scholarly journals Adverse effects of COVID-19 related lockdown on pain, physical activity and psychological wellbeing in people with chronic pain

2020 ◽  
Author(s):  
Nicholas Fallon ◽  
Christopher Brown ◽  
Hannah Twiddy ◽  
Eleanor Brian ◽  
Bernhard Frank ◽  
...  
Keyword(s):  
Physical Activity ◽  
Chronic Pain ◽  
Adverse Effects ◽  
Physical Exercise ◽  
Online Survey ◽  
Pain Catastrophizing ◽  
Control Group ◽  
The United Kingdom ◽  
Healthy Control ◽  
Pain Symptoms

AbstractCountries across the world imposed lockdown restrictions during the COVID-19 pandemic. It has been proposed that lockdown conditions disproportionately impact those living with chronic pain, requiring adaptation to treatment and care strategies. We investigated how lockdown restrictions in the United Kingdom impacted individuals with chronic pain (N = 431) relative to a healthy control group (N = 88) using an online survey. In accordance with the fear-avoidance model, we hypothesised increases in perceived pain and psychological distress that would be mediated by pain catastrophizing. Survey questions answered during the lockdown period, probing patients’ self-perceived changes retrospectively, revealed that people with chronic pain perceived increases in their pain severity compared to before lockdown. They were also more adversely affected by lockdown compared to pain-free individuals, demonstrating greater increases in anxiety and depressed mood, increased loneliness and reduced levels of physical exercise. Pain catastrophizing was found to be an important factor in predicting the extent of self-perceived increases in pain, and accounted for the relationship between decreased mood and pain. Perceived decreases in levels of physical exercise also independently predicted perceptions of increased pain. Interestingly, actual changes in pain symptoms (measured at two time points at pre- and post-lockdown in a subgroup, N = 85) did not change significantly on average, but those reporting increases also demonstrated greater baseline levels of pain catastrophizing. Overall, the findings suggest that remote pain management provision to target reduction of catastrophizing and increases to physical activity could be beneficial for chronic pain patients in overcoming the adverse effects of lockdown.

scholarly journals Adverse effects of COVID-19-related lockdown on pain, physical activity and psychological well-being in people with chronic pain

2020 ◽  
pp. 204946372097370
Author(s):  
Nicholas Fallon ◽  
Christopher Brown ◽  
Hannah Twiddy ◽  
Eleanor Brian ◽  
Bernhard Frank ◽  
...  
Keyword(s):  
Physical Activity ◽  
Chronic Pain ◽  
United Kingdom ◽  
Adverse Effects ◽  
Physical Exercise ◽  
Well Being ◽  
Pain Severity ◽  
Control Group ◽  
The United Kingdom ◽  
Pain Catastrophising

Countries across the world imposed lockdown restrictions during the COVID-19 pandemic. It has been proposed that lockdown conditions, including social and physical distancing measures, may disproportionately impact those living with chronic pain and require rapid adaptation to treatment and care strategies. Using an online methodology, we investigated how lockdown restrictions in the United Kingdom impacted individuals with chronic pain (N = 431) relative to a healthy control group (N = 88). Data were collected during the most stringent period of lockdown in the United Kingdom (mid-April to early-May 2020). In accordance with the fear-avoidance model, we hypothesised lockdown-related increases in pain and psychological distress, which would be mediated by levels of pain catastrophising. Responses indicated that people with chronic pain perceived increased pain severity, compared to their estimation of typical pain levels prior to lockdown (p < .001). They were also more adversely affected by lockdown conditions compared to pain-free individuals, demonstrating greater self-perceived increases in anxiety and depressed mood, increased loneliness and reduced levels of physical exercise (p ⩽ .001). Hierarchical regression analysis revealed that pain catastrophising was an important factor relating to the extent of self-perceived increases in pain severity during lockdown (β = .27, p < .001) and also mediated the relationship between decreased mood and pain. Perceived decreases in levels of physical exercise also related to perceptions of increased pain (β = .15, p < .001). Interestingly, levels of pain intensity (measured at two time points at pre and during lockdown) in a subgroup (N = 85) did not demonstrate a significant change. However, individuals in this subgroup still reported self-perceived pain increases during lockdown, which were also predicted by baseline levels of pain catastrophising. Overall, the findings indicate that people with chronic pain suffer adverse effects of lockdown including self-perceived increases in their pain. Remote pain management provision to target reduction of pain catastrophising and increase health behaviours including physical activity could be beneficial for this vulnerable population.

scholarly journals Physical exercise during pregnancy and its influence in the type of birth

2012 ◽  
Vol 10 (4) ◽  
pp. 409-414 ◽  
Author(s):  
Lílian Cristina da Silveira ◽  
Conceição Aparecida de Mattos Segre
Keyword(s):  
Physical Activity ◽  
Physical Exercise ◽  
Basic Education ◽  
Exercise Program ◽  
Regular Physical Activity ◽  
Control Group ◽  
Significance Level ◽  
Vaginal Deliveries ◽  
Significant Difference ◽  
Primiparous Women

OBJECTIVE: To verify if medium intensity exercise performed during pregnancy can influence in the type of delivery, and to observe compliance to an exercise program among primiparous women with different levels of schooling. METHODS: A study carried out at the Centro de Incentivo ao Aleitamento Materno, in São Sebastiao (SP), between April 7, 2008, and April 14, 2009. A prospective study involving 66 primiparous women who were divided into two groups: an Exercise Group, engaged in regular physical activity during pregnancy, and the Control Group, that did not participate in regular physical activity during the same period. Significance level in this project was 5% (p=0.05). RESULTS: The group that did engage in regular exercise had a higher rate of vaginal deliveries, with a statistically significance difference evaluated by the χ² test (p=0.031). The pregnant women with the highest level of schooling showed greater compliance with the exercise program, with a statistically significant difference (p=0.01736). CONCLUSION: Physical exercise in primiparous women increased the chances of vaginal deliveries, and there was greater compliance with the exercise program among those with a higher level of schooling when compared to those with a basic education.

scholarly journals The relationship between psychosocial factors and reported disability: The role of pain self-efficacy

2021 ◽  
Author(s):  
Antonio Varela
Keyword(s):  
Physical Activity ◽  
Chronic Pain ◽  
Low Back Pain ◽  
Psychosocial Factors ◽  
Self Efficacy ◽  
Pain Catastrophizing ◽  
Low Back ◽  
Mediating Role ◽  
The Relationship

Abstract Background Chronic pain in all its forms and the accompanying level of disability is a healthcare crisis that reaches epidemic proportions and is considered a world level crisis. Chronic non-specific low back pain contributes a significant proportion of chronic pain. Specific psychosocial factors and their influence on reported disability in a chronic non-specific low back pain (CNLBP) population was researched. Methods Psychosocial factors examined include fear, catastrophizing, depression, and pain self-efficacy. This cross-sectional correlational study examined the mediating role between pain self-efficacy and the specific psychosocial factors with reported disability. The study included 90 participants with CNLBP between 20 and 60 years of age. Participants completed the Fear Avoidance Belief Questionnaire, The Pain Catastrophizing Scale, The Patient Health Questionnaire-9, The Pain Self-Efficacy Questionnaire, and The Lumbar Oswestry Disability Index to measure fear of physical activity, pain catastrophizing, depression, pain self-efficacy, and reported disability, respectively. The study used multivariate regression and mediation analyses. Results The principal finding of the study was a strong inverse relationship between pain self-efficacy and reported disability. Further, pain self-efficacy was considered a statistic mediator for all psychosocial factors investigated within this data set. Pain self-efficacy was strongly considered to have a mediating role between reported fear of physical activity and disability, reported pain catastrophizing and disability, and reported depression and disability. Additionally, adjusting for age and reported pain levels proved to be statistically significant, and it did not alter the role of pain self-efficacy. Conclusion The results identified that pain self-efficacy had a mediating role in the relationship between the specific psychosocial factors of fear, catastrophizing, and depression and reported disability. Pain self-efficacy plays a more significant role in the relationships between specific psychosocial factors and reported disability with CNLBP than previously considered.

The association of innate and acquired aerobic capacity with resilience in healthy adults: Protocol for an eight-week randomized controlled web-based physical exercise intervention study (Preprint)

2021 ◽  
Author(s):  
David Tobias Ochmann ◽  
Keito F A Philippi ◽  
Peter Zeier ◽  
Magdalena Sandner ◽  
Barlo Hillen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Physical Exercise ◽  
Aerobic Capacity ◽  
Exercise Intervention ◽  
Intervention Group ◽  
Control Group ◽  
Active Lifestyle ◽  
Web Based ◽  
Before And After ◽  
Physically Inactive

BACKGROUND Physical activity ameliorates chronic stress. Latest research suggests a relation between resilience and physical fitness. Beneficial adaptations of the hypothalamic-pituitary-adrenal axis, the sympathetic nervous system, the endocannabinoid system, and the tryptophan pathway, induced by an active lifestyle, are considered to be resilience conducive. However, detailed knowledge on the molecular link between the effects of acute and chronic physical exercise and an improved resilience is missing. OBJECTIVE Therefore, we implement a human exercise intervention trial addressing the main hypotheses: (1) web-based exercise training improves aerobic capacity of physically inactive adults, which (2) is accompanied by improved resilience. In this setting, we will analyze the relation of resilience parameters with innate and acquired aerobic capacity as well as circulating signaling molecules. METHODS 70 healthy physically inactive (<150min/week physical activity) adults (18-45y) will be randomly assigned to an intervention or control group. Participants in the intervention group receive weekly training utilizing progressive endurance and interval running individually adapted to their training performance via web-based physician support. A standardized incremental treadmill exercise test is performed before and after the intervention period of eight weeks to determine innate and acquired aerobic capacity. Before and after the intervention psychological tests and questionnaires that characterize parameters implicated in resilience (including impulse control, working memory, stress coping, emotion regulation) will be applied. Blood, and saliva will be sampled for analysis of lactate, cortisol, endocannabinoids, catecholamines, kynurenic acid, cell-free DNA and further circulating signal transducers. Statistical analysis will provide comprehensive knowledge on the relation of aerobic capacity and resilience, and furthermore, the capacity of peripheral factors to mediate the promoting effects of exercise on resilience. RESULTS The study was registered in October 2019. Enrollment began in September 2019. Out of 161 subjects, who were initially screened via telefon survey, 43 fulfilled the inclusion criteria and were included. Among the 17 participants in the intervention group, and 14 participants in the control group, who completed the study (total 31), no serious adverse event has been reported. Four participants withdrew during the programm (individual reasons), and 8 participants have not yet completed or begun the program due to the Covid-19 pandemic. Enrollment and data analysis are ongoing, and results are expected to be submitted for publication in October 2021. CONCLUSIONS Our study aims to demonstrate that an increase in physical activity with a simultaneous improvement in aerobic capacity is associated with an increase in resilience. This study design allows to investigate the effect of an active lifestyle on circulating molecular marker levels and their relationship to resilience factors. This will offer novel approaches for the diagnosis of depression and the therapy by exercise prescription. CLINICALTRIAL DRKS00018078, registered October 02, 2019, German Clinical Trials Register. Retrospectively registered: First participant September 10, 2019.

PENGARUH LATIHAN FISIK AEROBIK DENGAN INTENSITAS SEDANG TERHADAP KONDISI MAKROSKOPIK DAN GAMBARAN HISTOPATOLOGI MIOKARD MENCIT BALB/C

2019 ◽  
Vol 1 (2) ◽  
pp. 30
Author(s):  
Niswan Helja Batubara ◽  
Nova Sylviana ◽  
Hasrayati Agustina ◽  
Hadaral Hudanul Qolbi
Keyword(s):  
Physical Activity ◽  
Cardiovascular Diseases ◽  
Physical Exercise ◽  
Aerobic Exercise ◽  
Pathological Condition ◽  
Moderate Intensity ◽  
Control Group ◽  
Intensity Increase ◽  
Pathological Features ◽  
Histopathologic Features

Cardiovascular diseases is one of the non-communicable diseases that has been the leading cause of death compared to other causes. Actually, cardiovascular diseases can be prevented with avoiding the risk factors and lifestyle improvements such as doing physical exercise. Useful physical exercise according to according to The American College of Cardiology/American Heart Association (ACC/AHA) is a moderate intensity aerobic exercise conducted 30 minutes in time for 5 days a week. This research aims to study the effects of moderate intensity aerobic exercise on macroscopic conditions, histopathologic features of the myocardium of mice. This research using 35 male balb/c mice devided to 3 groups (control, physical activity, exercise). Variables in this research included duration of physical activity and exercise, macroscopic conditions, histopathologic features of the myocardium of balb/c mice. After 10 and 28 days of exposure, the heart were harvested. The macroscopic conditions, histopathologic features of the myocardium were examined. The weight of heart in physical activity group was greater than control group (p=0.009). Similarly, the weight of heart exercise group was also greater compared to control group (p=0.013). The histopathologic features in physical activity and physical exercise groups showed pathological features of myocardial infarction (p=0.242). While in the control group did not show pathological features. Aerobic physical activity moderate intensity increase the risk of pathological condition of heart in the form of myocardial infarct through the macroscopic conditions and histological features of myocardium. Meanwhile, exercise with moderate intensity affect the physiological hypertrophy of the myocardium.

scholarly journals Brief Mindfulness-Based Therapy for Chronic Tension-Type Headache: A Randomized Controlled Pilot Study

2013 ◽  
Vol 42 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Stuart Cathcart ◽  
Nicola Galatis ◽  
Maarten Immink ◽  
Michael Proeve ◽  
John Petkov
Keyword(s):  
Chronic Pain ◽  
Pilot Study ◽  
Stress Reduction ◽  
Controlled Trial ◽  
Tension Type Headache ◽  
Control Group ◽  
Chronic Tension Type Headache ◽  
Randomized Controlled ◽  
Type Headache ◽  
Pain Symptoms

Background: Mindfulness-based therapy (MBT) has been demonstrated to be effective for reducing chronic pain symptoms; however, the use of MBT for Chronic Tension-Type Headache (CTH) exclusively has to date not been examined. Typically, MBT for chronic pain has involved an 8-week program based on Mindfulness Based Stress Reduction. Recent research suggests briefer mindfulness-based treatments may be effective for chronic pain. Aims: To conduct a pilot study into the efficacy of brief MBT for CTH. Method: We conducted a randomized controlled trial of a brief (6-session, 3-week) MBT for CTH. Results: Results indicated a significant decrease in headache frequency and an increase in the mindfulness facet of Observe in the treatment but not wait-list control group. Conclusion: Brief MBT may be an effective intervention for CTH.

Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up

Pain Medicine ◽  
2021 ◽  
Author(s):  
Matthew E Schumann ◽  
Brandon J Coombes ◽  
Keith E Gascho ◽  
Jennifer R Geske ◽  
Mary C McDermott ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cognitive Behavioral Therapy ◽  
Self Efficacy ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Rehabilitation Program ◽  
Cognitive Behavioral ◽  
Pain Outcomes ◽  
Pain Symptoms

Abstract Background Decreasing pain catastrophizing and improving self-efficacy to self-manage chronic pain symptoms are important treatment targets in the context of interdisciplinary cognitive behavioral therapy for chronic pain. Greater pain catastrophizing has been shown to be associated with greater impact of pain symptoms on functioning, while conversely, greater pain self-efficacy has been associated with lower pain intensity and lower levels of disability. Objective To prospectively evaluate interdisciplinary cognitive behavioral therapy for pain outcomes, as well as to the mediating effects of both pain catastrophizing and pain self-efficacy on outcome. Methods Participants were 315 patients with chronic pain between April 2017 and April 2018 who completed a three-week interdisciplinary pain rehabilitation program. Pain severity, pain interference, pain catastrophizing, pain self-efficacy, quality of life, and depressive symptom questionnaires, and measures of physical performance were assessed at pre- and posttreatment. Follow-up questionnaires were returned by 163 participants. Effect size and reliable change analyses were conducted from pre- to posttreatment and pretreatment to 6-month follow-up. Mediation analyses were conducted to determine the mediating effect of pain catastrophizing and pain self-efficacy on pain outcome. Results Significant improvements from pre- to posttreatment in pain outcomes were observed, and over 80% evidenced reliable change in at least one pain-relevant measure. Pain catastrophizing and pain self-efficacy mediated the relationship between changes in pain outcomes. Conclusions Interdisciplinary pain rehabilitation is an effective treatment and decreasing pain catastrophizing and increasing pain self-efficacy can influence maintenance of treatment gains.

scholarly journals Protocol for the impact of CBT for insomnia on pain symptoms and central sensitisation in fibromyalgia: a randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e033760
Author(s):  
Christina S McCrae ◽  
Ashley F Curtis ◽  
Jason Craggs ◽  
Chelsea Deroche ◽  
Pradeep Sahota ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Controlled Trial ◽  
Control Group ◽  
Behavioural Treatment ◽  
Pain Mechanisms ◽  
University Of Missouri ◽  
Central Sensitisation ◽  
Pain Symptoms ◽  
The University ◽  
The Impact

IntroductionApproximately 50% of individuals with fibromyalgia (a chronic widespread pain condition) have comorbid insomnia. Treatment for these comorbid cases typically target pain, but growing research supports direct interventions for insomnia (eg, cognitive behavioural treatment for insomnia (CBT-I)) in these patients. Previous research suggests sustained hyperarousal mediated by a neural central sensitisation mechanism may underlie insomnia and chronic pain symptoms in fibromyalgia. We hypothesise CBT-I will improve insomnia symptoms, improve clinical pain and reduce central sensitisation. The trial will be the first to evaluate the short-term and long-term neural mechanisms underlying insomnia and pain improvements in fibromyalgia. Knowledge obtained from this trial might allow us to develop new or modify current treatments to better target pain mechanisms, perhaps reversing chronic pain or preventing it.Methods and analysisFemale participants (n=130) 18 years of age and older with comorbid fibromyalgia (with pain severity of at least 50/100) and insomnia will be recruited from the University of Missouri in Columbia, Missouri, and surrounding areas. Participants will be randomised to 8 weeks (plus 4 bimonthly booster sessions) of CBT-I or a sleep hygiene control group (SH). Participants will be assessed at baseline, post-treatment, 6 and 12 months follow-ups. The following assessments will be completed: 2 weeks of daily diaries measuring sleep and pain, daily actigraphy, insomnia severity index, pain-related disability, single night of polysomnography recording, arousal (heart rate variability, cognitive affective arousal), structural and functional MRI to examine pain-related neural activity and plasticity and mood (depression, anxiety).Ethics and disseminationEthics approval was obtained in July 2018 from the University of Missouri. All data are expected to be collected by 2022. Full trial results are planned to be published by 2024. Secondary analyses of baseline data will be subsequently published.Trial registration numberNCT03744156.

scholarly journals A GROUP FOR PARENTS OF YOUTH WITH CHRONIC PAIN: RATIONALE, STRUCTURE, CONTENT, AND PRELIMINARY OUTCOME DATA

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e2-e2
Author(s):  
Kim Edwards ◽  
C Meghan McMurtry ◽  
Soeun Lee ◽  
Elena Jackson
Keyword(s):  
Chronic Pain ◽  
School Attendance ◽  
Pain Catastrophizing ◽  
Child Outcomes ◽  
Parent Satisfaction ◽  
Outcome Data ◽  
Feedback Form ◽  
School Partnerships ◽  
High Satisfaction ◽  
Pain Symptoms

Abstract BACKGROUND Parenting a youth with chronic pain can be challenging and have a significant impact relationally, emotionally and financially on caregivers (Palermo, 2000; Lewandowski et al., 2010). There is a growing literature indicating that parent emotions (e.g., anxiety, depression), cognitions (e.g., coping, pain catastrophizing), and behaviours (e.g., attending to pain symptoms) can moderate a child’s adjustment to chronic pain (Logan & Scharff, 2005; Palermo et al., 2014; Palermo & Eccleston, 2008). Therefore, intervening with parents of youth with chronic pain is believed to foster better outcomes regarding children’s functioning (e.g., school attendance; Coakley & Wihak, 2017). OBJECTIVES No study has evaluated a stand-alone intervention targeted at parents of youth with chronic pain. Consequently, this poster presents a five week parenting group that we developed and ran on four occasions. Preliminary results pertaining to group feasability, satisfaction, and effectiveness will also be presented. DESIGN/METHODS The group is designed to augment the treatment of youth in our program and includes the following topics: chronic pain 101 (psychoeducation), impact of pain on the family, self-care, tools for managing a child’s pain, identifying and overcoming barriers, school partnerships, and celebrating successes. Each session involves homework review, a mindfulness activity, new material (inclusive of a didactic activity), goal-setting, and assigned readings. To date, 41 parents of youth with chronic pain have participated in the four group cycles. Outcomes were measured using the Adult Responses to Children’s Symptoms (ARCS) Questionnaire (Noel et al., 2015; Van Slyke & Walker, 2006) which parents completed at the start and end of the group. Feedback and parent satisfaction were also obtained on a feedback form designed by authors and given on the last session of group. RESULTS Overall, the group demonstrated adequate feasibility, was well-received by parents, and high satisfaction was reported. Preliminary data suggest that the group was helpful in reducing some parental responses associated with maladaptive child outcomes. More specifically, statistically significant decreases in protectiveness, monitoring, and minimizing (subscales of the ARCS) were found after the 5 week intervention. CONCLUSION “Anecdotally, many parents expressed uncertainty about how to respond when adolescents complained of pain and refused to go to school, and parents appeared eager for…strategies to help them negotiate the situation” (Logan & Simons, 2010, p. 833). Our results are consistent with previous literature (Logan & Simons, 2010; Saunders et al., 1994) and suggest that intervening with parents may help improve outcomes for youth with chronic pain.

scholarly journals Levels of physical activity in people with chronic pain

2017 ◽  
Vol 73 (1) ◽  
Author(s):  
Romy Parker ◽  
Emma Bergman ◽  
Anelisiwe Mntambo ◽  
Shannon Stubbs ◽  
Matthew Wills
Keyword(s):  
Physical Activity ◽  
Chronic Pain ◽  
Pain Management ◽  
Brief Pain Inventory ◽  
Cross Sectional Study ◽  
Control Group ◽  
Chronic Pain Management ◽  
Pain Group ◽  
Cross Sectional ◽  
Management Intervention

Background: People who suffer from chronic pain are thought to have lower levels of physical activity compared to healthy individuals. However, there is a lack of evidence concerning levels of physical activity in South Africans with chronic pain. Objectives: To compare levels of physical activity in a South African sample of people with chronic pain compared to matched controls. Methods: A cross-sectional study was conducted with 24 participants (12 with chronic pain and 12 in the control group matched for age, gender and residential area). Convenience sampling was used. The participants with chronic pain (12) were identified from the Groote Schuur Hospital, Chronic Pain Management Clinic (CPMC) waiting list and had not yet received any chronic pain management intervention. Healthy matched controls were selected from volunteers in the community. With the desired alpha level set at 0.05 and the power at 0.9, 45 participants were required to detect a minimum of a 50 per cent difference between groups in levels of physical activity as measured in steps per day using pedometers. The international physical activity questionnaire (IPAQ) and the brief pain inventory (BPI) were used as measures of physical activity and pain. Objective indicators of physical activity that were used included the 6-minute walk test (6MWT), repeated sit-to-stand test (RSST), 7 days of pedometry and body mass index (BMI). Results: The chronic pain group performed significantly worse on the 6MWT (335 m [30–430] vs 680 m [430–795]; U = 0.5; p < 0.01) and on the RSST (17.9 s [11.83–105] vs 7.85 s [5.5–11.5]; U = 0; p < 0.01). The chronic pain group also had significantly lower scores on pedometry (mean daily: 2985.1 [32.8–13785.4] vs 6409.4 [4207.1–15313.6]; U = 35; p < 0.03). The BMI for the chronic pain group was significantly higher than matched controls (29.36 kg/m2 [18.94–34.63] vs 22.16 kg/m2 [17.1–30.86]; U = 34; p < 0.03). Conclusion: Participants with chronic pain had a reduced capacity for physical activity. The pedometry results illustrate a range of maladaptive strategies adopted by those with chronic pain. The majority of people with chronic pain appear to avoid physical activity leading to greater disability as a result of immobility and muscle atrophy. However, a small subgroup appears to ignore their pain and push themselves physically despite their pain. This perseverance behaviour leads to further pain as a consequence of muscle and joint overuse. Both maladaptive behavioural responses result in further sensitisation of the central nervous system. The method used to target physical activity in these patients should be considered in treatment planning, specifically for physiotherapy.

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