Journal of Clinical Medicine

Editorial

6 pages, 202 KiB

Open AccessEditorial

Behavioral Graded Activity⁺ (BGA⁺) for Osteoarthritis: A Paradigm Shift from Disease-Based Treatment to Personalized Activity Self-Management

by Jo Nijs, Kelly Ickmans, David Beckwée and Laurence Leysen

J. Clin. Med. 2020, 9(6), 1793; https://doi.org/10.3390/jcm9061793 - 9 Jun 2020

Cited by 3 | Viewed by 3845

Abstract

Three promising directions for improving care for osteoarthritis (OA) include novel education strategies to target unhelpful illness and treatment beliefs; methods to enhance the efficacy of exercise interventions; and innovative, brain-directed treatments. Here we explain that each of those three promising directions can [...] Read more.

Three promising directions for improving care for osteoarthritis (OA) include novel education strategies to target unhelpful illness and treatment beliefs; methods to enhance the efficacy of exercise interventions; and innovative, brain-directed treatments. Here we explain that each of those three promising directions can be combined through a paradigm-shift from disease-based treatments to personalized activity self-management for patients with OA. Behavioral graded activity (BGA) accounts for the current understanding of OA and OA pain and allows a paradigm shift from a disease-based treatment to personalized activity self-management for patients with OA. To account for the implementation barriers of BGA, we propose adding pain neuroscience education to BGA (referred to as BGA⁺). Rather than focusing on the biomedical (and biomechanical) disease characteristics of OA, pain neuroscience education implies teaching people about the underlying biopsychosocial mechanisms of pain. To account for the lack of studies showing that BGA is “safe” with respect to disease activity and the inflammatory nature of OA patients, a trial exploring the effects of BGA⁺ on the markers of inflammation is needed. Such a trial could clear the path for the required paradigm shift in the management of OA (pain) and would allow workforce capacity building that de-emphasizes biomedical management for OA. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

4 pages, 184 KiB

Open AccessEditorial

Rehabilitation Succeeds Where Technology and Pharmacology Failed: Effective Treatment of Persistent Pain across the Lifespan

by Kelly Ickmans, Lennard Voogt and Jo Nijs

J. Clin. Med. 2019, 8(12), 2042; https://doi.org/10.3390/jcm8122042 - 21 Nov 2019

Cited by 2 | Viewed by 2840

Abstract

Chronic pain affects up to 30% of the adult population [...] Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

Research

Jump to: Editorial, Review

9 pages, 249 KiB

Open AccessArticle

Early Changes in Pain Acceptance Predict Pain Outcomes in Interdisciplinary Treatment for Chronic Pain

by Thomas Probst, Robert Jank, Nele Dreyer, Stefanie Seel, Ruth Wagner, Klaus Hanshans, Renate Reyersbach, Andreas Mühlberger, Claas Lahmann and Christoph Pieh

J. Clin. Med. 2019, 8(9), 1373; https://doi.org/10.3390/jcm8091373 - 2 Sep 2019

Cited by 10 | Viewed by 3880

Abstract

Studies have shown that pain acceptance is associated with a better pain outcome. The current study explored whether changes in pain acceptance in the very early treatment phase of an interdisciplinary cognitive-behavioral therapy (CBT)-based treatment program for chronic pain predict pain outcomes. A [...] Read more.

Studies have shown that pain acceptance is associated with a better pain outcome. The current study explored whether changes in pain acceptance in the very early treatment phase of an interdisciplinary cognitive-behavioral therapy (CBT)-based treatment program for chronic pain predict pain outcomes. A total of 69 patients with chronic, non-malignant pain (at least 6 months) were treated in a day-clinic for four-weeks. Pain acceptance was measured with the Chronic Pain Acceptance Questionnaire (CPAQ), pain outcomes included pain intensity (Numeric Rating Scale, NRS) as well as affective and sensory pain perception (Pain Perception Scale, SES-A and SES-S). Regression analyses controlling for the pre-treatment values of the pain outcomes, age, and gender were performed. Early changes in pain acceptance predicted pain intensity at post-treatment measured with the NRS (B = −0.04 (SE = 0.02); T = −2.28; p = 0.026), affective pain perception at post-treatment assessed with the SES-A (B = −0.26 (SE = 0.10); T = −2.79; p = 0.007), and sensory pain perception at post-treatment measured with the SES-S (B = −0.19 (SE = 0.08); T = −2.44; p = 0.017). Yet, a binary logistic regression analysis revealed that early changes in pain acceptance did not predict clinically relevant pre-post changes in pain intensity (at least 2 points on the NRS). Early changes in pain acceptance were associated with pain outcomes, however, the impact was beneath the threshold defined as clinically relevant. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

20 pages, 732 KiB

Open AccessArticle

Cost–Utility of Mindfulness-Based Stress Reduction for Fibromyalgia versus a Multicomponent Intervention and Usual Care: A 12-Month Randomized Controlled Trial (EUDAIMON Study)

by Adrián Pérez-Aranda, Francesco D’Amico, Albert Feliu-Soler, Lance M. McCracken, María T. Peñarrubia-María, Laura Andrés-Rodríguez, Natalia Angarita-Osorio, Martin Knapp, Javier García-Campayo and Juan V. Luciano

J. Clin. Med. 2019, 8(7), 1068; https://doi.org/10.3390/jcm8071068 - 20 Jul 2019

Cited by 21 | Viewed by 6882

Abstract

Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost–utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to [...] Read more.

Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost–utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention (“FibroQoL”) and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost–utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms (p < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (ΔQALYs = 0.053, p < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

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24 pages, 482 KiB

Open AccessArticle

Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain

by Anneleen Malfliet, Kelly Ickmans, Eva Huysmans, Iris Coppieters, Ward Willaert, Wouter Van Bogaert, Emma Rheel, Thomas Bilterys, Paul Van Wilgen and Jo Nijs

J. Clin. Med. 2019, 8(7), 1063; https://doi.org/10.3390/jcm8071063 - 19 Jul 2019

Cited by 78 | Viewed by 26177

Abstract

Chronic Low Back Pain (CLBP) is a major and highly prevalent health problem. Given the high number of papers available, clinicians might be overwhelmed by the evidence on CLBP management. Taking into account the scale and costs of CLBP, it is imperative that [...] Read more.

Chronic Low Back Pain (CLBP) is a major and highly prevalent health problem. Given the high number of papers available, clinicians might be overwhelmed by the evidence on CLBP management. Taking into account the scale and costs of CLBP, it is imperative that healthcare professionals have access to up-to-date, evidence-based information to assist them in treatment decision-making. Therefore, this paper provides a state-of-the-art overview of the best evidence non-invasive rehabilitation for CLBP. Taking together up-to-date evidence from systematic reviews, meta-analysis and available treatment guidelines, most physically inactive therapies should not be considered for CLBP management, except for pain neuroscience education and spinal manipulative therapy if combined with exercise therapy, with or without psychological therapy. Regarding active therapy, back schools, sensory discrimination training, proprioceptive exercises, and sling exercises should not be considered due to low-quality and/or conflicting evidence. Exercise interventions on the other hand are recommended, but while all exercise modalities appear effective compared to minimal/passive/conservative/no intervention, there is no evidence that some specific types of exercises are superior to others. Therefore, we recommend choosing exercises in line with the patient’s preferences and abilities. When exercise interventions are combined with a psychological component, effects are better and maintain longer over time. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

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18 pages, 2076 KiB

Open AccessArticle

Motor Imagery and Action Observation of Specific Neck Therapeutic Exercises Induced Hypoalgesia in Patients with Chronic Neck Pain: A Randomized Single-Blind Placebo Trial

by Luis Suso-Martí, Jose Vicente León-Hernández, Roy La Touche, Alba Paris-Alemany and Ferran Cuenca-Martínez

J. Clin. Med. 2019, 8(7), 1019; https://doi.org/10.3390/jcm8071019 - 12 Jul 2019

Cited by 22 | Viewed by 5986

Abstract

The aim of the present study was to explore the pain modulation effects of motor imagery (MI) and action observation (AO) of specific neck therapeutic exercises both locally, in the cervical region, and remotely. A single-blind, placebo clinical trial was designed. A total [...] Read more.

The aim of the present study was to explore the pain modulation effects of motor imagery (MI) and action observation (AO) of specific neck therapeutic exercises both locally, in the cervical region, and remotely. A single-blind, placebo clinical trial was designed. A total of 30 patients with chronic neck pain (CNP) were randomly assigned to an AO group, MI group, or placebo observation (PO) group. Pain pressure thresholds (PPTs) of C2/C3, trapezius muscles, and epicondyle were the main outcome variables. Secondary outcomes included heart rate measurement. Statistically significant differences were observed in PPTs of the cervical region in the AO and MI groups between the preintervention and first postintervention assessment. Significant differences were found in the AO group in the epicondyle between the preintervention, first and second post-intervention assessments. Regarding heart rate response, differences were found in the AO and MI groups between the preintervention and average intervention measurements. AO and MI induce immediate pain modulation in the cervical region and AO also induces remote hypoalgesia. OA appears to lead to greater pain modulation as well as a greater heart rate response, however, both should be clinically considered in patients with CNP. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

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28 pages, 1308 KiB

Open AccessArticle

Moderate and Stable Pain Reductions as a Result of Interdisciplinary Pain Rehabilitation—A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

by Åsa Ringqvist, Elena Dragioti, Mathilda Björk, Britt Larsson and Björn Gerdle

J. Clin. Med. 2019, 8(6), 905; https://doi.org/10.3390/jcm8060905 - 24 Jun 2019

Cited by 55 | Viewed by 4963

Abstract

Few studies have investigated the real-life outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRP) for chronic pain. This study has four aims: investigate effect sizes (ES); analyse correlation patterns of outcome changes; define a multivariate outcome measure; and investigate whether the clinical self-reported [...] Read more.

Few studies have investigated the real-life outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRP) for chronic pain. This study has four aims: investigate effect sizes (ES); analyse correlation patterns of outcome changes; define a multivariate outcome measure; and investigate whether the clinical self-reported presentation pre-IMMRP predicts the multivariate outcome. To this end, this study analysed chronic pain patients in specialist care included in the Swedish Quality Registry for Pain Rehabilitation for 22 outcomes (pain, psychological distress, participation, and health) on three occasions: pre-IMMRP, post-IMMRP, and 12-month follow-up. Moderate stable ES were demonstrated for pain intensity, interference in daily life, vitality, and health; most other outcomes showed small ES. Using a Multivariate Improvement Score (MIS), we identified three clusters. Cluster 1 had marked positive MIS and was associated with the overall worst situation pre-IMMRP. However, the pre-IMMRP situation could only predict 8% of the variation in MIS. Specialist care IMPRPs showed moderate ES for pain, interference, vitality, and health. Outcomes were best for patients with the worst clinical presentation pre-IMMRP. It was not possible to predict who would clinically benefit most from IMMRP. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

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17 pages, 1827 KiB

Open AccessArticle

A Meta-Epidemiological Appraisal of the Effects of Interdisciplinary Multimodal Pain Therapy Dosing for Chronic Low Back Pain

by Elena Dragioti, Mathilda Björk, Britt Larsson and Björn Gerdle

J. Clin. Med. 2019, 8(6), 871; https://doi.org/10.3390/jcm8060871 - 18 Jun 2019

Cited by 12 | Viewed by 3692

Abstract

Using a meta-analysis, meta-regression, and a meta-epidemiological approach, we conducted a systematic review to examine the influence of interdisciplinary multimodal pain therapy (IMPT) dosage on pain, disability, return to work, quality of life, depression, and anxiety in published randomised controlled trials (RCTs) in [...] Read more.

Using a meta-analysis, meta-regression, and a meta-epidemiological approach, we conducted a systematic review to examine the influence of interdisciplinary multimodal pain therapy (IMPT) dosage on pain, disability, return to work, quality of life, depression, and anxiety in published randomised controlled trials (RCTs) in patients with non-specific chronic low back pain (CLBP). We considered all RCTs of IMPT from a Cochrane review and searched PubMed for additional RCTs through 30 September 2018. A subgroup random-effects meta-analysis by length, contact, and intensity of treatment was performed followed by a meta-regression analysis. Using random and fixed-effect models and a summary relative odds ratio (ROR), we compared the effect sizes (ES) from short-length, non-daily contact, and low-intensity RCTs with long-length, daily contact, and high-intensity RCTs. Heterogeneity was quantified with the I² metric. A total of 47 RCTs were selected. Subgroup meta-analysis showed that there were larger ES for pain and disability in RCTs with long-length, non-daily contact, and low intensity of treatment. Larger ES were also observed for quality of life in RCTs with short-length, non-daily contact, and low intensity treatment. However, these findings were not confirmed by the meta-regression analysis. Likewise, the summary RORs were not significant, indicating that the length, contact, and intensity of treatment did not have an overall effect on the investigated outcomes. For the outcomes investigated here, IMPT dosage is not generally associated with better ES, and an optimal dosage was not determined. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

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15 pages, 296 KiB

Open AccessArticle

Dissociation and Pain-Catastrophizing: Absorptive Detachment as a Higher-Order Factor in Control of Pain-Related Fearful Anticipations Prior to Total Knee Arthroplasty (TKA)

by Matthias Vogel, Martin Krippl, Lydia Frenzel, Christian Riediger, Jörg Frommer, Christoph Lohmann and Sebastian Illiger

J. Clin. Med. 2019, 8(5), 697; https://doi.org/10.3390/jcm8050697 - 16 May 2019

Cited by 10 | Viewed by 4658

Abstract

Total Knee Arthroplasty (TKA) is the ultima-ratio therapy for knee-osteoarthritis (OA), which is a paradigmatic condition of chronic pain. A hierarchical organization may explain the reported covariation of pain-catastrophizing (PC) and dissociation, which is a trauma-related psychopathology. This study tests the hypotheses of [...] Read more.

Total Knee Arthroplasty (TKA) is the ultima-ratio therapy for knee-osteoarthritis (OA), which is a paradigmatic condition of chronic pain. A hierarchical organization may explain the reported covariation of pain-catastrophizing (PC) and dissociation, which is a trauma-related psychopathology. This study tests the hypotheses of an overlap and hierarchical organization of the two constructs, PC and dissociation, respectively, using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Childhood Trauma Screener (CTS), a shortened version of the Dissociative Experiences Scale (FDS-20), the Brief Symptom Inventory (BSI-18), the Pain-Catastrophizing Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) in 93 participants with knee-OA and TKA. Non-parametric correlation, linear regression, and an exploratory factor analysis comprising the PCS and the FDS-20 in aggregate were run. The three factors: (1) PC factor, (2) absorptive detachment, and (3) conversion altogether explained 60% of the variance of the two scales. Dissociative factors were related to childhood trauma, and the PC-factor to knee-pain. The latter was predicted by absorptive detachment, i.e., disrupted perception interfering with the integration of trauma-related experiences possibly including invasive surgery. Absorptive detachment represents negative affectivity and is in control of pain-related anxieties (including PC). The clinical associations of trauma, psychopathology, and maladaptation after TKA may be reflections of this latent hierarchical organization of trauma-related dissociation and PC. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

17 pages, 1896 KiB

Open AccessArticle

Effectiveness of an Attachment-Informed Working Alliance in Interdisciplinary Pain Therapy

by Ann-Christin Pfeifer, Pamela Meredith, Paul Schröder-Pfeifer, Juan Martin Gomez Penedo, Johannes C. Ehrenthal, Corinna Schroeter, Eva Neubauer and Marcus Schiltenwolf

J. Clin. Med. 2019, 8(3), 364; https://doi.org/10.3390/jcm8030364 - 14 Mar 2019

Cited by 12 | Viewed by 4107

Abstract

Attachment theory provides a useful framework for understanding individual differences in pain patients, especially with insecure attachment shown to be more prevalent in chronic pain patients compared to the general population. Nevertheless, there is little evidence of attachment-informed treatment approaches for this population. [...] Read more.

Attachment theory provides a useful framework for understanding individual differences in pain patients, especially with insecure attachment shown to be more prevalent in chronic pain patients compared to the general population. Nevertheless, there is little evidence of attachment-informed treatment approaches for this population. The present study compares outcomes from two different attachment-informed treatment modalities for clinicians, with outcomes from treatment as usual (TAU). In both intervention groups (IG1 and IG2), clinicians received bi-monthly training sessions on attachment. Additionally, clinicians in IG1 had access to the attachment diagnostics of their patients. All treatments lasted for four weeks and included a 6-month follow up. A total of 374 chronic pain patients were recruited to participate in this study (TAU = 159/IG1 = 163/IG2 = 52). Analyses were carried out using multilevel modeling with pain intensity as the outcome variable. Additionally, working alliance was tested as a mediator of treatment efficacy. The study was registered under the trial number DRKS00008715 on the German Clinical Trials Register (DRKS). Findings show that while IG2 was efficient in enhancing treatment outcomes, IG1 did not outperform TAU. In IG2, working alliance was a mediator of outcome. Results of the present study indicate that attachment-informed treatment of chronic pain can enhance existing interdisciplinary pain therapies; however, caveats are discussed. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

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13 pages, 1256 KiB

Open AccessArticle

Effects of Adding Interferential Therapy Electro-Massage to Usual Care after Surgery in Subacromial Pain Syndrome: A Randomized Clinical Trial

by Manuel Albornoz-Cabello, Jose Antonio Sanchez-Santos, Rocio Melero-Suarez, Alberto Marcos Heredia-Rizo and Luis Espejo-Antunez

J. Clin. Med. 2019, 8(2), 175; https://doi.org/10.3390/jcm8020175 - 2 Feb 2019

Cited by 6 | Viewed by 7122

Abstract

Subacromial pain syndrome (SAPS) is a prevalent condition that results in loss of function. Surgery is indicated when pain and functional limitations persist after conservative measures, with scarce evidence about the most-appropriate post-operative approach. Interferential therapy (IFT), as a supplement to other interventions, [...] Read more.

Subacromial pain syndrome (SAPS) is a prevalent condition that results in loss of function. Surgery is indicated when pain and functional limitations persist after conservative measures, with scarce evidence about the most-appropriate post-operative approach. Interferential therapy (IFT), as a supplement to other interventions, has shown to relieve musculoskeletal pain. The study aim was to investigate the effects of adding IFT electro-massage to usual care after surgery in adults with SAPS. A randomized, single-blinded, controlled trial was carried out. Fifty-six adults with SAPS, who underwent acromioplasty in the previous 12 weeks, were equally distributed into an IFT electro-massage group or a control group. All participants underwent a two-week intervention (three times per week). The control group received usual care (thermotherapy, therapeutic exercise, manual therapy, and ultrasound). For participants in the IFT electro-massage group, a 15-min IFT electro-massage was added to usual care in every session. Shoulder pain intensity was assessed with a 100-mm visual analogue scale. Secondary measures included upper limb functionality (Constant-Murley score), and pain-free passive range of movement. A blinded evaluator collected outcomes at baseline and after the last treatment session. The ANOVA revealed a significant group effect, for those who received IFT electro-massage, for improvements in pain intensity, upper limb function, and shoulder flexion, abduction, internal and external rotation (all, p < 0.01). There were no between-group differences for shoulder extension (p = 0.531) and adduction (p = 0.340). Adding IFT electro-massage to usual care, including manual therapy and exercises, revealed greater positive effects on pain, upper limb function, and mobility in adults with SAPS after acromioplasty. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

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14 pages, 1098 KiB

Open AccessArticle

Eye Gaze Markers Indicate Visual Attention to Threatening Images in Individuals with Chronic Back Pain

by Zoë C. Franklin, Paul S. Holmes and Neil E. Fowler

J. Clin. Med. 2019, 8(1), 31; https://doi.org/10.3390/jcm8010031 - 31 Dec 2018

Cited by 14 | Viewed by 4335

Abstract

Research into attentional biases and threatening, pain-related information has primarily been investigated using reaction time as the dependent variable. This study aimed to extend previous research to provide a more in depth investigation of chronic back pain and individuals’ attention to emotional stimuli [...] Read more.

Research into attentional biases and threatening, pain-related information has primarily been investigated using reaction time as the dependent variable. This study aimed to extend previous research to provide a more in depth investigation of chronic back pain and individuals’ attention to emotional stimuli by recording eye movement behavior. Individuals with chronic back pain (n = 18) were recruited from a back rehabilitation program and age and sex matched against 17 non-symptomatic controls. Participants’ eye movements were recorded whilst they completed a dot probe task, which included back pain specific threatening images and neutral images. There were no significant differences between chronic pain and control participants in attentional biases recorded using reaction time from the dot probe task. Chronic pain participants, however, demonstrated a significantly higher percentage of fixations, larger pupil diameter, a longer average fixation duration and faster first fixation to threatening compared to neutral images. They also had a significantly longer average fixation duration and larger pupil diameter to threatening images compared to control participants. The findings of this study suggest eye gaze metrics may provide a more sensitive measure of attentional biases in chronic pain populations. These findings may have important therapeutic implications for the patient and therapist. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

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Review

Jump to: Editorial, Research

31 pages, 348 KiB

Open AccessReview

Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis

by David Rice, Peter McNair, Eva Huysmans, Janelle Letzen and Patrick Finan

J. Clin. Med. 2019, 8(11), 1769; https://doi.org/10.3390/jcm8111769 - 24 Oct 2019

Cited by 48 | Viewed by 13702

Abstract

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, [...] Read more.

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. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

23 pages, 2047 KiB

Open AccessReview

The Evolving Case Supporting Individualised Physiotherapy for Low Back Pain

by Jon Ford, Andrew Hahne, Luke Surkitt, Alexander Chan and Matthew Richards

J. Clin. Med. 2019, 8(9), 1334; https://doi.org/10.3390/jcm8091334 - 28 Aug 2019

Cited by 12 | Viewed by 7433

Abstract

Low-back pain (LBP) is one of the most burdensome health problems in the world. Guidelines recommend simple treatments such as advice that may result in suboptimal outcomes, particularly when applied to people with complex biopsychosocial barriers to recovery. Individualised physiotherapy has the potential [...] Read more.

Low-back pain (LBP) is one of the most burdensome health problems in the world. Guidelines recommend simple treatments such as advice that may result in suboptimal outcomes, particularly when applied to people with complex biopsychosocial barriers to recovery. Individualised physiotherapy has the potential of being more effective for people with LBP; however, there is limited evidence supporting this approach. A series of studies supporting the mechanisms underpinning and effectiveness of the Specific Treatment of Problems of the Spine (STOPS) approach to individualised physiotherapy have been published. The clinical and research implications of these findings are presented and discussed. Treatment based on the STOPS approach should also be considered as an approach to individualised physiotherapy in people with LBP. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

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19 pages, 562 KiB

Open AccessReview

Best-Evidence for the Rehabilitation of Chronic Pain Part 1: Pediatric Pain

by Lauren E. Harrison, Joshua W. Pate, Patricia A. Richardson, Kelly Ickmans, Rikard K. Wicksell and Laura E. Simons

J. Clin. Med. 2019, 8(9), 1267; https://doi.org/10.3390/jcm8091267 - 21 Aug 2019

Cited by 84 | Viewed by 13390

Abstract

Chronic pain is a prevalent and persistent problem in middle childhood and adolescence. The biopsychosocial model of pain, which accounts for the complex interplay of the biological, psychological, social, and environmental factors that contribute to and maintain pain symptoms and related disability has [...] Read more.

Chronic pain is a prevalent and persistent problem in middle childhood and adolescence. The biopsychosocial model of pain, which accounts for the complex interplay of the biological, psychological, social, and environmental factors that contribute to and maintain pain symptoms and related disability has guided our understanding and treatment of pediatric pain. Consequently, many interventions for chronic pain are within the realm of rehabilitation, based on the premise that behavior has a broad and central role in pain management. These treatments are typically delivered by one or more providers in medicine, nursing, psychology, physical therapy, and/or occupational therapy. Current data suggest that multidisciplinary treatment is important, with intensive interdisciplinary pain rehabilitation (IIPT) being effective at reducing disability for patients with high levels of functional disability. The following review describes the current state of the art of rehabilitation approaches to treat persistent pain in children and adolescents. Several emerging areas of interventions are also highlighted to guide future research and clinical practice. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

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20 pages, 322 KiB

Open AccessReview

Best Evidence Rehabilitation for Chronic Pain Part 4: Neck Pain

by Michele Sterling, Rutger M. J. de Zoete, Iris Coppieters and Scott F. Farrell

J. Clin. Med. 2019, 8(8), 1219; https://doi.org/10.3390/jcm8081219 - 15 Aug 2019

Cited by 71 | Viewed by 18794

Abstract

Neck pain, whether from a traumatic event such as a motor vehicle crash or of a non-traumatic nature, is a leading cause of worldwide disability. This narrative review evaluated the evidence from systematic reviews, recent randomised controlled trials, clinical practice guidelines, and other [...] Read more.

Neck pain, whether from a traumatic event such as a motor vehicle crash or of a non-traumatic nature, is a leading cause of worldwide disability. This narrative review evaluated the evidence from systematic reviews, recent randomised controlled trials, clinical practice guidelines, and other relevant studies for the effects of rehabilitation approaches for chronic neck pain. Rehabilitation was defined as the aim to restore a person to health or normal life through training and therapy and as such, passive interventions applied in isolation were not considered. The results of this review found that the strongest treatment effects to date are those associated with exercise. Strengthening exercises of the neck and upper quadrant have a moderate effect on neck pain in the short-term. The evidence was of moderate quality at best, indicating that future research will likely change these conclusions. Lower quality evidence and smaller effects were found for other exercise approaches. Other treatments, including education/advice and psychological treatment, showed only very small to small effects, based on low to moderate quality evidence. The review also provided suggestions for promising future directions for clinical practice and research. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

19 pages, 258 KiB

Open AccessReview

Best-Evidence Rehabilitation for Chronic Pain Part 2: Pain during and after Cancer Treatment

by An De Groef, Frauke Penen, Lore Dams, Elien Van der Gucht, Jo Nijs and Mira Meeus

J. Clin. Med. 2019, 8(7), 979; https://doi.org/10.3390/jcm8070979 - 5 Jul 2019

Cited by 30 | Viewed by 7135

Abstract

Pain during, and especially after, cancer remains underestimated and undertreated. Moreover, both patients and health care providers are not aware of potential benefits of rehabilitation strategies for the management of pain during and following cancer treatment. In this paper, we firstly provided a [...] Read more.

Pain during, and especially after, cancer remains underestimated and undertreated. Moreover, both patients and health care providers are not aware of potential benefits of rehabilitation strategies for the management of pain during and following cancer treatment. In this paper, we firstly provided a state-of-the-art overview of the best evidence rehabilitation modalities for patients having (persistent) pain during and following cancer treatment, including educational interventions, specific exercise therapies, manual therapies, general exercise therapies and mind-body exercise therapies. Secondly, the findings were summarized from a clinical perspective and discussed from a scientific perspective. In conclusion, best evidence suggests that general exercise therapy has small pain-relieving effects. Supporting evidence for mind-body exercise therapy is available only in breast cancer patients. At this moment, there is a lack of high-quality evidence to support the use of specific exercises and manual therapy at the affected region for pain relief during and after cancer treatment. No clinically relevant results were found in favor of educational interventions restricted to a biomedical approach of pain. To increase available evidence these rehabilitation modalities should be applied according to, and within, a multidisciplinary biopsychosocial pain management approach. Larger, well-designed clinical trials tailored to the origin of pain and with proper evaluation of pain-related functioning and the patient’s pain experience are needed. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

15 pages, 2785 KiB

Open AccessReview

Are Mindful Exercises Safe and Beneficial for Treating Chronic Lower Back Pain? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Liye Zou, Yanjie Zhang, Lin Yang, Paul D. Loprinzi, Albert S. Yeung, Jian Kong, Kevin W Chen, Wook Song, Tao Xiao and Hong Li

J. Clin. Med. 2019, 8(5), 628; https://doi.org/10.3390/jcm8050628 - 8 May 2019

Cited by 62 | Viewed by 13519

Abstract

Background: Chronic low back pain (CLBP) is a common health issue worldwide. Tai Chi, Qigong, and Yoga, as the most widely practiced mindful exercises, have promising effects for CLBP-specific symptoms. Objective: We therefore conducted a comprehensive review investigating the effects of mindful exercises [...] Read more.

Background: Chronic low back pain (CLBP) is a common health issue worldwide. Tai Chi, Qigong, and Yoga, as the most widely practiced mindful exercises, have promising effects for CLBP-specific symptoms. Objective: We therefore conducted a comprehensive review investigating the effects of mindful exercises versus active and/or non-active controls while evaluating the safety and pain-related effects of mindful exercises in adults with CLBP. Methods: We searched five databases (MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Library) from inception to February 2019. Two investigators independently selected 17 eligible randomized controlled trials (RCT) against inclusion and exclusion criteria, followed by data extraction and study quality assessment. Standardized mean difference (SMD) was used to determine the magnitude of mindful exercises versus controls on pain- and disease-specific outcome measures. Results: As compared to control groups, we observed significantly favorable effects of mindful exercises on reducing pain intensity (SMD = −0.37, 95% CI −0.5 to −0.23, p < 0.001, I² = 45.9 %) and disability (SMD = −0.39, 95% CI −0.49 to −0.28, p < 0.001, I² = 0 %). When compared with active control alone, mindful exercises showed significantly reduced pain intensity (SMD = −0.40, p < 0.001). Furthermore, of the three mindful exercises, Tai Chi has a significantly superior effect on pain management (SMD= −0.75, 95% CI −1.05 to −0.46, p < 0.001), whereas Yoga-related adverse events were reported in five studies. Conclusion: Findings of our systematic review suggest that mindful exercises (Tai Chi and Qigong) may be beneficial for CLBP symptomatic management. In particular, Tai Chi appears to have a superior effect in reducing pain intensity irrespective of non-control comparison or active control comparison (conventional exercises, core training, and physical therapy programs). Importantly, training in these mindful exercises should be implemented with certified instructors to ensure quality of movement and injury prevention. Full article

(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)

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