scholarly journals Athletic therapist's management of persistent musculoskeletal pain: Time to embrace a biopsychosocial lens.

2021 ◽  
Author(s):  
Megan Pomarensky ◽  
Luciana Macedo ◽  
Lisa Carlesso
Keyword(s):  
Chronic Pain ◽  
Clinical Practice ◽  
Musculoskeletal Pain ◽  
International Association ◽  
Management Strategies ◽  
Chronic Musculoskeletal Pain ◽  
Athletic Trainer ◽  
Therapeutic Modalities ◽  
Pain Knowledge ◽  
Athletic Therapy

Abstract Chronic musculoskeletal pain continues to be a rising cost and burden on individuals and society on a global level, thus driving the demand for improved management strategies. Despite the fact that the biopsychosocial model has long been a recommended approach to help manage chronic pain with its' consideration of the person and their experiences, psychosocial context and societal considerations, the biomedical model continues to be the basis of athletic therapy/training education programs and therefore clinical practice. For over 30 years, psychosocial factors have been identified in the literature to be predictors of outcomes relating to chronic pain, including (but not limited to) catastrophizing, fear-avoidance, and self-efficacy. Physical assessment strategies including use of validated outcome measures can be used by the Athletic Therapist and Athletic Trainer to determine the presence and/or severity of non-biogenic pain. Knowledge of these predictors and strategies will allow the Athletic Therapist and Athletic Trainer to frame use of exercise (e.g. graded exposure), manual therapy and/or therapeutic modalities in the appropriate way to improve clinic outcomes. Through change in educational curricula content, such as that recommended by the International Association for the Study of Pain (IASP), Athletic Therapists and Athletic Trainers can develop profession-specific knowledge and skills that will enhance clinical practice to better assist those living with chronic musculoskeletal pain conditions.

scholarly journals Qualitative Evidence from Studies of Interventions Aimed at Return to Work and Staying at Work for Persons with Chronic Musculoskeletal Pain

2021 ◽  
Vol 10 (6) ◽  
pp. 1247
Author(s):  
Gunilla M. Liedberg ◽  
Mathilda Björk ◽  
Elena Dragioti ◽  
Christina Turesson
Keyword(s):  
Return To Work ◽  
Musculoskeletal Pain ◽  
Health Professionals ◽  
Management Strategies ◽  
Chronic Musculoskeletal Pain ◽  
Moderate Evidence ◽  
Staying At Work ◽  
Significant Burden ◽  
Returning To Work ◽  
Key Terms

Chronic musculoskeletal pain is a significant burden for employees, employers, and society. However, more knowledge is needed about which interventions reduce sick leave. Interventions were defined as the act or an instance of intervening, provided by different stakeholders. This review synthesizes the experiences of patients, employers, and health professionals concerning the interventions that influence returning to work and staying at work for persons with chronic musculoskeletal pain. A literature search was performed using several combinations of key terms. Overall, 18 qualitative studies published between 2002 and 2018 were included. Qualitative analysis assessed how much confidence could be placed in each review finding. Moderate evidence was found for factors improving the return to work process such as collaboration between stakeholders, including the persons with chronic musculoskeletal pain and support from all involved actors in the process. Moderate evidence was found for self-management strategies and workplace adjustments needed to facilitate more persons to returning to work and staying at work despite pain. This review provides stakeholders, employers, and health professionals’ information that could be used to develop and implement interventions to increase the possibilities for persons with chronic musculoskeletal pain returning to work or staying at work

scholarly journals Utilisation of pain counselling in osteopathic practice: secondary analysis of a nationally representative sample of Australian osteopaths

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Kylie Fitzgerald ◽  
Brett Vaughan ◽  
Michael Fleischmann ◽  
Shane Pritchard ◽  
Jane Mulcahy ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Musculoskeletal Pain ◽  
Representative Sample ◽  
Secondary Analysis ◽  
Chronic Musculoskeletal Pain ◽  
Guideline Recommendation ◽  
Allied Health Professionals ◽  
Practice Characteristics ◽  
Nationally Representative ◽  
Evidence Based Care

AbstractObjectivesAdvice, reassurance and education are recommended as first line treatments for musculoskeletal pain conditions such as low back pain. Osteopaths are registered primary contact allied health professionals in the Australian healthcare system who primarily manage acute and chronic musculoskeletal pain conditions. This study aimed to investigate the proportion of Australian osteopaths who do and do not utilise advice, reassurance and education (pain counselling) in their clinical practice, and determine the characteristics associated with the frequency of using pain counselling in clinical practice.MethodsA secondary analysis of practice characteristics from a nationally representative sample of Australian osteopaths was undertaken. Participants completed a 27-item practice characteristics questionnaire between July-December 2016. Bivariate analyses were used to identify significant variables for inclusion in a backward multiple logistic regression model. Adjusted odds ratios (OR) were calculated for significant variables.ResultsResponses were received from 991 Australian osteopaths, representing 49% of the profession. Of these 264 (26.64%) indicated often utilising pain counselling, and 727 (73.36%) reported not often utilising pain counselling. Those who utilised pain counselling were more than twice as likely to report research evidence had a high impact on their clinical practice (OR 2.11), and nearly twice as likely to discuss physical activity with their patients (OR 1.84).ConclusionsPain counselling is under-utilised by nearly three quarters of the Australian osteopathic profession as a management strategy. Future studies are required to explore the reasons why most in the profession comprised in this sample are infrequently utilising this guideline recommendation. Given the frequency of chronic musculoskeletal pain conditions presenting to Australian osteopaths, strategies appear to be needed to advance the profession via professional development in accessing and using evidence-based care for pain conditions.

Pain and Psychological Outcomes Among Iraq and Afghanistan Veterans with Chronic Pain and PTSD: ESCAPE Trial Longitudinal Results

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1369-1376
Author(s):  
Matthew J Bair ◽  
Samantha D Outcalt ◽  
Dennis Ang ◽  
Jingwei Wu ◽  
Zhangsheng Yu
Keyword(s):  
Chronic Pain ◽  
Musculoskeletal Pain ◽  
Pain Catastrophizing ◽  
Psychological Outcomes ◽  
Stepped Care ◽  
Chronic Musculoskeletal Pain ◽  
Pain Severity ◽  
Analysis Of Covariance ◽  
Escape Trial ◽  
Care Intervention

Abstract Objective To compare pain and psychological outcomes in veterans with chronic musculoskeletal pain and comorbid post-traumatic stress disorder (PTSD) or pain alone and to determine if veterans with comorbidity respond differently to a stepped-care intervention than those with pain alone. Design Secondary analysis of data from the Evaluation of Stepped Care for Chronic Pain (ESCAPE) trial. Setting Six Veterans Health Affairs clinics. Subjects Iraq and Afghanistan veterans (N = 222) with chronic musculoskeletal pain. Methods Longitudinal analysis of veterans with chronic musculoskeletal pain and PTSD or pain alone and available baseline and nine-month trial data. Participants randomized to either usual care or a stepped-care intervention were analyzed. The pain–PTSD comorbidity group screened positive for PTSD and had a PTSD Checklist–Civilian score ≥41 at baseline. Results T tests demonstrated statistically significant differences and worse outcomes on pain severity, pain cognitions, and psychological outcomes in veterans with comorbid pain and PTSD compared with those with pain alone. Analysis of covariance (ANCOVA) modeling change scores from baseline to nine months indicated no statistically significant differences, controlling for PTSD, on pain severity, pain centrality, or pain self-efficacy. Significant differences emerged for pain catastrophizing (t = 3.10, P < 0.01), depression (t = 3.39, P < 0.001), and anxiety (t = 3.80, P < 0.001). The interaction between PTSD and the stepped-care intervention was not significant. Conclusions Veterans with the pain–PTSD comorbidity demonstrated worse pain and psychological outcomes than those with chronic pain alone. These findings indicate a more intense chronic pain experience for veterans when PTSD co-occurs with pain. PTSD did not lead to a differential response to a stepped-care intervention.

scholarly journals Patients’ Views on Self-Management of Chronic Musculoskeletal Pain

2020 ◽  
Vol 5 (4) ◽  
pp. 254-266
Author(s):  
Barbka Huzjan ◽  
Ivana Hrvatin
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Musculoskeletal Pain ◽  
Health Care Providers ◽  
Multidisciplinary Approach ◽  
Research Question ◽  
Chronic Musculoskeletal Pain ◽  
Self Management ◽  
Care Providers ◽  
The Individual

Research Question (RQ): Chronic musculoskeletal pain is a complex condition and one of the most important causes of suffering of modern times. Self-management refers to the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and life style changes inherent in living with a chronic condition. The research question is; what is the view on the selfmanagement of chronic musculoskeletal pain from the patient's perspective? Purpose: The purpose of this literature review was to review original articles that reported how selfmanagement educational programmes are viewed from the patient’s perspective. Method: We used an integrative review of the literature. The search was conducted from November 2019 to March 2020 on the PubMed, PEDro and OTseeker databases. We included original studies, written in English that examined the patients’ point of view on self-management. The included studies, needed to be conducted on adult patients of both sexes, that were suffering from chronic pain and were educated on self-management of their pain. Two authors independently searched for original studies. Results: Nine article were included in the review. Most of the studies included a multidisciplinary approach. Patients reported they more frequently used passive strategies to manage their pain. They want to be included in the management and be able to communicate with the provider of selfmanagement. There are several positive aspects of a multidisciplinary and groups approach. Organization: Health care providers can encourage an individual to proactively behave through ongoing processes of communication, partnerships and the creation of appropriate self-management plans over time. Society: We assume that the analysis will help to identify the social responsibility of the individual and society in the common concern for the health of the population and the individual within it. Originality: The research provides an up-to-date, new overview of the patients' perspective on self management on chronic pain. The review can be helpful to health care providers s they can compare their expectations with patients's. Limitations / further research: Further research would focus on high quality studies, and specific forms of multidisciplinary approach, and finding what patients use at a home setting and how to help them continue in the self management of their pain. Limitations of this review include the lack of risk of bias assessment and the fact that this is not a systematic review.

scholarly journals Central neurobiological effects of physical exercise in individuals with chronic musculoskeletal pain: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036151
Author(s):  
Rutger M J de Zoete ◽  
Kenneth Chen ◽  
Michele Sterling
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
High Risk ◽  
Physical Exercise ◽  
Clinical Outcomes ◽  
Musculoskeletal Pain ◽  
Exercise Intervention ◽  
Risk Of Bias ◽  
Chronic Musculoskeletal Pain ◽  
Brain Areas

ObjectivePrimary objectives: to investigate the central neurobiological effects (using MRI) of physical exercise in individuals with chronic pain. Secondary objectives: (1) to investigate the associations between central changes and clinical outcomes and (2) to investigate whether different types and dosages of physical exercise exert different central changes.DesignSystematic review searching four electronic databases up to September 2018: AMED, CINAHL, Embase and MEDLINE. Two reviewers independently assessed the methodological quality of included studies using the Cochrane Collaboration’s Risk of Bias in Non-Randomised Studies-I tool. A standardised extraction table was used for data extraction, which was performed by two reviewers.InterventionsStudies reporting any physical exercise intervention in any chronic musculoskeletal pain condition were included. Eligibility of 4011 records was screened independently by two reviewers, and four studies were included in the review.Primary and secondary outcome measuresPrimary outcome: any brain outcome assessed with any MR technique. Secondary outcomes: any self-reported clinical outcomes, and type and dosage of the exercise intervention.ResultsAll four studies had high risk of bias. There was heterogeneity between the brain areas studied and the types of exercise interventions delivered. All studies reported functional MRI changes in various brain areas following an exercise intervention. Insufficient data were available to conduct a meta-analysis or to answer the secondary aims.ConclusionsOnly a limited number of studies were available and all were at high risk of bias. None of the studies was randomised or included blinded assessment. Exercise may exert effects on brain neurobiology in people with chronic pain. Due to the high risk of bias, future studies should use a randomised study design. Investigation of morphological brain changes could be included.PROSPERO registration numberCRD42018108179.

scholarly journals Problems, Solutions, and Strategies Reported by Users of Transcutaneous Electrical Nerve Stimulation for Chronic Musculoskeletal Pain: Qualitative Exploration Using Patient Interviews

2016 ◽  
Vol 96 (7) ◽  
pp. 1039-1048 ◽  
Author(s):  
Peter William Gladwell ◽  
Kathryn Badlan ◽  
Fiona Cramp ◽  
Shea Palmer
Keyword(s):  
Clinical Practice ◽  
Data Analysis ◽  
Musculoskeletal Pain ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Chronic Musculoskeletal Pain ◽  
Pain Clinic ◽  
Electrical Nerve Stimulation ◽  
Primary Data Analysis ◽  
Semistructured Interviews

Abstract Background Transcutaneous electrical nerve stimulation (TENS) could offer a non-drug form of pain relief, but there is no consensus regarding its effectiveness for chronic musculoskeletal pain or chronic low back pain. A recent review of previous trial methods identified significant problems with low treatment fidelity. There is little information available to inform the development of a pragmatic implementation design for a TENS evaluation. Objectives The aim of this study was to explore the experiences of patients who were receiving secondary care in a pain clinic and who had expertise in using TENS to manage chronic musculoskeletal pain. These key informants were selected because they had the potential to generate knowledge that could inform research design and clinical practice. Design A qualitative method using individual semistructured interviews with open questions was selected for its capacity to generate rich data. Methods Semistructured interviews were conducted with 9 patients (6 women, 3 men). Thematic analysis was used as the primary data analysis method, and this analysis was enhanced by a case-level analysis of the context and processes of TENS use of each individual. Results Data analysis indicated that patients learned to address a range of problems in order to optimize TENS use. Patients may need to personalize the positioning of electrodes and the TENS settings and to readjust them over time. Patients learned to use TENS in a strategic manner, and the outcomes of each strategy varied. Conclusions The findings indicated that a pragmatic TENS evaluation may need to incorporate a learning phase to allow patients to optimize this complex pattern of TENS usage, and evaluation may need to be sensitive to the outcomes of strategic use. These findings also have implications for clinical practice.

scholarly journals Optimism, Positive and Negative Affect, and Goal Adjustment Strategies: Their Relationship to Activity Patterns in Patients with Chronic Musculoskeletal Pain

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Rosa Esteve ◽  
Alicia E. López-Martínez ◽  
Madelon L. Peters ◽  
Elena R. Serrano-Ibáñez ◽  
Gema T. Ruiz-Párraga ◽  
...  
Keyword(s):  
Negative Affect ◽  
Musculoskeletal Pain ◽  
Structural Equation ◽  
Activity Patterns ◽  
Self Regulation ◽  
Management Strategies ◽  
Chronic Musculoskeletal Pain ◽  
Positive And Negative Affect ◽  
Goal Management ◽  
Goal Adjustment

Objective. Activity patterns are the product of pain and of the self-regulation of current goals in the context of pain. The aim of this study was to investigate the association between goal management strategies and activity patterns while taking into account the role of optimism/pessimism and positive/negative affect. Methods. Two hundred and thirty-seven patients with chronic musculoskeletal pain filled out questionnaires on optimism, positive and negative affect, pain intensity, and the activity patterns they employed in dealing with their pain. Questionnaires were also administered to assess their general goal management strategies: goal persistence, flexible goal adjustment, and disengagement and reengagement with goals. Results. Structural equation modelling showed that higher levels of optimism were related to persistence, flexible goal management, and commitment to new goals. These strategies were associated with higher positive affect, persistence in finishing tasks despite pain, and infrequent avoidance behaviour in the presence or anticipation of pain. Conclusions. The strategies used by the patients with chronic musculoskeletal pain to manage their life goals are related to their activity patterns.

scholarly journals Exploring Patient Perceptions of Repetitive Transcranial Magnetic Stimulation as a Treatment for Chronic Musculoskeletal Pain: A Qualitative Study

2021 ◽  
Author(s):  
G Stillianesis ◽  
R Cavaleri ◽  
SJ Summers ◽  
CY Tang
Keyword(s):  
Chronic Pain ◽  
Transcranial Magnetic Stimulation ◽  
Qualitative Study ◽  
Musculoskeletal Pain ◽  
Treatment Option ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Structured Interview ◽  
Patient Perceptions ◽  
Chronic Musculoskeletal Pain

Abstract Background: Repetitive transcranial magnetic stimulation (rTMS), a form of non-invasive brain stimulation, represents a novel avenue for the management of chronic musculoskeletal pain. Despite evidence for the effectiveness of rTMS in chronic pain conditions, the clinical uptake of rTMS remains limited. One plausible reason for this discrepancy may be a lack of understanding regarding patient perceptions and their willingness to engage with rTMS. Therefore, this study aimed to explore patient perceptions of rTMS as a treatment for chronic musculoskeletal pain. Methods: Using a phenomenological approach, this qualitative study utilised a semi-structured interview to explore overall knowledge, pre-conceived concerns and attitudes regarding rTMS as a treatment for chronic musculoskeletal pain. All participants had a diagnosis of chronic musculoskeletal pain, a history of seeking treatment, and no prior experience with rTMS. The interviews were transcribed verbatim and analysed thematically. Results: Majority of the participants were willing to consider the use of rTMS as a treatment option, with most having high expectations regarding the effectiveness of the treatment due to its sophisticated appearance. Acceptance to utilise rTMS was influenced by knowledge of pain, cost and travel, and the perceived sophistication of the intervention.Conclusions: This is the first qualitative study to the authors’ knowledge that explores the perception of rTMS as a treatment among people with chronic musculoskeletal pain, a key gap in the current literature. Repetitive transcranial magnetic stimulation appears to be accepted as a treatment option amongst individuals with chronic musculoskeletal pain. Adequate levels of funding support, accessibility and the need for medical professions to endorse the treatment are important considerations that influenced uptake. Developing targeted strategies to address these considerations may encourage use of rTMS in a clinical chronic pain setting.

scholarly journals Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS)

2016 ◽  
Vol 4 (14) ◽  
pp. 1-440 ◽  
Author(s):  
Stephanie JC Taylor ◽  
Dawn Carnes ◽  
Kate Homer ◽  
Tamar Pincus ◽  
Brennan C Kahan ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Social Integration ◽  
Usual Care ◽  
Musculoskeletal Pain ◽  
Primary Outcome ◽  
Research Programme ◽  
Clinical Effectiveness ◽  
Chronic Musculoskeletal Pain ◽  
Self Management ◽  
Management Support

BackgroundChronic musculoskeletal pain is a common problem that is difficult to treat. Self-management support interventions may help people to manage this condition better; however, there is limited evidence showing that they improve clinical outcomes. Our overarching research question was ‘Does a self-management support programme improve outcomes for people living with chronic musculoskeletal pain?’.AimTo develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically grounded self-management support intervention for people living with chronic musculoskeletal pain.MethodsIn phase 1 we carried out two systematic reviews to synthesise the evidence base for self-management course content and delivery styles likely to help those with chronic pain. We also considered the psychological theories that might underpin behaviour change and pain management principles. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in Self-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session after 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with experience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the literature on potential outcome domains and measures and consulted widely with patients, tutors and experts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English and, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community. In phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of adding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain toolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and musculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire. We collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs, health utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression Scale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by participants were extracted from NHS electronic records.ResultsWe recruited 703 participants with a mean age of 60 years (range 19–94 years); 81% were white and 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and anxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants received 85% of the course content. At 12 months there was no difference between treatment groups in our primary outcome of pain-related disability [difference –1.0 intervention vs. control, 95% confidence interval (CI) –4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration all improved more in the intervention group at 6 months. At 1 year these differences remained for depression (–0.7, 95% CI –1.2 to –0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS intervention had a high probability (87%) of being cost-effective compared with usual care at a threshold of £30,000 per quality-adjusted life-year.ConclusionsAlthough the COPERS intervention did not affect our primary outcome of pain-related disability, it improved psychological well-being and is likely to be cost-effective according to current National Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a substitute for less well-evidenced (and more expensive) pain self-management programmes. Effective interventions to improve hard outcomes in chronic pain patients, such as disability, are still needed.Trial registrationCurrent Controlled Trials ISRCTN22714229.FundingThe project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 14. See the NIHR Journals Library website for further project information.

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