AUTHOR]

AbstractObjective: To understand the lived experiences and needs of college students with chronic pain living in the US and the UK. Participants: College students (n = 115), mean age 21.4 years (SD = 1.73). Methods: As part of a larger survey, students were asked: (1) How, if at all, living with pain impacted their college experience; (2) Support they did/did not receive from students, faculty, staff, and college services; (3) What support would be most helpful to them as a college student living with pain. Qualitative data were analyzed using an immersion/crystallization approach. Results: Four main themes were identified: (1) Stress resulting from the rigid demands of academic life can exacerbate pain; (2) Lack of communication leaves many students feeling isolated; (3) Frustration at lack of faculty support; and (4) Need for chronic pain to be recognized. Conclusions: The findings suggest areas for intervention to support college students living with pain during this defining period. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONChronic pain is prevalent among breast cancer survivors. Bio-psychosocial factors interplay in its exacerbation and maintenance. Therefore, prevention and treatment require an interdisciplinary response and the integration of various approaches. To deliver this way of working, healthcare professionals may need training. We developed an e-learning intervention, aimed at increasing awareness and interdisciplinary collaboration in response to pain after cancer. We aimed to gain insight into the intervention’s implementation, mechanisms, and outcomes through a realist evaluation.A mixed-methods pre- and post-test design with follow-up was used. Via questionnaires, professionals reported on the feasibility of the e-learning and their knowledge, beliefs, confidence, and professional role in pain prevention and treatment. Six-month post-intervention, interviews were conducted to explore transferability in practice.An interdisciplinary group of 22 professionals completed the intervention. Overall, e-learning was deemed a feasible format for training. An increase in confidence was found, whereas no changes were detected in knowledge and professional role. Configurations were outlined between these mechanisms and behaviors in practice, influenced by implementation processes and context-related factors.E-learning holds promise in stimulating knowledge, beliefs, confidence, and professional role. In this, the value of asynchronous discussion forums, case-based exercises, practical tools, and models were emphasized.The prevention and treatment of chronic pain following cancer treatment is a complex given, requiring interdisciplinary collaboration and the integration of care.E-learning training holds the potential to stimulate a shared vision of pain and an interdisciplinary attitude among healthcare professionals.Based on our findings, we suggest implementing e-learning training within local learning communities followed by continuing (online) interactions on experienced challenges and cases in practice.The prevention and treatment of chronic pain following cancer treatment is a complex given, requiring interdisciplinary collaboration and the integration of care.E-learning training holds the potential to stimulate a shared vision of pain and an interdisciplinary attitude among healthcare professionals.Based on our findings, we suggest implementing e-learning training within local learning communities followed by continuing (online) interactions on experienced challenges and cases in practice. [ABSTRACT FROM AUTHOR]

Purpose: Psychosocial factors are a barrier to recovery for people with musculoskeletal pain and psychosocial screening tools are consistently recommended by best practice guidelines to assist in identification. However, many physiotherapists do not use these tools. Presently, the perspectives on psychosocial screening tools of Australian physiotherapists are unknown. Exploration of these factors may create targets for increased uptake. The purpose of this paper is to qualitatively explore Australian physiotherapists' attitudes, perceptions, and behaviours towards psychosocial screening tools for musculoskeletal pain conditions. Materials and Methods: An Interpretive description qualitative study design was employed. Seventeen Australian physiotherapists were interviewed about their attitudes, perceptions, and behaviours towards psychosocial screening tools. Interviews were transcribed verbatim and analysed according to interpretive description. Results: Analysis highlighted three major themes: (1) understanding the patient through psychosocial screening, (2) confidence and competence with psychosocial factors, and (3) factors outside of my control influence screening. Conclusions: This study presents a deeper understanding of Australian physiotherapists' diverse attitudes and practices regarding psychosocial screening tools. The research highlights not only the variability in perspectives towards the relevance of psychosocial factors in patient assessments, but also the influence of external elements such as patient demographics and clinic culture on the utilization of these screening methods. IMPLICATIONS FOR REHABILITATION: Australian physiotherapists' varying attitudes and limited understanding of the impact of psychosocial factors may hinder the use of recommended psychosocial screening. Concerns about scope of practice, tool appropriateness for different patients, and clinic culture further challenge the integration of psychosocial assessments. The findings from this study indicate the need to provide more education to Australian physiotherapists on the importance and use of psychosocial risk factor screening, as part of clinical care standards and best practice guidelines in the management of patients, with musculoskeletal pain conditions. The findings from this study can support the creation of targeted training/innovations to improve the uptake of screening tools in Australian musculoskeletal clinical practice, to improve the care of patients with musculoskeletal pain conditions. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsDiscussion/ConclusionRising surgical rates for lumbar spinal stenosis (LSS) and underutilization of physical therapist services for this condition may increase patient risks and healthcare costs. Patient beliefs may also contribute to this problem. Therefore, our objective was to determine which messages about physical therapy were perceived as strongest by patients with LSS and whether those messages were influenced by patient factors.The study used a cross-sectional survey design, and participants were patients of outpatient physical therapy clinics with imaging or clinical evidence of LSS. Participants completed an electronic survey containing different messages about physical therapist services for LSS. Messages were designed using the health belief model. Perceived message strength was scored using the perceived argument strength scale (PASS). Pain catastrophizing and pain self-efficacy were measured to determine whether they influenced participant perceptions. Occurrence of magnetic resonance imaging and surgical consultations were also measured.Of 189 potential participants, 101 were included in the study. The message perceived as strongest emphasized physical therapists as listeners who would customize a plan (PASS 36.1 [5.0]) Similar scores were seen for messages that emphasized benefits of education and self-management and de-emphasized severity. The message that emphasized research findings was rated the least strong. Participants who had high levels of pain catastrophizing were more likely to have had imaging and perceived arguments as less strong.Results of the current study suggested patients with LSS preferred a message that emphasized physical therapists as listeners who would customize a plan. The message about research outcomes was perceived as the least strong. Therefore, awareness campaigns intended to influence the beliefs or behavior of patients with LSS should emphasize the individualized nature of physical therapy more than research evidence. [ABSTRACT FROM AUTHOR]

Purpose: There are known disparities in chronic pain severity, treatment, and opioid-related risks amongst individuals from lower socioeconomic status, including Medicaid beneficiaries, but little is known about whether Medicaid beneficiaries benefit in a similar way from multidisciplinary chronic pain rehabilitation. This study investigated differences in clinical outcomes between Medicaid and non-Medicaid beneficiaries who completed a 3-week multidisciplinary chronic pain rehabilitation program.Methods: Participants (N = 131) completed a broad range of clinical measures pre- and post-treatment including pain severity, pain interference, depression, anxiety, objective physical functioning, and opioid misuse risk. Patients with Medicaid were compared with non-Medicaid patients in terms of baseline characteristics and rate of change, utilizing two-factor repeated measures analyses of variance.Results: There were baseline characteristic differences, with Medicaid beneficiaries being more likely to be African American, have higher rates of pain, worse physical functioning, and lower rates of opioid use. Despite baseline differences, both groups demonstrated significantly improved outcomes across all measures (p<.001) and no significant difference in rate of improvement.Conclusions: Results suggest that pain rehabilitation is as effective for Medicaid recipients as non-Medicaid recipients. Patients with Medicaid are particularly vulnerable to disparities in treatment, so efforts to expand access to multidisciplinary pain treatments are warranted. IMPLICATIONS FOR REHABILITATION: Medicaid beneficiaries, who tend to be from lower socioeconomic status (SES), with chronic pain have poorer baseline functioning compared to non-Medicaid beneficiaries, including worse pain severity, poorer physical functioning, and higher levels of anxiety. Medicaid beneficiaries appear to benefit significantly and in a similar way to non-Medicaid individuals from participating in multidisciplinary, non-pharmacological chronic pain rehabilitation. Expanding access to evidence-based chronic pain rehabilitation, including nonopioid and multidisciplinary treatments, is a key component to address the chronic pain and opioid crises that differentially impact individuals from lower SES. [ABSTRACT FROM AUTHOR]

AbstractA machine-learning system is constructed to alleviate chronic knee pain through exercise and muscle strengthening. Three user-focused features are offered: video-based exercise demonstrations, real-time posture analysis and feedback, and performance and progress tracking. This system, which functions as an artificially-intelligent “technological surrogate physiotherapist,” applies human-computer incentive compatibility and joint learning-by-doing to reify and strengthen motivation, trust and acceptance and to increase effectiveness and efficacy, initial exacerbation of knee pain notwithstanding. In a 3-week experiment involving 60 individuals carrying chronic knee pain, positive and statistically significant outcomes were recorded regarding the Western Ontario and McMaster Universities Osteoarthritis Index physical function (p = 0.001), quality of life (EQ-5D-5L: < 0.001; EQ VAS: p = 0.004), exercise engagement (p < 0.001), system usability, and system acceptance. Technology-based solutions hold significant promise for improving future clinical practice by reducing professional resource demand and increasing the accessibility and caregiver-patient incentive compatibility under physiological healthcare. [ABSTRACT FROM AUTHOR]