Chronic pain affects the whole person – a phenomenological study

Abstract

Purpose: The aim of this qualitative study was to explore participants’ perspectives on the effects of chronic pain on the psychophysical unity. Methods: Thirty-four chronic pain outpatients were interviewed, and the transcribed interviews were analysed with Giorgi’s four-phase phenomenological method. The mean age of the participants was 48 years, and 19 of them were women. For 21 of the participants, the pain duration was more than 5 years, and most had degenerative spinal pain. Results: The results of this whole research project indicated that the phenomenon chronic pain consisted of four essential themes: Pain affects the whole person, invisibility, negativity, and dominance of pain. This study concentrates only on one theme “Chronic pain affects the whole person”, in which were found eight subthemes in the interviews. The strongest argument made by the participants was not the physical pain itself but the psychosocial consequences, such as distress, loneliness, lost identity, and low quality of life which were their main problems. Conclusions: In multidisciplinary holistic rehabilitation, it is essential to take care of the patient’s psychological distress. A potential source of psychosocial symptoms may be the subjective responses to experience of chronic pain due to the subjective meanings of pain.

• Implications for Rehabilitation

• About chronic pain

• Pain is an experience, not only an aversive sensation. Intensity of pain describes only the sensation, not the experience of pain.

• In chronic pain, the main complaint may be not the physical pain, but the distress. In rehabilitation, the patient needs to be taken as a whole person.

• Multidisciplinary rehabilitation, including patient counselling should be the fundamental part of treatment.

• In rehabilitation, the individual meaning of chronic pain needs to be disclosed.

     

Shoulder pain after stroke – experiences,consequences in daily life and effects of interventions: a qualitative study

Purpose: To describe experiences of shoulder pain after stroke, how pain affects daily life and perceived effects of interventions.

Method: A qualitative interview study including 13 community-dwelling persons (six women; median age 65?years) with persistent shoulder pain after stroke.

Results: Three categories emerged from the content analysis. In “Multiple pain characteristics” an insidious pain onset was reported. The pain existed both day and night and could be located around the shoulder girdle but also have radiation to the arm and hand. An explanation of the pain was seldom given. In “Limitations caused by the pain” it was described how the pain negatively influenced personal care, household activities and leisure, but also could lead to emotional reactions. In “Multiple pain interventions with various effects” a variety of interventions were described. Self-management interventions with gentle movements were perceived most effective. A restraint attitude to pain medication due to side effects was reported.

Conclusions: Shoulder pain after stroke can lead to a variety of pain characteristics. As the pain is complex and may affect many important areas in a person’s life, multidisciplinary rehabilitation interventions are important.

• Implications for rehabilitation

• Shoulder pain after stroke can lead to a variety of pain characteristics with radiation to the arm and hand

• Shoulder pain often influence personal care, household activities and leisure negatively, which may lead to emotional reactions

• Self-management interventions with gentle movements are perceived most effective

• As the shoulder pain after stroke is complex, interventions by a multidisciplinary team may be needed

     

Practice guidelines for program evaluation in community-based rehabilitation

Purpose: This paper proposes practice guidelines to evaluate community-based rehabilitation (CBR) programs.

Method: These were developed through a rigorous three-phase research process including a literature review on good practices in CBR program evaluation, a field study during which a South Africa CBR program was evaluated, and a Delphi study to generate consensus among a highly credible panel of CBR experts from a wide range of backgrounds and geographical areas.

Results: The 10 guidelines developed are summarized into a practice model highlighting key features of sound CBR program evaluation. They strongly indicate that sound CBR evaluations are those that give a voice and as much control as possible to the most affected groups, embrace the challenge of diversity, and foster use of evaluation processes and findings through a rigorous, collaborative and empowering approach.

Conclusions: The practice guidelines should facilitate CBR evaluation decisions in respect to facilitating an evaluation process, using frameworks and designing methods.

• Implications for rehabilitation

• Ten practice guidelines provide guidance to facilitate sound community-based rehabilitation (CBR) program evaluation decisions. Key indications of good practice include:

• ??being as participatory and empowering as possible;

• ??ensuring that all, including the most affected, have a real opportunity to share their thoughts;

• ??highly considering mixed methods and participatory tools;

• ??adapting to fit evaluation context, local culture and language(s);

• ??defining evaluation questions and reporting findings using shared CBR language when possible, which the framework offered may facilitate.

     

Pain management for children with cerebral palsy in school settings in two cultures: action and reaction approaches

Background: Children with cerebral palsy (CP) face particular challenges, e.g. daily pain that threaten their participation in school activities. This study focuses on how teachers, personal assistants, and clinicians in two countries with different cultural prerequisites, Sweden and South Africa, manage the pain of children in school settings.

Method: Participants’ statements collected in focus groups were analysed using a directed qualitative content analysis framed by a Frequency of attendance-Intensity of involvement model, which was modified into a Knowing-Doing model.

Results: Findings indicated that pain management focused more on children’s attendance in the classroom than on their involvement, and a difference between countries in terms of action-versus-reaction approaches. Swedish participants reported action strategies to prevent pain whereas South African participants primarily discussed interventions when observing a child in pain.

Conclusion: Differences might be due to school- and healthcare systems. To provide effective support when children with CP are in pain in school settings, an action-and-reaction approach would be optimal and the use of alternative and augmentative communication strategies would help to communicate children’s pain. As prevention of pain is desired, structured surveillance and treatment programs are recommended along with trustful collaboration with parents and access to “hands-on” pain management when needed.

• Implications for rehabilitation

• ??When providing support, hands-on interventions should be supplemented by structured preventive programs and routines for parent collaboration (action-and-reaction approach).

• ??When regulating support, Sweden and South Africa can learn from each other;

• ○?In Sweden, the implementation of a prevention program has been successful.

• ○?In South Africa, the possibilities giving support directly when pain in children is observed have been beneficial.

     

The therapeutic role of motor imagery on the functional rehabilitation of a stage II shoulder impingement syndrome

Abstract

Purpose: Motor imagery (MI) has been used as a complementary therapeutic tool for motor recovery after central nervous system disease and peripheral injuries. However, it has never been used as a preventive tool. We investigated the use of MI in the rehabilitation of stage II shoulder impingement syndrome. For the first time, MI is used before surgery. Method: Sixteen participants were randomly assigned to either a MI or control group. Shoulder functional assessment (Constant score), range of motion and pain were measured before and after intervention. Results: Higher Constant score was observed in the MI than in the control group (p?=?0.04). Participants in the MI group further displayed greater movement amplitude (extension (p?<?0.001); flexion (p?=?0.025); lateral rotation (p?<?0.001). Finally, the MI group showed greater pain decrease (p?=?0.01). Conclusion: MI intervention seems to alleviate pain and enhance mobility, this is probably due to changes in muscle control and consequently in joint amplitude. MI might contribute to postpone or even protect from passing to stage III that may require surgery.

• Implications for Rehabilitation

• Adding motor imagery training to classical physical therapy in a stage II impingement syndrome:

• Helps in alleviating pain

• Enhances shoulder mobility

• Motor imagery is a valuable technique that can be used as a preventive tool before the stage III of the impingement syndrome.

     

Examination of contraction-induced muscle pain as a behavioral correlate of physical activity in women with and without fibromyalgia

Abstract

Purpose: This study aimed to compare muscle pain intensity during a sustained isometric contraction in women with and without fibromyalgia (FM), and examine the association between muscle pain and self-reported levels of physical activity. Methods: Fourteen women with FM and 14 healthy women completed the study, where muscle pain ratings (MPRs) were obtained every 30?s during a 3?min isometric handgrip task at 25% maximal strength, and self-reported physical activity was quantified using the Baecke Physical Activity Questionnaire. Results: Women with FM were less physically active than healthy controls. During the isometric contraction, MPR progressively increased in both groups at a comparable rate, but women with FM generally reported a greater intensity of muscle pain than healthy controls. Among all women, average MPR scores were inversely associated with self-reported physical activity levels. Conclusions: Women with FM exhibit augmented muscle pain during isometric contractions and reduced physical activity than healthy controls. Furthermore, contraction-induced muscle pain is inversely associated with physical activity levels. These observations suggest that augmented muscle pain may serve as a behavioral correlate of reduced physical activity in women with FM.

• Implications for Rehabilitation

• Women with fibromyalgia experience a greater intensity of localized muscle pain in a contracting muscle compared to healthy women.

• The intensity of pain during muscle contraction is inversely associated with the amount of physical activity in women with and without fibromyalgia.

• Future studies should determine whether exercise adherence can be improved by considering the relationship between contraction-induced muscle pain and participation in routine physical activity.

     

Ankle positions potentially facilitating greater maximal contraction of pelvic floor muscles: a systematic review and meta-analysis

Abstract

Objectives: To evaluate the effect of ankle positions on pelvic floor muscles in women.

Methods: Multiple databases were searched from inception-July 2017. Study quality was rated using the grading of recommendations, assessment, development, and evaluation system and the “threats to validity tool”.

Results: Four studies were eligible for inclusion. Meta-analysis revealed significantly greater resting activity of pelvic floor muscles in neutral ankle position (?1.36 (95% CI ?2.30, ?0.42) p?= 0.004) and induced 15° dorsiflexion (?1.65 (95% CI ?2.49, ?0.81) p?= 0.0001) compared to induced 15° plantar flexion. Significantly greater maximal voluntary contraction of pelvic floor was found in dorsiflexion compared to plantar flexion (?2.28 (95% CI ?3.96, ?0.60) p?= 0.008). Meta-analyses revealed no significant differences between the neutral ankle position and 15° dorsiflexion for either resting activity (0.30 (95% CI ?0.75, 1.35) p?= 0.57) or maximal voluntary contraction (0.97 (95% CI ?0.77, 2.72) p?= 0.27).

Conclusion: Pelvic floor muscle-training for women with urinary incontinence could be performed in standing with ankles in a neutral position or dorsiflexion to facilitate greater maximal pelvic floor muscle contraction. As urethral support requires resting contraction of pelvic floor muscles, decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with urinary incontinence might potentially experience more leakage during exertion in a standing position.

• Implications for rehabilitation

• Pooled analyses revealed that maximal voluntary contraction of pelvic floor muscle is greater in induced ankle dorsiflexion than induced plantar flexion.

• As pelvic floor muscle strengthening involves achieving a greater maximal voluntary contraction, pelvic floor muscle training for women with stress urinary incontinence could be performed in standing either with ankles in a neutral position or dorsiflexion.

• Decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with stress urinary incontinence might potentially experience more leakage during exertion in a standing position.

• Women with stress urinary incontinence should be advised to wear flat shoes instead of high-heels and should be cautioned about body posture and ankle positions assumed during exercise and daily activities.

     

Getting the pain right: how low back pain patients manage and express their pain experiences

Purpose: Biopsychosocial interventions in low back pain (LBP) rehabilitation aim at preparing patients to accept and manage their pain conditions and to encourage them to maintain their everyday life routines. Although such approaches have demonstrated a positive effect, for example, in relation to return to work (RTW), few studies have explored how social contexts influence how pain is being managed. Using a theoretical approach that addresses pain as social performance, we illustrate how pain is expressed and managed in three different contexts: at the clinic, at home and at work. Methods: Qualitative in-depth interviews were conducted with eight patients who had followed a hospital-based RTW intervention. Results: Low back patients experience dilemmas of how to express their pain sensations and constantly evaluate whether the activities they participate in will ease or worsen their pain sensations. In this process, their behavior is guided by how they think their social role will be affected by their decision to abstain from or undertake the activities in question. Conclusions: Interventions in rehabilitation may benefit from knowledge of the social processes at play when LBP patients articulate, express and suppress their symptoms in their interaction with health professionals, workmates, families and friends.

Implications for Rehabilitation

Low back pain

• In order to manage pain, patients with low back pain are encouraged to exercise and to maintain their everyday activities.

• Choosing to become physically active, although in pain, is related to those social roles one wishes to maintain or support.

• Future interventions could offer support so that patients will be able both to maintain their social roles and to retire from social activities without their social roles being threatened.

     

Explaining daily functioning in young adults with obstetric brachial plexus lesion

Abstract

Purpose: To study the influence of obstetric brachial plexus lesion (OBPL) on arm–hand function and daily functioning in adults, and to investigate the relationship of arm-hand function and pain to daily functioning. Method: Adults with unilateral OBPL who consulted the brachial plexus team at the VU University Medical Center in the past were invited to participate. Daily functioning was measured with the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the SF36, pain with VAS Pain Scales and arm-hand function with the Nine Hole Peg Test (9-HP-test) and the Action Research Arm Test (ARAT). Scores of the affected arm were compared to those of the non-affected arm or norm values for healthy controls. Results: Twenty-seven persons (mean age 22, SD 4.2 years), of whom 10 men, participated. The ARAT and 9-HP-test scores for the affected arm were significantly worse than those for the non-affected arm. Moderate to severe pain in the affected arm, the non-affected arm or the back was reported by 50% of the participants. The DASH general, sports/music and SF36 physical functioning scores were significantly worse than norm values. The ARAT/9-HP-test and daily functioning showed little association. Low to moderate associations were found between pain and daily functioning. Conclusions: Many young adults with OBPL experience limitations in daily functioning. Pain, rather than arm-hand function, seems to explain these limitations.

• Implications for Rehabilitation

• Obstetric brachial plexus lesion (OBPL) is caused by traction to the brachial plexus during labour, resulting in denervation of the muscles of the arm and shoulder girdle.

• Adults with OBPL are hardly seen in rehabilitation medicine.

• This study shows that many young adults with OBPL experience limitations in daily functioning. Pain, rather than arm-hand function, seems to explain these limitations.

• Fifty percent of the participants complained about moderate or severe pain, which was located in the affected arm, the back and the non-affected arm. There seems an age-related increase in pain prevalence.

• Persons who had undergone plexus surgery had a significantly worse arm-hand function, but comparable scores on daily functioning scales compared to persons without plexus surgery.

• When limitations in daily functioning or pain occur, referral to a rehabilitation physician is indicated.

     

The significance of FM associations for women with FM

Abstract

Purpose: Living with fibromyalgia (FM) means living with a long-term pain syndrome that is invisible to others. Support and understanding from others seem to be important to managing the affected daily life. The aim of this study was to describe the significance of FM associations for women with FM. Methods: Data collection was carried out through focus group discussions with seventeen women with FM. Data were analyzed through thematic content analysis. Results: The findings show that women experienced associations for people with FM as important as they gave access to contacts with others with similar experiences. Their need of togetherness was fulfilled at the association and they described being strengthened by the support received. Because of the lack of information and knowledge about FM, the association was described as an important venue for getting and mediating information about the illness. Conclusions: At the association the women seem to be empowered, which increases their ability to manage their daily lives despite the limitations imposed by FM. Healthcare personnel could not satisfy the women’s needs and to manage to support women with FM. There is a need for communication based on a shared understanding between the women and healthcare personnel.

• Implications for Rehabilitation

• This study highlighted the need for communication based on a shared understanding between people with chronic illness and healthcare personnel to support and strengthen women with FM in their daily lives.

• The FM associations meet the needs for togetherness, confirmation, and information that the women with FM in this study described and healthcare personnel could not satisfy.

• Healthcare personnel can learn from FM associations how to empower women with FM in their everyday lives.

     

The effect of word prediction settings (frequency of use) on text input speed in persons with cervical spinal cord injury: a prospective study

Purpose: To determine whether activation of the frequency of use and automatic learning parameters of word prediction software has an impact on text input speed.

Methods: Forty-five participants with cervical spinal cord injury between C4 and C8 Asia A or B accepted to participate to this study. Participants were separated in two groups: a high lesion group for participants with lesion level is at or above C5 Asia AIS A or B and a low lesion group for participants with lesion is between C6 and C8 Asia AIS A or B. A single evaluation session was carried out for each participant. Text input speed was evaluated during three copying tasks:

??without word prediction software (WITHOUT condition)

??with automatic learning of words and frequency of use deactivated (NOT_ACTIV condition)

??with automatic learning of words and frequency of use activated (ACTIV condition)

Results: Text input speed was significantly higher in the WITHOUT than the NOT_ACTIV (pp?=?0.02) for participants with low lesions. Text input speed was significantly higher in the ACTIV than in the NOT_ACTIV (p?=?0.002) or WITHOUT (p?Conclusions: Use of word prediction software with the activation of frequency of use and automatic learning increased text input speed in participants with high-level tetraplegia. For participants with low-level tetraplegia, the use of word prediction software with frequency of use and automatic learning activated only decreased the number of errors.

• Implications in rehabilitation

• Access to technology can be difficult for persons with disabilities such as cervical spinal cord injury (SCI). Several methods have been developed to increase text input speed such as word prediction software.This study show that parameter of word prediction software (frequency of use) affected text input speed in persons with cervical SCI and differed according to the level of the lesion.

• ??For persons with high-level lesion, our results suggest that this parameter must be activated so that text input speed is increased.

• ??For persons with low lesion group, this parameter must be activated so that the numbers of errors are decreased.

• ??In all cases, the activation of the parameter of frequency of use is essential in order to improve the efficiency of the word prediction software.

• ??Health-related professionals should use these results in their clinical practice for better results and therefore better patients ‘satisfaction.

     

Ratings of pain and activity limitation on the visual analogue scale and global impression of change in multimodal rehabilitation of back pain – analyses at group and individual level

Purpose: To evaluate changes in pain intensity and activity limitation, at group and individual levels, and their associations with the global impression of change after multimodal rehabilitation in patients with back pain.

Method: Patients with long-term back pain (n?=?282) participated in a 4-week programme with a follow-up after 6 months. Visual analogue scales (VAS) were used to rate pain intensity and activity limitation. Global impression of change (GIC) was rated on a 7-category scale. The sign test, the Svensson method and the Spearman rank correlation were used for analyses.

Results: Significantly lower ratings in pain and activity limitation at follow-up were found at group level. However, a large individual variability was found by the Svensson method. The correlations between GIC and changes in pain and activity limitation were r_s??=_? 0.49 and r_s =?_?0.50, respectively. A rated GIC of at least “much better” on group level showed changes of ≥20?mm on the VAS.

Conclusions: At group level, lower VAS ratings were found in patients with back pain. However, a large individual variability in pain and activity limitation was also found resulting in low to moderate associations between GIC and the change in VAS ratings. The large individual variability might be due to the impreciseness in the ratings on the VAS. We have presented a critical discussion of statistical methods in connection with the VAS.

• Implications for Rehabilitation

• The use of VAS as a rating instrument may be questioned, especially for perceived pain intensity which is a too complex experience to be rated on a line without any visible categories.

• Single ratings of pain intensity should preferably be complemented with the ratings of activity limitation in patients with long-term back pain.

• Global impression of change is a suggested inclusive rating after rehabilitation.

• The improvement desired by the patient should preferably be determined before rehabilitation.

     

Cancer patients’ use of primary care out-of-hours services: a cross-sectional study in Norway

Objective: To investigate how cancer patients in Norway use primary care out-of-hours (OOH) services and describe different contact types and procedures.

Design: A retrospective cross-sectional registry study using a billing registry data source.

Setting: Norwegian primary care OOH services in 2014.

Subjects: All patients’ contacts in OOH services in 2014. Cancer patients were identified by ICPC-2 diagnosis.

Main outcome measures: Frequency of cancer patients’ contacts with OOH services, contact types, diagnoses, procedures, and socio-demographic characteristics.

Results: In total, 5752 cancer patients had 20,220 contacts (1% of all) in OOH services. Half of the contacts were cancer related. Cancer in the digestive (22.9%) and respiratory (18.0%) systems were most frequent; and infection/fever (21.8%) and pain (13.6%) most frequent additional diagnoses. A total of 4170 patients had at least one cancer-related direct contact; of these, 64.5% had only one contact during the year. Cancer patients had more home visits and more physicians’ contact with municipal nursing services than other patients, but fewer consultations (p?p?Conclusion: There was no indication of overuse of OOH services by cancer patients in Norway, which could indicate good quality of cancer care in general.

• KEY POINTS

• Many are concerned about unnecessary use of emergency medical services for non-urgent conditions.

• ??There was no indication of overuse of out-of-hours services by cancer patients in Norway.

• ??Cancer patients had relatively more home visits, physician’s contact with the municipal nursing service, and weekend contacts than other patients.

• ??Cancer patients in the least central municipalities had relatively more contacts with out-of-hours services than those in more central municipalities.

     

The processes underpinning reductions in disability among people with chronic neck pain. A preliminary comparison between two distinct types of physiotherapy intervention

Purpose: To establish whether different processes underpin changes in disability in people with neck pain who underwent two types of active physiotherapy intervention.

Materials and methods: This study was a sub-analysis of a randomized controlled trial assessing whether the addition of Interactive Behavioral Modification Therapy (a cognitively informed physiotherapy treatment) to a Progressive Neck Exercise Program improved outcome in patients with chronic neck pain. Regression analyses were performed to determine the extent to which demographics, changes in pain, and changes in certain cognitive factors were related to changes in disability.

Results: In the progressive neck exercise group, changes in levels of pain intensity were the only factor significantly related to change in disability, explaining 33% of the variance. In the interactive behavioral modification therapy group, changes in pain intensity, and catastrophizing together explained 54% of the variance in change in disability. Only changes in catastrophizing displayed a significant β value in the final model.

Conclusions: Different processes appear to underpin changes in disability in patients undergoing cognitively informed physiotherapy to those undergoing a primarily exercise-based approach.

• Implications for rehabilitation

• Certain cognitive factors are known to be related to levels of disability in patients with chronic neck pain

• Specifically targeting these factors results in more patients making a clinically meaningful reduction in disability

• Different processes appear to underpin reductions in disability when people with neck pain are treated with cognitively informed physiotherapy to when treated with exercise alone, which may account for why more patients improve when treated in this manner.

• Reductions in catastrophizing appear to be particularly important and efforts should be made to assess and treat catastrophic thoughts in people with chronic neck pain.

     

Predictors of depressed mood 12 months after injury. Contribution of self-efficacy and social support

Abstract

Purpose: There is evidence that depressed mood and perception of pain are related in patients with chronic illness. However, how individual resources such as self-efficacy and social support play a role in this association remains unclear. The aim of this study was to investigate the influence of both variables as either moderator or mediator. Method: In a longitudinal study, 274 injured workers (M?=?43.24 years) were investigated. Data were collected on sociodemographics, depressed mood, pain, social support, and self-efficacy at three months post-injury, and depressed mood one year post-injury. Results: Hierarchical multiple linear regression analyses revealed that pain (β?=?0.14; p?<?0.01) and social support (β?=??0.18; p?<?0.001) were significant predictors of depressed mood. Self-efficacy moderated the relationship of pain (β?=??0.12; p?<?0.05) and depressed mood after one year. Lower self-efficacy in combination with pain had a stronger impact than higher self-efficacy and pain on depressed mood. Social support did not moderate the association. Conclusions: Self-efficacy for managing pain is important in the development of depressed mood. According to the results of this study, we suggest that the detection of low social support and low self-efficacy might be important in long-term rehabilitation process.

• Implications for Rehabilitation

• Risk for depressed mood one year after an accident is high: One in five workers report depressed mood.

• Protective factors for depressed mood in injured workers needs to be considered in the rehabilitation.

• Focusing on resources like social support and self-efficacy could be protective against depressed mood.

• The early detection of low social support and low self-efficacy might be important in long-term rehabilitation processes.

     

The importance of a daily rhythm in a supportive environment – promoting ability in activities in everyday life among older women living alone with chronic pain

Abstract

Purpose: The aim of this study was to explore how older women living alone with chronic musculoskeletal pain, describe their ability in performing activities in everyday life and what could promote their ability in activities in everyday life as well as their perceived meaning of a changed ability to perform activities in everyday life. Method: Qualitative interviews were conducted with 12 women, and an inductive content analysis was used. Results: The results showed the importance of a daily rhythm of activities. Activities included in the daily rhythm were socializing with family and friends, physical activities, doing own activities as well as activities supported by relatives and the community. The activities described by the women also promoted their ability in activities in everyday life. Other findings were the women’s perceived meaning of being independent and maintaining that independency, along with the meaning of accepting and adapting to a changed life situation. Conclusion: This paper concludes that it is important to be sensitive of individual needs regarding the daily rhythm of activities when health-care professionals intervene in the activities in everyday life of older women living alone, promote the women’s independency, and enable them to participate in the community.

• Implications for Rehabilitation

• A daily rhythm of activities is important for older women who live alone with chronic musculoskeletal pain.

• The importance of health-care professionals being sensitive to individual needs to promote ability in activities in everyday life and to encourage the everyday activities into a daily rhythm.

• Facilitate the women’s desire and will of independency, despite their needs of help from their environment to manage their everyday life.

     

Health-related quality of life improvements among women with chronic pain: comparison of two multidisciplinary interventions

Purpose: To measure the effect of 4 weeks traditional multidisciplinary pain management program (TMP) versus neuroscience education and mindfulness-based cognitive therapy (NEM) on quality of life (HRQL) among women with chronic pain. Method: This observational longitudinal cohort study conducted in an Icelandic rehabilitation centre included 122 women who received TMP, 90 receiving NEM, and 57 waiting list controls. Pain intensity (visual analogue scale) and HRQL (Icelandic Quality of Life scale) were measured before and after interventions. ANOVA and linear regression were used for comparisons. Results: Compared with controls we observed statistically significant changes in pain intensity (p?p?p?=?0.008). Head to head comparison between study groups revealed that pain intensity improved more among TMP participants (21.8 versus 17.2?mm; p?=?0.013 adjusted). Women with low HRQL at baseline improved more than those with higher HRQL (mean TMP?=?13.4; NEM?=?12.9 if HRQL?≤?35 versus mean TMP?=?6.6 and NEM?=?7.8 if HQRL?>?35). Conclusions: Our non-randomized study suggests that both NEM and TMP programs improve pain and HRQL among women with chronic pain. Sleep quality showed more improvements in NEM while pain intensity in TMP. Longer-term follow-ups are needed to address whether improvements sustain.

• Implications for Rehabilitation

• Chronic pain is a debilitating condition affecting quality of life and restricting societal participation.

• Intensive multidisciplinary bio-psycho-social rehabilitation is essential for this patient group.

• This study shows improvement in health-related quality of life and pain intensity following such rehabilitation.

• Emphasizing mindfulness based cognitive therapy and neuroscience patient education improves sleep to more extend than more traditional approach.

     

Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: a randomized controlled trial

Purpose: To determine the short- and long-term effectiveness of the application of Clinical Pilates in addition to physical therapy versus a physical therapy treatment alone in a population of postmenopausal women with chronic low back pain (CLBP). Methods: A single-blind randomized controlled trial with repeated measures and a follow-up period. One hundred and one patients were randomly allocated to a Pilates?+?physical therapy (PPT) group or to a physical therapy (PT) only group for six weeks. Pain and disability were measured by visual analog scale (VAS) and the Oswestry disability index respectively preintervention, after 6 weeks of treatment and after 1-year follow-up. Results: There were significant differences between groups in pain and disability after 6 weeks of treatment, with better results in the PPT group with an effect size of d?=?3.14 and d?=?2.33 for pain and disability. After 1-year follow-up, only PPT group showed better results compared with baseline with an effect size of d?=?2.49 and d?=?4.98 for pain and disability. Conclusion: The results suggest that using Clinical Pilates in addition to physical therapy provides improved results on pain management and functional status for postmenopausal woman with CLBP and that its benefits still linger after one year.

• Implications for Rehabilitation

• Chronic Low Back Pain could benefit from the Pilates practice in postmenopausal women.

• Improvement in pain and disability derived from CLBP seem to be maintained over time due to Pilates practice.

• Pilates constitutes a safe tool to be applied in older population with CLBP due to its ability to be adapted to every performance and physical level.

     

Long-lasting improvements in health-related quality of life among women with chronic pain,following multidisciplinary rehabilitation

Purpose: To determine whether observed health-related quality-of-life improvements after four-week traditional multidisciplinary pain management program and additional neuroscience education and mindfulness-based cognitive therapy for chronic pain are sustained at six-month follow-up.

Method: This observational longitudinal follow-up study, with complete follow-up of 75 women, 61.5% of initial traditional approach group (treated 2001–2005) and 56 (62.2%) receiving the new approach (treated 2006–2009). Pain intensity and quality of life were measured at baseline and six months after interventions. Analysis of variance (ANOVA) and paired samples t-tests were used for statistical analysis.

Results: Both groups showed sustained improvements in pain intensity (traditional approach?=??10.6 [p?<?0.001]; new approach?=??14.5 [p?p?p?p?=?0.066]), whereas all other domains among both groups were sustained. Significant decline was observed from discharge to six month among both groups with the exception of the sleep domain among the traditional approach group, pain intensity among the new approach and financial status among both groups. No baseline differences were revealed between responders and nonresponders.

Conclusions: Multidisciplinary interventions for women with chronic pain conditions improved quality of life and pain intensity with lasting improvements observed half a year after treatment completion.

• Implications for rehabilitation

• Intensive multidisciplinary biopsychosocial rehabilitation is essential for chronic pain conditions.

• This follow-up study shows sustained improvement in health-related quality of life and pain intensity six months after such rehabilitation was completed.

• Emphasizing mindfulness-based cognitive therapy and neuroscience patient education may contribute to less decline in pain intensity from discharge to six-month follow-up compared with a more traditional approach.

     

Predictors of multidisciplinary treatment outcome in patients with chronic musculoskeletal pain

Abstract

Purpose: The present study aimed to identify predictors of rehabilitation outcome for patients with chronic musculoskeletal pain (CMP) and psychological problems. Methods: A retrospective cohort study including 230 adult patients with CMP admitted for multidisciplinary pain rehabilitation. Potential predictors were patient characteristics, duration of complaints, baseline functioning, pain, personality, coping style, fear of movement, psychological distress and type of treatment. Outcome measures were physical functioning, mental health, pain and patient-reported effect. Multiple (logistic) regression models were used to identify predictors. Results: Patients who were more disabled and patients with more pain benefitted more from the rehabilitation treatment than less disabled patients or those with less pain. Age, work status, vitality, depression and coping style also predicted outcomes significantly. The models explained between 27 and 80% of the outcomes. There was an interaction between type of treatment, work status and the baseline pain score as regards the outcome in terms of pain. Conclusions: No strong predictors of treatment outcome were found other than the baseline scores of the respective outcome variables. More disabled patients and patients with more pain benefitted more from the rehabilitation program. Other predictors improved the prediction models slightly.

• Implications for Rehabilitation

• It remains challenging to correctly predict the outcome of treatment from patients’ baseline sociodemographic and psychological characteristics; predictors other than baseline scores of the outcome variables are only slightly associated with treatment outcome.

• Patients with chronic musculoskeletal pain and poor physical functioning or mental health benefit most from pain rehabilitation.

• Older patients benefit less from a pain rehabilitation program than younger patients in terms of physical functioning.

• Pain reduction during a pain rehabilitation program is greatest in patients with high pain intensity who are not at work at the start of the rehabilitation program.

• Coping style influences the outcome of rehabilitation of patients with chronic musculoskeletal pain.