The Europain Epidemic: pain prevalence and socioeconomic inequalities in pain across 19 European countries

Abstract

Background

Using data from the European Social Survey (ESS) 2014, this study presents an update of pain prevalence amongst men and women across Europe and undertakes the first analysis of socioeconomic inequalities in pain.

Methods

Data from the ESS 2014 survey were analysed for three pain variables: back/neck pain (n=11,032), arm/hand pain (n=5,954), and foot/leg pain (n=6,314). Education was used as the indicator of socio‐economic status (SES). Age adjusted risk differences (ARD) and age adjusted risk ratios (ARR) were calculated from predicted probabilities generated by means of binary logistic regression. These analyses compared the lower education group with the higher education group (the socioeconomic gap), and the medium education group with the higher education group (the gradient).

Results

High prevalence rates were reported for all three types of pain across European countries. At a pan‐European level, back/neck pain was the most prevalent with 40% of survey participants experiencing pain; then hand/arm pain at 22%, and then foot/leg pain at 21%. There was considerable cross‐national variation in pain across European counties, as well as are significant socio‐economic inequalities in the prevalence of pain – with social gradients or socio‐economic gaps evident for both men and women; socio‐economic inequalities were most pronounced for hand/arm pain, and least pronounced for back/neck pain. The magnitudes of the socioeconomic pain inequalities differed between countries, but were generally higher for women.

Conclusions

Future strategies to reduce the burden of pain should acknowledge and consider the associated socioeconomic inequalities of pain to ensure the ‘pain gap’ does not widen.

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Conditioning pain modulation reduces pain only during the first stmimulation of temporal summation of pain paradigm in healthy participants

Abstract

Background

Pro‐nociceptive and anti‐nociceptive mechanisms are commonly assessed in clinical and experimental pain studies, while their potential interaction is not well understood.

Objectives

Investigate the effect of conditioning pain modulation (CPM) on temporal summation of pain (TSP).

Methods

Twenty healthy participants underwent cuff algometry assessment on the lower legs to establish the pressure pain tolerance threshold (PTT). For the TSP assessment, ten stimuli at the level of the PTT were delivered by computerised cuff inflations (1‐s stimulation, 1‐s break) while participants rated pain intensity on a 10‐cm electronic visual analogue scale (VAS). This TSP paradigm was repeated with a simultaneous conditioning stimulus induced by a cuff on the contralateral leg, inflated to a constant pressure corresponding to 30% (mild), 70% (moderate) or 100% (severe) of the PTT. These were assessed in a randomised order, with a fifteen‐minute break between tests and a final TSP test without conditioning was reassessed in the end (post‐recording).

Results

An interaction between stimuli (1‐10) and repetition (P<0.05) was found for VAS scores. VAS scores for the first stimulus were decreased during 30%, 70%, and 100% conditioning intensities, compared to baseline (P<0.05). There was a significant increase in TSP during conditioning (P<0.05). There were no significant differences between baseline and post‐recordings for any stimuli (P>0.05).

Conclusions

The current study indicates that mild to severe stimuli administered by cuff algometry does not modulate summation effect of temporal summation of pain, which could indicate that pain facilitatory mechanisms are more potent compared with pain inhibitory mechanisms.

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Gamma Oscillations Shape Pain in Animals and Humans

Publication date: Available online 29 April 2019

Source: Trends in Cognitive Sciences

Author(s): Markus Ploner, Joachim Gross

Recent studies (Hu and Iannetti Proc. Natl. Acad. Sci. U. S. A. 2019;116:1782–1791 and Tan et al. Nat. Commun. 2019;10:983) in animals and humans provide converging evidence that gamma oscillations in the primary somatosensory cortex are closely and causally related to pain behavior and pain perception. These findings could help to identify brain-based markers of pain, as well as urgently needed novel targets for pain therapeutics.

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Differences in Long‐Term Physical Activity Trajectories among Individuals with Chronic Widespread Pain: A Secondary Analysis of a Randomized Controlled Trial

Abstract

Background

Little is known about long‐term physical activity (PA) maintenance in those with chronic widespread pain (CWP) following an exercise intervention. This study examined PA over time to identify the existence and characteristics of subgroups following distinct PA trajectories.

Methods

Data come from individuals with CWP who took part in a 2x2 factorial randomized controlled trial, receiving either exercise or both exercise and cognitive behavioural therapy treatment. Information, including self‐report PA, was collected at baseline recruitment, immediately post‐intervention, 3, 24 and 60+ month post‐treatment. Analyses were conducted on 196 men and women with ≥3 PA data‐points. Group‐based trajectory modelling was used to identify latent PA trajectory groups and baseline characteristics (e.g., demographics, pain, self‐rated health, fatigue, coping‐strategy use, kinesiophobia) of these groups.

Results

The best fitting model identified was one with three trajectories: “non‐engagers” (n=32), “maintainers” (n=144) and “super‐maintainers” (n=20). Overall, mean baseline PA levels were significantly different between groups (non‐engagers: 1.1; maintainers: 4.6; super‐maintainers: 8.6, p<0.001) and all other follow‐up points. Non‐engagers reported, on average, greater BMI, higher disabling chronic pain, poorer self‐rated health, physical functioning, as well as greater use of passive coping strategies and lower use of active coping strategies.

Conclusions

The majority of individuals with CWP receiving exercise as part of a trial were identified as long‐term PA maintainers. Participants with poorer physical health and coping response to symptoms were identified as non‐engagers. For optimal symptom management, a stratified approach may enhance initiation and long‐term PA maintenance in individuals with CWP.

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Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial

Abstract

Background

Low back pain (LBP) is a global public health challenge, which causes high health‐care costs and the highest burden on society in terms of years lived with disability. While patient expectations for improvement may have effects on LBP treatment outcomes, it remains unclear if psychological profiles modify this relationship. Therefore, the objectives of this study were to investigate if (1) patient expectations predicted short‐term outcome, and (2) psychological profile, pain intensity, and self‐rated health modified the relationship between expectations and outcome.

Methods

Data were collected between April 2012 and January 2016 during the inclusion into a randomized controlled trial. Potentially eligible participants were identified through 40 chiropractic clinics located across Sweden. Patient expectations, psychological profile, pain intensity, activity limitation, and self‐rated health were collected from patients with recurrent persistent LBP during their first chiropractic visit (n=593). Subjective improvement was measured at the fourth visit.

Results

Patients with a high expectation of improvement had 58% higher risk to report an improvement at the fourth visit (RR=1.58, 95% CI: 1.28, 1.95). Controlling for potential confounders only slightly decreased the strength of this association (RR=1.49, 95% CI: 1.20, 1.86). Baseline pain intensity, psychological profile, and self‐rated health did not modify the effect of expectation on outcome.

Conclusions

Baseline patient expectations play an important role when predicting LBP treatment outcomes. Clinicians should consider and address patient expectations at the first visit to best inform prognosis.

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Differential Perception of Sharp Pain in Patients with Borderline Personality Disorder

Abstract

Background

Cutting is the most common method of non‐suicidal self‐injury (NSSI) to reduce inner tension in patients with Borderline Personality Disorder (BPD). Aim of this study was to compare pain perception induced by an incision and by application of a surrogate model for sharp mechanical pain (a non‐invasive “blade”) in BPD.

Methods

22 female patients and 20 healthy controls (HC) received a small incision into the volar forearm, a 7s‐blade application on the same side, and non‐invasive phasic stimuli (pinprick, blade, laser, tactile). Pain intensity as well as affective vs. sensory components were assessed.

Results

Incision was rated similarly by both groups (BPD: 28.6 ± 5.5 vs. HC: 33.9 ± 6.6; mean maximum pain ± SEM; p > 0.8), without significant difference for “7‐sec‐blade” (BPD: 18.1 ± 3.8 vs. HC: 25.3 ± 3.6; mean maximum pain ± SEM; p > 0.17) or between “7‐sec‐blade” and incision (BPD: p > 0.12; HC: p > 0.84). However, patients’ intensity ratings returned significantly faster to baseline after incision (BPD: 38.9 ± 12.6 s vs. HC: 74.52 ± 11.5 s; p < 0.05), and patients evaluated “blade” and incision without any affective and with different sensory descriptors, indicating an altered evaluation of NSSI‐like stimulation with qualitative in addition to quantitative differences – especially for the sharp pain component.

Conclusions

The reduced perception of suprathreshold nociceptive stimuli is based on a missing affective component and specific loss of the perception of “sharpness” as part of the sensory component of pain. The results further demonstrate the usefulness of the “blade” for the perception of sharpness in patients.

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Anterior and Posterior Approaches for Cervical Myelopathy: Clinical and Radiographic Outcomes

Study Design. A retrospective cohort study. Objective. The aim of this study was to identify advantages and disadvantages of the anterior and posterior approaches in the treatment of cervical stenosis and myelopathy. Summary of Background Data. Both anterior and posterior surgical approaches for cervical stenosis and myelopathy have been shown to result in improvement in health-related outcomes. Despite the evidence, controversy remains regarding the best approach to achieve decompression and correct deformity. Methods. We retrospectively reviewed patients with cervical stenosis and myelopathy who had undergone anterior cervical fusion and instrumentation (n = 38) or posterior cervical laminectomy and instrumentation (n = 51) with at least 6 months of follow-up. Plain radiographs, magnetic resonance imaging, and computed tomography scans, as well as health-related outcomes, including Visual Analog Scale for neck pain, Japanese Orthopedic Association score for myelopathy, Neck Disability Index, and Short Form-36 Health Survey, were collated before surgery and at follow-up (median 12.0 and 12.1 months for anterior and posterior group, respectively). Results. Both anterior and posterior approaches were associated with significant improvements in all studied quality of life parameters with the exception of general health in the anterior group and energy and fatigue in the posterior group. In the anterior group, follow-up assessment revealed a significant increase in C2–7 lordosis. Both approaches were accompanied by significant increases in C2–7 sagittal balance [sagittal vertical axis (SVA)]. There were two complications in the anterior group and nine complications in the posterior group; the incidence of complications between the two groups was not significantly different. Conclusion. When the benefits of one approach over the other are not self-evident, the anterior approach is recommended, as it was associated with a shorter hospital stay and more successful restoration of cervical lordosis than posterior surgery. Level of Evidence: 3

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Group and Individual-level Change on Health-related Quality of Life in Chiropractic Patients With Chronic Low Back or Neck Pain

Study Design. A prospective observational study. Objective. The aim of this study was to evaluate group-level and individual-level change in health-related quality of life among persons with chronic low back pain or neck pain receiving chiropractic care in the United States. Summary of Background Data. Chiropractors treat chronic low back and neck pain, but there is limited evidence of the effectiveness of their treatment Methods. A 3-month longitudinal study of 2024 patients with chronic low back pain or neck pain receiving care from 125 chiropractic clinics at six locations throughout the United States was conducted. Ninety-one percent of the sample completed the baseline and 3-month follow-up survey (n = 1835). Average age was 49, 74% females, and most of the sample had a college degree, were non-Hispanic White, worked full-time, and had an annual income of $60,000 or more. Group-level (within-group t tests) and individual-level (coefficient of repeatability) changes on the Patient-Reported Outcomes Measurement Information System (PROMIS-29) v2.0 profile measure was evaluated: six multi-item scales (physical functioning, pain, fatigue, sleep disturbance, social health, emotional distress) and physical and mental health summary scores. Results. Within-group t tests indicated significant group-level change (P < 0.05) for all scores except for emotional distress, and these changes represented small improvements in health (absolute value of effect sizes ranged from 0.08 for physical functioning to 0.20 for pain). From 13% (physical functioning) to 30% (PROMIS-29 v2.0 Mental Health Summary Score) got better from baseline to 3 months later according to the coefficient of repeatability. Conclusion. Chiropractic care was associated with significant group-level improvement in health-related quality of life over time, especially in pain. But only a minority of the individuals in the sample got significantly better (“responders”). This study suggests some benefits of chiropractic on functioning and well-being of patients with low back pain or neck pain. Level of Evidence: 3

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Reliability and Validity of the Turkish Version of the Fremantle Back Awareness Questionnaire

Study Design. Cross-cultural adaptation and psychometric analysis. Objective. To develop the Turkish version of the Fremantle Back Awareness Questionnaire (FreBAQ-T) and to evaluate its psychometric properties. Summary of Background Data. There is a growing interest in the role that the disturbance of body perception may lead to long-lasting pain problems such as chronic low back pain (CLBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is a simple and low-cost way of evaluating disturbed back awareness in people with CLBP. Methods. The FreBAQ was translated from English into Turkish using the forward-backward-forward method. One hundred four participants with low back pain completed the FreBAQ-T. The FreBAQ-T was repeated in 15 participants after 1 week to establish test-retest reliability. Although internal and external construct validity was investigated using Rasch analysis and Spearman correlation coefficient, respectively; reliability was evaluated in terms of internal consistency by Cronbach alpha and Person Separation Index. Results. All items of the FreBAQ-T were found to fit the Rasch Model (chi-square 6.17 [df = 9], P = 0.723). The internal construct validity was good, overall mean item fit residual was −0.305 (standard deviation: 0.369) and mean person fit residual was −0.290 (standard deviation: 1.349). The reliability was good with Cronbach alpha of 0.87 and Person Separation Index of 0.82. When the test-retest was examined via differential item functioning by time, none of the items showed differential item functioning. Conclusion. The FreBAQ-T is a valid, reliable, and unidimensional scale for patients with CLBP. This scale will allow assessing back-specific perception in the Turkish population with CLBP. Level of Evidence: 3

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A Strategy for Risk-adjusted Ranking of Surgeons and Practices Based on Patient-reported Outcomes After Elective Lumbar Surgery

Study Design. This study retrospectively analyzes prospectively collected data. Objective. The primary aim of this study is to present a scheme for patient-reported outcome (PRO)-based, risk-adjusted rankings of spine surgeons and sites that perform elective lumbar surgery, using the Quality and Outcomes Database (QOD). Summary of Background Data. There is currently no means of determining which spine surgeons or centers are positive or negative outliers with respect to PROs for elective lumbar surgery. This is a critical gap as we move toward a value-based model of health care in which providers assume more accountability for the effectiveness of their treatments. Methods. Random effects regression models were fit for the following outcomes, with QOD site as a fixed effect but surgeon ID as a random effect: Oswestry Disability Index, EQ-5D, back pain and leg pain, and satisfaction. Hierarchical Bayesian models were also fit for each outcome, with QOD site as a random effect and surgeon as a nested random effect. Results. Our study cohort consists of 8834 patients who underwent surgery by 124 QOD surgeons, for the degenerative lumbar diseases. Nonoverlapping Bayesian credible intervals demonstrate that the variance attributed to QOD site was greater than the nested variance attributed to surgeon ID for the included PROs. Conclusion. This study presents a novel strategy for the risk-adjusted, PRO-based ranking of spine surgeons and practices. This can help identify positive and negative outliers, thereby forming the basis for large-scale quality improvement. Assuming adequate coverage of baseline risk adjustment, the choice of surgeon matters when considering PROs after lumbar surgery; however, the choice of site appears to matter more. Level of Evidence: 3

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Opioids for chronic pain: US doctors are misapplying guideline, say its authors

Government guidance for prescribing opioids that has informed most treatment for chronic pain in the US since 20161 is being interpreted in ways that can worsen the harms of addiction and leave...

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Implementation of Patient Reported Outcomes (PROMs) from Specialist Pain Clinics in England and Wales: experience from a nationwide study

Abstract

Introduction

Evaluating outcomes in routine clinical practice is a significant challenge for specialist pain clinics due to the complexity of interventions provided and the subjective nature of pain. This study reports findings from implementation of Patient Reported Outcomes (PROMs) in pain clinics in England and Wales between 2011‐2013.

Methods

A paper‐based questionnaire was administered at a first appointment in participating centres. This assessed quality of life, experience of health care and health care usage with postal follow‐up at 6 and 12 months by the research team. Feasibility was assessed in terms of response rates, completion rates and outcomes.

Results

Ninety‐one (56%) clinics participated, entering 9588 patients (19% of those eligible). For responders there was a 92% item completion rate. The drop‐out rate was high, 46% and 19% returned questions at 6 and 12 months respectively. Quality of life at baseline was low, with a mean EQ5D‐3L Time Trade Off (TTO) value of 0.32. Amongst responders at 12 months, 92% continued to experience significant pain. For those with planned discharges 30% achieved the Minimal Important Change (MIC) for quality of life. Nonetheless, 70% reported positive experiences of care.

Conclusions

Patients attending UK pain clinics report an extraordinarily poor quality of life and difficulty with understanding their condition. Problems with PROMs implementation included initial recruitment, follow‐up response rates, classification systems and benchmarking. Successful implementation should include use of electronic data capture, feedback and focus on gradual improvement. To achieve this would require extended periods of funding.

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Muscle Activity Pattern Dysfunction During Sit to Stand and Stand to Sit in the Movement System Impairment Subgroups of Low Back Pain

Publication date: May 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 5

Author(s): Neda Orakifar, Mohammad Jafar Shaterzadeh-Yazdi, Reza Salehi, Mohammad Mehravar, Neda Namnik

Abstract

Objective

To investigate impairment in the activity pattern of some muscles involved in sit to stand (STD) and stand to sit (STS) among 2 low back pain (LBP) subgroups of the Movement System Impairment (MSI) model.

Design

Case-control study.

Setting

A university medical center.

Participants

Fifteen women without chronic LBP and 22 women with chronic LBP (N=37) in 2 subgroups (15 into the lumbar extension rotation (LER) and 7 into lumbar flexion rotation [LFR]) voluntarily participated in this study.

Interventions

Participants were asked to perform STD and STS at a preferred speed. Surface electromyography (EMG) were measured bilaterally from the internal oblique (IO), lumbar erector spine (ES), medial hamstring (MH), and lateral hamstring (LH) muscles.

Main Outcome Measures

Changes in mean and maximum amplitude, time to peak amplitude, duration of muscle activity, and bilateral asymmetry of these variables.

Results

During STD, bilateral asymmetry in mean amplitude of MH in the LER subgroup (P=.031) and bilateral asymmetry in duration of LH in the LFR subgroup (P=.026) were exhibited. Also, in this task reduced time to peak left MH activation were found in the LFR subgroup than 2 other groups (control; P=.028/LER; P=.004). During STS, increased left ES maximum amplitude were observed in the LFR subgroup than LER subgroup (P=.029). Also, reduced time to peak right ES (P=.035) and left LH (P=.038) activation in the LER subgroup than control subjects and reduced time to peak left LH activation in LFR subgroup than control subjects (P=.041) were observed during STS.

Conclusions

The differences between the 2 LBP subgroups may be a result of impairment in the activity pattern of some muscles during functional activity.

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Predicting Outcome After Hand Orthosis and Hand Therapy for Thumb Carpometacarpal Osteoarthritis: A Prospective Study

Publication date: May 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 5

Author(s): Jonathan Tsehaie, Kim R. Spekreijse, Robbert M. Wouters, Reinier Feitz, Steven E.R. Hovius, Harm P. Slijper, Ruud W. Selles, Hand-Wrist Study Group

Abstract

Objectives

(1) To identify predictive factors for outcome after splinting and hand therapy for carpometacarpal (CMC) osteoarthritis (OA) and to identify predictive factors for conversion to surgical treatment; and (2) to determine how many patients who have not improved in outcome within 6 weeks after start of treatment will eventually improve after 3 months.

Design

Observational prospective multicenter cohort study.

Setting

Xpert Clinic in the Netherlands. This clinic comprises 15 locations in the Netherlands, with 16 European Board certified (FESSH) hand surgeons and over 50 hand therapists.

Participants

Between 2011 and 2014, patients with CMC OA (N=809) received splinting and weekly hand therapy for 3 months.

Intervention

Not applicable.

Main Outcome Measures

Satisfaction and pain were measured with a visual analog scale and function with the Michigan Hand Questionnaire at baseline, 6 weeks, and 3 months posttreatment. Using regression analysis, patient demographics and pretreatment baseline scores were considered as predictors for the outcome of conservative treatment after 3 months and for conversion to surgery.

Results

Multivariable regression model explained 34%-42% of the variance in outcome (P<.001) with baseline satisfaction, pain, and function as significant predictors. Cox regression analysis showed that baseline pain and function were significant predictors for receiving surgery. Of patients with no clinically relevant improvement in pain and function after 6 weeks, 73%-83% also had no clinically relevant improvement after 3 months.

Conclusion

This study showed that patients with either high pain or low function may benefit most from conservative treatment. We therefore recommend to always start with conservative treatment, regardless of symptom severity of functional loss at start of treatment. Furthermore, it seems valuable to discuss the possibility of surgery with patients after 6 weeks of therapy, when levels of improvement are still mainly unsatisfactory.

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The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy—A Double-Blind Randomized Controlled Trial

Publication date: May 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 5

Author(s): Kiran Satpute, Toby Hall, Richa Bisen, Pramod Lokhande

Abstract

Objectives

To evaluate the effect of spinal mobilization with leg movement (SMWLM) on low back and leg pain intensity, disability, pain centralization, and patient satisfaction in participants with lumbar radiculopathy.

Design

A double-blind randomized controlled trial.

Setting

General hospital.

Participants

Adults (N=60; mean age 44y) with subacute lumbar radiculopathy.

Interventions

Participants were randomly allocated to receive SMWLM, exercise and electrotherapy (n=30), or exercise and electrotherapy alone (n=30). All participants received 6 sessions over 2 weeks.

Main Outcome Measures

The primary outcomes were leg pain intensity and Oswestry Disability Index score. Secondary variables were low back pain intensity, global rating of change (GROC), straight leg raise (SLR), and lumbar range of motion (ROM). Variables were evaluated blind at baseline, post-intervention, and at 3 and 6 months of follow-up.

Results

Significant and clinically meaningful improvement occurred in all outcome variables. At 2 weeks the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.0; 95% confidence interval [95% CI], 1.4-2.6) and disability (MD 3.9; 95% CI, 5.5-2.2). Similarly, at 6 months, the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.6; 95% CI, 1.9-3.2) and disability (MD 4.7; 95% CI, 6.3-3.1). The SMWLM group also reported greater improvement in the GROC and in SLR ROM.

Conclusion

In patients with lumbar radiculopathy, the addition of SMWLM provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term.

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Effectiveness of Physical Therapy Combined With Epidural Steroid Injection for Individuals With Lumbar Spinal Stenosis: A Randomized Parallel-Group Trial

Publication date: May 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 5

Author(s): Amy Hammerich, Julie Whitman, Paul Mintken, Thomas Denninger, Venu Akuthota, Eric E. Sawyer, Melissa Hofmann, John D. Childs, Joshua Cleland

Abstract

Objective

To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in individuals with lumbar spinal stenosis (LSS).

Design

Randomized clinical trial.

Setting

Orthopedic spine clinics.

Participants

A total of 390 individuals were screened with 60 eligible and randomly selected to receive ESI and education with or without PT (N=54).

Interventions

A total of 54 individuals received 1-3 injections and education in a 10-week intervention period, with 31 receiving injections and education only (ESI) and 23 additionally receiving 8-10 sessions of multimodal PT (ESI+PT).

Main Outcome Measures

Disability, pain, quality of life, and global rating of change were collected at 10 weeks, 6 months, and 1 year and analyzed using linear mixed model analysis.

Results

No significant difference was found between ESI and ESI+PT in the Oswestry Disability Index at any time point, although the sample had significant improvements at 10 weeks (P<.001; 95% confidence interval [CI], −18.01 to −5.51) and 1 year (P=.01; 95% CI, −14.57 to −2.03) above minimal clinically important difference. Significant differences in the RAND 36-Item Short Form Health Survey 1.0 were found for ESI+PT at 10 weeks with higher emotional role function (P=.03; 95% CI, −49.05 to −8.01), emotional well-being (P=.02; 95% CI, −19.52 to -2.99), and general health perception (P=.05; 95% CI, −17.20 to −.78).

Conclusions

Epidural steroid injection plus PT was not superior to ESI alone for reducing disability in individuals with LSS. Significant benefit was found for the addition of PT related to quality of life factors of emotional function, emotional well-being, and perception of general health.

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Towards a neurobiological understanding of pain in neurofibromatosis type 1: mechanisms and implications for treatment

Neurofibromatosis type 1 (NF1) is the most common of a group of rare diseases known by the term, “Neurofibromatosis,” affecting 1 in 3000 to 4000 people. NF1 patients present with, among other disease complications, café au lait patches, skin fold freckling, Lisch nodules, orthopedic complications, cutaneous neurofibromas, malignant peripheral nerve sheath tumors, cognitive impairment, and chronic pain. Although NF1 patients inevitably express pain as a debilitating symptom of the disease, not much is known about its manifestation in the NF1 disease, with most current information coming from sporadic case reports. Although these reports indicate the existence of pain, the molecular signaling underlying this symptom remains underexplored, and thus, we include a synopsis of the literature surrounding NF1 pain studies in 3 animal models: mouse, rat, and miniswine. We also highlight unexplored areas of NF1 pain research. As therapy for NF1 pain remains in various clinical and preclinical stages, we present current treatments available for patients and highlight the importance of future therapeutic development. Equally important, NF1 pain is accompanied by psychological complications in comorbidities with sleep, gastrointestinal complications, and overall quality of life, lending to the importance of investigation into this understudied phenomenon of NF1. In this review, we dissect the presence of pain in NF1 in terms of psychological implication, anatomical presence, and discuss mechanisms underlying the onset and potentiation of NF1 pain to evaluate current therapies and propose implications for treatment of this severely understudied, but prevalent symptom of this rare disease.

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Haploinsufficiency of the brain-derived neurotrophic factor gene is associated with reduced pain sensitivity

Rare pain-insensitive individuals offer unique insights into how pain circuits function and have led to the development of new strategies for pain control. We investigated pain sensitivity in humans with WAGR (Wilms tumor, aniridia, genitourinary anomaly, and range of intellectual disabilities) syndrome, who have variably sized heterozygous deletion of the 11p13 region. The deletion region can be inclusive or exclusive of the brain-derived neurotrophic factor (BDNF) gene, a crucial trophic factor for nociceptive afferents. Nociceptive responses assessed by quantitative sensory testing demonstrated reduced pain sensitivity only in the WAGR subjects whose deletion boundaries included the BDNF gene. Corresponding behavioral assessments were made in heterozygous Bdnf knockout rats to examine the specific role of Bdnf. These analogous experiments revealed impairment of Aδ- and C-fiber-mediated heat nociception, determined by acute nociceptive thermal stimuli, and in aversive behaviors evoked when the rats were placed on a hot plate. Similar results were obtained for C-fiber-mediated cold responses and cold avoidance on a cold-plate device. Together, these results suggested a blunted responsiveness to aversive stimuli. Our parallel observations in humans and rats show that hemizygous deletion of the BDNF gene reduces pain sensitivity and establishes BDNF as a determinant of nociceptive sensitivity.

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Chronic pain is associated with a brain aging biomarker in community-dwelling older adults

Chronic pain is associated with brain atrophy with limited evidence on its impact in the older adult's brain. We aimed to determine the associations between chronic pain and a brain aging biomarker in persons aged 60 to 83 years old. Participants of the Neuromodulatory Examination of Pain and Mobility Across the Lifespan (NEPAL) study (N = 47) completed demographic, psychological, and pain assessments followed by a quantitative sensory testing battery and a T1-weighted magnetic resonance imaging. We estimated a brain-predicted age difference (brain-PAD) that has been previously reported to predict overall mortality risk (brain-PAD, calculated as brain-predicted age minus chronological age), using an established machine-learning model. Analyses of covariances and Pearson/Spearman correlations were used to determine associations of brain-PAD with pain, somatosensory function, and psychological function. Individuals with chronic pain (n = 33) had “older” brains for their age compared with those without (n = 14; F[1,41] = 4.9; P = 0.033). Greater average worst pain intensity was associated with an “older” brain (r = 0.464; P = 0.011). Among participants with chronic pain, those who reported having pain treatments during the past 3 months had “younger” brains compared with those who did not (F[1,27] = 12.3; P = 0.002). An “older” brain was significantly associated with decreased vibratory (r = 0.323; P = 0.033) and thermal (r = 0.345; P = 0.023) detection, deficient endogenous pain inhibition (F[1,25] = 4.6; P = 0.044), lower positive affect (r = −0.474; P = 0.005), a less agreeable (r = −0.439; P = 0.020), and less emotionally stable personality (r = −0.387; P = 0.042). Our findings suggest that chronic pain is associated with added “age-like” brain atrophy in relatively healthy, community-dwelling older individuals, and future studies are needed to determine the directionality of our findings. A brain aging biomarker may help identify people with chronic pain at a greater risk of functional decline and poorer health outcomes.

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Opioid cessation and chronic pain: perspectives of former opioid users

Current guidelines for addressing opioid cessation in the context of chronic pain management recommend that opioids be discontinued if the risks outweigh the benefits. However, few studies have focused on understanding opioid cessation from the perspective of individuals with chronic pain. This mixed-method study included 49 former opioid users with chronic pain and used quantitative survey data and qualitative focus group data to identify themes pertaining to former opioid user's experience before, during, and after opioid cessation. Participants described several reasons for wanting to stop opioids including lack of efficacy, impact on quality of life, and concerns about addiction. Barriers to cessation included concerns about inadequate pain management and concerns about the impact of stopping opioids on mood. After opioid cessation, the sample was mixed regarding the benefit of cessation. Half of the former opioid users reported their pain to be better or the same after stopping opioids; however, 47% of the sample reported feeling worse pain since stopping their opioids. As the pendulum swings from pain control to drug control, we must ensure that the response to the opioid epidemic does not cause harm to individuals with chronic pain. Novel opioid cessation interventions are needed in combination with methods of addressing individual challenges and barriers to adequate pain relief including access to and provision of nonopioid alternatives for pain management.

from PAIN - Featured Articles - Current Issue Highlights http://bit.ly/2XHyCJy
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Peripheral oxytocin restores light touch and nociceptor sensory afferents towards normal after nerve injury

Oxytocin reduces primary sensory afferent excitability and produces analgesia in part through a peripheral mechanism, yet its actions on physiologically characterized, mechanically sensitive afferents in normal and neuropathic conditions are unknown. We recorded intracellularly from L4 dorsal root ganglion neurons characterized as low-threshold mechanoreceptors (LTMRs) or high-threshold mechanoreceptors (HTMRs) in female rats 1 week after L5 partial spinal nerve injury or sham control (n = 24 rats/group) before, during, and after ganglionic perfusion with oxytocin, 1 nM. Nerve injury desensitized and hyperpolarized LTMRs (membrane potential [Em] was −63 ± 1.8 mV in sham vs −76 ± 1.4 mV in nerve injury; P < 0.001), and sensitized HTMRs without affecting Em. In nerve-injured rats, oxytocin depolarized LTMRs towards normal (Em = −69 ± 1.9 mV) and, in 6 of 21 neurons, resulted in spontaneous action potentials. By contrast, oxytocin hyperpolarized HTMRs (Em = −68 ± 2.7 mV before vs −80 ± 3.2 mV during oxytocin exposure; P < 0.01). These effects were reversed after removal of oxytocin, and oxytocin had minimal effects in neurons from sham surgery animals. Sensory afferent neurons immunopositive for the vasopressin 1a receptor were larger (34 ± 6.3 μm, range 16-57 μm) than immunonegative neurons (26 ± 3.4 μm, range 15-43 μm; P < 0.005). These data replicate findings that neuropathic injury desensitizes LTMRs while sensitizing HTMRs and show rapid and divergent oxytocin effects on these afferent subtypes towards normal, potentially rebalancing input to the central nervous system. Vasopressin 1a receptors are present on medium to large diameter afferent neurons and could represent oxytocin's target.

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Normative data for common pain measures in chronic pain clinic populations: closing a gap for clinicians and researchers

Normative data for chronic pain questionnaires are essential to the interpretation of aggregate scores on these questionnaires, for both clinical trials and clinical practice. In this study, we summarised data from 13,343 heterogeneous patients on several commonly used pain questionnaires that were routinely collected from 36 pain clinics in Australia and New Zealand as part of the electronic Persistent Pain Outcomes Collaboration (ePPOC) including the Brief Pain Inventory (BPI); the Depression Anxiety and Stress Scales (DASS); the Pain Self-Efficacy Questionnaire (PSEQ); and the Pain Catastrophizing Scale (PCS). The data are presented as summarised normative data, broken down by demographic (age, sex, work status, etc) and pain site/medical variables. The mean BPI severity score was 6.4 (moderate-severe), and mean interference score was 7.0. The mean DASS depression score was 20.2 (moderate-severe), mean DASS anxiety was 14.0 (moderate), and mean DASS stress was 21.0 (moderate). The mean PCS scores were 10.0, 5.9, 14.1, and 29.8 for rumination, magnification, helplessness, and total, respectively. The mean PSEQ score was 20.7. Men had slightly worse scores than women on some scales. Scores tended to worsen with age until 31 to 50 years, after which they improved. Scores were worse for those who had a greater number of pain sites, were unemployed, were injury compensation cases, or whose triggering event was a motor vehicle accident or injury at work or home. These results and comparisons with data on the same measures from other countries, as well as their uses in both clinical practice and clinical trials, are discussed.

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Anterior nucleus of paraventricular thalamus mediates chronic mechanical hyperalgesia

Pain-related diseases are the top leading causes of life disability. Identifying brain regions involved in persistent neuronal changes will provide new insights for developing efficient chronic pain treatment. Here, we showed that anterior nucleus of paraventricular thalamus (PVA) plays an essential role in the development of mechanical hyperalgesia in neuropathic and inflammatory pain models in mice. Increase in c-Fos, phosphorylated extracellular signal–regulated kinase, and hyperexcitability of PVA neurons were detected in hyperalgesic mice. Direct activation of PVA neurons using optogenetics and pharmacological approaches were sufficient to induce persistent mechanical hyperalgesia in naive animals. Conversely, inhibition of PVA neuronal activity using DREADDs (designer receptors exclusively activated by designer drugs) or inactivation of PVA extracellular signal–regulated kinase at the critical time window blunted mechanical hyperalgesia in chronic pain models. At the circuitry level, PVA received innervation from central nucleus of amygdala, a known pain-associated locus. As a result, activation of right central nucleus of amygdala with blue light was enough to induce persistent mechanical hyperalgesia. These findings support the idea that targeting PVA can be a potential therapeutic strategy for pain relief.

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Shorter versus longer immobilization after surgery for thumb carpometacarpal osteoarthritis: a propensity score matched study

Publication date: Available online 23 April 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Jonathan Tsehaie, Robbert M. Wouters, Reinier Feitz, Harm P. Slijper, Steven Hovius, Ruud W. Selles, Hand-Wrist Study Group

Abstract

Objective

To investigate if shorter immobilization is non-inferior to longer immobilization after Weilby procedure for thumb carpometacarpal osteoarthritis.

Design

Prospective cohort study with propensity score matching (PSM).

Setting

Data collection took place in sixteen outpatient clinics for hand surgery and hand therapy.

Participants

131 participants with shorter immobilization and 131 participants with longer immobilization.

Intervention

Shorter immobilization (3-5 days plaster cast followed by a thumb spica orthosis including wrist until 4 weeks postoperatively) was compared with longer immobilization (10-14 days plaster cast followed by a thumb spica orthosis including wrist until 6 weeks postoperatively) after Weilby procedure for CMC-1 osteoarthritis. PSM was used to control for confounders.

Main outcome measures

Outcomes were pain measured with a Visual Analogue Scale (VAS) and hand function measured with the Michigan Hand outcomes Questionnaire (MHQ) at three and twelve months. Secondary outcomes were complications, range of motion, grip and pinch strength, satisfaction with treatment and return to work.

Results

No significant differences were found in VAS pain (effect size 0.03, 95% C.I. -0.21-0.27) or the MHQ (effect size 0.01, 95% C.I. -0.23-0.25) between the groups at three months or at twelve months. Furthermore, no differences were found in complication rate or in other secondary outcomes.

Conclusions

In conclusion, shorter immobilization of 3-5 days of a plaster cast after Weilby procedure is equal compared to longer immobilization for outcomes on pain, hand function and our secondary outcomes. These results indicate that shorter immobilization is safe and can be recommended, since discomfort of longer immobilization may be prevented and patients may be able to recover sooner which may lead to reduced loss of productivity. Future studies need to investigate effectiveness of early active and more progressive hand therapy following CMC-1 arthroplasty.

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation http://bit.ly/2UCSTxV
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Heterogeneity of treatment effects in a randomized trial of literacy-adapted group cognitive-behavioral therapy, pain psychoeducation, and usual medical care for multiply disadvantaged patients with chronic pain

Chronic pain affects over 100 million American adults, costing up to $635 billion annually.27,28 Although recent advances have increased our understanding of treatment efficacy for chronic pain, about 40% of individuals report inadequate pain relief.7 Many individuals suffer from the negative effects of chronic pain, such as frequent absence from work and unemployment,6,19 limitations in physical activities,54 disability,47 decreased social interactions and/or perceived support,9,12 depression35 and anxiety.

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Splinting for the carpometacarpal joint relieves experimental basal thumb pain and loss of pinch strength

Abstract

Background

Splinting is a quite common intervention for the first carpometacarpal (CMC) osteoarthritis, however, underlying mechanisms of biomechanical and analgesic effects has not been fully investigated. The aim of this study was to develop an experimental basal thumb pain model and to elucidate the effects of CMC splinting on the pain profile and motor function.

Methods

In 14 healthy subjects, experimental basal thumb pain was induced by hypertonic saline injection into the dorsal radial ligament located on base of the first metacarpal bone. Isotonic saline was injected contralaterally as a control. Two experimental sessions with or without CMC splinting ware conducted. Before, during, and after injections, tip‐pinch strength was measured and surface electromyography (EMG) of the abductor pollicis longus (APB), first dorsal interosseous (FDI) and extensor pollicis longus (EPL) during tip‐pinch were evaluated in each session.

Results

Hypertonic saline induced significantly greater pain compared with baseline and isotonic saline (P<0.01). Following hypertonic saline injection, the tip‐pinch strength decreased compared with baseline, concomitant with reduction of electromyographical activity of APB and FDI, but not of EPL (P<0.05). The CMC splinting significantly improved the experimental pain, loss of pinch strength, and inhibited intrinsic muscle activity compared with bare hand (P<0.05).

Conclusions

A novel experimental model mimicking the first CMC joint pain was developed. The CMC splinting relieved the basal thumb pain and augmented pinch strength as well as intrinsic muscle activity. This study provides new insights into the pain relief and pinch strength improvement by splinting for painful CMC joint disorders.

This article is protected by copyright. All rights reserved.

from Wiley: European Journal of Pain: Table of Contents http://bit.ly/2ISq3Yf
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An internet delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: A randomised controlled trial

Abstract

Chronic pain is common after spinal cord injury (SCI) and dedicated SCI cognitive behavioural therapy pain management programmes (CBT‐PMPs) have a growing evidence‐base to support their uptake clinically. The development of internet‐delivered treatment options may overcome barriers to the access and uptake of centre‐based programmes. This study examines such an approach on quality of lie (QoL), pain, mood and sleep.

Methods

Adults with SCI pain (>3 months) were recruited and randomly assigned to the intervention or control group. The intervention comprised a six module CBT‐PMP delivered once weekly. A blinded assessor determined changes in self‐reported outcome measures post intervention and at three months. Linear Mixed Models and effect sizes based on changes between groups were reported. Significance was set P<0.05.

Results

The recruitment rate was 32% (intervention n=35, control n=34), and the drop‐out rate at three months was 26%. On average participants accessed 3 (sd 2.1) of 6 modules. Whilst no difference in QoL was reported, a significant group*time interaction was found for NRS of current pain (Χ²=8.22, p=0.016) worst pain (Χ²=11.20, p=0.004) and Brief Pain Inventory (interference) (Χ²= 6.924, p= 0.031). Moderate to large effect sizes favouring the intervention were demonstrated at each timepoint for the pain metrics (Cohen's d: 0.38‐0.84). At three month follow up 48% of the intervention group rated themselves improved or very much improved.

Conclusions

This study demonstrates the potential of an internet delivered SCI specific CBT‐PMP in reporting significant statistical and clinical benefit in pain intensity and interference. Strategies to improve engagement are needed.

This article is protected by copyright. All rights reserved.

from Wiley: European Journal of Pain: Table of Contents http://bit.ly/2Iwp68e
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Commentary to the paper: The effectiveness of self‐management interventions in adults with chronic orofacial pain: A systematic review, Meta‐analysis and Meta‐regression. European Journal of Pain

Abstract

The current issue includes a paper by Aggarwal et al (2019), entitled “The effectiveness of self‐management interventions in adults with chronic orofacial pain: A Systematic review, Meta‐analysis and Meta‐regression”. The paper is very relevant for both research and evidenced‐based practice, since it presents a comprehensive overview of existing published findings on self‐management programmes in chronic orofacial pain.

This article is protected by copyright. All rights reserved.

from Wiley: European Journal of Pain: Table of Contents http://bit.ly/2Xo1dDe
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Parent psychological flexibility in the context of pediatric pain: Brief assessment and associations with parent behavior and child functioning

Abstract

Background

The parent's role in the context of pediatric chronic pain is essential. There is growing evidence that parent psychological flexibility positively impacts child functioning. To assess parents’ abilities to respond with psychological flexibility to their child's pain, the Parent Psychological Flexibility Questionnaire (PPFQ) was developed. Here, we aim to validate the 10‐item version of the questionnaire in an English‐speaking population and to evaluate associations with parent behavior, child pain acceptance and functioning.

Methods

578 parent‐child dyads presenting at a pediatric pain clinic were included (92% mothers, average child age 15.2 ± 1.6y). The PPFQ was completed by the parent. Parent and child also completed other standardized questionnaires. In addition to confirmatory factor analysis and assessments of reliability and validity of the PPFQ‐10, a mediation analysis was performed to examine the direct and indirect effects of parent psychological flexibility on child functioning.

Results

Confirmatory factor analysis supported the three‐factor model with subscales for Values‐Based Action, Pain Willingness and Emotional Acceptance, and the PPFQ‐10 demonstrated strong psychometric properties. After controlling for child pain, parent psychological flexibility indirectly affected child functioning through its association with both parent behavior (i.e., protectiveness) and child pain acceptance.

Conclusions

Our findings provide further support for use of the PPFQ‐10 and the importance of assessing and addressing parent psychological flexibility in the context of child chronic pain. Our data show that parent psychological flexibility has an important adaptive role and can impact child functioning through two different routes, both of which can be actively targeted in treatment.

This article is protected by copyright. All rights reserved.

from Wiley: European Journal of Pain: Table of Contents http://bit.ly/2IxzPj8
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The Relationships between Worry, Happiness, and Pain Catastrophizing in the Experience of Acute Pain

Abstract

Background

The current study aimed to (1) evaluate the effects of an experimental manipulation of worry and happiness on pain perception and measures of worry about pain and pain catastrophizing and (2) determine if changes in situation‐specific worry about pain and pain catastrophizing would be related to changes in acute pain.

Methods

The study included 120 healthy, pain‐free volunteers. Participants were exposed to four levels of noxious stimulation and asked to report on the pain intensity, worry about pain, and pain catastrophizing they experienced during the stimulation procedures. They were then randomly assigned to either a Happy or a Worry condition, where they were exposed to emotion induction procedures. The noxious exposure procedures and measures of pain, pain‐related worry, and pain catastrophizing were then repeated.

Results

Participants in the Worry condition reported significant increases in pain intensity, and those in the Happy condition reported significant decreases in pain intensity. Further, the Worry condition participants reported significant increases in both pain‐related worry and pain catastrophizing, while the Happy condition showed the opposite effects. Finally, changes in worry about pain and pain catastrophizing were found to mediate the impact of the affect induction procedure on pain intensity.

Conclusions

The findings demonstrate that pain intensity, worry about pain and pain catastrophizing are all sensitive to changes in mood. The results have potential clinical implications.

This article is protected by copyright. All rights reserved.

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Oxytocin Effects on Pain Perception and Pain Anticipation

Searching for new analgesics there is an ongoing debate whether the hypothalamic neuropeptide oxytocin (OT) has a modulatory effect on pain processing. Strong evidence for an analgesic property of OT comes from rodents, where OT was shown to act in several regions of the pain matrix with the ventral striatum (VS) being identified as a main target region of antinoiceptive OT effects 14, 44. OT may also exert effects on pain anticipation since a specific subpopulation of OT neurons was found to be activated during pain anticipation in rodents (V.

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[Editorial] The doctors' predicament: China's health-care growing pains

The Chinese characters for doctor also refer to scholar-bureaucrats, which was the highest aspiration for intellectuals in ancient China. Doctors were then respected as much as Confucian elites who were supposed to have high moral standards and be well educated, altruistic, and dedicated to serving the country. However, in modern China, medicine is no longer seen as a noble or an attractive profession. Last week, four officials were removed from their posts on the basis of their negligence in reviewing and approving an anti-gang brochure in which doctors were portrayed as gangs and listed as first among the top ten gang categories in China.

from The Lancet http://bit.ly/2Pl38WG
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[Comment] Opioid analgesics pass the acid test

Understanding of the neurobiology of pain continues to increase at a remarkable pace, raising optimism for improvements in pain therapy. Physicians can choose from multiple classes of medications to treat acute or chronic pain that can often be highly effective. Many patients, however, do not have their pain well controlled with available drugs, and these drugs often have severe side-effects that can ultimately diminish quality of life and potentially result in serious harm.1 Hence, the need for new medicines for treatment of pain remains very high.

from The Lancet http://bit.ly/2Pq7FqV
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AAPT Diagnostic Criteria for Chronic Painful Temporomandibular Disorders

In order to resolve well-known problems arising from the lack of a comprehensive, reliable, valid and utilitarian taxonomy of common chronic pain conditions, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership has joined together with the U.S. Food and Drug Administration (FDA) and with the American Pain Society (APS) in order to develop an evidence-based taxonomy applicable to research and clinical management for diagnosing and classifying the most common chronic pain conditions.

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Evaluation of post-surgical hyperalgesia and sensitization after open inguinal hernia repair: a useful model for neuropathic pain?

Pre-clinical research has identified numerous mechanisms for neuropathic pain that can be targeted by drugs for pain relief in patients,11 but most novel compounds have failed as clinically useful analgesics.33 These failures emphasize the extent of the difficulties translating drug efficacy from animal models to patients.38 To aid clinical translation, early phase studies may involve testing of potentially analgesic compounds in healthy human volunteers. Such studies involve the induction of symptoms that are relevant to peripheral or central sensitization, against which the potential of an analgesic can be assessed.

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Desmetramadol has the Safety and Analgesic Profile of Tramadol Without Its Metabolic Liabilities: Consecutive Randomized, Double-Blind, Placebo- and Active Comparator-Controlled Trials

It has been recommended that the morphine milligram equivalent dose in patients receiving opioid therapy be reduced in order to reduce opioid-related overdose and death.15, 20, 30 There are unfortunately limited pharmacologic options for patients seeking an alternative to schedule II opioids who still require effective analgesia. A critical challenge therefore exists to identify analgesic options for those suffering from pain that are safer and reduce the risk of treatment-related death.

from The Journal of Pain http://bit.ly/2v9hXlL
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Adverse Childhood Experiences in Mothers with Chronic Pain and Intergenerational Impact on Children

Exposure to adverse childhood experiences (ACEs) (e.g. abuse, neglect, parental divorce, etc.) has been linked to a number of poor physical and mental health outcomes in adulthood.12 These poor health outcomes often include multiple somatic symptoms, chronic pain, depression and anxiety.9, 28, 42 In a study examining ACE prevalence in childhood, and risk of frequent headaches in adulthood, researchers found that as ACE scores increased, the prevalence and risk of headaches increased significantly.

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Whole body vibration exercise for chronic musculoskeletal pain: A Systematic review and meta-analysis of randomized controlled trials

Publication date: Available online 17 April 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Yulin Dong, Wang Wu, Jiejiao Zheng, Su Chen, Jun Qiao, Xueqiang Wang

Abstract

Objective

This study systematically reviews previous work on the effects of whole body vibration exercise (WBVE) on pain associated with chronic musculoskeletal disorders.


Data Sources

Seven electronic databases (PubMed, Embase, CINAHL, Web of Science, Cochrane, Physiotherapy Evidence and CNKI) were searched for articles published between January 1980 and September 2018.


Study Selection

Randomized control trials involving adults with chronic low back pain (CLBP), osteoarthritis (OA) or fibromyalgia were included. Participants in the WBVE intervention group were compared with those in the non-treatment and non-WBVE control groups.


Data Extraction

Data were independently extracted using a standardised form. Methodological quality was assessed using the Physiotherapy Evidence Database scale (Pedro).

Data Synthesis

Suitable data from 16 studies were pooled for meta-analysis. A random effects model was used to calculate between-groups mean differences at 95% confidence interval (CI). The data were analysed depending on the duration of the follow-up, common disorders and different control interventions.

Results

Alleviation of pain was observed at medium term (standardised mean difference (SMD, −0.67; 95% CI, −1.14 to −0.21; I², 80%) and long term (SMD, −0.31; 95% CI, −0.59 to −0.02; I², 0%). Pain was alleviated in OA (SMD, −0.37; 95% CI, −0.64 to −0.10; P < 0.05; I², 22%) and CLBP (SMD, −0.44; 95% CI, −0.75 to −0.13; P < 0.05; I², 12%). Long term WBVE could relieve chronic musculoskeletal pain conditions of OA (SMD, −0.46; 95% CI, −0.80 to −0.13; I², 0%; P < 0.05). WBVE improved chronic musculoskeletal pain compared with the treatment “X” control (SMD, −0.37; 95% CI, −0.61 to −0.12; I², 26%; P < 0.05), traditional treatment control (SMD, -1.02; 95% CI, −2.44 to 0.4; I², 94%; P > 0.05) and no treatment control (SMD, −1; 95% CI, −1.76 to −0.24; I², 75%; P < 0.05).

Conclusions

Evidence suggests the positive effects of WBVE on chronic musculoskeletal pain, long durations of WBVE could be especially beneficial. However, WBVE doesn’t significantly relieve chronic musculoskeletal pain compared with the traditional treatment. Further work is required to identify which parameters of WBVE are ideal for patients with chronic musculoskeletal pain.

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Is surgery effective in patients with femoroacetabular impingement syndrome?

What you need to knowConsider femoroacetabular impingement syndrome (FAIS) as a possible diagnosis in young adults with hip or groin pain and features suggestive of impingement on imagingTrials...

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BMJ Awards 2019: Primary Care Team of the Year

Novel approach to opiate useStation Practice in Hastings developed a novel, holistic model of care to wean patients with chronic pain off opiates when they identified a problem with opiate...

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BMJ Awards 2019: Clinical Leadership Team of the Year

A multidisciplinary team for trigeminal neuralgiaTrigeminal neuralgia is a rare chronic condition that causes agonising facial pain and is commonly triggered by light touch. “It’s like an electric...

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