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The Biopsychosocial Model of the Assessment, Prevention, and Treatment of Chronic Pain
Abstract
The biopsychosocial model has been demonstrated to be the most heuristic approach to chronic pain assessment, prevention, and treatment. Currently, this model also provides the best foundation for tailoring the most comprehensive pain management program for each specific patient. Chronic pain patients have an increased risk for developing deficits in physical functioning, emotional reactivity, and cognition. Interdisciplinary treatment, based on the biopsychosocial model, is vital to address these multifaceted issues facing chronic pain sufferers. These interdisciplinary pain management strategies have progressed with advancements in science and technology in an attempt to provide the best possible outcomes for pain patients. However, while research has made enormous advances, there are still some clinical research gaps to be addressed. This article will begin with a historical overview of pain management in order to demonstrate the evolution in theory from ancient practices to the modern biopsychosocial model. Additionally, functional restoration and other early interdisciplinary intervention programs will be highlighted for their importance and effectiveness in chronic pain management, assessment, and prevention.
... Como padecimiento, la complejidad de la experiencia de dolor dificulta su adecuada evaluación y tratamiento en términos clínicos, lo que ha derivado en tratamientos enfocados exclusivamente en disminuirlo sin tomar en consideración otros aspectos de relevancia (Bevers, Watts, Kishino, & Gatchel, 2016). Esto le ha valido poseer una prevalencia del 25 al 29% a nivel mundial, siendo una de las causas más comunes por lo que se acude a consulta médica (Harstall & Ospina, 2003) y junto a padecimientos asociados es la principal causa global de discapacidad laboral y carga de enfermedad (Vos, Abajobir, Abate, Abbafati, Abbas, Abd-Allah, & Aboyans, 2017) aunado al alto costo social y económico implicado (Donker, 1991). ...
... Previo a la concepción del dolor como un fenómeno complejo y multideterminado en la década de los 70's, su estudio a través de un enfoque biomédico giraba en torno aspectos fisiológicos y somáticos (Bevers, Watts, Kishino, & Gatchel, 2016). A raíz de los avances en la investigación y una mayor comprensión del fenómeno, su estudio se diversificó a diversas disciplinas como las ciencias cognitivas, que gracias a su carácter interdisciplinario y su amplia variedad de recursos experimentales (Stenberg & Sternberg, 2011;Neufel, Brust, Sten, 2011), dieron pie a la exploración de un fenómeno tan complejo como el dolor desde una perspectiva más amplia y flexible. ...
... El protagonismo de variables biológicas/somáticas individuales tendía a excluir a aspectos psicosociales, resultando en una atribución psicológica o simplemente de índole idiopático a cuadros de dolor sin una causa médicamente identificable (Synnott, O'Keeffe, Bunzli, Dankaerts, O'Sullivan, & O'Sullivan, 2015;Bevers, Watts, Kishino, & Gatchel, 2016;Stilwall & Harman, 2019). Como respuesta a este hegemonismo reduccionista, el Modelo Biopsicosocial de la Enfermedad (Engel, 1970) consideraba al individuo como una unidad de mente y cuerpo influida en distintas proporciones por factores biológicos, psicológicos y sociales (Bevers, et al., 2016). ...
Pain is a complex relational phenomenon with a high prevalence in clinical contexts. The role of both constitutive and acquired factors in the conception and management of physical pain across various populations has been extensively documented. The aim of this study was to compare and analyze the relationships between personality traits, attitudes toward pain, natural semantic networks of pain-related concepts, and coping strategies in a sedentary group (SED, n=80) and a group composed of combat athletes (PEL, n=63), seeking to clarify a functional profile of pain management that could be extrapolated to clinical settings.
... Effective management of chronic pain conditions requires a comprehensive approach, and evidencebased practice emphasizes the biopsychosocial model (Bevers et al., 2016). This model ...
... acknowledges the complex interplay of biological, psychological, and social factors in the perception and experience of pain (Bevers et al., 2016). A comprehensive approach to chronic pain management must consider these multifaceted influences of the biopsychosocial factors to provide effective patient care and education (Bevers et al., 2016). ...
... acknowledges the complex interplay of biological, psychological, and social factors in the perception and experience of pain (Bevers et al., 2016). A comprehensive approach to chronic pain management must consider these multifaceted influences of the biopsychosocial factors to provide effective patient care and education (Bevers et al., 2016). Thus, pain education for affected patients emerges as a promising first-line intervention method (Moseley et al., 2024;Clarke et al., 2011). ...
Background: Pain management for patients with chronic pain requires a comprehensive biopsychosocial approach that includes pain neuroscience education. Physiotherapists play a crucial role in delivering pain education and require a strong understanding of pain neuroscience education to enable them to tailor individual patient education, refine clinical decision-making, and potentially address central sensitization. However, limited research explores the Saudi physiotherapists' knowledge and attitudes towards pain neuroscience education. Objectives: This study investigated the impact of pain neuroscience education training on physiotherapists' knowledge, attitudes and beliefs towards working with people with chronic pain. Methods: Twenty-six physiotherapists participated in a 3-day, 21-hour intensive pain neuroscience education training program aligned with International Association for the Study of Pain (IASP) standards. The program included lectures, case studies, and group discussions led by a pain rehabilitation expert. Participants completed the Health Care Pain Attitudes and Impairment Relationship Scale (HC-PAIRS) and the Revised-Neuroscience Pain Questionnaire (R-NPQ) before and after the training. Results: Knowledge scores (R-NPQ) significantly increased post-intervention (p < .001), with a greater number of correct responses and fewer incorrect responses. No significant changes were observed in attitudes towards chronic pain patients (HC-PAIRS, p = .99). Conclusion: This study demonstrates that a structured pain neuroscience education (PNE) training program can significantly enhance the knowledge of Saudi physiotherapists. However, it highlights a potential gap in influencing attitudes towards chronic pain patients. Future research should explore the effectiveness of multi-component interventions, including clinical supervision, to foster long-term behavioural changes aligned with biopsychosocial principles of pain management.
... Given the infusion of nurses throughout the healthcare system, nurses are in a unique position to champion this biopsychosocial-spiritual approach to care. outdated biomedical model ( Baria et al., 2019 ;Bevers et al., 2016 ). A recent study of more than 32,0 0 0 patients experiencing chronic pain that had affected their lives in a significant way (i.e., high-impact chronic pain) revealed that higher age, female gender, single/widowed/divorced marital status, ethnicity, lower education attainment, unemployed status, birth in the United States, lower income level, and uninsured status were all risk factors for increasing the prevalence of high-impact chronic pain ( Falasinnu et al., 2023 ). ...
... More than 50 million adults in the United States experience chronic pain, which costs society billions per year in lost productivity and health care services ( Institute of Medicine, 2011 ; Rikard et al., 2023 ). Outside of a brief time in the 1970's and 1980's when the focus was on multidisciplinary care ( Bevers et al., 2016 ;Gatchel et al., 2014 ), the biomedical model has been the predominant approach for chronic pain including provider-led treatment services such as interventional pain, physical therapy, and prescription of opioids ( Roth et al., 2013 ). These traditional pain services are costly, time consuming, and often involve substantial risk for adverse events ( Desai et al., 2022 ;Manchikanti et al., 2017 ). ...
... Furthermore, there is now a plethora of research demonstrating that the problem of chronic pain is more complex than a biologic one to be approached using the tient, the biopsychosocial approach encourages the use of an interdisciplinary team to assess the biological factors (e.g., findings on imaging, medication regimen), psychological components (e.g., depression, anxiety, pain catastrophizing), and social aspects (e.g., relationship conflict, isolation) which contribute to the patient's chronic pain experience. Several studies have demonstrated the efficacy of the biopsychosocial model, which have been reviewed elsewhere ( Baria et al., 2019 ;Bevers et al., 2016 ;Darnall, 2018 ). Overall, the use of the biopsychosocial model for case conceptualization has been thoroughly vetted. ...
Chronic pain affects over 50 million Americans per year and costs society billions of dollars annually. It is widely accepted that the biomedical model is outdated and research on the biopsychosocial model of chronic pain has increased in recent years, concurrent with investigations into self-management of chronic pain. The Veterans Health Administration (VHA) has incorporated both of these approaches into their Whole Health System. This work describes the VHA Whole Health System, reviews the literature on alignment between the Whole Health System’s Circle of Health and chronic pain, and explains how the VHA Whole Health model may be used as a method for organizing self-management strategies within a personal health plan in the context of chronic pain. Given the infusion of nurses throughout the health- care system, nurses are in a unique position to champion this biopsychosocial-spiritual approach to care.
... Native Americans (NAs) experience higher rates of chronic pain than other racial/ethnic groups in the United States. 52,129 To elucidate the mechanisms of this inequity, the Oklahoma Study of Native American Pain Risk (OK-SNAP) recruited a cohort of ;300 healthy, chronic pain-free NAs and non-Hispanic whites (NHWs) and assessed multiple domains of risk associated with the biopsychosocial model of pain, 10 including demographics, physical variables, psychosocial factors, and nociceptive/pain phenotyping. 91 Cross-sectional results found that psychosocial stressors (trauma exposure, 56,106 interpersonal discrimination 43 ), cognitive-emotional processes (pain-related anxiety, 87 situational pain catastrophizing 116 ), and cardiometabolic load (higher body mass index [BMI] & blood pressure [BP], lower heart rate variability [HRV]) 60,89,115 were associated with spinal nociceptive sensitization (enhanced temporal summation of nociceptive flexion reflex [TS-NFR] and/or impaired NFR inhibition during conditioned pain modulation, ie, CPM-NFR]), but not impaired modulation of pain experience (ie, no enhanced TS-pain, no impaired pain inhibition during CPM). ...
... The biopsychosocial model of pain 10 states that the experience of pain stems from the complex interplay of biological, psychological, and social factors. Our findings are in line with this and show that these factors are involved with the NA pain inequity. ...
A pain inequity exists for Native Americans (NAs), but the mechanisms are poorly understood. The Oklahoma Study of Native American Pain Risk (OK-SNAP) addressed this issue and recruited healthy, pain-free NAs and non-Hispanic Whites (NHWs) to attend 2 laboratory visits and assessed mechanisms consistent with the biopsychosocial model of pain: demographics, physical variables, psychosocial factors, and nociceptive/pain phenotypes. Then participants were surveyed every 6 months to assess for chronic pain onset. Results at the 2-year follow-up found that NAs were ∼3x more likely than NHWs to develop chronic pain. Moreover, psychosocial factors (discrimination, stress, pain-related anxiety), cardiometabolic load (higher body mass index and blood pressure, lower heart rate variability), and impaired inhibition of spinal nociception partly mediated the pain inequity. The present study examined mechanisms of chronic pain at the 5-year follow-up for OK-SNAP. Results found that the NA pain inequity worsened—NAs were 4x more likely to develop chronic pain (OR = 4.025; CI = 1.966, 8.239), even after controlling for baseline age, sex assigned at birth, income, and education. Moreover, serial mediation models replicated paths from the 2-year follow-up that linked psychosocial variables, cardiometabolic load, and impaired inhibition of spinal nociception to chronic pain onset. Further, 2 new significant paths were observed. One linked discrimination, stress, sleep problems, and facilitated pain perception to increased pain risk. The other linked discrimination with higher spinal nociceptive threshold and pain risk. These results provide further evidence for a NA pain inequity and identify multiple psychosocial, cardiometabolic, and pronociceptive targets for primary interventions.
... Pain can impair physical functioning, raise the probability of injury, and increase the experience of psychological distress, which in turn may be associated with worsening of pain (23), contributing to a cascade of increasing pain and distress that may affect other areas of functioning. One such impact is hypercortisolism, which results from overactivation of the hypothalamic-pituitary-adrenal axis. ...
... Because loneliness enhances stressful perceptions of daily events or challenges (13,35), the reciprocal relationship of risk exposure and loneliness may contribute to prolonged and higher levels of stress among Black and Latino persons across the life course. Experiencing more stress and its biological impact could accelerate physical decline and contribute to a cyclical relationship between stress and physical dysregulation that results in worse pain outcomes in midlife and older Black and Latino individuals (23). We thus suggest that the impact of loneliness on pain presence and intensity may be worse for Black and Latino individuals than their White counterparts. ...
Background
Prior research has demonstrated a strong and independent association between loneliness and pain, but few studies to date have explored this relationship in racially and ethnically diverse groups of midlife and older adults. We drew on the diathesis stress model of chronic pain and cumulative inequality theory to examine the relationship of loneliness and the presence and intensity of pain in a nationally representative sample of Black, Latino, and White adults aged 50 or older in the United States.
Methods
Data were from Wave 3 of the National Social Life, Health, and Aging Project (n = 2,706). We used weighted logistic and ordinary least squares regression analyses to explore main and interactive effects of loneliness and race and ethnicity while adjusting for well-documented risk and protective factors (e.g., educational attainment, perceived relative income, inadequate health insurance, perceived discrimination) and salient social and health factors.
Results
Almost half (46%) of the participants reported feeling lonely and 70% reported the presence of pain. Among those who reported pain (n = 1,910), the mean intensity score was 2.89 (range = 1–6) and 22% reported severe or stronger pain. Greater loneliness was associated with increased odds of pain presence (AOR = 1.154, 95% CI [1.072, 1.242]) and higher pain intensity (β = 0.039, p < 0.01). We found no significant interaction effects involving Black participants. However, Latino participants who reported greater loneliness had significantly higher levels of pain (β = 0.187, p < 0.001) than their White counterparts with similar levels of loneliness.
Discussion
Loneliness is an important correlate of pain presence and intensity and may have a stronger effect on pain intensity among Latino adults aged 50 or older. We discuss clinical and research implications of these findings, including the need for more fine-grained analyses of different types of loneliness (e.g., social, emotional, existential) and their impact on these and other pain-related outcomes (e.g., interference). Our findings suggest a need for interventions to prevent and manage pain by targeting loneliness among middle-aged and older adults, particularly Latino persons.
... Thus, the biopsychosocial model of prevention and treatment could be particularly useful for firefighters. This model of care has been advocated for the management of musculoskeletal disorders, such as LBP [20], and "evaluates the integrated 'whole person', with both the mind and the body together as interconnected entities, recognizing biological, psychological, and social components of pain and illness" [21]. In the biopsychosocial model, musculoskeletal pain and physical deconditioning interact with each other, make the other worse, and lead to psychological deconditioning, which lowers self-confidence, creates fear avoidance behaviors, and exacerbates physical deconditioning [21,22]. ...
... This model of care has been advocated for the management of musculoskeletal disorders, such as LBP [20], and "evaluates the integrated 'whole person', with both the mind and the body together as interconnected entities, recognizing biological, psychological, and social components of pain and illness" [21]. In the biopsychosocial model, musculoskeletal pain and physical deconditioning interact with each other, make the other worse, and lead to psychological deconditioning, which lowers self-confidence, creates fear avoidance behaviors, and exacerbates physical deconditioning [21,22]. To adequately address these factors and their interconnections, clinically meaningful assessments across important health domains are beneficial, which in turn are used to guide the delivery of evidencebased and patient-centered interventions. ...
Introduction: Low back pain (LBP) is highly prevalent and a top cause of disability-related early retirement in firefighters. Those with a lifetime history of LBP have various deficiencies that are associated with increased injury risk and absenteeism. However, the influence of working with current LBP on disability, physical performance, and other biopsychosocial factors has not been fully characterized in this population. The purpose of this study was to compare anthropometric measures, exercise habits, physical fitness/performance, disability/work ability, and other biopsychosocial factors of firefighters working with and without current LBP.
Methods: A cross-sectional study was conducted using baseline assessments from 419 full-duty career firefighters without documented work restrictions (age: 37.6 ± 8.8 y; 5 F, 414 M) who were enrolled in a regional wellness initiative in Southern California, USA. Current LBP status was determined by a questionnaire and confirmed by an interview. Anthropometric measures, patient-reported outcomes, and physical fitness tests were used to assess body mass index; body fat %; waist circumference; strengthening, cardiovascular, and flexibility exercise frequency; back and core muscular endurance; functional movement quality, perceived back-related disability, lift and carry ability, and firefighter task ability; sleep quality; and perceptions of fear and fatigue and catastrophic injustice experience. Scores for participants with and without current LBP were compared using analysis of variance and chi-square analysis.
Results: The point prevalence of current LBP was 19.81% (83/419). For the entire cohort, those with current LBP had significantly worse scores than those without current LBP for all assessed variables, except core muscular endurance and functional movement quality. These trends held up when analyses were stratified by age and obesity categories, and approximately half of the comparisons retained statistical significance. A significantly greater percentage of participants with current LBP were working with some level of back-related disability and/or perceived physical demand characteristics of work level below the required very heavy job demands.
Conclusion: Nearly one-fifth of full-duty career firefighters without documented work restrictions reported having current LBP, and these individuals had deficits in several modifiable biopsychosocial factors across five health domains. These findings can help guide future research and implementation efforts in the fire service designed to improve performance, resiliency, work readiness, recovery, and quality of life, as well as to reduce impairment, disability, and absenteeism and increase presenteeism.
... [18] [SEID], which are associated with many overlapping diagnostic criteria, thus creating high confusion for the primary care doctors. [15][16][17][18][19][20] The evaluation of a patient presenting with CNMSP without obvious medical cause needs the biopsychosocial [BPS] model for further management. [6,20] The BPS model has three components: biological, psychological, and social. ...
... [15][16][17][18][19][20] The evaluation of a patient presenting with CNMSP without obvious medical cause needs the biopsychosocial [BPS] model for further management. [6,20] The BPS model has three components: biological, psychological, and social. Therefore, through this study, we are going to describe method of the BPS model for the evaluation of patients with CNMSP of unknown etiology so that the classification and treatment of these patients can be easy at the primary care level. ...
A BSTRACT
Background
Understanding and dealing with chronic nonspecific pain (CNP) is the important entity at primary care hospital. Chronic nonspecific multiple-site pain [CNMSP] of unknown etiology creates diagnostic and therapeutic challenges for primary care physicians due to lack of guidance regarding evaluation and treatment.
Aims and Objectives
To classify and formulate the evaluation, treatment strategies, and prediction of prognosis of patients with CNMSP of unknown etiology.
Methods
Patients present with CNMSP of more than 3-month duration without any obvious medical cause. The biopsychosocial [BPS] model with 3P model was applied to see the biological, psychological, and social factors behind persistence. Finally, patients were classified into four groups for evaluation response to treatment and relapse rates in 12-month follow-up.
Results
Of the total 243 patients of CNMSP, 243 [96.3%] were females. Sixty [24.7%] patients had short duration, and 183 [75.3%] had long duration. Headache was in 115 [47%], low back pain ± leg pain in 96 [39.4%], cervical pain ± shoulder/arm pain in 83 [34.1%], and diffuse body pain in 50 [20.5%] in various combinations. A total of 155 [63.8%] patients had high somatization–sensitization index (SSI), and 144 [59.3%] had low ferritin level. Group 1 [high SSI and low ferritin] had 37.9% of patients, group 2 [high SSI and normal ferritin] had 25.9% of patients, group 3 [low to medium SSI with low ferritin] had 21.4% of patients, and group 4 [low to medium SSI with normal ferritin] had 14.8% of patients. Response to pain symptoms was better in group 1, and relapse rate was higher in group 2.
Conclusion
CNMSP of unknown etiology itself is a heterogeneous entity, and assessment based on the BPS model can be very useful to understand the treatment plan and outcome of these patients.
... The biopsychosocial model considers the interconnectedness of the mind and body, addressing biological, psychological, and social aspects of pain and illness (39). In contrast, the biomedical disease model focuses on bodily disruption caused by physiological factors. ...
... Catastrophizing and avoidance stem from anticipated pain, exacerbating these behaviors. Patient differences in persistent personality traits as well as self-control and self-efficacy may impact learned helplessness and similar behaviors, but this remains uncertain (39). Negative affect is likely the most frequently evaluated psychological aspects in individuals with persistent pain. ...
Postoperative headaches (POH) following retrosigmoid microsurgery for ves-tibular schwannoma (VS) can significantly diminish patients' perceived health benefits (PHB). A survey of 101 VS patients, utilizing the Rostock Headache Compendium, Glasgow Benefit Inventory, Ten-Item Personality Inventory (TI-PI-G), and German pain processing questionnaire (FESV), revealed that almost half experienced POH, leading to a markedly reduced overall PHB compared to those without POH. This decrease in PHB was linked to higher levels of pain-related helplessness, depression, anxiety, and anger. Positive associations were found between PHB and action-planning competence, cognitive restruc-turing, and experience of competence. Personality traits, particularly low emo-tional stability and openness, were associated with pain-related psychological impairment. Interestingly, hearing loss and facial paresis did not impact PHB. The study underscores the influence of pain-related mental interference and coping strategies on PHB in long-term POH patients, suggesting a role for personality traits in their pain management. The findings advocate for short-term psychological interventions, emphasizing adaptive coping mecha-nisms like cognitive restructuring, to enhance PHB in VS patients post-microsurgery.
... Approach coping, on the other hand, includes patients trying to actively reduce, manage, or eliminate the stressor [46,47]. Biopsychosocial research has shown that avoidance strategies can work in the short term but lead to worsened outcomes in the long term (e.g., pain and disability) [46][47][48][49]. Because approach coping strategies are more effective in the long run [46][47][48][49][50], patients should be encouraged to adopt associated strategies of which relatively few or no patients in our study indicated they have adopted, such as acceptance, seeking support, and positive reinterpretation. ...
... Biopsychosocial research has shown that avoidance strategies can work in the short term but lead to worsened outcomes in the long term (e.g., pain and disability) [46][47][48][49]. Because approach coping strategies are more effective in the long run [46][47][48][49][50], patients should be encouraged to adopt associated strategies of which relatively few or no patients in our study indicated they have adopted, such as acceptance, seeking support, and positive reinterpretation. Psychosocial interventions such as cognitive behavioral therapy (CBT) may help patients adopt helping strategies such as improving planning or reducing focusing on and venting emotions [17]. ...
Purpose
Patients with chronic painful chemotherapy-induced peripheral neuropathy (CIPN) may experience a negative impact of CIPN on daily life. They can use various coping (i.e., dealing with symptoms and resulting impairments in general) and self-management (i.e., practical actions to reduce symptoms) strategies to live with their limitations. This paper aimed to examine experienced helpful coping and self-management strategies of patients with chronic painful CIPN.
Methods
Semi-structured interviews were conducted with twelve patients with chronic painful CIPN. We applied a hybrid deductive-inductive coding approach. ATLAS.ti was used for coding.
Results
Generated from the data were two themes and nine codes for coping and four themes and 31 codes for self-management strategies. Coping of patients often included active strategies like planning, seeking social support, and acceptance. Additionally, patients often used passive strategies such as focusing on and venting emotions and suppressing competing activities. The most common self-management strategies were mostly passive (i.e., medication, deliberate choice of shoes, resting, sitting, and consulting healthcare professionals) but also active (i.e., exercising) strategies.
Conclusion
Patients exhibit a great variety of coping and self-management strategies that they perceive as helpful to deal with chronic painful CIPN. However, research has shown that certain strategies are not that helpful or even come with aversive effects. More research into the effectiveness and implementation of psychosocial interventions is needed since it may help patients adopting helping strategies. In addition, healthcare professionals need to refer patients with CIPN in a timely manner to physical therapists, occupational therapists, or rehabilitation teams to reduce or prevent (further) impairments.
Implications for Cancer Survivors
Patients can consult one of their healthcare providers in case of problems in dealing with their symptoms, to get proper guidance and possible referral.
... It is a complex and distressing health issue Pain Ther associated with significant disability [2], poorer quality of life [3], and with both high individual and societal economic impact [4]. Recent literature [5][6][7][8] has strongly advocated the viewing of CP as a biopsychosocial rehabilitative phenomenon comprising the dynamic interaction of factors across different domains. Within this framework, research surrounding psychopathology has also indicated reciprocal links between pain and certain psychiatric conditions, such as depression and anxiety [9]. ...
The aim of this study was to map the association between Chronic Pain (CP) and Obsessive–Compulsive Disorder (OCD) in the present literature.
A scoping review was conducted with a comprehensive search of literature in peer-reviewed journals. Search parameters included articles written in English, published at any time, and including terms associated with both CP and OCD. Databases searched for purposes of this study included Psychinfo, Medline, Embase, Emcare, CINAHL, Scopus, Web of Science, Cochrane, and Google Scholar.
The review included 87 records, comprising 49 primary research and 38 secondary research records. Extracted information from these were grouped into four broad classifications. The Prevalence and Severity classification included information from 39 records which comprised: (1) primary research detailing current OCD prevalence rates in CP conditions (differentiated between general population and Pain/Medical/Hospital clinics); (2) primary research detailing lifetime OCD prevalence rates in CP conditions; (3) primary research detailing CP prevalence rates in OCD; (4) primary research detailing relationships between OCD and CP through psychometric measures; and (5) secondary research relating to prevalence rates. The Neurobiology classification included information from 28 records (primary and secondary research) detailing convergent and divergent neurobiological/neurophysiological aspects as reported for both OCD and CP. The Psychological Models/Factors classification included information from 7 records (primary and secondary research) detailing pain-related anxiety, neuropsychological measures, catastrophic thinking, preservative thinking, early maladaptive schemas, schema modes, childhood trauma experiences, and conditional associative learning, as reported for OCD and CP. The Intervention classification included information from 32 records which comprised: (1) primary research on neurosurgical, medication, and psychotherapeutic interventions; (2) secondary research on Deep Brain Stimulation; (3) secondary research on Medication; (4) secondary research on lesion, cingulotomy, and other surgical procedures; and (5) secondary research on other interventional procedures.
While there has been considerable and growing research in the fields of both OCD and CP over the years, focused research into their potential association has been limited and potentially overlooked. The results of this review, however, suggest a complex relationship between CP and OCD. Prevalence rates between the two conditions vary widely across different populations, although the underlying reason for this remains unclear at this stage. There are commonalities in terms of alterations in pain processing, the dysregulation of certain brain regions, and the abnormalities in neurotransmitter systems in both conditions. In their treatment, use can be made of overlapping pathophysiological processes, the convergent and divergent psychological aspects, and the range of interventional approaches that share targets to promote efficacy. However, the complex presentations of both OCD and CP make it a challenging relationship to accurately clarify. Further directed and robust, high-quality studies will be needed to expand our understanding of this area.
... The medical treatment of chronic pain is undergoing a shift towards an evidence-based multidisciplinary approach rooted in the biopsychosocial model, which incorporates medical management alongside physical rehabilitation and psychological support [1,2]. Implementing this approach, however, can pose challenges for pain clinics. ...
Evidence-based treatment of chronic pain requires a multidisciplinary approach grounded in the biopsychosocial model. Implementing this approach within health systems relies on its acceptance by both healthcare providers and patients. While pioneering multidisciplinary pain clinics can serve as a model for implementation, a systematic effort is needed to share knowledge effectively and broadly. In the current paper we provide an overview of the knowledge translation initiatives undertaken at our Transitional Pain Service (TPS) at Toronto General Hospital, a state-of-the-art multidisciplinary pain program established in 2014 for patients at risk of developing chronic pain after surgery. The TPS team strives to enhance acceptance of this model of care among patients and providers, facilitate the establishment of similar clinics, and promote patient understanding of the integrated multidisciplinary pain care approach. Guided by the Knowledge to Action (KTA) framework, knowledge translation activities undertaken by our TPS team include clinician training, resources and outreach activities for providers, and patient education. Resource development was preceded by consultation and needs assessment among patients and providers and feedback from both groups was incorporated as part of the development process. The tailored resources were disseminated via the TPS clinic website and monitoring of online usage enables continuous evaluation of engagement. Barriers to engagement with the resources were examined through patient surveys and staff interviews. Based on these activities, we offer insights gained by our team throughout the knowledge translation process and provide recommendations for other clinical teams who wish to undertake similar initiatives.
... In recent decades, research has challenged these models, as complex conditions that fall under the professional scope of practice, such as persistent MSK pain, are poorly explained or treated by reductionist approaches (28-30). To address the multifactorial and interrelated nature of pain, the biopsychosocial (BPS) model has been used as a framework to understand complex conditions as emergent states arising from the interaction of biological, emotional/psychological, and social domains (31,32). While the BPS model has led to promising developments in research and practice (33), it has also been argued that the general understanding and implementation of the model remains reductionist and particularly social and environmental factors are not yet considered sufficiently (34)(35)(36). ...
Nature-based health and therapy (NBHT) is a term incorporating a broad suite of practices that focus on engagement with the natural world and nature-rich spaces for potential physical and mental health benefits. As healthcare professions such as physiotherapy and osteopathy move away from biomedical/reductionist models of care for complex conditions towards approaches which take into account social and environmental determinants of health, NBHT may become part of clinical interventions and public health messaging. However, there are multiple challenges in aspects of NBHT research and application, from methodological issues in the primary research base, to questions of environmental injustice and access inequalities in many areas. In addition, engaging with natural environments which are vulnerable to the entwinned threats of climate change and biodiversity collapse requires consideration of the effects of ecological disturbance and the underlying anthropocentric/utilitarian view of the natural world. In this perspective, we outline a critique of NBHT literature and offer positive suggestions for how better-quality research can be conducted and implemented by focusing on local environmental, social, and political factors. We conclude by outlining a set of critical considerations that healthcare professionals might use to develop and implement NBHT programmes in their specific regional contexts.
... This study will use the biopsychosocial model, which provides a comprehensive picture of the biological, social/environmental, and psychological factors that may all play a role in the development and persistence of chronic pain. (15) A plethora of research supports an integrated care model for children with CP that includes highly specialized, interprofessional care. (16) However, this care model tends to dissolve after the transition to adult-based care,(17) making adults with CP an underserved and under resourced population. ...
AIM
Determine biopsychosocial factors associated with pain interference and pain intensity in adults with cerebral palsy (CP) and chronic low back pain (LBP).
METHOD
Cross-sectional secondary data analysis of a community survey examining function and chronic pain in adults with CP and LBP. We examined bivariate relationships and built two regression models with pain interference with general activities and pain intensity as dependent variables and biopsychosocial factors as explanatory factors.
RESULTS
We included 295 participants with CP and LBP in our analyses. Average age was 43.2 ± 13.9 years, and 81% were ambulatory (GMFCS I-III). Pain was present for 17.9 ± 13.4 years. Ordinary least squares regression models indicated greater pain interference with: change in best motor function since childhood (p=0.002), stigma (p=0.01), and anxiety (p=0.01; N=238; adjusted R ² =0.17); and greater pain intensity with: lower income (p=0.01), Hispanic/Latino ethnicity (p=0.04), anxiety (p=0.01), and less satisfaction with social roles, (p<0.001; N=290, R ² =0.18; Adjusted R ² =0.16).
INTERPRETATION
These findings emphasize the importance of assessing and interpreting chronic pain in the context of biopsychosocial factors, particularly anxiety, stigma, race, ethnicity, income, satisfaction with social roles, and changes in motor function.
... The notion that chronic pain should always be understood as a biopsychosocial phenomenon is not a novel idea. 8,30,37 The introduction of the International Classification of Diseases, 11th Revision (ICD-11) classification of chronic pain 106,107 takes this concept into account, particularly with regard to the diagnostic entity of chronic primary pain. Chronic primary pain (CPP) is defined as pain that persists or recurs 3 or more months, is associated with significant emotional distress or functional disability, and that is not better accounted for by another chronic (secondary) pain diagnosis. ...
Introduction
Chronic primary musculoskeletal pain (CPMP) poses a major problem of public health, with high prevalence rates and economic burden. There is a wealth of clinical trials examining pharmacological interventions for patients with CPMP. Nevertheless, evidence from such trials does not necessarily mirror clinical realities.
Objectives
We aimed to compare data sets from a clinical sample with an randomized controlled trial (RCT)-based sample.
Methods
Both data sets included participants living with CPMP who received pharmacological interventions. The clinical sample was retrieved from electronic health records. The RCT-based sample stemmed from a network meta-analysis project. The following outcomes were used: demographic information, diagnosis-specific data, and pharmacological interventions (categorized according to the World Health Organization [WHO] analgesic ladder).
Results
The clinical sample consisted of 103 patients (mean age: 50.25 years; SD: 14.0) and the RCT-based samples contributed 8665 participants (mean age: 51.97 years; SD: 6.74). In both samples, the proportion of women was higher than that of men (ie, 74.8% vs 58.9%). Psychiatric disorders were the most common comorbidities in the clinic sample but also the most frequent reason for patient exclusion in RCTs. The 2 samples differed significantly in medication classified as WHO III (clinical sample: 12.9%; RCT sample: 23.5%; P = 0.023) and WHO IV (clinical sample: 23.4%; RCT sample: 8.6%; P < 0.001), yet not WHO I and II.
Conclusion
Our findings suggest a disparity between research-based study populations and clinical populations with CPMP. We advocate for future investigations on how to implement robust scientific evidence into real-world clinical practice, with a particular focus on addressing psychiatric comorbidities.
... The biopsychosocial model of pain recognizes the importance of various psychological factors in pain [10]. One such factor, pain catastrophizing-cognitive and affective pain appraisal characterized by the tendency to address and magnify the threat value of painful stimuli and feel helpless owing to pain-is reportedly signi cantly correlated with increased knee pain severity in both clinical and experimental settings [11][12][13]. ...
Background: Although a few studies have delineated the disparities in knee osteoarthritis (OA) pain between non-Hispanic Whites (NHWs) and Asian Americans, a significant research gap persists in elucidating the mechanisms underlying these differences.
Objective: This pilot study aimed to examine psychological factors, specifically pain catastrophizing and negative affect, as potential explanatory mechanisms for these dissimilarities.
Methods: Forty community-dwelling participants aged 50–70 years with self-reported knee OA pain, including 20 NHWs and 20 Asian Americans, were recruited. Clinical knee OA pain intensity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short -Form-McGill Pain Questionnaire-2 (SF-MPQ-2). Quantitative sensory testing was used to measure experimental sensitivity to heat- and mechanically induced pain. Pain catastrophizing was evaluated using the Coping Strategies Questionnaire-Revised Pain Catastrophizing subscale, while negative affect was assessed using the Positive and Negative Affect Schedule. Bayesian mediation analyses were employed to examine both direct and indirect effects (mediation) between variables.
Results: Asian Americans exhibited higher pain catastrophizing scores than NHWs. Pain catastrophizing, at high levels, contributed to WOMAC- and SF-MPQ-2-measured clinical pain, and it fully mediated the relationship between race and these pain measures. However, race had no indirect effects on experimental pain sensitivity through pain catastrophizing. While Asian Americans yielded higher negative affect scores and greater experimental pain sensitivity than NHWs, race exerted no indirect effects on all pain measures via negative affect.
Conclusions: Pain catastrophizing appears crucial in addressing racial disparities in clinical knee OA pain between NHWs and Asian Americans. The lack of indirect effects of race on experimental pain sensitivity through pain catastrophizing suggests the need to explore other factors, such as genetic and biological influences. Further research using larger sample sizes is essential to validate our findings and clarify the role of negative affect.
... Knowledge of psychosocial factors and how they influence the pain experience is necessary in assisting people in making sense of their pain and preventing unhelpful beliefs from manifesting [20]. Individuals' experience of pain is subjectively based on their perceptions, descriptions, and how information is conveyed, which affects the healthcare professional's interpretation, assessment, and treatment of pain, which is an enormous task [21]. A biomedical lens has become the premise for maladaptive beliefs as it is based upon ideas that pain equals damage, only medication can treat pain, rest is essential, and these problems result from your age [22]. ...
Background
Pain attributed to musculoskeletal disorders are a significant hinderance to work ability and economic growth, especially in developing countries. Quality of life and lived experience of workers with musculoskeletal disorders have not been explored enough to determine whether person-centred care is provided. There is a wealth of evidence for using the biomedical approach in the management of workers with musculoskeletal disorders, which has proved ineffective in reducing absenteeism and symptoms experienced by workers. The purpose of this study was to explore the lived experience of workers seeking care for musculoskeletal disorders and how their pain attitudes and beliefs influenced their experience.
Methods
A qualitative approach with thematic analysis was used. Purposive sampling was used to recruit six participants for semi-structured interviews. All participants were either experiencing pain attributed to a musculoskeletal disorder or had received care for a musculoskeletal disorder.
Results
Pain attitudes and beliefs of workers with a musculoskeletal disorder and healthcare professionals greatly influenced the care and recovery process of musculoskeletal disorders. There is a primary biomedical lens informing care of workers with musculoskeletal disorders received. Workers expect healthcare professionals to explore their concerns further, but the focus of care for most participants was their presenting complaint. There is also a need for the autonomy of workers to be preserved, and communication between healthcare professionals and workers with musculoskeletal disorders needs to improve.
Conclusions
Many stakeholders are involved in the recovery process from musculoskeletal disorders. There is a need for a biopsychosocial informed practice to improve return-to-work (RTW) in workers with musculoskeletal disorders. Change is needed at all healthcare system levels to reduce the negative experiences of workers and maladaptive pain beliefs that is associated with persisting symptoms and extended absenteeism.
... According to the biopsychosocial model, 22 chronic pain is a multidimensional construct composed of interacting biological, cognitive/affective, interpersonal, and sociocultural characteristics. 22,23 Researchers have shown that these pain characteristics (e.g., pain severity, self-perceived pain-related disability, negative mood, partner support, pain acceptance, and perceived pain control) are negatively associated with quality of life. [24][25][26][27] These characteristics also are likely associated with SWB; however, research examining these associations is scant. ...
Background
Individuals experiencing chronic pain often report adverse effects on their sexual functioning. However, other important aspects of sexual well-being (SWB), such as sexual distress and sexual self-esteem, have received little attention. This is an important omission because a SWB involves more than just good sexual function. Similarly, past research has not examined how chronic pain characteristics affect the different aspects of SWB.
Aim
The goal of this cross-sectional study was to examine the SWB of individuals living with chronic pain and to examine the extent to which SWB is associated with different chronic pain characteristics.
Methods
A total of 310 individuals (28.1% men, 70.6% women, 1.3% transgender men) with ages between 21 and 50 (M = 31.96, SD = 6.13) who were in a romantic relationship and with self-reported chronic pain for three months or longer completed an online survey.
Outcomes
The following indicators of SWB were included in the study: frequency of genital sexual activity, sexual satisfaction, sexual self-esteem, sexual desire, sexual function, genital pain, and sexual distress.
Results
The results show that most individuals with chronic pain maintain an active and satisfying sexual life and feel positive about themselves as a sexual partner. Slightly more than a fourth reported experiencing at least one sexual functioning difficulty and almost three-fourths of them found those difficulties sexually distressing. A first canonical correlation showed that more negative pain characteristics were associated with poorer SWB. The second canonical correlation showed that greater perceived partner support can offset the negative relationship between pain and some aspects of SWB.
Clinical implications
These findings show that individuals living with chronic pain can experience positive SWB. Furthermore, the buffering effect of partner support suggests it is important to involve romantic partners in interventions aimed at improving the SWB of people living with chronic pain.
Strengths and limitations
The study examined a large number of indicators of SWB using a sample of individuals with different types of chronic pain. Limitations include potential self-selection bias and a sample that was predominantly white and highly educated.
Conclusions
The results paint a more positive picture of the SWB of individuals living with pain and show that individuals living with chronic pain can experience positive SWB. These findings can help for researchers, educators, and clinicians about how to conceptualize, understand, and improve the SWB of individuals living with chronic pain.
... The experience of pain is multi-faceted [58,59], and this pilot study reinforces the need to investigate patients' experiences of meaningfulness in rehabilitation in greater depth. Recent research has shown that when therapy goals are underpinned by a person's global meaning or sense of meaning in life, the person is also likely to derive greater situational meaning or the sense that their therapy goals are meaningful [60,61]. ...
Chronic pain rehabilitation helps to reduce pain and restore valued life roles. Patients may have more positive outcomes when they perceive rehabilitation to be personally meaningful. This study examined associations between self-reported, personally meaningful rehabilitation and well-being. A pilot study was conducted using an online survey of people with chronic pain and experiences of rehabilitation. The PROMIS Pain Interference Short Form 8a and The Flourishing Scale were used to explore well-being. A modified self-report measure, the Meaningfulness in Rehabilitation Scale, was pilot-tested for construct validity and used in the survey. Of the 48 participants (81% female; 19% male), most attended a generalist therapy practice (62%) once per week (33%) or once per fortnight (29%). No statistically significant relationship was found between self-reported meaningfulness in rehabilitation and pain interference or other patient and therapy characteristics (duration of chronic pain category, type of therapy practice, resolution of rehabilitation category, and frequency of appointments). The nonparametric analysis identified a statistically significant moderate positive correlation between self-reported meaningfulness in rehabilitation and the flourishing aspect of well-being. This raises important questions and suggests that patients’ perception of rehabilitation as meaningful warrants further research. This pilot study provides valuable guidance to inform a larger investigation.
... First, our study is unique in quantitatively examining the dynamics of online chronic pain support communities, contrasting the current literature that is primarily qualitative and focused on pain narratives [28,73,80,87,123,137,138]. Second, the qualities of pain are typically investigated through measures of central tendency (ie, by comparing average pain catastrophizing across groups). However, the biopsychosocial model describes chronic pain as a dynamic (changing over time) and complex (evolving from the interactions of multiple factors) process [14,139,140]. Consistent with this framing of chronic pain, we used wavelet analysis to analyze sentiment synchrony, which is an analytic technique better suited to describe complex system interactions and nonstationary behavior [92,107]. ...
Background
Peer support for chronic pain is increasingly taking place on social media via social networking communities. Several theories on the development and maintenance of chronic pain highlight how rumination, catastrophizing, and negative social interactions can contribute to poor health outcomes. However, little is known regarding the role web-based health discussions play in the development of negative versus positive health attitudes relevant to chronic pain.
Objective
This study aims to investigate how participation in online peer-to-peer support communities influenced pain expressions by examining how the sentiment of user language evolved in response to peer interactions.
Methods
We collected the comment histories of 199 randomly sampled Reddit (Reddit, Inc) users who were active in a popular peer-to-peer chronic pain support community over 10 years. A total of 2 separate natural language processing methods were compared to calculate the sentiment of user comments on the forum (N=73,876). We then modeled the trajectories of users’ language sentiment using mixed-effects growth curve modeling and measured the degree to which users affectively synchronized with their peers using bivariate wavelet analysis.
Results
In comparison to a shuffled baseline, we found evidence that users entrained their language sentiment to match the language of community members they interacted with (t198=4.02; P<.001; Cohen d=0.40). This synchrony was most apparent in low-frequency sentiment changes unfolding over hundreds of interactions as opposed to reactionary changes occurring from comment to comment (F2,198=17.70; P<.001). We also observed a significant trend in sentiment across all users (β=–.02; P=.003), with users increasingly using more negative language as they continued to interact with the community. Notably, there was a significant interaction between affective synchrony and community tenure (β=.02; P=.02), such that greater affective synchrony was associated with negative sentiment trajectories among short-term users and positive sentiment trajectories among long-term users.
Conclusions
Our results are consistent with the social communication model of pain, which describes how social interactions can influence the expression of pain symptoms. The difference in long-term versus short-term affective synchrony observed between community members suggests a process of emotional coregulation and social learning. Participating in health discussions on Reddit appears to be associated with both negative and positive changes in sentiment depending on how individual users interacted with their peers. Thus, in addition to characterizing the sentiment dynamics existing within online chronic pain communities, our work provides insight into the potential benefits and drawbacks of relying on support communities organized on social media platforms.
... Integrated treatments for chronic pain are broadly based on the biopsychosocial model which posits pain as a reciprocating assimilation of physiological, psychological, social, and environmental factors. 2,9 The biological underpinnings of the biopsychosocial model are supported by the pain matrix, which is recognized as a hierarchical multilevel neural network that processes painful stimuli. 15 This processing spans the encoding of nociceptive stimuli and memory formation of pain experiences, 15 which can be further modulated by immune and endocrine mechanisms. ...
Sustained widespread deployment of clinically and cost-effective models of integrated pain care could be bolstered by optimally aligning shared stakeholder values.
... Yes, I use prescribed pain medication 1 (5.9%) 0 (0.0%) 1 (3.0%) Missing 1 2 3 Note: OTC: over-the-counter relation to the subacute phase after discharge; a critical time regarding the transition to CPSP in which patients still experience high levels of pain (Chan et al., 2013), and have to take charge of pain management, brief MBI represent tools that can promote adaptive behaviors, pain self-management and pain self-efficacy, which are believed to be protective factors for CPSP and the development of disability (Bevers, 2016;Gatchel et al., 2007;Weinrib et al., 2017). In sum, brief MBI may have a multidimensional protective effect in the face of pain and the development of CPSP (Zeidan & Vago, 2016). ...
Objectives
Recent brief mindfulness-based interventions (MBI) provided before surgery have shown promising results in improving clinical outcomes in patients undergoing total joint arthroplasty (TJA). However, they have not been delivered in the subacute phase after surgery to target patients at risk for chronic postsurgical pain (CPSP). The use of technologies allowing remote and online delivery can help increase the accessibility of these interventions.
Method
We conducted a single site, two-arm pilot randomized controlled trial to evaluate the feasibility, acceptability, and preliminary effects of online Mini More (i.e., a condensed, 4-week mindfulness-based program) promoting pain self-management during the subacute postoperative phase. We randomized 36 patients into two groups (Mini MORE, n = 18 and Pain Coping Education, n = 18). Postoperative outcomes were: pain intensity, pain interference, analgesic medication use, pain catastrophizing, pain acceptance and mindfulness.
Results
Results indicated that Mini MORE was highly feasible and well received. Further, results indicated that pain intensity (d = 1.47, p < 0.001) as well as pain interference levels (d = 1.04, p = 0.005) and medication use (Cliff’s Delta=-0.56, p = 0.02) were significantly different between groups after treatment. Statistically significant group by time interactions were found for both pain intensity (p < 0.001) and pain interference (p = 0.003), and a trend toward a decrease in pain medication use (p = 0.05) was observed in favor of the Mini MORE group. No statistically significant differences were found between groups for pain acceptance (d = -0.58), pain catastrophizing (d = 0.01) and mindfulness (d = -0.23).
Conclusions
Our results suggest Mini MORE is a feasible and acceptable brief, online MBI potentially capable of decreasing pain intensity and pain interference in the subacute period after TJA, thus Mini MORE may be a promising tool for preventing CPSP.
Preregistration
NCT04848428
... The most commonly affected are the L5 and S1 nerve roots, somewhat less often the L4 nerve roots (2). However, there are other possible causes of sciatica, such as traumatic injury of the sciatic nerve, muscle hematomas, tumors, piriformis syndrome and myofascial pain syndrome (3)(4)(5)(6). ...
... 7 Treatment for persistent pain is focused not only on pharmaceutical pain relief, 8 but also multidisciplinary interventions aimed at considering biopsychosocial factors surrounding the person and their experience of pain. 9 Within the approaches adopted by medicine and allied health professionals, mindfulness-based interventions (MBIs) have recently been developed to help alleviate pain and pain-related distress, with the view of educating and equipping people to better manage their persistent pain conditions. 10 ...
Purpose of the Study
Research indicates that acquiring compassion is an integral part to positive outcomes to Mindfulness-based interventions (MBI), yet there is both theoretic and empirical literature suggesting that people with persistent pain are more likely to experience challenges and distress when engaging compassion-based practices. Mindfulness for Health is a standardised MBI for people with persistent pain and health conditions. This study sought to explore the positive, neutral and difficult experiences of compassion-based practice and meditation for participants in Mindfulness for Health to further understand implications and risks for participants of MBI’s.
Method and Design
A qualitative design using Interpretative Phenomenological Analysis was applied to explore how participants understood of the experience of compassion-based practice and the meaning they gave to it. Eight participants who had completed the Mindfulness for Health from four separate groups were interviewed about their experience.
Results
Five master themes were identified ‘turning away from self-with-pain’, ‘self-with-pain experienced as shameful’, ‘facilitating change’, ‘turning towards self-with-pain’, and ‘accepting self’. Participants identified both perceived positive changes and difficult emotional experiences during the meditation practice, which they related to the context of compassion in their past and present life.
Conclusions
Developing compassion is an important part of Mindfulness for Health, which is salient for participants as both a challenging and potentially valuable experience. Acquisition of mindfulness skills, supporting group dynamics and modelling compassion are understood as helpful in overcoming personal barriers and challenging experiences. Further research is needed to understand processes involved and explore the experience of non-completers.
... [1][2][3][4][5][6][7][8] There has been substantial progress in the neuroscientific knowledge of pain, taking into account that biomedical, psychological, and social factors significantly influence chronic pain and pain-related disability. [9][10][11][12][13] Yet, many physical therapists think pain and disability result from a specific structural impairment, and pain management remains mainly biomedically oriented. [14][15][16][17][18][19] Physical therapists with higher biomedical attitudes and beliefs generally adhere less to the clinical guidelines, are more likely to advise patients to restrict physical activities and work, and are associated with worsening pain and poor disability outcomes. ...
Background
In 2013, physical therapy students demonstrated low guideline-adherent recommendations regarding chronic low back pain (CLBP) for spinal pathology, activity, and work.
Objectives
To assess the differences in physical therapy students’ attitudes, beliefs, and adherence to guideline recommendations regarding CLBP and knee osteoarthritis between 2013 and 2020.
Methods
In 2013 and 2020, second and fourth-year physical therapy students were recruited from 6 Belgian and 2 Dutch institutions. Attitudes and beliefs regarding CLBP and knee OA were evaluated using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS), and a questionnaire regarding therapeutic exercise and knee osteoarthritis. A clinical vignette was used to measure guideline-adherent recommendations regarding spinal pathology, activity and work.
Results
In 2013, 927 s-year and 695 fourth-year students; in 2020, 695 s-year and 489 fourth-year students; were recruited to participate in the study. Compared to 2013, students had less biomedical and stronger biopsychosocial attitudes and beliefs regarding CLBP, more guideline-adherent recommendations for activity, and more biopsychosocial beliefs regarding the benefits of exercise for patients with knee osteoarthritis in both the second year and fourth year. Only fourth-year students in 2020 scored significantly better on HC-PAIRS and guideline-adherent recommendation relating to spinal pathology. No differences were found regarding work recommendations.
Conclusions
Between 2013 and 2020, physical therapy students made a positive shift towards a more biopsychosocial approach to CLBP and knee osteoarthritis management. Guideline-adherent recommendations for CLBP concerning activity improved, however, concerning work and spinal pathology, it remained low.
... 43,44 When pain is incorporated into curricula for health-care providers, physiological systems and pharmacological treatments are prioritized, 42 despite decades of evidence supporting the biopsychosocial model and interdisciplinary approaches to pain management. 45 Improving pain education for health-care providers (eg, mandatory curricula and interprofessional education opportunities) may enhance referrals to interdisciplinary chronic pain treatment programs by both ensuring that the patients who would most benefit from these programs are identified and that accurate information is provided to families receiving these referrals. However, these changes must go beyond addressing inadequate or outdated knowledge and include strategies for health-care providers to identify and actively dismantle their own biases to prevent harm to oppressed and historically marginalized groups experiencing pain. ...
Purpose
We examine referral sources and clinical characteristics for youth presenting to an outpatient interdisciplinary pediatric chronic pain program.
Patients and Methods
Referral data were extracted from the electronic health record. PROMIS Pediatric Anxiety and Pain Interference Scales were administered at an initial evaluation visit.
Results
The program received 1488 referrals between 2016 and 2019, representing 1338 patients, with increasing volume of referrals over time. Referrals were primarily from orthopedics (19.6%), physical medicine and rehabilitation (18.8%), neurology (14.4%), and rheumatology (12.6%). Patients referred were primarily female (75.4%), White (80.1%), English-speaking (98.4%) adolescents (median=15.0 years). Of those referred, 732 (54.7%) attended an interdisciplinary evaluation (ie, with ≥2 disciplines). Adolescent anxiety was within the expected range by self-report (N=327, MT-score=55.67) and parent proxy-report (N=354, MT-score=57.70). Pain interference was moderately elevated by self-report (N=323, MT-score=61.52) and parent proxy-report (N=356, MT-score=64.02). There were no differences between patients referred who attended versus did not attend an interdisciplinary evaluation based on age, sex, ethnicity, or language. A smaller than expected proportion of referred Black patients (44%, P=0.02) and patients referred from orthopedics (40%) or pulmonology (11%) attended an evaluation, whereas a larger than expected proportion of those referred from physical medicine and rehabilitation (78%) were evaluated (P<0.001).
Conclusion
Results highlight the demand for outpatient interdisciplinary pediatric chronic pain treatment. Findings can inform decisions related to staffing and service design for pediatric hospitals that aim to establish or grow outpatient pediatric chronic pain programs.
... The biopsychosocial model of pain suggested that the perception of pain arose from the dynamic interplay among biological, psychological, and social factors. The model emphasized how the interaction among these factors influenced the patient's individualized pain experience, potentially leading to a decline in quality of life [19,20]. In our analysis, determinants were selected and categorized in accordance with the biopsychosocial model of pain, ensuring a comprehensive evaluation of their impact. ...
Background
This study aimed to identify the significant physical, psychological, and social determinants associated with EuroQuol-5D (EQ-5D) among Chinese older people with chronic musculoskeletal pain, and to evaluate how these determinants affected the five dimensions of EQ-5D.
Method
This is a cross-sectional study. Data were collected through a cohort involving 946 community-dwelling older people aged ≥ 60 with chronic musculoskeletal pain in Hong Kong. Selected independent variables were categorized into physical, psychological, and social domains. Physical variables included age, sex, body mass index (BMI), pain severity score, number of pain regions, the most painful site, and the number of comorbidities. Psychological variables included depression level measured using the 9-question Patient Health Questionnaire (PHQ-9), and anxiety level measured using the Generalized Anxiety Disorder Assessment (GAD-7). Social variables included living, marital, and social welfare recipient’s status. The dependent variables comprised the index scores and the five dimensions of the EQ-5D descriptive system. Ordinal least squares (OLS) model and logistic regression model were used for data analysis.
Results
The mean age of the participants was 67.1 (SD = 5.1), with 77.6% being female. Higher pain severity scores (beta (β) coefficient =-0.044, P < 0.001), depression scores (β=-0.007, P < 0.001) and higher anxiety scores (β=-0.01, P < 0.001) were associated with lower EQ-5D index scores. Specifically, knee pain (β=-0.061, P < 0.001) was significantly associated with lower EQ-5D index scores. Participants with higher pain severity and depression scores were more likely to report problems in most EQ-5D dimensions. Participants with anxiety primarily faced challenges related to mood, and those with knee pain were more likely to have problems with mobility and daily activities.
Conclusion
Among the selected determinants in our study, pain intensity, depression, anxiety, and knee pain were identified as key determinants associated with reduced HRQoL in older Chinese people with chronic musculoskeletal pain. Each of these determinants showed distinct associations with different dimensions of the EQ-5D, potentially informed resource allocation and the development of targeted interventions to improve the overall HRQoL of this specific population.
... This review will adopt a biopsychosocial approach to explore what is available for PwP to support pain management, including how behaviour change interventions, education and pain self-management strategies might support this. A biopsychosocial perspective can include physical functioning, emotional reactivity and cognition to address all the key domains affected by chronic pain [7]. Recent research reveals potential disparities regarding how pain is managed by PwP from different ethnic backgrounds with respect to analgesia [48]. ...
Objective
A scoping review will be undertaken to examine and map the available evidence that has been produced in relation to pain management in Parkinson’s, with a focus on behavioural interventions, resources and/or how professionals support people with Parkinson’s self-management of pain.
Methods
This review will be based on the methodological framework given by Arksey and O’Malley’s (2005), including enhancements by Levac et al., Peters et al. and the Joanna Briggs Institute. We will include studies from PubMed, SCOPUS, CINAHL, MEDLINE Web of Science, APA PsycINFO and ASSIA from January, 2010 onwards. Both quantitative and qualitative data will be analysed separately to identify the characteristics of support for pain management available, orientation of the approach and any identifiable behaviour change components and their outcomes. The COM-B behaviour change model and Theoretical Domains Framework will provide a theoretical framework for synthesising evidence in this review.
Conclusion
This scoping review will help to explore studies focusing on the evidence supporting a range of interventions relating to the management of pain experienced by people living with Parkinson’s. The focus will be on describing what is available to support self-management, identify what behaviour change components have been used and their effectiveness, identify barriers and enablers to pain management and explore gaps in current provision of pain management. This review will identify implications and priorities for the follow-up phases to the larger ‘Pain in Parkinson’s’ Project which is designed to support clinicians and individuals living with Parkinson’s.
... This approach was identified as focus areas in the three newer statelevel curricula (RI, CA and AZ), and was not specifically mentioned in the 17 research articles. Given the complex nature of both pain and OUD, the existence of various psychiatric comorbidities and social factors associated with both pain and OUD, biopsychosocial approach offers the most comprehensive, interdisciplinary assessment and intervention for patients (44)(45)(46). The aforementioned three state-level curricula could serve as the starting point for one to further develop an OUD curriculum with an emphasis on the biopsychosocial approach (19)(20)(21). ...
The opioid crisis in the US severely affected and continues to affect population's health. The opioid crisis was in part fueled by inadequate pain management, which is in part due to the inadequate education in both pain and opioid use disorder (OUD) for health care professionals. In 2021, the Coalition on Physician Education in Substance Use Disorders (COPE) organized a curricular competition soliciting US medical students-designed OUD-related curricula. Twelve winning curricula were identified. Here, we first conducted a topic review regarding current US medical school OUD curricula. Then we evaluated the COPE winning curricula and compared them to the curricula identified in the topic review. For the topic review, ten relevant databases were searched up to December 31, 2021 using a combination of pre-determined keywords. Total of 25 peer-reviewed articles were selected based on the pre-determined criteria, which included 5 articles describing opioid curricular development at the state level (AZ, CA, MA, PA, and RI), 17 research articles evaluating a curriculum developed in a single institution, 2 literature reviews, and 1 article detailing curricular development and validation processes in a single institution. Although vary in organizations and formats, state-level curricula were comprehensive and could be adopted by other states or institutions with necessary local issue-based modifications. Faculty development and critical resources were major challenges for curricular implementation. The 17 research articles exhibited good scientific quality (Medical Education Research Study Quality Instrument (MERSQI) score = 11.94 ± 2.33 (maximal score = 18)). All research articles reported to some extent, the success of respective curriculum, in improving students' knowledge in and/or attitude towards OUD, based on primarily pre- and post- comparisons. Compared to these published curricula, winning students-designed curricula had more specific focuses, diverse learning activities, and varieties in assessment methods. For all curricula, long-term evaluations were lacking. Except for the state level curricula, majority of the other curricula did not emphasize specifically on chronic pain education or the biopsychosocial approach. Interprofessional education approach was also lacking. Our topic review and curricular evaluation highlighted the needs for integrating OUD and chronic pain medical curricula, developing long-term assessment tools, and more OUD curriculum research overall.
... The biopsychosocial model describes a dynamic interaction of biological (e.g., tissue injury, genetics, neurobiology, sex differences, physical health conditions), psychological (e.g., thoughts, beliefs, attitudes, emotions, coping patterns), and social (e.g., poverty, access to welfare, stigma, discrimination) influences to explain between and within person variability in pain experience, including cognitive appraisal of symptoms. Biopsychological approaches to the management of pain are incorporated within an interdisciplinary model of care, emphasizing holistic patient-centred strategies, that combine pharmacotherapy, physical therapy, cognitive-behavioural counselling and other psychotherapeutic modalities, progressive muscle relaxation, risk-reduction training, biofeedback training, social support groups and networking (14,15). ...
In this perspective paper, we argue for incorporating personal narratives in positive psychology interventions for chronic pain. Narratives refer to the telling and retelling of events. Narratives detail accounts of events and provide rich, in-depth information on human interactions, relationships, and perspectives. As such, narratives have been used to understand people’s experiences with pain and pain coping mechanisms—as well as to facilitate therapeutic outcomes. Furthermore, narrative research has shown that narration can help restore and promote relief, calm, hope, self-awareness, and self-understanding in chronic pain sufferers. Positive psychology interventions have been successful in improving the lives of people living with chronic pain, but these psychology interventions do not typically incorporate personal narratives. Still, narrative, and positive psychology scholarship foci overlap, as both aim to enhance people’s quality of life, happiness, and well-being, and to promote the understanding of psychosocial strengths and resources. In this article, we provide a rationale for incorporating personal narratives as an agentic form of positive psychology intervention. To that aim, we outline areas of convergence between positive psychology and narrative research and show how combining positive psychology exercises and narration can have additive benefits for pain sufferers. We also show how integrating narration in positive psychology intervention research can have advantages for healthcare research and policy.
... 1,14 An interdisciplinary approach to treating CPPS involves evaluation of psychosocial factors, such as acceptance of pain, diet and exercise, predisposition to illness, as well as socioeconomic status. 15,16 In particular, cognitive behavioral therapy has been identified as a crucial part of the multidisciplinary approach to treating CPPS. 17 The holistic biopsychosocial ideology of treating chronic pelvic pain shows promise as an adjunct to traditional pharmacologic or biological treatments. ...
Introduction
Chronic pelvic pain syndrome (CPPS) is a common urologic condition that can cause significant disability in affected individuals. Physiologic explanations of chronic pain are often incomplete; appropriate management of CPPS includes recognition of biological, psychological, and social elements, known as the biopsychosocial model.
Objective
The aim of this narrative review is to investigate treatments for men with CPPS, with a special focus on those utilizing the biopsychosocial model of care.
Methods
A comprehensive literature search was conducted on the electronic databases PubMed, Embase, and Cochrane Library, using relevant Medical Subject Heading terms and keywords related to CPPS treatments. The search was limited to studies published in English from inception to January 2023. Additionally, reference lists of selected studies were manually reviewed to find studies not identified by the initial search. Studies were included if they investigated pharmacologic or nonpharmacologic treatments for men with CPPS.
Results
A total of 30 studies met the inclusion criteria. Antibiotics, α-blockers, nonsteroidal anti-inflammatory drugs, gabapentinoids, antidepressants, and phosphodiesterase type 5 inhibitors were among the pharmacologic agents included in trials attempting to reduce symptoms of male CPPS. Studies that focused on treating CPPS without medication included interventions such as shockwave therapy, acupuncture, physical therapy, botulinum toxin, cryotherapy, electrotherapy, exercise, and cognitive behavioral therapy.
Conclusion
α-Blockers and nonsteroidal anti-inflammatory drugs have shown promising results in treating CPPS in men, while the effectiveness of antibiotics remains controversial. Antidepressants and phosphodiesterase type 5 inhibitors may also be useful in decreasing symptoms in patients with CPPS. Treatments such as pelvic floor muscle therapy, acupuncture, shockwave therapy, and cognitive behavioral therapy must be considered effective complements to medical management in men with CPPS. While these interventions demonstrate benefits as monotherapies, the individualization and combination of treatment modalities are likely to result in reduced pain and improved quality of life.
... Multidisciplinary pain management is characterized by the bio-psycho-social approach using an integrated combination of somatic and psychosocial-oriented pain management strategies [1,2]. This multidisciplinary pain management approach should be performed by a team of healthcare professionals who understand basic science and clinical practice on pain relevant to the patient's case [3]. ...
Aim: Before establishing a multidisciplinary pain center (MPC), the pain problem, healthcare professionals (HCP) perceptions, expectations and the potential challenges of multidisciplinary pain center establishment need to be identified. Methods: A quantitative survey study on 1058 Indonesian HCP. The study uses a national inquiry sent by the national International Association for the Study of Pain (IASP) chapter for pain. Results: 99.0% of respondents had met patients with pain as the primary complaint and acute pain as the most common complaint. Insufficient pain management in Indonesian healthcare, insufficient pain epidemiological data, and unaware HCP about MPC become problems of pain management in Indonesia. However, most HCP agreed that health facilities should have MPC. Financial issues (insufficient patient insurance) were considered the most important barrier for referring patients to MPC. Conclusion: The identified core problem, HCP perceptions, expectations and challenges of MPC establishment should become a consideration in the strategic planning of MPC establishment.
... As outlined above, the current conceptualization underlines pain as a biopsychosocial and multidimensional phenomenon [2]. In the present study, ACT was chosen as a framework to embed this broader understanding of pain and people in pain in clinical assessment encounters, as opposed to a more traditional, symptom focused biomedical approach [20,21]. A successful assessment in line with the biopsychosocial model relies on therapeutic and communicative skills and the exploration of patients' beliefs and concerns. ...
Introduction
Assessment is an important part of chronic pain rehabilitation and should be conducted in line with the current biopsychosocial conceptualization of pain to capture the subjectivity and context of pain. However, pain assessment is commonly conducted from a biomedical framework. A course in Acceptance and Commitment Therapy (ACT) was provided to spinal pain clinicians as a framework to promote more person-centered and psychosocially focused assessments and related psychologically informed practices. The purpose of this qualitative study was to explore the verbal content of clinicians’ communication with patients experiencing spinal pain in assessment situations before and after clinicians participated in an ACT course.
Methods
Pain assessments of patients with chronic low back pain conducted by six spinal pain clinicians from different professions were audio-recorded and transcribed. This was done before and after participation in an eight-day ACT course with four following supervisions. A thematic analysis was carried out by two authors across all material, and a comparison of the applied number of codes pre-course and post-course was carried out as an indicator of change.
Results
Data consisted of transcripts from the six clinicians across 23 different patients (12 before course participation). Through analysis, 11 codes were developed, which were clustered in three overarching themes: Psychological domains, Communication Techniques, and Intervention Elements. Overall, there was an increase in the application of many of the codes in the transcripts from pre-course to post-course, however with large differences across codes. Increases were primary related to the discussion of life values and value-based action and quality of life as well as the employment of mirroring, challenging beliefs and assumptions, and addressing coping and pacing.
Conclusions
While not the case for all factors, the present findings indicate an increase in including psychological factors and employing interpersonal communication skills after a course in ACT. However, it remains unknown due to the design if the changes reported in this study reflect a clinically valuable change and whether they are due to the ACT training itself. Future research will improve our understanding of the effectiveness of this type of intervention in assessment practices.
Background: Chronic non-cancer-related pain is an independent condition with a multicausal genesis. Guidelines highlight the need for holistic treatment based on the bio-psycho-social model. While prescribing medication is common, it remains unclear how and to what extent non-pharmacological interventions are considered and recommended in general practice pain management. The project RELIEF explored the integration of non-pharmacological interventions in general practices in Germany from both physician and patient perspectives. Methods: A mixed-methods study collected data with patients and general practitioners via semi-structured telephone interviews and self-developed questionnaires. Qualitative data were analyzed in a reflexive thematic analysis. Survey data were analyzed descriptively. Results: N = 383 questionnaires (n = 131 general practitioners, n = 252 patients) and n = 61 interviews (n = 21 general practitioners, n = 40 patients) were analyzed. Patient and physician perceptions regarding the integration of non-pharmacological interventions differed. Patients felt pharmacological therapy was recommended primarily, applied non-pharmacological interventions based on their own initiative, and were aware of bio-psycho-social interrelations. Physicians perceived that they often recommended physiotherapy and psychotherapy alongside analgesics, and asked about non-pharmacological interventions (79.4%), explained the bio-psycho-social chronic pain genesis (55.7%), and provided information on physical (48.9%) and social (35.9%) activity, relaxation techniques (42%), topical applications (31.9%), and support groups (25.2%). Conclusions: The integration of holistic pain management and communication between patients and general practitioners appear to need strengthening.
Background
Chronic pain among children and adolescents negatively impacts overall functioning and quality of life. Although Intensive Interdisciplinary Pain Treatment (IIPT) programs aim to reduce functional impairment and perceived pain, overall evidence is limited and restricted by small sample sizes and limited diversity in pain diagnoses.
Objective
To determine whether children and adolescents with chronic pain participating in an inpatient IIPT program experience improvements in their physical function and perceived pain.
Design
Cross‐sectional, secondary analysis.
Setting
Inpatient acute rehabilitation.
Participants
Children and adolescents with chronic pain ( n = 258; females/males = 204/54; age = 16.5 ± 2.6) admitted to a 4‐week inpatient IIPT program from November 2011 to January 2023.
Intervention
Participants attended individual and group sessions involving physical therapy, occupational therapy, aquatic therapy, cognitive behavioral therapy, school‐related tasks, and meditation. The sessions focused on improving strength, endurance, and function, while helping participants modify physical sensations, catastrophic thinking, and maladaptive behaviors.
Main Outcome Measures
Collected at admission and discharge: pain intensity (Numerical Pain Rating Scale; scale: 0–10), lower extremity function (Lower Extremity Functional Scale [LEFS]; scale: 0–80), upper extremity function (Upper Extremity Functional Index [UEFI]; scale: 0–80), motor proficiency (Bruininks–Oseretsky Test of Motor Proficiency, Second Edition short form [BOT‐2 SF]; scale: 0–70), and occupational performance and satisfaction (Canadian Occupational Performance Measure [COPM]; scale: 0–10 for both).
Results
Overall, participants reported significant improvements ( p < .05) in median LEFS (median change [MC] = +30.5; 25th, 75th percentile range [PR] = 19, 42), UEFI (MC = +21; PR = 12.8, 31), BOT‐2 SF (MC = +9; PR = 5, 15), COPM performance (MC = +4; PR = 2.8, 5.4), and COPM satisfaction (MC = +5.6; PR = 3.8, 7.2). Moreover, participants reported significant reduction ( p < .05) in median pain intensity (MC = −3; PR = 1, 5). For a majority of participants, MC surpassed previously reported minimally clinical important difference thresholds.
Conclusions
Findings highlight the relevance of inpatient IIPT programs in enhancing physical function and reducing perceived pain in children and adolescents with chronic pain.
Chronic non-cancer-related pain is an independent condition with a multi-causal genesis. Guide-lines highlight the need for holistic treatment based on the bio-psycho-social model. While pre-scribing medication is common, it remains unclear how and to what extent non-pharmacological interventions are considered and recommended in general practice pain management. The pro-ject RELIEF explored integration of non-pharmacological interventions in general practice in Germany from physician and patient perspectives. A mixed-methods study collected data with patients and general practitioners via semi-structured telephone interviews and self-developed questionnaires. Qualitative data were analyzed in a reflexive thematic analysis. Survey data were analyzed descriptively. N=383 questionnaires (n=131 General practitioners, n=252 patients) and n=61 interviews (n=21 General practitioners, n=40 patients) were analyzed. Patient and physician perceptions of inte-grating non-pharmacological interventions differed. Patients felt pharmacological therapy was recommended primarily, applied non-pharmacological interventions based on own initiative, and were aware of bio-psycho-social interrelations. Physicians perceived they often recom-mended physiotherapy and psychotherapy alongside analgesics, and asked about non-pharmacological interventions (79.4%), explained the bio-psycho-social chronic pain genesis (55.7%), and provided information on physical (48.9%) and social (35.9%) activity, relaxation techniques (42%), topical applications (31.9%), and support groups (25.2%). Integration of holistic pain management and communication between patients and GPs appear to need strengthening.
Background
Patients with gastrointestinal cancers commonly experience acute and chronic pain. This study aimed to determine the effect of deep diaphragmatic breathing on acute and chronic pain in patients with metastatic gastrointestinal cancers.
Methods
This clinical trial was conducted in Kermanshah-Iran in 2022. The sample consisted of 44 patients hospitalized in the oncology ward, who were selected by convenient sampling and randomly allocated into case and control groups. The case group performed diaphragmatic deep breathing intervention for 10 days, twice a day, for 10 min. The subjects completed pain assessment tools before and after the intervention. Data were analyzed using SPSS Version 24.
Results
The study included participants with a Mean and Standard Deviation(SD) age of 53.95 ± 10.51 years. The case and control groups were similar in terms of demographic variables. The mean and sd acute pain score before the intervention was 3.50 ± 1.84 in the experimental group and 2.18 ± 1.65 in the control group (p = 0.01). However, after the intervention, the score decreased to 1.72 ± 1.07 in the experimental group and increased to 3.72 ± 1.95 in the control group (p = 0.001). The two groups did not differ significantly in terms of chronic pain before the intervention (p = 0.07). However, after the intervention, the score decreased in the experimental group and increased in the control group, with a significant difference (p = 0.01).
Conclusion
The results of this study suggest that deep diaphragmatic breathing reduces pain in patients with gastrointestinal cancer. Including this method as a routine care program for cancer patients is recommended.
Background:
The Multidimensional Task Ability Profile (MTAP) is a measure of self reported physical work capacity developed for injured workers with musculoskeletal disorders (MSDs) to determine readiness to return to work.
Objective:
This study compared the concurrent validity of a new short form MTAP (MTAP-SF) comprised of 16 lifting and/or carrying items with the MTAP 55-item version. The hypothesis addressed is whether the validity of a version that imposes less respondent burden (MTAP-SF) would be comparable to the more burdensome instrument (MTAP-55).
Methods:
MTAP scores were compared with demonstrated lift capacity in 1,252 healthy adults. Parallel regression analyses were conducted to examine the explanatory power of both MTAP versions.
Results:
Age, gender, body mass and MTAP-SF explained 55% of the variance (p < 0.001) in demonstrated lift capacity, equivalent to MTAP-55.
Conclusions:
Self reported performance in physical work capacity tasks accounts for significant variance in lifting performance. MTAP-SF diminishes respondent burden while maintaining validity and may be useful for managing MSDs by enhancing understanding of the evaluee's psychophysical component in return-to-work rehabilitation planning.
Background
Virtual reality (VR) in different immersive conditions has been increasingly used as a nonpharmacological method for managing chronic musculoskeletal pain.
Objective
We aimed to assess the effectiveness of VR-assisted active training versus conventional exercise or physiotherapy in chronic musculoskeletal pain and to analyze the effects of immersive versus nonimmersive VR on pain outcomes.
Methods
This systematic review of randomized control trials (RCTs) searched PubMed, Scopus, and Web of Science databases from inception to June 9, 2024. RCTs comparing adults with chronic musculoskeletal pain receiving VR-assisted training were included. The primary outcome was pain intensity; secondary outcomes included functional disability and kinesiophobia. Available data were pooled in a meta-analysis. Studies were graded using the Cochrane Risk-of-Bias Tool version 2.
Results
In total, 28 RCTs including 1114 participants with some concerns for a high risk of bias were identified, and 25 RCTs were included in the meta-analysis. In low back pain, short-term outcomes measured post intervention showed that nonimmersive VR is effective in reducing pain (standardized mean difference [SMD] –1.79, 95% CI –2.72 to –0.87; P<.001), improving disability (SMD –0.44, 95% CI –0.72 to –0.16; P=.002), and kinesiophobia (SMD –2.94, 95% CI –5.20 to –0.68; P=.01). Intermediate-term outcomes measured at 6 months also showed that nonimmersive VR is effective in reducing pain (SMD –8.15, 95% CI –15.29 to –1.01; P=.03), and kinesiophobia (SMD –4.28, 95% CI –8.12 to –0.44; P=.03) compared to conventional active training. For neck pain, immersive VR reduced pain intensity (SMD –0.55, 95% CI –1.02 to –0.08; P=.02) but not disability and kinesiophobia in the short term. No statistical significances were detected for knee pain or other pain regions at all time points. In addition, 2 (8%) studies had a high risk of bias.
Conclusions
Both nonimmersive and immersive VR–assisted active training is effective in reducing back and neck pain symptoms. Our study findings suggest that VR is effective in alleviating chronic musculoskeletal pain.
Trial Registration
PROSPERO CRD42022302912; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302912
Background
The availability of multidisciplinary care for the management of chronic pain is uncommon outside specialist clinics. The current study aims to determine the physical intervention use of patients participating in an online psychological pain management program and whether exposure to physical interventions in these patients alters treatment outcomes compared to patients who do not access physical interventions.
Methods
Data were obtained from two previously published randomised control trials of an online psychological pain management program. Physical intervention exposure (category: None, 1–3, 4+ sessions) was assessed at baseline, post-treatment and at 3-month follow-up. Primary outcomes included depression, anxiety, pain intensity and pain-related disability. Generalised estimating equation models were used to compare treatment outcomes between those with different physical intervention frequencies and period of exposure. We assessed whether changes in primary outcomes differed (moderated) depending on the period and category of physical intervention exposure.
Results
N = 1,074 patients completed the baseline questionnaire across both RCTs, of whom 470 (44%) reported physical intervention use at baseline, 383 (38%) at post-treatment and 363 (42%) at 3-month follow-up. On average, there were moderate-large reductions from baseline to post-treatment with respect to all outcomes (Cohen’s d = 0.36–0.82). In all outcomes, the interaction of time by physical intervention exposure was statistically non-significant.
Conclusion
A substantial proportion of patients who participated in a psychologically informed pain management program were establishing, continuing, or stopping additional physical interventions. The frequency and period of exposure to physical interventions did not appear moderate treatment outcomes.
Purpose
Chronic pain is a complex biopsychosocial experience, and rehabilitation helps people to manage pain, and restore valued life roles. Evidence suggests that more positive outcomes occur when clients perceive their rehabilitation to be meaningful. People with chronic pain describe rehabilitation as personally-meaningful when they develop a genuine connection with a credible therapist who they see as a guiding partner, and when rehabilitation holds personal value, is self-defined, and relevant to their sense of self-identity. This paper presents a qualitative study of therapists’ experience using an e-learning package on patient-defined, personally-meaningful rehabilitation.
Methods
A qualitative descriptive design was used to explore rehabilitation therapists’ experience of a prototype evidence-informed, online resource developed on the basis of eLearning and web-design principles. Semi-structured interviews and focus groups were conducted with a purposive sample of occupational therapists and physiotherapists, and inductive coding and thematic analysis of transcripts was completed.
Findings
Twenty-four therapists (12 occupational therapists, 12 physiotherapists) participated, representing a mix of gender and experience (early career; experienced; and specialist). Four themes and 12 sub-themes emerged from the analysis. The resource delivered a positive user experience, which added (translational) value to enhance learning, and participants were highly positive about the future potential of the resource to translate chronic pain rehabilitation research for early career, experienced, and specialist rehabilitation therapists.
Conclusion
Results suggest that the disparate learning needs of rehabilitation therapists from diverse professional backgrounds and experience, may be addressed through the one resource. Participant feedback provides evidence that the resource fits with current models of learning and behaviour change. This study demonstrates the importance of basing online resources on eLearning and web-design principles to translate complex biopsychosocial chronic pain rehabilitation research for rehabilitation therapists.
Objectives
A biopsychosocial approach to understand and treat pain is crucial; however, there are limited socially-targeted interventions for adolescents with chronic pain. Peer support interventions implemented with other populations are associated with positive outcomes. Adolescents with chronic pain perceive peer support to have high potential value. This study explored the preferences of adolescents with chronic pain regarding the content and design of a group peer support intervention.
Methods
Fourteen adolescents with chronic pain (M age : 15.21 y; 9 females; 3 males, 1 non-binary, 1 gender questioning) completed a virtual interview and survey. Interviews were analyzed using inductive qualitative content analysis and surveys were analyzed using descriptive statistics.
Results
Adolescents described how they want to both talk and do activities together within a fun and casual environment with a facilitator present - ideally someone with lived experience of chronic pain. Preferences were for a medium sized group intervention that was in-person, at a consistent time on a weekday after school, and semi-structured. Barriers to attending and engaging in the potential group peer intervention were also discussed.
Discussion
Adolescents with chronic pain desire a facilitated socially-focused intervention that provides them with the opportunity to spend time with other adolescents with chronic pain. A group peer support environment where adolescents with chronic pain can provide and receive peer support through sharing their experiences with others who understand them as well as engage in activities was described. The findings from this study provide insights for the development of a group peer support intervention.
Background
Brief Pain Inventory (BPI) is one of the most commonly used self‐initiated questionnaire for people with chronic pain. Although the questionnaire has been translated into multiple different languages and tested for its inter‐tester reliability, no study has currently explored the differences in interpretation of this questionnaire between non‐English speakers as compared to English‐speakers.
Purpose
Using the Arabic‐language group as the comparator, this study explored the interpretation of the English and Arabic language Brief Pain Inventory (BPI) among participants living with chronic neuromusculoskeletal pain from Arabic‐ and English‐speaking backgrounds.
Methods
This qualitative study utilises the Think Aloud method to explore the differences in the interpretation of the BPI between two language groups. Consecutive consenting adults attending a tertiary pain clinic for management of a chronic neuromusculoskeletal pain condition and self‐identifying with a native English‐speaking ( n = 15) or Arabic‐speaking ( n = 15) background were included. Structured interviews using the think‐aloud method were conducted, audio‐recorded and analysed using coding and thematic analysis.
Results
Interpretation errors across three or more questions were recorded for all Arabic‐speaking participants and two English‐speaking participants. Three themes characterised appraisals of pain and interpretation of the BPI across the two cohorts: 1) pain constancy vs. variability, 2) the ability‐disability spectrum and 3) variance in expression of pain.
Conclusion
Cross‐cultural differences in the appraisal of pain influenced participants' interpretation of the BPI. The cultural influences on conceptualisation of pain need to be considered when using the BPI across different cultures.
Background: Chronic pain poses a challenge to the health and well-being of people globally. A biopsychosocial approach is recommended for the management of chronic pain. Little is known about how the curriculum prepares students to apply this approach in practice. The aim of this study was to explore the facilitators and barriers for the use of the biopsychosocial approach, as experienced by physiotherapy students.
Methods: The study utilised a case study approach located within an interpretive paradigm. Purposive and snowball sampling were used to select physiotherapy students in their clinical years. In-depth interviews were conducted over Microsoft Teams using a semi-structured interview guide. The interviews were recorded, transcribed and coded after which thematic analysis was conducted.
Results: The study found that students were aware of the biopsychosocial approach and understood its importance in theory but had difficulty translating their theoretical understanding to practice. Facilitators to the use of the approach included positive attitudes towards patients with chronic pain, good interpersonal skills, emotional awareness, effective clinical supervision, guidance from supervisors and personal experience with pain. Barriers to the use of this approach included negative attitudes towards patients with chronic pain, clinical supervision and minimal interaction with members of the interdisciplinary team.
Conclusion: The study highlights the gap between theoretical training and practice when using the biopsychosocial model when treating patients with chronic pain. The importance of supporting and guiding students when treating patients with chronic pain is emphasised. The use of a biopsychosocial approach and an interdisciplinary team must be encouraged in practice.
Recent evidence suggests that individuals living with chronic pain demonstrate reduced tolerance of uncertainty compared to healthy individuals. Intolerance of uncertainty often lead to excessive worry, which may be related not only to the tendency to catastrophize pain, but also to increased distress. However, the specific nature of these relationships remains largely unexplored. The present study sought to investigate the associations between intolerance of uncertainty, pain catastrophizing, and symptoms of depression, while exploring how they differ between adults with and without chronic pain. Questionnaires were administered electronically to a community sample of 160 adults. All variables were significantly and positively correlated in the chronic pain group (n = 80), while only intolerance of uncertainty and symptoms of depression were positively and strongly correlated in the pain-free group (n = 80). Individuals in the chronic pain group reported higher levels of pain catastrophizing and symptoms of depression compared to the pain-free group, but both groups exhibited similar levels of intolerance of uncertainty. Intolerance of uncertainty and pain catastrophizing were significant predictors of the severity of depression in both groups, even after controlling for age and gender. However, intolerance of uncertainty was no longer statistically significant in the chronic pain group once pain catastrophizing was considered. These findings suggest that intolerance of uncertainty serves as a general vulnerability factor for psychological distress in adults, while pain catastrophizing acts as a specific vulnerability factor for individuals living with chronic pain. Enhancing knowledge about the role of cognitive factors in depression among individuals with chronic pain could help improve the management of this debilitating condition.
Background
Low back pain (LBP) is a major health problem. Globally it is responsible for the most years lived with disability. The most problematic type of LBP is chronic LBP (pain lasting longer than 3 mo); it has a poor prognosis and is costly, and interventions are only moderately effective. Targeting interventions according to risk profile is a promising approach to prevent the onset of chronic LBP. Developing accurate prognostic models is the first step. No validated prognostic models are available to accurately predict the onset of chronic LBP. The primary aim of this study was to develop and validate a prognostic model to estimate the risk of chronic LBP.
Methods and Findings
We used the PROGRESS framework to specify a priori methods, which we published in a study protocol. Data from 2,758 patients with acute LBP attending primary care in Australia between 5 November 2003 and 15 July 2005 (development sample, n = 1,230) and between 10 November 2009 and 5 February 2013 (external validation sample, n = 1,528) were used to develop and externally validate the model. The primary outcome was chronic LBP (ongoing pain at 3 mo). In all, 30% of the development sample and 19% of the external validation sample developed chronic LBP. In the external validation sample, the primary model (PICKUP) discriminated between those who did and did not develop chronic LBP with acceptable performance (area under the receiver operating characteristic curve 0.66 [95% CI 0.63 to 0.69]). Although model calibration was also acceptable in the external validation sample (intercept = −0.55, slope = 0.89), some miscalibration was observed for high-risk groups. The decision curve analysis estimated that, if decisions to recommend further intervention were based on risk scores, screening could lead to a net reduction of 40 unnecessary interventions for every 100 patients presenting to primary care compared to a “treat all” approach. Limitations of the method include the model being restricted to using prognostic factors measured in existing studies and using stepwise methods to specify the model. Limitations of the model include modest discrimination performance. The model also requires recalibration for local settings.
Conclusions
Based on its performance in these cohorts, this five-item prognostic model for patients with acute LBP may be a useful tool for estimating risk of chronic LBP. Further validation is required to determine whether screening with this model leads to a net reduction in unnecessary interventions provided to low-risk patients.
Employing a simple approach for coding pain severity, the present study describes self-reported pain in United States adults. Data are included for 8,781 adults who completed the Functioning and Disability Supplement of the 2012 National Health Interview Survey. An internationally piloted pain-severity coding system was used to group participants into five discrete ordered pain categories based on their pain persistence (days with pain in last three months) and bothersomeness (little, lot, somewhere in between): Pain Free and Categories 1(low) to 4(high). It is estimated that 126.1 million adults reported some pain in the previous 3 months, with 25.3 million adults (11.2%) suffering from daily (chronic) pain and 23.4 million (10.3%) reporting "a lot" of pain. Based on the persistence and bothersomenes of their pain, 14.4 million adults (6.4%) were classified as having the highest level of pain, Category 4, with an additional 25.4 million adults (11.3%) experiencing Category 3 pain. Individuals with Category 3 or 4 pain were likely to have worse health status, to use more healthcare, and to suffer from more disability than those with less severe pain. Associations were seen between pain severity and selected demographic variables including race, ethnicity, preferred language, sex and age.
United States estimates of pain prevalence are presented using a simple approach for assigning pain severity developed by the Washington Group on Disability Statistics. Concurrent validity is assessed. While this approach is promising, additional work is required to determine the utility of the Washington Group pain categories for pain research or clinical practice.
Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
A number of studies have shown an association between health-related quality of life (HRQL) and socioeconomic status (SES). Indicators of SES usually serve as potential confounders; associations between SES and HRQL are rarely discussed in their own right. Also, few studies assess the association between HRQL and SES among those with a chronic disease. The study focuses on the question of whether people with the same state of health judge their HRQL differently according to their SES, and whether a bias could be introduced by ignoring these differences.
The analyses were based on a representative sample of the adult population in Germany (n = 11,177). HRQL was assessed by the EQ-5D-3 L, i.e. the five domains (e.g. 'moderate or severe problems' concerning mobility) and the Visual Analog Scale (VAS). SES was primarily assessed by educational level; age, sex and family status were included as potential confounders. Six chronic diseases were selected, each having a prevalence of at least 1% (e.g. diabetes mellitus). Multivariate analyses were conducted by logistic and linear regression.
Among adults with a chronic disease, most 'moderate or severe problems' are reported more often in the low (compared with the high) educational group. The same social differences are seen for VAS values, also in subgroups characterized by 'moderate or severe problems'. Gender-specific analyses show that for women the associations with VAS values can just be seen in the total sample. For men, however, they are also present in subgroups defined by 'moderate or severe problems' or by the presence of a chronic disease; some of these differences exceed 10 points on the VAS scale.
Low SES groups seem to be faced with a double burden: first, increased levels of health impairments and, second, lower levels of valuated HRQL once health is impaired. These associations should be analysed and discussed in their own right, based on interdisciplinary co-operation. Social epidemiologists could include measures of HRQL in their studies more often, for example, and health economists could consider assessing whether recommendations based on HRQL scales might include a social bias.
Chronic pain is a significant and costly problem in the United States as well as throughout the industrialized world. Unfortunately, there have been concerns about the effectiveness of traditional medical interventions, suggesting the need for alternative chronic pain treatment strategies. However, the introduction of the biopsychosocial model of pain during the past decade stimulated the development of more therapeutically effective and cost-effective interdisciplinary chronic pain management programs. In the present article we briefly review the history of pain management, discuss the major components of a "true" interdisciplinary pain management program, focus on the evidence-based outcomes that have documented the effectiveness of such interdisciplinary pain management programs, and note the barriers that have blocked the wider use of such programs. Finally, we discuss future directions in interdisciplinary pain management. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Objective:
To review the scientific status of the biopsychosocial (BPS) model and to propose a way to improve it.
Discussion:
Engel's BPS model added patients' psychological and social health concerns to the highly successful biomedical model. He proposed that the BPS model could make medicine more scientific, but its use in education, clinical care, and, especially, research remains minimal. Many aver correctly that the present model cannot be defined in a consistent way for the individual patient, making it untestable and non-scientific. This stems from not obtaining relevant BPS data systematically, where one interviewer obtains the same information another would. Recent research by two of the authors has produced similar patient-centered interviewing methods that are repeatable and elicit just the relevant patient information needed to define the model at each visit. We propose that the field adopt these evidence-based methods as the standard for identifying the BPS model.
Conclusion:
Identifying a scientific BPS model in each patient with an agreed-upon, evidence-based patient-centered interviewing method can produce a quantum leap ahead in both research and teaching.
Practice implications:
A scientific BPS model can give us more confidence in being humanistic. In research, we can conduct more rigorous studies to inform better practices.
Nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, the phenomenon of central sensitization. Central sensitization manifests as pain hypersensitivity, particularly dynamic tactile allodynia, secondary punctate or pressure hyperalgesia, aftersensations, and enhanced temporal summation. It can be readily and rapidly elicited in human volunteers by diverse experimental noxious conditioning stimuli to skin, muscles or viscera, and in addition to producing pain hypersensitivity, results in secondary changes in brain activity that can be detected by electrophysiological or imaging techniques. Studies in clinical cohorts reveal changes in pain sensitivity that have been interpreted as revealing an important contribution of central sensitization to the pain phenotype in patients with fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, dental pain, neuropathic pain, visceral pain hypersensitivity disorders and post-surgical pain. The comorbidity of those pain hypersensitivity syndromes that present in the absence of inflammation or a neural lesion, their similar pattern of clinical presentation and response to centrally acting analgesics, may reflect a commonality of central sensitization to their pathophysiology. An important question that still needs to be determined is whether there are individuals with a higher inherited propensity for developing central sensitization than others, and if so, whether this conveys an increased risk in both developing conditions with pain hypersensitivity, and their chronification. Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity. We have certainly come a long way since the first discovery of activity-dependent synaptic plasticity in the spinal cord and the revelation that it occurs and produces pain hypersensitivity in patients. Nevertheless, discovering the genetic and environmental contributors to and objective biomarkers of central sensitization will be highly beneficial, as will additional treatment options to prevent or reduce this prevalent and promiscuous form of pain plasticity.
An official journal of the Genetics Society, Heredity publishes high-quality articles describing original research and theoretical insights in all areas of genetics. Research papers are complimented by News & Commentary articles and reviews, keeping researchers and students abreast of hot topics in the field.
In an earlier study, Gatchel et al. (J Occup Rehabil 13:1-9, 2003) demonstrated that participants at high risk for developing chronic low back pain disability (CLBPD), who received a biopsychosocial early intervention treatment program, displayed significantly more symptom improvement, as well as cost savings, relative to participants receiving standard care. The purpose of the present study was to expand on these results by examining whether the addition of a work-transition component would further strengthen the effectiveness of this early intervention treatment.
Using an existing algorithm, participants were identified as being high-risk (HR) or low-risk (LR) for developing CLBPD. HR participants were then randomly assigned to one of three groups: early intervention (EI); early intervention with work transition (EI/WT); or standard care (SC). Participants provided information regarding pain, disability, work status, and psychosocial functioning at baseline, periodically during treatment, and again 1 year following completion of treatment.
At 1-year follow-up, no significant differences were found between the EI and EI/WT groups in terms of occupational status, self-reports of pain and disability, coping ability or psychosocial functioning. However, significant differences in all these outcomes were found comparing these groups to standard care.
The addition of a work transition component to an early intervention program for the treatment of ALBP did not significantly contribute to improved work outcomes. However, results further support the effectiveness of early intervention for high-risk ALBP patients.
The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment, and treatment. The purpose of the present article is to provide a review of the most noteworthy developments in the field. The biopsychosocial model is now widely accepted as the most heuristic approach to chronic pain. With this model in mind, a review of the basic neuroscience processes of pain (the bio part of biopsychosocial), as well as the psychosocial factors, is presented. This spans research on how psychological and social factors can interact with brain processes to influence health and illness as well as on the development of new technologies, such as brain imaging, that provide new insights into brain-pain mechanisms.
Chronic pain from job-related stressors is responsible for countless lost work hours and considerable lost revenue--and if current statistics are any indication, the problem isn't going away anytime soon. Between rising numbers of affected workers and rising health care costs, musculoskeletal pain has taken on crisis proportions.
The Handbook of Musculoskeletal Pain and Disability Disorders in the Workplace addresses the complex state of the issues in authoritative and practical fashion. Divided evenly between common occupational pain disorders, conceptual and methodological issues, and evidence-based intervention methods, this comprehensive reference presents current findings on prevalence, causation, and physical and psychosocial aspects common to these disorders. Attention is given to working-world concerns, including insurance and compensation issues and AMA guidelines for disability evaluations. Also, specialized chapters offer lenses for understanding and administering the best approaches for treating specific pain disorders, as well as explore what workplaces can do to accommodate affected employees and prevent injuries from occurring in the first place. Among the Handbook's featured topics:
• Chronic widespread pain.
• Whiplash injuries: etiology, assessment, and treatment.
• Acute, postacute, and chronic disorders: differences and potential recovery outcomes.
• Medicolegal issues involved in occupational musculoskeletal injuries.
• Self-management techniques for musculoskeletal pain.
• Models of return-to-work for musculoskeletal disorders.
The Handbook of Musculoskeletal Pain and Disability Disorders in the Workplace offers expert, up-to-date coverage suited to health psychologists, rehabilitation specialists (including physical, vocational, and occupational therapists), human resources and disability management
professionals, and occupational medicine physicians.
Aims:
To evaluate whether a biobehavioral intervention would be more effective than a self-care intervention or no intervention in reducing psychosocial distress, reducing pain, and improving functioning in patients with an acute myofascial temporomandibular disorder (m-TMD).
Methods:
Participants (n = 435) were from community dental clinics in the Dallas-Fort Worth Metroplex who were seeking treatment for their acute TMD symptoms and were recruited between 2008 and 2013. The participants were diagnosed using the Research Diagnostic Criteria for TMD (RDC/TMD) and assigned to a biobehavioral intervention, self-care intervention, or no intervention. Three outcomes were assessed: psychosocial distress, pain, and functioning; and treatment effectiveness was assessed according to TMD diagnosis. Outcome evaluations were conducted immediately postintervention as well as at 1 and 2 years postintervention. Analyses were conducted using two-level hierarchical multilevel linear models (MLMs).
Results:
Contrary to expectations, patients did not respond differently to the intervention based on their TMD diagnosis. Acute m-TMD patients, especially those with other comorbid TMD diagnoses, reported the highest levels of pain and pain-related symptoms and disability. They also exhibited poorer jaw functioning, especially if they were at high risk for chronic TMD.
Conclusion:
This study indicates that acute m-TMD tends to result in more severe symptom presentations, particularly if diagnosed in combination with other TMD comorbidities. Additionally, patients do not appear to respond better to biobehavioral or self-care intervention on the basis of their TMD diagnosis.
Communication that empowers the public, patients, clinicians, and policy makers to think differently about overdiagnosis will help support a more sustainable healthcare future for all, argue Kirsten McCaffery and colleagues. Overdiagnosis and overtreatment have serious implications for individuals, healthcare systems, and society, and effective strategies are urgently needed to help the public, clinicians, and policy makers address this problem. Communication about overdiagnosis has been highlighted as essential for moving forward but presents several challenges, such as the potential to confuse the public, undermine trust, and adversely affect people who already have a diagnosis. Various communication based strategies offer real promise; we describe what is known and what we need to know to communicate effectively and safely about overdiagnosis and overtreatment.
This Viewpoint discusses the distinction between personalized and precision medicine and the roles the US initiative can play in addressing unmet needs and remaining challenges.
The announcement by President Obama of a precision medicine initiative created excitement in the medical community. The president referred not to personalized medicine but to “precision medicine,” a term given profile by a recent publication from the National Research Council,¹ in which the authors explain that their use of “precision” was intended to avoid the implication that medications would be synthesized personally for single patients. Rather, they hoped to convey a broader concept that would include precisely tailoring therapies to subcategories of disease, often defined by genomics.
The brain is the central organ of the body's response to and perception of stress. Both the juvenile and the adult brain show a significant capacity for lasting physiological, structural and behavioral plasticity as a consequence of stress exposure. The hypothesis that epigenetic mechanisms might lie behind the lasting effects of stress upon the brain has proven a fruitful one. In this review, we examine the growing literature showing that stress has a direct impact on epigenetic marks at all life history stages thus far examined and how, in turn, epigenetic mechanisms play a role in altering stress responsiveness, anxiety and brain plasticity across the lifespan and beyond to succeeding generations. In addition, we will examine our own recent findings that stress interacts with the epigenome to regulate the expression of transposable elements in a regionally specific fashion, a finding with significant implications for a portion of the genome which is tenfold larger than that occupied by the genes themselves.
Clinical Essentials of Pain Management lays out an empirically documented program for treating patients experiencing acute and chronic pain, two of the most common symptoms in modern society. Going beyond traditional biomedical remedies, Robert J. Gatchel offers a comprehensive viewpoint that takes into consideration not only biological but also psychological and social variables. This book gives mental health practitioners guidance on how to assess and treat pain patients, including discussions of frequently used measurement tools, instruments for matching patients with the best treatment, the interaction of mental states and the experience of pain, and details about cognitive-behavioral interventions. The author illustrates the assessment-treatment process in a number of evocative case examples and provides chapter appendixes that feature everything from pain questionnaires to relaxation exercises that may be administered to clients. In addition, the author provides a look at the nuts and bolts of operating a successful pain clinic, with guidance on privacy and reimbursement issues as well as information on choosing pharmaceutical options when the level of pain requires more than psychological interventions. This rich resource will serve as an essential handbook for psychologists, psychiatrists, counselors, social workers, nurses, occupational therapists, and other caring professionals working in the field of pain management. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
in the biopsychosocial model, psychological and social factors are viewed as intricately related to the pain perception process / as pain becomes more chronic, these factors play an increasingly dominant role in the maintenance of pain behavior and suffering / discuss the issue of one of the important concomitants that clinicians must be prepared to deal with when treating chronic pain patients—psychopathology
presented a conceptual model of the transition from acute to chronic pain, in which it is assumed that the type of psychological distress displayed by patients whose pain becomes subacute or chronic depends upon the premorbid or pre-existing personality/psychological characteristics of each individual / preliminary research addressing the . . . question of what occurs first—the chronic pain or the psychopathology—suggests that either may occur first, depending upon the form of psychopathology / in terms of rehabilitation, [the author has] argued that function should "drive" the treatment process, rather than self-report of pain or disability (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The neuromatrix theory of pain (R. Melzack, 1995) proposes that pain is a multidimensional experience produced by characteristic "neurosignature" patterns of nerve impulses in the brain. These neurosignature patterns may be triggered by sensory inputs or independently of them. This theory of pain proposes that the output patterns of the neuromatrix activate perceptual, homeostatic, and behavioral programs after injury or pathology or as a result of multiple other inputs that act on the neuromatrix.
Pain, then, is produced by the output of a widely distributed neural network in the brain rather than directly by sensory input evoked by injury, inflammation, or other pathology. The neuromatrix, which is genetically determined and modified by sensory experience, is the primary mechanism that generates the neural pattern that produces pain. Its output pattern is determined by multiple influences, of which the somatic sensory input is only a part.
We are so used to considering pain as a purely perceptual phenomenon that we have ignored the fact that injury also disrupts the body's homeostatic regulation systems, thereby producing stress and initiating complex programs to restore homeostasis. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol 109: 5-12, 2013. First published October 3, 2012; doi:10.1152/jn.00457.2012.-Several theoretical frameworks have been proposed to explain the physiological basis of pain, although none yet completely accounts for all aspects of pain perception. Here, we provide a historical overview of the major contributions, ideas, and competing theories of pain from ancient civilizations to Melzack and Wall's Gate Control Theory of Pain.
Objective:
To investigate whether a pretreatment multimodal (MM) assessment of patients with chronic muscular pain has an impact on treatment outcome.
Methods:
The present randomized-controlled study evaluated an MM assessment compared with routine multidisciplinary assessment given to a control group. The study population consisted of primary care patients with mixed chronic muscular pain. Variables assessed were: pain intensity, depression, life stress, quality of life (QOL), disability, working ability, and treatment satisfaction. Follow-up was performed at 15 months and 182 patients of 220 (83%) completed the study.
Results:
Univariate and multivariate logistic regression showed from baseline to 15 months a significant improvement in QOL as measured by Short-Form 36 in the MM group compared with the control group on the domains of physical function (odds ratio 2.40; 95% confidence interval 1.32-4.37), role physical (2.37; 1.10-5.09), and role emotional (2.05; 1.05-3.96). Working ability improved more significantly in the MM group (46% vs. 35%) and impairment was less (1% vs. 15%) compared with the control group (P=0.016). Satisfaction with the assessment was, on average, higher (P<0.001) in the MM group than in the control group.
Discussion:
Patients who underwent an MM assessment before treatment in comparison with patients receiving routine multidisciplinary assessment improved QOL, working ability, and were also significantly more satisfied. This result indicates that MM pretreatment assessment could be advantageous in the selection of patients for suitable rehabilitation treatment in a primary care setting, and also be used to prepare patients for future rehabilitation.
Previous studies have shown that a small fraction of patients with peripheral neuropathic pain experiences >50% pain relief during treatment with selective serotonin reuptake inhibitors (SSRIs), whereas most patients have no or only slight relief. The aim of this study was to investigate the association between polymorphisms in genes involved in the serotonergic pathway and the effect of escitalopram on peripheral neuropathic pain.
We genotyped 34 participants from a placebo-controlled trial of escitalopram in peripheral neuropathic pain for polymorphisms in five genes: the serotonin receptor 2A (HTR2A) gene, the serotonin receptor 2C (HTR2C) gene, the ABCB1 gene encoding for the P-glycoprotein, the CYP2C19 gene, and the serotonin transporter gene (SLC6A4).
The SNP rs6318 (Cys23Ser) in the HTR2C gene showed significant association with treatment response in men (p = 0.047), with 75% carrying the C allele being responders. The same tendency was seen in women. Similarly, carriership of the C allele at rs6318 was associated with better pain relief during treatment with escitalopram [odds ratio (OR) 15.5, p = 0.014)] Furthermore, there was a tendency of better relief with increasing number of short alleles for the 5-HTTLPR polymorphism of the serotonin transporter (OR 5.7, p = 0.057). None of the other polymorphisms showed a significant association with treatment response to escitalopram.
This study indicates that variation in the HTR2C gene is associated to the pain-relieving effect of escitalopram in patients with painful polyneuropathy.
Chronic opioid exposure is known to produce neuroplastic changes in animals; however, it is not known if opioids used over short periods of time and at analgesic dosages can similarly change brain structure in humans. In this longitudinal, magnetic resonance imaging study, 10 individuals with chronic low back pain were administered oral morphine daily for 1 month. High-resolution anatomical images of the brain were acquired immediately before and after the morphine administration period. Regional changes in gray matter volume were assessed on the whole brain using tensor-based morphometry, and those significant regional changes were then independently tested for correlation with morphine dosage. Thirteen regions evidenced significant volumetric change, and degree of change in several of the regions was correlated with morphine dosage. Dosage-correlated volumetric decrease was observed primarily in the right amygdala. Dosage-correlated volumetric increase was seen in the right hypothalamus, left inferior frontal gyrus, right ventral posterior cingulate, and right caudal pons. Follow-up scans that were conducted an average of 4.7 months after cessation of opioids demonstrated many of the morphine-induced changes to be persistent. In a separate study, 9 individuals consuming blinded placebo capsules for 6 weeks evidenced no significant morphologic changes over time. The results add to a growing body of literature showing that opioid exposure causes structural and functional changes in reward- and affect-processing circuitry. Morphologic changes occur rapidly in humans during new exposure to prescription opioid analgesics. Further research is needed to determine the clinical impact of those opioid-induced gray matter changes.
Catechol-O-methyltransferase (COMT) is an enzyme that plays a key role in the modulation of catechol-dependent functions such as cognition, cardiovascular function, and pain processing. Recently, our group demonstrated that three common haplotypes of the human COMT gene, divergent in two synonymous and one nonsynonymous position, are associated with experimental pain sensitivity and onset of temporomandibular joint disorder. In order to determine the functional mechanisms whereby these haplotypes contribute to pain processing, a series of in vitro experiments were performed. Haplotypes divergent in synonymous changes exhibited the largest difference in COMT enzymatic activity because of reduced amount of translated protein. The major COMT haplotypes varied significantly with respect to mRNA local stem-loop structures such that the most stable structure was associated with the lowest protein levels and enzymatic activity. Site-directed mutagenesis that eliminated the stable structure restored the amount of translated protein. These data provide the first demonstration that combinations of commonly observed alleles in the coding region of the human COMT gene can significantly affect the secondary structure of corresponding mRNA transcripts, which in turn leads to dramatic alterations in the translation efficiency of enzyme crucial for a variety of essential functions. The protocols applied to the study of these molecular genetic mechanisms are detailed herein.
( This reprinted article originally appeared in Science, 1977, Vol 196[4286], 129–236. The following abstract of the original article appeared in PA, Vol 59:1423. ) Although it seems that acceptance of the medical model by psychiatry would finally end confusion about its goals, methods, and outcomes, the present article argues that current crises in both psychiatry and medicine as a whole stem from their adherence to a model of disease that is no longer adequate for the work and responsibilities of either field. It is noted that psychiatrists have responded to their crisis by endorsing 2 apparently contradictory positions, one that would exclude psychiatry from the field of medicine and one that would strictly adhere to the medical model and limit the work of psychiatry to behavioral disorders of an organic nature. Characteristics of the dominant biomedical model of disease are identified, and historical origins and limitations of this reductionistic view are examined. A biopsychosocial model is proposed that would encompass all factors related to both illness and patienthood. Implications for teaching and health care delivery are considered.
The Western Collaborative Group Study is a prospective study of 3,154 employed men aged 39 to 59 years. Ischemic heart disease occurred in 257 subjects during 8.5 years of follow-up. Risk of coronary heart disease was studied with use of the multiple logistic risk model. The incidence of coronary heart disease had a highly significant association with serum cholesterol level, behavior pattern, cigarette smoking and systolic blood pressure in younger (39 to 49 years) and older (50 to 59 years) men and also with age and corneal arcus in the younger group. Type A behavior pattern was strongly related to the incidence of coronary disease in both age groups, independent of interrelations of behavior patterns with any other risk factor.
An inception cohort design was used in which 421 patients were evaluated systematically with a standard battery of psychosocial assessment tests (Structured Interview for DSM-III-R Diagnosis, Minnesota Multiphasic Personality Inventory, and Million Visual Pain Analog Scale) within 6 weeks of acute back pain onset.
The present study evaluated the predictive power of a comprehensive assessment of psychosocial and personality factors in identifying acute low back pain patients who subsequently develop chronic pain disability problems (as measured by job-work status at 1-year follow-up evaluation).
There has been a relative paucity of prospective research in the United States comprehensively evaluating potential psychosocial risk factors that are associated with those injured workers who subsequently fail to return to work and productivity after 1 year because of low back pain disability. Such research has been quite limited because of the time and cost involved in conducting prospective studies.
All study patients were symptomatic with lumbar pain syndrome for no more than 6 weeks. These acute patients were tracked every 3 months, culminating in a structured telephone interview being conducted 1 year after the initial evaluation to document return-to-work status.
Logistic regression analyses, conducted to differentiate between patients who were back at work after 1 year versus patients who were not because of the original back injury, revealed the importance of three psychosocial measures: self-reported pain and disability, scores on Scale 3 of the Minnesota Multiphasic Personality Inventory, and workers' compensation and personal injury insurance status. The model generated correctly classified 90.7% of the cases. Results revealed that major psychopathology, such as depression and substance abuse, did not precede or cause the development chronic pain disability.
These results show the presence of a robust "psychosocial disability factor" that is associated with those injured workers who are likely to develop chronic low back pain disability problems. Based on these data, a statistical algorithm has been generated that can identify those acute patients who will require early intervention to prevent the development of chronic disability. The second major result is that preinjury or concomitant psychopathology does not appear to predispose patients to chronic pain disability, although high rates of psychopathology have been shown in chronic low back pain. Future research should be directed at emotional vulnerability and psychosocial events in the period after the injury that may lead to chronicity.
Substantial cost is associated with the treatment of chronic temporomandibular disorders, or TMDs, and patients with TMDs often experience significant psychosocial distress. Early intervention based on identified risk factors has potential financial and functional benefits.
Two hundred four patients with acute TMD were evaluated via an assessment battery that included physical, psychological and social measures. All participants were diagnosed as having TMD on the basis of the research diagnostic criteria for TMD, Axis I. At the six-month follow-up assessment, patients were considered to have chronic TMD if they continued to have TMD pain. This resulted in 144 of the patients being classified in the chronic group and 60 being classified in the nonchronic group.
A comparison of the acute TMD data demonstrated that the group that went on to develop chronic TMD and the group that did not differed significantly in their scores on numerous biopsychosocial indexes. Although several biopsychosocial measures were found to differentiate these two groups before the onset of chronic TMD, logistic regression analysis demonstrated that a two-variable predictive model consisting of the presence of a muscle disorder and characteristic pain intensity (that is, the mean of these three ratings: patient's report of current pain, worst pain in the last three months and mean pain in the last three months) accurately classified 91 percent of the subjects who went on to develop chronic TMD.
During the acute phase of TMD, two variables allowed for an accurate prediction rate of 91 percent among patients who went on to develop chronic TMD.
This model provides clinicians with the opportunity to identify at-risk patients early and initiate adjunctive or alternative treatments, thus reducing the likelihood of the development of TMD chronicity.