scholarly journals Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis

2019 ◽  
Vol 8 (11) ◽  
pp. 1769 ◽  
Author(s):  
David Rice ◽  
Peter McNair ◽  
Eva Huysmans ◽  
Janelle Letzen ◽  
Patrick Finan
Keyword(s):  
Chronic Pain ◽  
State Of The Art ◽  
Behavioral Therapy ◽  
Self Management ◽  
Future Research ◽  
Psychological Function ◽  
Pharmacological Interventions ◽  
First Line ◽  
Exercise Interventions ◽  
Established Disease

Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.

scholarly journals A systematic review of behavioural and exercise interventions for the prevention and management of chemotherapy-induced peripheral neuropathy symptoms

2021 ◽  
Author(s):  
Mary Anne Lagmay Tanay ◽  
Jo Armes ◽  
Rona Moss-Morris ◽  
Anne Marie Rafferty ◽  
Glenn Robert
Keyword(s):  
Peripheral Neuropathy ◽  
Health Management ◽  
Experimental Studies ◽  
Self Management ◽  
Cochrane Library ◽  
Pharmacological Interventions ◽  
Behavioural Interventions ◽  
Exercise Interventions ◽  
Beneficial Effects ◽  
Recommended Treatment

Abstract Background Chemotherapy-induced peripheral neuropathy (CIPN) can result in functional difficulties. Pharmacological interventions used to prevent CIPN either show low efficacy or lack evidence to support their use and to date, duloxetine remains the only recommended treatment for painful CIPN. Non-pharmacological interventions such as exercise and behavioural interventions for CIPN exist. Purpose The aims were to (1) identify and appraise evidence on existing behavioural and exercise interventions focussed on preventing or managing CIPN symptoms, (2) describe psychological mechanisms of action by which interventions influenced CIPN symptoms, (3) determine the underpinning conceptual models that describe how an intervention may create behaviour change, (4) identify treatment components of each intervention and contextual factors, (5) determine the nature and extent of patient and clinician involvement in developing existing interventions and (6) summarise the relative efficacy or effectiveness of interventions to lessen CIPN symptoms and to improve quality of life, balance and muscle strength. Methods A systematic search of Ovid Medline, Cochrane Library, EMBASE, PsycINFO, Health Management Information Consortium, Global Health and CINAHL was performed to identify articles published between January 2000 to May 2020, followed by OpenGrey search and hand-searching of relevant journals. Studies that explored behavioural and/or exercise interventions designed to prevent or improve symptoms of CIPN in adults who had received or were receiving neurotoxic chemotherapy for any type of cancer, irrespective of when delivered within the cancer pathway were included. Results Nineteen randomised controlled trials and quasi-experimental studies which explored behavioural (n=6) and exercise (n=13) interventions were included. Four studies were rated as methodologically strong, ten were moderate and five were weak. Ten exercise and two behavioural interventions, including those that improved CIPN knowledge and self-management resources and facilitated symptom self-reporting, led to reduced CIPN symptoms during and/or after chemotherapy treatment. Conclusions The extent of potential benefits from the interventions was difficult to judge, due to study limitations. Future interventions should incorporate a clear theoretical framework and involve patients and clinicians in the development process. Implications for Cancer Survivors Our findings show exercise interventions have beneficial effects on CIPN symptoms although higher quality research is warranted. Behavioural interventions that increase patient’s CIPN knowledge, improve self-management capacity and enable timely access to symptom management led to reduced CIPN symptoms.

scholarly journals Participants and developers experiences with a chronic pain self-management intervention under development: A qualitative study

2018 ◽  
Vol 6 ◽  
pp. 205031211881742 ◽  
Author(s):  
Kjersti Grønning ◽  
Torunn Hatlen Nøst ◽  
Toril Rannestad ◽  
Ola Bratås
Keyword(s):  
Chronic Pain ◽  
Qualitative Study ◽  
Behavioural Change ◽  
User Involvement ◽  
Social Needs ◽  
Self Management ◽  
Pharmacological Interventions ◽  
Healthy Life ◽  
Management Intervention ◽  
Cognitive Techniques

Background: Non-pharmacological interventions aim to promote health and self-management for people with chronic pain. Objective: The aim of this study was to explore if the participants’ experiences with a self-management intervention under development were aligned with the developers’ rationale and desired outcome of the intervention. Methods: This was a qualitative study interviewing both participants and developers of a chronic pain self-management intervention. Seven participants, six females and one male in the age from early thirties to mid-seventies attended the chronic pain self-management intervention developed by the staff at a Healthy Life Centre. The data were analysed by the systematic text condensation method. Results: The analyses showed that the participants evaluated the intervention as valuable. They described using coping techniques to manage their chronic pain better, and the developers stated that the aim with the intervention was to provide the participants with coping techniques. The intervention was built upon the developers’ professional knowledge and experience in cognitive techniques, health theories, models for behavioural change, and service user involvement. Conclusion: This study found that the chronic pain self-management intervention was in concordance with theory of health promotion and empowerment. The participants experienced the intervention as targeting their resources, capacities, and fulfilling social needs, which aligned with the developers aim with the intervention. The participants found the intervention evocative; they learned new ways to manage their pain through theory/education, movement exercises, homework, and sharing their experiences with each other.

scholarly journals Physical Activity and Exercise Engagement in Patients Diagnosed with Transient Ischemic Attack and Mild/Non-disabling Stroke: A Commentary on Current Perspectives

2014 ◽  
Vol 3 ◽  
pp. RPO.S12338 ◽  
Author(s):  
James Faulkner ◽  
Lee Stoner ◽  
Danielle Lambrick
Keyword(s):  
Transient Ischemic Attack ◽  
Population Group ◽  
Care Program ◽  
Pharmacological Intervention ◽  
Future Research ◽  
Pharmacological Interventions ◽  
Exercise Interventions ◽  
Ischemic Attack ◽  
Research Initiatives ◽  
Cerebrovascular Stroke

Individuals diagnosed with a transient ischemic attack (TIA) or mild/non-disabling stroke are at high risk of cardiovascular or recurrent cerebrovascular (stroke, TIA) events. Pharmacological intervention (ie anti-platelet and anti-coagulant medication) is considered the cornerstone of secondary prevention care for this population group. However, recent research has explored the utility of non-pharmacological interventions (eg exercise, diet, education) in improving health outcomes and reducing the risk of secondary events in patients with TIA or mild/non-disabling stroke. This commentary discusses the efficacy of implementing exercise interventions as a part of the secondary care program for acute and non-acute TIA and stroke patients. Current perspectives and future research initiatives are also discussed.

scholarly journals A systematic review of interventions for reducing heavy episodic drinking in sub-Saharan African settings

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242678
Author(s):  
Katelyn M. Sileo ◽  
Amanda P. Miller ◽  
Tina A. Huynh ◽  
Susan M. Kiene
Keyword(s):  
Systematic Review ◽  
Behavioral Therapy ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Heavy Episodic Drinking ◽  
Sub Saharan Africa ◽  
Future Research ◽  
Pharmacological Interventions ◽  
Sub Saharan ◽  
Meta Analyses

Objective Assess the effect of non-pharmacological alcohol interventions on reducing heavy episodic drinking (HED) outcomes in sub-Saharan Africa. Methods A systematic review of the available literature through August 19, 2020 was conducted. Randomized and non-randomized controlled trials testing non-pharmacological interventions on alcohol consumption in sub-Saharan Africa were eligible for inclusion. Eligible outcomes included measures of HED/binge drinking, and measures indicative of this pattern of drinking, such as high blood alcohol concentration or frequency of intoxication. Three authors extracted and reconciled relevant data and assessed risk of bias. The review protocol is available on PROSPERO (registration number: CRD42019094509). The Cochrane Handbook recommendations for the review of interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines guided all methodology. Results Thirteen intervention trials were identified that met our inclusion criteria and measured change in HED. Studies were judged of moderate quality. A beneficial effect of non-pharmacological interventions on HED was reported in six studies, three of which were deemed clinically significant by the review authors; no statistically significant effects were identified in the other seven studies. Interventions achieving statistical and/or clinical significance had an intervention dose of two hours or greater, used an array of psychosocial approaches, including Motivational Interviewing integrated in Brief Intervention, cognitive behavioral therapy and integrated risk reduction interventions, and were delivered both individually and in groups. Conclusions Evidence for the effectiveness of non-pharmacological interventions to reduce HED in sub-Saharan African settings was limited, demonstrating the need for more research. To strengthen the literature, future research should employ more rigorous study designs, improve consistency of HED measurement, test interventions developed specifically to address HED, and explore structural approaches to HED reduction.

A Brief Report on the Evaluation of a Pain Self-Management Program for Older Adults

2012 ◽  
Vol 26 (2) ◽  
pp. 157-168 ◽  
Author(s):  
Clair Barefoot ◽  
Thomas Hadjistavropoulos ◽  
R. Nicholas Carleton ◽  
James Henry
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Pain Management ◽  
Behavioral Therapy ◽  
Management Program ◽  
The Self ◽  
Self Management ◽  
Control Group ◽  
Self Help ◽  
Professional Intervention

Chronic pain is often resistant to traditional medical management and other types of professional intervention. As such, several investigators have conducted studies of pain self-management programs. These self-management programs, however, were often led by therapists and shared much in common with traditional cognitive behavioral therapy (CBT); the efficacy of which, despite some inconsistencies, is largely supported in the literature. Although, like CBT, many therapist led programs involve a component of self-management in the form of “homework assignments,” it is important to evaluate the effectiveness of pain self-management, which is not therapist led. Within the context of controlled investigation, we evaluated a pain self-management program that involved use of a comprehensive self-help pain management book for older adults. Contrary to expectation, we did not identify any differences in the outcomes observed in the self-help patient group as compared to the control group (i.e., participants who did not receive the pain management book until after the study was completed) despite a great deal of satisfaction with the manualized program that was expressed by the participants. The implications of these findings are discussed.

scholarly journals Smartphone Applications Designed to Improve Older People’s Chronic Pain Management: An Integrated Systematic Review

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 40
Author(s):  
Margaret Dunham ◽  
Antonio Bonacaro ◽  
Patricia Schofield ◽  
Liz Bacon ◽  
Fotios Spyridonis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Cost Benefit ◽  
Self Management ◽  
Treatment Modalities ◽  
Future Research ◽  
Smartphone Applications ◽  
Population Demographics ◽  
Cochrane Database ◽  
Cost Benefit Ratio

(1) Background: Older people’s chronic pain is often not well managed because of fears of side-effects and under-reporting. Telehealth interventions, in the form of smartphone applications, are attracting much interest in the management of chronic diseases, with new and evolving approaches in response to current population demographics. However, the extent to which telehealth interventions may be used to promote and effect the self-management of chronic pain is not established. (2) Aim: To provide an objective review of the existing quantitative and qualitative evidence pertaining to the benefits of smartphone applications for the management of chronic pain in older people. (3) Methods: A literature search was undertaken using PubMed, Medline, CINAHL, Embase, PsychINFO, the Cochrane database, Science Direct and references of retrieved articles. The data were independently extracted by two reviewers from the original reports. (4) Results: This integrative systematic review identified 10 articles considering smartphone applications related to self-management of chronic pain among older adults. (5) Conclusions: It is important for future research to not only examine the effects of smartphone initiatives, but also to compare their safety, acceptability, efficacy and cost–benefit ratio in relation to existing treatment modalities.

Recruiting patients with advanced cancer to participate in a non-opioid intervention for chronic pain management.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14085-e14085
Author(s):  
Preethi Selvan ◽  
Katherine Myers-Coffman ◽  
Karolina Bryl ◽  
Jasmine Tenpa Lama ◽  
Brigette Sutton ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Music Therapy ◽  
Advanced Cancer ◽  
Research Participation ◽  
Future Research ◽  
Control Group ◽  
Pharmacological Interventions ◽  
Chi Square ◽  
Recruitment Methods

e14085 Background: Chronic pain related to advanced cancer is difficult to treat. In addition to traditional analgesics, non-pharmacological interventions, such as music therapy, may help alleviate pain in this population. Research studies to test the efficacy of these non-pharmacological interventions are necessary and important. However, recruiting patients with advanced cancer to participate in such interventions can be challenging. Identifying effective sources of referrals and barriers to participation may help increase recruitment rates in the future. Methods: We recruited patients with advanced cancer (stage III or IV) with chronic pain from two major hospital systems to participate in a pain management interventional study. The experimental group received individualized music therapy, while the control group received talk therapy. Participants attended six weekly sessions at the hospital and were compensated for time and travel. Recruitment methods included referrals from care teams, advertisement through flyers and posters, EMR chart reviews, and in-person recruitment at multiple infusion centers. Missing data was excluded from analyses. Chi-square tests assessed significant differences between groups. Results: Of 594 patients that were referred to the study, 7% enrolled (n = 40), 35% declined (n = 208), and 58% were ineligible (n = 346). Forty-seven percent (n = 19) of enrolled participants were female; race/ethnic distributions were the following: African American/Black (55%; n = 22), Caucasian/White (28%; n = 11), or other (17%; n = 7). The most effective recruitment method was through self-referral; of the 40 patients enrolled in the study, 9 (23%) were enrolled through this method. There were no statistically significant differences between referral source and enrollment. The top three reasons patients declined to participate included lack of interest (32%; n = 67), lack of time and/or energy (28%; n = 59), and lack of transportation (16%, n = 34). Conclusions: Although there were no differences in referral sources, more patients were enrolled through self-referral or in-person recruitment, showing the power of personal motivation and personal touch. While lack of participation due to interest, time, or energy are hard to overcome, future research should consider campaigns to reach patients who are motivated to participate. In addition to referrals, resources for in-person recruitment and transportation to help alleviate barriers to research participation should be considered.

scholarly journals Comparative Effectiveness of Cognitive Behavioral Therapy for Chronic Pain and Chronic Pain Self-Management within the Context of Voluntary Patient-Centered Prescription Opioid Tapering: The EMPOWER Study Protocol

Pain Medicine ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1523-1531 ◽  
Author(s):  
Beth D Darnall ◽  
Sean C Mackey ◽  
Kate Lorig ◽  
Ming-Chih Kao ◽  
Aram Mardian ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cognitive Behavioral Therapy ◽  
Study Protocol ◽  
Comparative Effectiveness ◽  
Behavioral Therapy ◽  
Self Management ◽  
Prescription Opioid ◽  
Patient Centered ◽  
Opioid Tapering

Abstract Objective. Evidence to date, while sparse, suggests that patients taking long-term opioids require special considerations and protections to prevent potential iatrogenic harms from opioid de-prescribing, such as increased pain or suffering. Following this study protocol, the EMPOWER study seeks to address multiple unmet needs of patients with chronic pain who desire to reduce long-term opioid therapy, and provide the clinical evidence on effective methodology. Methods. EMPOWER applies patient-centered methods for voluntary prescription opioid reduction conducted within a comprehensive, multi-state, 3-arm randomized controlled comparative effectiveness study of three study arms (1) group cognitive behavioral therapy for chronic pain; (2) group chronic pain self-management; and (3) usual care (taper only). Specialized electronic data capture systems collect patient reported symptoms and satisfaction data weekly and monthly during the taper, with real-time clinical alerts and electronic feedback loops informing, documenting, and steering needed care actions. Conclusion. The EMPOWER study seeks to provide granular evidence on patient response to voluntary opioid tapering, and will provide evidence to inform clinical systems changes, clinical care, patient satisfaction, and patient outcomes for opioid reduction.

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