Objective: To explore predictors of dropout of patients with chronic musculoskeletal pain from an interdisciplinary chronic pain management programme, and to develop and validate a multivariable prediction model, based on the Extended Common- Sense Model of Self-Regulation (E-CSM). Methods: In this prospective cohort study consecutive patients with chronic pain were recruited and followed up (July 2013 to May 2015). Possible associations between predictors and dropout were explored by univariate logistic regression analyses. Subsequently, multiple logistic regression analyses were executed to determine the model that best predicted dropout. Results: Of 188 patients who initiated treatment, 35 (19%) were classified as dropouts. The mean age of the dropout group was 47.9 years (standard deviation 9.9). Based on the univariate logistic regression analyses 7 predictors of the 18 potential predictors for dropout were eligible for entry into the multiple logistic regression analyses. Finally, only pain catastrophizing was identified as a significant predictor. Conclusion: Patients with chronic pain who catastrophize were more prone to dropout from this chronic pain management programme. However, due to the exploratory nature of this study no firm conclusions can be drawn about the predictive value of the E-CSM of Self-Regulation for dropout.
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Background: Self-management support is considered an important component in the physiotherapeutic treatment of people with chronic low back pain. The stratified blended physiotherapy intervention e-Exercise Low Back Pain is an example of a self-management intervention. More insight may contribute to improving blended interventions to stimulate self-management after treatment and thus hopefully prevent chronicity and/or relapses in patients with chronic low back pain. Objectives: The aim of this study was to gain an in-depth understanding of the self-management behaviour after a physiotherapist guided blended self-management intervention in people with chronic low back pain. Design: A qualitative study with semi-structured interviews nested within a randomized controlled trial on the (cost-)effectiveness of e-Exercise Low Back Pain was conducted. Method: Thematic analysis was used to analyse the transcriptions. A hybrid process of both deductive and inductive approaches was used. Results: After 12 interviews, data saturation was reached. Analysis of the data yielded six themes related to self-management behaviour: illness beliefs, coping, cognitions, social support and resource utilization, physiotherapeutic involvement and motivation. Conclusions: In our study the majority of the participants seemed to show adequate self-management behaviour when experiencing low back pain. Most participants first try to gain control over their low back pain themselves when experiencing a relapse before contacting the physiotherapist. Participants struggle in continuing health behaviour in pain free periods between relapses of low back pain. Physiotherapists are recommended to encourage long-term behaviour change. Additionally, better facilitation by the physiotherapist or additional functionalities in the app to stimulate social support might have a useful contribution.
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Objective: Systematic review to identify predictors for dropout during interdisciplinary pain management programmes. Data sources: PubMed, PsycINFO, CINAHL, Embase, and SPORTDiscus were searched from inception to 22 June 2017. Study selection: Screening, data-extraction and quality assessment was carried out independently by 2 researchers. Data synthesis: Eight studies with low methodological quality were included in this review. Out of 63 potential predictors identified in univariate analyses, significant results were found for 18 predictors of dropout in multiple logistic regression analyses in 4 domains, as described by Meichenbaum & Turk: (i) sociodemographic domain (2); (ii) patient domain (8); (iii) disease domain (6); and (iv) treatment domain (2). Conclusion: This systematic review presents an overview of predictors of dropout. The literature with regard to the prediction of dropout has focused mainly on patient characteristics and is still in the stage of model development. Future research should focus on therapist/therapy-related predictors and the interaction between these predictors. This review suggests future research on this topic, in order to generate better outcomes in interdisciplinary pain management programmes.
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AIM: To understand the steps in the decision-making process regarding pain assessment and management for people living with dementia from the perspectives and experiences of people with dementia, formal and informal carers.METHODS: A systematic review was conducted. Seven English databases were searched, including PubMed, Psychological Information Database, Cochrane Library, Scopus, Cumulative Index of Nursing and Allied Health Literature, Web of Science, and ProQuest, using synonyms and derivatives for "dementia", "cognitive impairment", "pain", "pain assessment", "pain management", "decision", "decision support", and "decision-making".RESULTS: Twenty-eight studies fulfilled the eligibility criteria. Pain assessment and management in dementia are complex, successive, and collaborative processes carried out by different individuals over a period based on one's understanding of the person with dementia but with high uncertainty. Pain assessment involves a certain degree of guesswork, while pain management is a trial-and-error process.CONCLUSION: More pragmatic approaches are needed to overcome challenges, including uncertainty and decisional conflicts.
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Purpose To empirically define the concept of burden of neck pain. The lack of a clear understanding of this construct from the perspective of persons with neck pain and care providers hampers adequate measurement of this burden. An additional aim was to compare the conceptual model obtained with the frequently used Neck Disability Index (NDI). Methods Concept mapping, combining qualitative (nominal group technique and group consensus) and quantitative research methods (cluster analysis and multidimensional scaling), was applied to groups of persons with neck pain (n = 3) and professionals treating persons with neck pain (n = 2). Group members generated statements, which were organized into concept maps. Group members achieved consensus about the number and description of domains and the researchers then generated an overall mind map covering the full breadth of the burden of neck pain. Results Concept mapping revealed 12 domains of burden of neck pain: impaired mobility neck, neck pain, fatigue/concentration, physical complaints, psychological aspects/consequences, activities of daily living, social participation, financial consequences, difficult to treat/difficult to diagnose, difference of opinion with care providers, incomprehension by social environment, and how person with neck pain deal with complaints. All ten items of the NDI could be linked to the mind map, but the NDI measures only part of the burden of neck pain. Conclusion This study revealed the relevant domains for the burden of neck pain from the viewpoints of persons with neck pain and their care providers. These results can guide the identification of existing measurements instruments for each domain or the development of new ones to measure the burden of neck pain.
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Generic self-management programs aim to facilitate behavioural adjustment and therefore have considerable potential for patients with chronic musculoskeletal pain. Our main objective was to collect and synthesize all data on the effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain in terms of physical function, self-efficacy, pain intensity and physical activity. Our secondary objective was to describe the content of these interventions, by means of classification according to the Behaviour Change Technique Taxonomy. We searched PubMed, CENTRAL, Embase and Psycinfo for eligible studies. Study selection, data extraction and risk of bias were assessed by two researchers independently. Meta-analyses were only performed if the studies were sufficiently homogeneous and GRADE was used to determine the quality of evidence. We identified 20 randomized controlled trials that compared a self-management intervention to any type of control group. For post-intervention results, there was moderate quality evidence of a statistically significant but clinically unimportant effect for physical function and pain intensity, both favouring the self-management group. At follow-up, there was moderate quality evidence of a small clinically insignificant effect for self-efficacy, favouring the self-management group. All other comparisons did not indicate an effect. Classification of the behaviour change techniques showed large heterogeneity across studies. These results indicate that generic self-management interventions have a marginal benefit for patients with chronic musculoskeletal pain in the short-term for physical function and pain intensity and for self-efficacy in the long-term, and vary considerably with respect to intervention content. Significance: This study contributes to a growing body of evidence that generic self-management interventions have limited effectiveness for patients with chronic musculoskeletal pain. Furthermore, this study has identified substantial differences in both content and delivery mode across self-management interventions.
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Pain following burn injuries can be severe and may persist after hospital discharge. The experience of pain is influenced by multiple biological and psychosocial factors. Post-discharge pain may be related to pain experienced during hospitalization as well as anxiety associated with these pain experiences. There are also protective factors; one notable example is optimism. However, the role of optimism in burn-related pain has not yet been investigated. This study aimed to describe the extent of pain measured over 14 consecutive days post-discharge and to examine its relationship with background pain, procedural pain, pain-related anxiety, and optimism. This multi-center longitudinal cohort study was conducted in five burns centres. The results showed that 50 % of the patients had a pain score ≥ 2 on a 0 – 10 scale after discharge, which on average decreased further over the next 14 days. However, a subgroup of patients maintained elevated pain levels. Patients with higher pain scores postdischarge were more likely to have experienced higher levels of background pain and procedural pain in-hospital and they scored lower on optimism. Pain-related anxiety did not independently contribute to pain postdischarge. The results indicate that patients with high pain scores during hospital admission may need specific attention regarding pain management when they leave the hospital. Furthermore, patients may benefit from optimism-inducing interventions in the hospital and thereafter.
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Objective To develop and internally validate a prognostic model to predict chronic pain after a new episode of acute or subacute non-specific idiopathic, non-traumatic neck pain in patients presenting to physiotherapy primary care, emphasising modifiable biomedical, psychological and social factors. Design A prospective cohort study with a 6-month follow-up between January 2020 and March 2023. Setting 30 physiotherapy primary care practices. Participants Patients with a new presentation of non-specific idiopathic, non-traumatic neck pain, with a duration lasting no longer than 12 weeks from onset. Baseline measures Candidate prognostic variables collected from participants included age and sex, neck pain symptoms, work-related factors, general factors, psychological and behavioural factors and the remaining factors: therapeutic relation and healthcare provider attitude. Outcome measures Pain intensity at 6 weeks, 3 months and 6 months on a Numeric Pain Rating Scale (NPRS) after inclusion. An NPRS score of ≥3 at each time point was used to define chronic neck pain. Results 62 (10%) of the 603 participants developed chronic neck pain. The prognostic factors in the final model were sex, pain intensity, reported pain in different body regions, headache since and before the neck pain, posture during work, employment status, illness beliefs about pain identity and recovery, treatment beliefs, distress and self-efficacy. The model demonstrated an optimism-corrected area under the curve of 0.83 and a corrected R2 of 0.24. Calibration was deemed acceptable to good, as indicated by the calibration curve. The Hosmer–Lemeshow test yielded a p-value of 0.7167, indicating a good model fit. Conclusion This model has the potential to obtain a valid prognosis for developing chronic pain after a new episode of acute and subacute non-specific idiopathic, non-traumatic neck pain. It includes mostly potentially modifiable factors for physiotherapy practice. External validation of this model is recommended.
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Pain following burn injuries can be severe and may persist after hospital discharge. The experience of pain is influenced by multiple biological and psychosocial factors. Post-discharge pain may be related to pain experienced during hospitalization as well as anxiety associated with these pain experiences. There are also protective factors; one notable example is optimism. However, the role of optimism in burn-related pain has not yet been investigated. This study aimed to describe the extent of pain measured over 14 consecutive days post-discharge and to examine its relationship with background pain, procedural pain, pain-related anxiety, and optimism. This multi-center longitudinal cohort study was conducted in five burns centres. The results showed that 50 % of the patients had a pain score ≥ 2 on a 0 – 10 scale after discharge, which on average decreased further over the next 14 days. However, a subgroup of patients maintained elevated pain levels. Patients with higher pain scores post-discharge were more likely to have experienced higher levels of background pain and procedural pain in-hospital and they scored lower on optimism. Pain-related anxiety did not independently contribute to pain post-discharge. The results indicate that patients with high pain scores during hospital admission may need specific attention regarding pain management when they leave the hospital. Furthermore, patients may benefit from optimism-inducing interventions in the hospital and thereafter.
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Studies about clinical pain in schizophrenia are rare. Conclusions on pain sensitivity in people with schizophrenia are primarily based on experimental pain studies. This review attempts to assess clinical pain, that is, everyday pain without experimental manipulation, in people with schizophrenia. PubMed, PsycINFO, Embase.com, and Cochrane were searched with terms related to schizophrenia and pain. Methodological quality was assessed with the Mixed Methods Appraisal Tool. Fourteen studies were included. Persons with schizophrenia appear to have a diminished prevalence of pain, as well as a lower intensity of pain when compared to persons with other psychiatric diseases. When compared to healthy controls, both prevalence and intensity of pain appear to be diminished for persons with schizophrenia. However, it was found that this effect only applies to pain with an apparent medical cause, such as headache after lumbar puncture. For less severe situations, prevalence and intensity of pain appears to be comparable between people with schizophrenia and controls. Possible underlying mechanisms are discussed. Knowledge about pain in schizophrenia is important for adequate pain treatment in clinical practice. Perspective This review presents a valuable insight into clinical pain in people with schizophrenia
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