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1. Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians

Author

Nijs, Jo, Wijma, Amarins J., Willaert, Ward, Huysmans, Eva, Mintken, Paul, Smeets, Rob, Goossens, Marielle, Wilgen, C. Paul van, Bogaert, Wouter Van, Louw, Adriaan, Cleland, Josh, and Donaldson, Megan

Subjects
Patient education, Chronic pain, Neurophysiology, Patient compliance, Cardiac patients, Pain management, Motivational interviewing, Neurosciences, Education, Clinical trials, Health education, Health
Abstract

Pain neuroscience education (PNE) and motivational interviewing (MI) have been widely implemented and tested in the field of chronic pain management, and both strategies have been shown to be effective in the short term (small effect sizes) for the management of chronic pain. PNE uses contemporary pain science to educate patients about the biopsychosocial nature of the chronicity of their pain experience. The goal of PNE is to optimize patients' pain beliefs/perceptions to facilitate the acquisition of adaptive pain-coping strategies. MI, on the other hand, is a patient-centered communication style for eliciting and enhancing motivation for behavior change by shifting the patient away from a state of indecision or uncertainty. Conceptually, PNE and MI appear to be complementary interventions, with complementary rather than overlapping effects; MI primarily improves cognitive and behavioral awareness and, potentially, adherence to treatment principles, whereas PNE potentially increases pain knowledge/beliefs, awareness, and willingness to explore psychological factors that are potentially associated with pain. Therefore, combining PNE with MI might lead to improved outcomes with larger and longer-lasting effect sizes. The combined use of PNE and MI in patients having chronic pain is introduced here, along with a description of how clinicians might be able to integrate PNE and MI in the treatment of patients experiencing chronic pain. Clinical trials are needed to examine whether combining PNE with MI is superior to PNE or MI alone for improving pain and quality of life in patients having chronic pain., Chronic pain (pain that persists beyond normal expected healing times or for >3 months) affects around 20% of the population. (1) The prevalence of chronic pain is higher than any [...]

Published
2020
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2. Predictors for physical activity and its change after active physical therapy in people with spinal pain and insomnia: Secondary analysis of a randomized controlled trial

Author

Bilterys, Thomas, primary, Van Looveren, Eveline, additional, Mairesse, Olivier, additional, Nijs, Jo, additional, Meeus, Mira, additional, Ickmans, Kelly, additional, Cagnie, Barbara, additional, Goubert, Dorien, additional, Willaert, Ward, additional, De Pauw, Robby, additional, Danneels, Lieven, additional, Moens, Maarten, additional, and Malfliet, Anneleen, additional

Published
2022
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3. Event-related potentials following cutaneous electrical stimulation in patients with chronic whiplash-associated disorders

Author

Lenoir, Dorine, Willaert, Ward, Ickmans, Kelly, Nijs, Jo, Cagnie, Barbara, Meeus, Mira, Vonck, Kristl, Delbeke, Jean, De Pauw, Robby, Coppieters, Iris, Brussels Heritage Lab, Physiotherapy, Human Physiology and Anatomy, Pain in Motion, Faculty of Physical Education and Physical Therapy, Movement and Sport Sciences, Physical Medicine and Rehabilitation, Movement and Nutrition for Health and Performance, and Spine Research Group

Subjects
Whiplash Injuries/complications, evoked potentials, Humans, Pain, Case-control studies, Human medicine, chronic disease, Electric Stimulation
Abstract

Background: Whiplash injuries typically occur from a motor vehicle collision and lead to chronic whiplash-associated disorders (CWAD) in 20% to 50% of cases. Changes in neurotransmission, metabolism, and networks seem to play a role in the pathogenic mechanism of CWAD. Objectives: To further elucidate the functional brain alterations, a neurophysiological study was performed to investigate the somatosensory processing of CWAD patients by comparing the event-related potentials (ERPs) resulting from electrical nociceptive stimulation between patients suffering from CWAD and healthy controls (HC). Study Design: Case-control study. Setting: University Hospital in Ghent. Methods: In this case-control study (CWAD patients/HC: 50/50), ankle and wrist electrical pain thresholds (EPT), and amplitude and latency of the event-related potentials (ERPs) resulting from 20 electrical stimuli were investigated. Correlations between the ERP characteristics, EPT, self-reported pain, disability, pain catastrophizing, and self-reported symptoms of central sensitization were investigated. Results: Only the latency of the P3 component after left wrist stimulation (t = -2.283; P = 0.023) differed between both groups. In CWAD patients, the ankle EPT correlated with the amplitude of the corresponding P1 (rho s = 0.293; P = 0.044) and P3 (rho s = 0.306; P = 0.033), as well as with the amplitude of the P3 to left wrist stimulation (rho s = 0.343; P = 0.017). Self-reported symptoms of CS correlated with right wrist P3 amplitude (rho s = 0.308; P = 0.030) and latency (rho s = -0.341; P = 0.015), and the worst pain reported during the past week was correlated with left wrist P1 latency (rho s = 0.319; P = 0.029). Limitations: Although the inclusion criteria stated that CWAD patients had to report a moderate-to-severe pain-related disability, 8 of the included CWAD patients (that scored above this threshold in the inclusion questionnaire), scored below the required cutoff at baseline. Conclusions: The CWAD patients did not show signs of hypersensitivity, but their ERP characteristics were related to the intensity of the applied stimulus, self-reported symptoms of CS, and the worst pain reported during the past week.

Published
2022

4. A contemporary neuroscience approach compared to biomedically focused education combined with symptom-contingent exercise therapy in people with chronic whiplash associated disorders: a randomized controlled trial protocol

Author

Coppieters, Iris, primary, Willaert, Ward, additional, Lenoir, Dorine, additional, Meeus, Mira, additional, Cagnie, Barbara, additional, Ickmans, Kelly, additional, Malfliet, Anneleen, additional, Danneels, Lieven, additional, De Petter, Brenda, additional, and Nijs, Jo, additional

Published
2021
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7. Combining Stress Management With Pain Neuroscience Education and Exercise Therapy in People With Whiplash-Associated Disorders: A Clinical Perspective.

Author

Willaert, Ward, Leysen, Laurence, Lenoir, Dorine, Meeus, Mira, Cagnie, Barbara, Nijs, Jo, Sterling, Michele, and Coppieters, Iris

Subjects
*WHIPLASH injuries treatment, *CHRONIC pain treatment, *NECK pain treatment, *NEUROSCIENCES, *AUTONOMIC nervous system, *PITUITARY gland, *ADRENAL glands, *COGNITION, *STRESS management, *HYPOTHALAMUS, *PATIENT education, *PAIN management, *EXERCISE therapy
Abstract

Individuals classified as having whiplash-associated disorder (WAD) grade II, which reflects approximately 93% of people with WAD who are commonly managed by health care professionals, exhibit both physical (eg, pain and disability) and psychological (eg, fear of movement, anxiety, posttraumatic stress) problems that, in approximately 50% of cases, persist beyond 3 months. There is still much ongoing debate regarding factors predictive of poor recovery. The strongest associations have been found for high initial pain and disability following whiplash injury. In addition, a growing body of evidence supports the clinical importance of characteristic features, such as disturbed nociceptive processing (eg, local or general hyperalgesia to cold and mechanical stimuli), inefficient cognitions and beliefs about pain/movement/recovery, and posttraumatic stress symptoms, in the development and maintenance of physical and psychological manifestations in individuals with WAD. For this reason, the field shifted away from single interventions that mainly follow a biomedical approach, such as exercise therapy and activity programs, to gold standard multimodal care (at least 2 distinct therapeutic modalities given by 1 or more health care professionals) that acknowledges the biopsychological nature of WAD. To date, there exist several multimodal care approaches to managing WAD; however, for most, the efficacy has been found to be rather limited. One may argue that the limited success of some approaches can be attributed to the fact that they focused mainly on rehabilitating the physical symptoms (eg, pain, disability) rather than also the associated cognitive (eg, catastrophizing) and psychological (eg, posttraumatic stress symptoms) symptoms of the condition, leaving much room for improvement. In this article, current and previous evidence is used to explain why and how a comprehensive and multimodal treatment for people with WAD—consisting of a combination of pain neuroscience education, cognition-targeted exercise therapy, and stress management—can be applied in clinical practice. [ABSTRACT FROM AUTHOR]

Published
2021
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