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Purpose An online randomised experiment found that the labels lumbar sprain, non-specific low back pain (LBP), and episode of back pain reduced perceived need for imaging, surgery and second opinions compared to disc bulge, degeneration, and arthritis among 1447 participants with and without LBP. They also reduced perceived seriousness of LBP and increased recovery expectations. Methods In this study we report the results of a content analysis of free-text data collected in our experiment. We used two questions: 1. When you hear the term [one of the six labels], what words or feelings does this make you think of? and 2. What treatment (s) (if any) do you think a person with [one of the six labels] needs? Two independent reviewers analysed 2546 responses. Results Ten themes emerged for Question1. Poor prognosis emerged for disc bulge, degeneration, and arthritis, while good prognosis emerged for lumbar sprain, non-specific LBP, and episode of back pain. Thoughts of tissue damage were less common for non-specific LBP and episode of back pain. Feelings of uncertainty frequently emerged for non-specific LBP. Twenty-eight treatments emerged for Question2. Surgery emerged for disc bulge, degeneration, and arthritis compared to lumbar sprain, non-specific LBP, and episode of back pain. Surgery did not emerge for non-specific LBP and episode of back pain. Conclusion Our results suggest that clinicians should consider avoiding the labels disc bulge, degeneration and arthritis and opt for labels that are associated with positive beliefs and less preference for surgery, when communicating with patients with LBP.

We will conduct an online international survey using large-scale qualitative content analyses of open-text answers. This current study aims to provide a comprehensive list of outcome domains that are important to people with chronic musculoskeletal pain, informal caregivers, and healthcare professionals.

Objective There is a large body of research exploring what it means for a person to live with chronic pain. However, existing research does not help us understand what it means to recover. We aimed to identify qualitative research that explored the experience of living with chronic pain published since 2012 and to understand the process of recovery. Design A synthesis of qualitative research using meta-ethnography. Methods We used the seven stages of meta-ethnography. We systematically searched for qualitative research, published since 2012, that explored adults’ experiences of living with, and being treated for, chronic pain. We used constant comparison to distill the essence of ideas into themes and developed a conceptual model. Results We screened 1,328 titles and included 195 studies. Our conceptual model indicates that validation and reconnection can empower a person with chronic pain to embark on a journey of healing. To embark on this journey requires commitment, energy, and support. Conclusions The innovation of our study is to conceptualize healing as an ongoing and iterating journey rather than a destination. Health interventions for chronic pain would usefully focus on validating pain through meaningful and acceptable explanations; validating patients by listening to and valuing their stories; encouraging patients to connect with a meaningful sense of self, to be kind to themselves, and to explore new possibilities for the future; and facilitating safe reconnection with the social world. This could make a real difference to people living with chronic pain who are on their own healing journeys.

Background Diagnostic labels may influence treatment intentions. We examined the effect of labelling low back pain (LBP) on beliefs about imaging, surgery, second opinion,seriousness, recovery, work, and physical activities. Methods Six-arm online randomized experiment with blinded participants with and without LBP. Participants received one of six labels:‘disc bulge’,‘degeneration’,‘arthritis’,‘lumbar sprain’,‘non-specific LBP’,‘episode of back pain’. The primary outcome was the belief about the need for imaging. Results A total of 1375 participants (mean [SD] age, 41.7 years [18.4 years]; 748 women [54.4%]) were included. The need for imaging was rated lower with the labels‘episode of back pain’(4.2 [2.9]),‘lumbar sprain’(4.2 [2.9]) and‘non-specific LBP’(4.4 [3.0]) compared to the labels‘arthritis’(6.0 [2.9]),‘degeneration’(5.7 [3.2]) and‘disc bulge’(5.7 [3.1]). The same labels led to higher recovery expectations and lower ratings of need for a second opinion, surgery and perceived seriousness compared to‘disc bulge’,‘degeneration’and‘arthritis’. Differences were larger amongst participants with current LBP who had a history of seeking care. No differences were found in beliefs about physical activity and work between the six labels. Conclusions ‘Episode of back pain’,‘lumbar sprain’and‘non-specific LBP’reduced need for imaging, surgery and second opinion compared to‘arthritis’,‘degeneration’and‘disc bulge’amongst public and patients with LBP as well as reducing the perceived seriousness of LBP and enhancing recovery expectations. The impact of labels appears most relevant amongst those at risk of poor outcomes (participants with current LBP who had a history of seeking care).

Objectives During the current COVID-19 pandemic, healthcare has been transformed by the rapid switch from in person care to use of remote consulting, including video conferencing technology. Whilst much has been published on one-to-one video consultations, little literature exists on use of this technology to facilitate group interventions. Group pain management programmes are a core treatment provided by many pain services. This rapid review aimed to identify the extent of use of video conferencing technology for delivery of group pain management programmes and provide an overview of its use. Methods A rapid review of the literature published up to April 2020 (PubMed, PsycINFO and PEDro) was performed. The search string consisted of three domains: pain/CP (MeSH term) AND Peer group[MeSH] AND Videoconferencing[MeSH]/Telemedicine[MeSH]/Remote Consultation[MeSH]. The studies were of poor methodological quality and study design, and interventions and chronic pain conditions were varied. Results Literature searching yielded three eligible papers for this review. All studies had low methodological quality and risk of bias. Heterogeneity and variability in outcome reporting did not allow any pooling of data. The results demonstrated that videoconferencing for delivery of group programmes is possible, yet there is little extant literature on how to develop, deliver and measure outcomes of such programmes. Conclusions This review demonstrates that there is little evidence to support or guide the use of synchronous videoconferencing to deliver pain management programmes. We present issues to consider, informed by this review and our experience, when implementing video conferencing. Study quality of existing work is variable, and extensive future research is necessary.

This is a modified three-stage international e-Delphi survey. The main objective of this e-Delphi survey is to reach consensus between stakeholders on telehealth terminology and research priorities in musculoskeletal pain research.

If including patients as equal partners in health care research is increasingly regarded as "the right thing to do," then it is important that researchers and patients "do it right." The research community should be aware of, use, and share resources that support best practices in this domain. The first editorial in the series focused on why researchers should engage patient partners on research teams. In this, the second editorial in the series, we concentrate on how to engage patient partners and highlight a selection of resources to help researchers and to demystify patient partnerships in research. J Orthop Sports Phys Ther 2020;50(5):219-221. doi:10.2519/jospt.2020.0104.

The health research landscape is changing, and it is time for the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) community to foster authentic opportunities for patient engagement in musculoskeletal research and practice. Although authentic engagement has challenges, the benefits are well worth the investment of time and energy to overcome these challenges and improve the quality of physical therapy research. In this editorial, the authors outline 3 steps JOSPT is taking to promote and support patient partnership in musculoskeletal research. J Orthop Sports Phys Ther 2019;49(9):623-626. doi:10.2519/jospt.2019.0106.

The President of the International Association for the Study of Pain (IASP) established a Taskforce on Cannabis and Cannabinoid Analgesia, to systematically examine the evidence on (i) analgesic pharmacology of cannabinoids and preclinical evidence on their efficacy in animal models of injury-related or pathological persistent pain, (ii) the clinical efficacy of cannabis, cannabinoids and cannabis-based medicines (CBM) for pain, (iii) harms related to long-term use of cannabinoids, as well as (iv) societal issues and policy implications related to the use of these compounds for pain management. Here, we summarize key knowledge gaps identified in the Taskforce outputs and propose a research agenda for generating high-quality evidence on the topic. The systematic assessment of preclinical and clinical literature identified gaps in rigor of study design and reporting across the translational spectrum. We provide recommendations to improve the quality, rigor, transparency, and reproducibility of preclinical and clinical research on cannabis and cannabinoids for pain, as well as for the conduct of systematic reviews on the topic. Gaps related to comprehensive understanding of the endocannabinoid system and cannabinoid pharmacology, including pharmacokinetics and drug formulation aspects, are discussed. We outline key areas where high quality clinical trials with cannabinoids are needed. Important remaining questions about long-term and short-term safety of cannabis and cannabinoids are emphasized. Finally, regulatory, societal and policy challenges associated with medicinal and non-medicinal use of cannabis are highlighted, with recommendations for improving patient safety and reducing societal harms in the context of pain management.

An online randomised experiment found that the labels lumbar sprain, non-specific low back pain (LBP), and episode of back pain reduced perceived need for imaging, surgery and second opinions compared to disc bulge, degeneration, and arthritis among 1447 participants with and without LBP. They also reduced perceived seriousness of LBP and increased recovery expectations.In this study we report the results of a content analysis of free-text data collected in our experiment. We used two questions: 1. When you hear the term [one of the six labels], what words or feelings does this make you think of? and 2. What treatment (s) (if any) do you think a person with [one of the six labels] needs? Two independent reviewers analysed 2546 responses.Ten themes emerged for Question1. Poor prognosis emerged for disc bulge, degeneration, and arthritis, while good prognosis emerged for lumbar sprain, non-specific LBP, and episode of back pain. Thoughts of tissue damage were less common for non-specific LBP and episode of back pain. Feelings of uncertainty frequently emerged for non-specific LBP. Twenty-eight treatments emerged for Question2. Surgery emerged for disc bulge, degeneration, and arthritis compared to lumbar sprain, non-specific LBP, and episode of back pain. Surgery did not emerge for non-specific LBP and episode of back pain.Our results suggest that clinicians should consider avoiding the labels disc bulge, degeneration and arthritis and opt for labels that are associated with positive beliefs and less preference for surgery, when communicating with patients with LBP.

Pain (e.g., needle injections, injuries, chronic pain) is highly prevalent in childhood and occurs in social contexts. Nevertheless, broader socio-cultural influences on pediatric pain, such as popular media, have not been empirically examined. The present study examined how pain is portrayed and gendered in children’s popular media. A cross-section of children’s media targeted towards 4-6-year-old children was selected based on popularity, including 10 movies and the first season of 6 television shows. Pain instances were extracted and coded using two established observational coding systems assessing sufferer pain characteristics, and observer responses (e.g., empathic responses). Findings identified 454 instances of pain across the selected media. Violent pain (i.e., intentionally inflicted) and injuries were most commonly represented, whereas everyday, chronic-type and procedural pains were infrequently portrayed. Pain instances were more commonly experienced by boy characters, who also expressed greater distress, yet observers were more responsive (e.g., expressed greater concern) towards girl characters’ pain. Overall, observer responses to pain were infrequent, with observers witnessing but not responding to nearly half of pain instances. Observers that did respond expressed an overall lack of empathy towards sufferers. These findings reveal a very narrow depiction of pain presented in children’s popular media, with an overall underrepresentation of pain, numerous maladaptive portrayals of pain, and gender differences in both sufferer and observer responses. This study underscores the need for further research to inform how children’s popular media is perceived by parents and children, and how media may be transformed and harnessed for effective pain education in childhood.