This study examined whether pain-related psychosocial factors predicted whether treatment gains were maintained following participation in a physical rehabilitation program for musculoskeletal injuries. The study assessed 310 individuals at admission to rehabilitation, discharge, and 1-year follow up. It found that individuals with high scores on measures of pain catastrophizing and fear of pain at discharge were more likely to experience a return of their pain symptoms and failure to maintain treatment gains at the 1-year follow up. The results suggest that treatment gains may not be sustained long-term if end-of-treatment scores on catastrophizing and fear of pain remain elevated.
Efficacy of classification-based_cft_in_nsclbpMeziat
Artigo (6) importante para a preparação para o curso de dor lombar crônica. "Eficácia da Terapia Cognitiva Funcional em pacientes com dor lombar crônica inespecífica: ensaio clínico randomizado controlado."
Free Sample copy of TSM MSK 07 Transformational Shift module for chronic pain complete with energetic downloads for more information visit our website www.VisualizeHealth.net
This randomized controlled trial compared the effectiveness of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain. The trial found that:
1) SMT had a statistically significant advantage over medication in reducing pain up to 1 year after treatment based on participant-reported pain levels.
2) HEA was as effective as SMT, with no important differences in pain reduction between the two treatments at any time point.
3) Both SMT and HEA were more effective for reducing neck pain than medication in both the short and long term.
Cognitive behavioral therapy (CBT) improved quality of life more than standard treatment alone in patients with chronic musculoskeletal pain. A randomized clinical trial assigned 93 patients to either CBT or standard treatment control groups. After 10 weeks, CBT resulted in a 54% reduction in pain levels compared to 28.9% for control. CBT also reduced depressive symptoms and improved physical limitations, general health, and limitations due to emotional problems domains of quality of life more than standard treatment alone. CBT was shown to be an effective addition to standard treatment for improving aspects of chronic pain.
The article discusses the impacts of the COVID-19 pandemic on physiatry and rehabilitation medicine. It highlights how physiatrists played a vital role in the front lines during the pandemic by converting rehabilitation units and innovating care delivery. However, the pandemic has also caused significant disruptions and stress for medical practices through reduced patient volumes, higher costs, and threats of reimbursement cuts from insurers and governments. Moving forward, physicians are questioning the level of support they will receive from their employers and the government given the sacrifices many have made during the pandemic.
The effectiveness of remedial massage therapy in dealing with muscular issues...Nicholaslaverty
This document summarizes a study on the effectiveness of remedial massage therapy for dealing with muscular issues in active adults. The study surveyed 47 active individuals who received remedial massage at least twice previously. Results showed remedial massage was used predominantly when needed rather than as part of regular training, and was rated most effective at increasing range of motion. Massage was often used in combination with physiotherapy and aids like stretching. Further research is still needed to verify all benefits and applications of massage therapy.
This document discusses effective physical treatments for chronic low back pain. It finds that exercise is one of the few clearly effective treatments, with systematic reviews finding exercise reduces pain and disability. While exercise is effective, the optimal implementation is unclear. Two example programs discussed are group general exercise and individually supervised specific spinal stabilization exercise. The document also discusses laser therapy for chronic back pain, but notes no systematic review has evaluated its efficacy.
This document discusses emerging pharmacological and non-pharmacological aspects in pain management. It notes that multimodal analgesia using combinations of drugs targeting different pain pathways can provide improved pain relief with reduced side effects compared to single drugs. Newer drugs targeting specific receptor subtypes are emerging. Non-invasive options such as topical agents, exercise, and interventional techniques are increasingly utilized before more invasive options. Interventional pain management techniques discussed include injections, neurolysis, and spinal cord stimulation.
Efficacy of classification-based_cft_in_nsclbpMeziat
Artigo (6) importante para a preparação para o curso de dor lombar crônica. "Eficácia da Terapia Cognitiva Funcional em pacientes com dor lombar crônica inespecífica: ensaio clínico randomizado controlado."
Free Sample copy of TSM MSK 07 Transformational Shift module for chronic pain complete with energetic downloads for more information visit our website www.VisualizeHealth.net
This randomized controlled trial compared the effectiveness of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain. The trial found that:
1) SMT had a statistically significant advantage over medication in reducing pain up to 1 year after treatment based on participant-reported pain levels.
2) HEA was as effective as SMT, with no important differences in pain reduction between the two treatments at any time point.
3) Both SMT and HEA were more effective for reducing neck pain than medication in both the short and long term.
Cognitive behavioral therapy (CBT) improved quality of life more than standard treatment alone in patients with chronic musculoskeletal pain. A randomized clinical trial assigned 93 patients to either CBT or standard treatment control groups. After 10 weeks, CBT resulted in a 54% reduction in pain levels compared to 28.9% for control. CBT also reduced depressive symptoms and improved physical limitations, general health, and limitations due to emotional problems domains of quality of life more than standard treatment alone. CBT was shown to be an effective addition to standard treatment for improving aspects of chronic pain.
The article discusses the impacts of the COVID-19 pandemic on physiatry and rehabilitation medicine. It highlights how physiatrists played a vital role in the front lines during the pandemic by converting rehabilitation units and innovating care delivery. However, the pandemic has also caused significant disruptions and stress for medical practices through reduced patient volumes, higher costs, and threats of reimbursement cuts from insurers and governments. Moving forward, physicians are questioning the level of support they will receive from their employers and the government given the sacrifices many have made during the pandemic.
The effectiveness of remedial massage therapy in dealing with muscular issues...Nicholaslaverty
This document summarizes a study on the effectiveness of remedial massage therapy for dealing with muscular issues in active adults. The study surveyed 47 active individuals who received remedial massage at least twice previously. Results showed remedial massage was used predominantly when needed rather than as part of regular training, and was rated most effective at increasing range of motion. Massage was often used in combination with physiotherapy and aids like stretching. Further research is still needed to verify all benefits and applications of massage therapy.
This document discusses effective physical treatments for chronic low back pain. It finds that exercise is one of the few clearly effective treatments, with systematic reviews finding exercise reduces pain and disability. While exercise is effective, the optimal implementation is unclear. Two example programs discussed are group general exercise and individually supervised specific spinal stabilization exercise. The document also discusses laser therapy for chronic back pain, but notes no systematic review has evaluated its efficacy.
This document discusses emerging pharmacological and non-pharmacological aspects in pain management. It notes that multimodal analgesia using combinations of drugs targeting different pain pathways can provide improved pain relief with reduced side effects compared to single drugs. Newer drugs targeting specific receptor subtypes are emerging. Non-invasive options such as topical agents, exercise, and interventional techniques are increasingly utilized before more invasive options. Interventional pain management techniques discussed include injections, neurolysis, and spinal cord stimulation.
This study tested a novel training program to recalibrate perceptions of body size in women with high body concerns and in women with atypical anorexia nervosa (aAN). In Study 1, women with high body concerns were randomly assigned to intervention or control groups. The intervention group underwent four daily training sessions where they judged body sizes and received feedback to improve accuracy. This significantly improved their body size judgements and reduced body and eating concerns compared to controls. In Study 2, the training also recalibrated judgements in women with aAN and reduced their body size and eating concerns. The training shows potential as a valuable addition to traditional therapies for treating body image disturbances.
The document discusses the high rates of burnout among clinicians and its negative consequences. It summarizes various studies that show mindfulness training through yoga, meditation, and other stress-reduction techniques can help reduce burnout. Implementing weekly mindfulness classes for clinicians may help improve their resilience, quality of life, work performance, and patient outcomes while providing cost savings for healthcare organizations.
Spinal manipulation therapy (SMT) was more effective than medication for relieving acute or subacute neck pain in both the short and long term. Home exercise with advice (HEA) resulted in similar pain outcomes to SMT at most time points. For 272 participants with neck pain lasting 2-12 weeks, SMT had statistically significantly less pain than medication after 8 weeks and up to 1 year later. HEA was superior to medication for pain relief at 26 weeks. No important differences in pain were found between SMT and HEA. The trial demonstrated that SMT and HEA were both more effective than medication for acute or subacute neck pain.
Cognitive Behavior Therapy combined with Physical Exercise for Adults with Ch...BERNARD Paquito
Cognitive Behavior Therapy combined with Physical Exercise for Adults with Chronic Diseases Systematic Review and Meta-Analysis
OPEN ACCESS https://archipel.uqam.ca/10922/1/Bernard%202018%20CBTEx.pdf
Common Brain Mechanisms Between Pain & AddictionPaul Coelho, MD
This document summarizes a perspective on common brain mechanisms of chronic pain and addiction. It proposes that chronic pain involves neuroadaptations similar to those seen in addiction, including reward deficiency, impaired inhibitory control, incentive sensitization, aberrant learning, and anti-reward allostatic neuroadaptations. The document provides epidemiological context on the prevalence and costs of chronic pain. It then reviews models of reward and addiction neurobiology and discusses how chronic pain may disrupt normal hedonic homeostasis in a manner analogous to addiction through an allostatic load. The perspective aims to inform improved chronic pain treatment by drawing parallels to addiction theories and interventions.
Laura Mann Center Integrative Lecture Series: Fall 2014Cara Feldman-Hunt
The document discusses the history and impact of the Penny George Institute for Health and Healing (PGIHH) at Allina Health, an integrated health system in Minnesota. Key points:
1) PGIHH was founded in 2003 and is now the largest integrative health program integrated within a health system. It focuses on prevention, wellness, and lifestyle-related diseases.
2) Studies show PGIHH services significantly reduce patient pain, anxiety, and length of hospital stays. For example, oncology patients saw a 46.9% reduction in pain and 56.1% reduction in anxiety.
3) PGIHH aims to transform healthcare delivery through a holistic, preventative approach.
‘Neurodynamics as a therapeutic intervention; the effectiveness and scientifi...NVMT-symposium
This document discusses the evidence for neural mobilization as a treatment for nerve disorders. It begins by reviewing animal studies showing that movement such as exercise prevents neuropathic pain development, aids nerve recovery after injury, and reduces neuropathic pain. However, the evidence for neural mobilization and nerve gliding exercises in humans is limited. A systematic review found limited evidence that neural mobilization is more effective than minimal interventions for pain and disability in carpal tunnel syndrome, but not more effective than other treatments. Another review found limited evidence for the effectiveness of nerve gliding exercises in carpal tunnel syndrome. The document concludes that while movement may be beneficial, the evidence does not clearly support neural mobilization over other conservative treatments, and more high-quality research is
This document summarizes evidence from research studies on the effectiveness of biofeedback-based interventions for various health conditions, rating the level of evidence on a scale from 1 to 4. It finds level 1 evidence for biofeedback helping problems like anxiety, arthritis, asthma, chronic pain, diabetes and others. Higher levels of evidence (3-4) are found for biofeedback reducing headaches, high blood pressure, insomnia, irritable bowel syndrome and temporomandibular disorders. The strongest evidence is for randomized controlled trials comparing biofeedback to no treatment or an alternative.
Assessment and management of complex pain conditionsSaurab Sharma
This was a presentation made at NITTE University during their first Physiotherapy Conference where I was invited as a Speaker. I am posting this thinking if this will be useful revision for those who attended and may be of some use to those who could not listen.
Comparison of Passive Stretching Versus Massage on Preventing the Symptoms of...dbpublications
This study compared the effectiveness of passive stretching and massage on preventing symptoms of delayed onset muscle soreness (DOMS) in normal adults. 50 subjects performed eccentric exercises to induce DOMS in their biceps, then were randomly assigned to receive either passive stretching or massage. Pain, range of motion, and swelling were measured before and after the interventions, and at 24, 48, and 72 hours. Massage decreased pain immediately after more than stretching, and improved range of motion recovery at all timepoints compared to stretching. However, both interventions had equal effects on reducing pain at later timepoints and reducing swelling. The results show that massage may provide faster relief of DOMS symptoms than passive stretching.
Poster on Psychosocial risk factors and musculoskeletal symptoms among nursesSiti Mastura
Nurses are at high risk of developing musculoskeletal symptoms due to the physical demands of their work including lifting, awkward postures, and transferring patients. This study examined the prevalence of musculoskeletal symptoms and relationship to psychosocial risk factors among nurses at Sultanah Bahiyah Hospital in Kedah, Malaysia. The results showed the highest prevalence of symptoms was in the upper back (70.6%), lower back (58%), and shoulders (55.9%). Most nurses reported high decision latitude, high job demands, good social support, high job insecurity, and job dissatisfaction. Social support and job insecurity were significantly associated with musculoskeletal symptoms. The findings suggest improving social support through team building and addressing job insecurity to help minimize
Pautas para el manejo del dolor en perros.pdfDanielBarriga10
These updated 2022 AAHA pain management guidelines provide a practical approach to assessing and managing acute and chronic pain in dogs and cats. Key points include:
- Emphasizing proactive, preemptive pain management rather than reactive approaches.
- Using a multimodal treatment strategy to minimize reliance on any single drug and reduce side effects.
- Developing coordinated pain management plans involving the entire veterinary team and regular communication with pet owners.
- Tailoring assessment and treatment approaches to differences between canine and feline patients.
This document provides an overview of day 2 of a course on integrating whole health approaches for pain and suffering. The day includes sessions on integrative health and whole health in practice, as well as mind-body skills training. Specific mind-body skills covered are diaphragmatic breathing, progressive muscle relaxation, autogenic training, guided imagery, and biofeedback training. The benefits of these skills for reducing pain and stress are discussed. Manual therapies like chiropractic, osteopathic medicine, massage, and physical therapy are presented as professional care approaches. Complementary therapies like acupuncture are also explored, including evidence for their effectiveness in treating low back pain and other conditions.
This randomized controlled trial examined whether cognitive behavioral therapy for insomnia (CBT-I) delivered by a therapist is more effective than self-help CBT-I materials at reducing insomnia and depression in individuals with comorbid insomnia and depression being treated with antidepressants. 41 participants were randomized to receive either 4 sessions of CBT-I or self-help materials over 8 weeks. Compared to the self-help group, the CBT-I group showed significantly greater reductions in both insomnia and depression scores post-treatment and at 3-month follow-up. The results suggest that targeting insomnia through CBT-I can effectively treat comorbid insomnia and depression and should be considered an important adjunct treatment for patients whose depression has not fully
Comparison of Passive Stretching Versus Massage on Preventing the Symptoms of...dbpublications
OBJECTIVE: To compare the effectiveness of passive stretching versus massage on preventing the symptoms of delayed onset muscle soreness in normal adults. STUDY DESIGN: Quasi- Experimental study design. SUBJECTS: 50subjects, with the age group of 18-21 years of both the genders were selected. INTERVENTION: Subjects were randomly divided into 2 groups (Group A& Group B), 25 subjects in Group A received passive stretching and 25 subjects in Group B received Massage after 3 hours of inducing DOMS. OUTCOME MEASURE: Pain, Elbow Range of Motion and swelling were assessed by Visual analogue scale, goniometer, Inch tape. RESULTS: Statistical analysis was done by using independent ‘t’ test and paired ‘t’ test which showed there is no statistical significant difference between Group A(Passive stretching) and Group B(Massage). CONCLUSION: The result of this study concludes that massage decreased the pain immediately after intervention and regained the Elbow Range of Motion at immediately at 24 hours, at 48 hours and 72 hours than passive stretching. But massage and passive stretching has equal effect on pain reduction at 24hours, 48 hours and 72 hours after intervention. Similarly they both have equal effect on Arm Circumference.
This document discusses pain assessment and management for people with advanced dementia. It notes that pain is underreported and undertreated in cognitively impaired older adults due to challenges in assessment. It recommends using behavioral observation scales to assess pain in people with dementia, and provides examples of assessment tools like the Doloplus-2 scale and Abbey Pain Scale. It also provides guidance on managing chronic pain in older adults with dementia, including starting low-dose regular analgesics and considering transdermal patches to provide steady doses.
This document discusses pain, including definitions of pain, types of pain, factors influencing pain, effects of pain, individual variations in pain response, and pain assessment tools. It also covers postoperative pain management principles like the WHO pain ladder, pharmacological and non-pharmacological interventions for pain control, preemptive analgesia using local anesthetics or other drugs before a painful stimulus to reduce later pain, and techniques like patient-controlled analgesia and epidural analgesia. The goal of pain management is to prevent pain from interfering with recovery through adequate assessment and treatment.
1) Exercise has been shown to have significant mental health benefits such as reducing symptoms of depression and anxiety. However, psychologists have been slow to incorporate exercise into treatment plans.
2) Research shows that both short-term and long-term exercise can help alleviate symptoms of depression and may be comparable to antidepressant medication. Exercise is also associated with reduced risk of relapse.
3) Exercise has benefits for reducing anxiety as well. Regular physical activity can help those prone to anxiety become less sensitive to fight-or-flight symptoms that could trigger panic attacks.
La Navidad es una festividad cristiana que celebra el nacimiento de Jesucristo. Se celebra el 25 de diciembre y es una ocasión para reunirse con la familia y los amigos, intercambiar regalos y mostrar afecto.
Incident opioid abuse and dependence sullivan 2014Paul Coelho, MD
This study investigated the association between prescription opioid exposure and risk of opioid use disorder (OUD) among individuals with chronic noncancer pain (CNCP). The study used claims data from 2000-2005 for over 500,000 individuals with a new CNCP diagnosis and no recent opioid use or OUD. The results showed significantly higher rates of OUD among those prescribed opioids compared to those not prescribed opioids. Risk increased with longer duration of therapy and higher daily doses. Chronic opioid therapy, even at low doses, was associated with substantially increased risk of OUD compared to acute therapy or no opioids. Duration of opioid therapy was more important than daily dose in determining OUD risk.
This study tested a novel training program to recalibrate perceptions of body size in women with high body concerns and in women with atypical anorexia nervosa (aAN). In Study 1, women with high body concerns were randomly assigned to intervention or control groups. The intervention group underwent four daily training sessions where they judged body sizes and received feedback to improve accuracy. This significantly improved their body size judgements and reduced body and eating concerns compared to controls. In Study 2, the training also recalibrated judgements in women with aAN and reduced their body size and eating concerns. The training shows potential as a valuable addition to traditional therapies for treating body image disturbances.
The document discusses the high rates of burnout among clinicians and its negative consequences. It summarizes various studies that show mindfulness training through yoga, meditation, and other stress-reduction techniques can help reduce burnout. Implementing weekly mindfulness classes for clinicians may help improve their resilience, quality of life, work performance, and patient outcomes while providing cost savings for healthcare organizations.
Spinal manipulation therapy (SMT) was more effective than medication for relieving acute or subacute neck pain in both the short and long term. Home exercise with advice (HEA) resulted in similar pain outcomes to SMT at most time points. For 272 participants with neck pain lasting 2-12 weeks, SMT had statistically significantly less pain than medication after 8 weeks and up to 1 year later. HEA was superior to medication for pain relief at 26 weeks. No important differences in pain were found between SMT and HEA. The trial demonstrated that SMT and HEA were both more effective than medication for acute or subacute neck pain.
Cognitive Behavior Therapy combined with Physical Exercise for Adults with Ch...BERNARD Paquito
Cognitive Behavior Therapy combined with Physical Exercise for Adults with Chronic Diseases Systematic Review and Meta-Analysis
OPEN ACCESS https://archipel.uqam.ca/10922/1/Bernard%202018%20CBTEx.pdf
Common Brain Mechanisms Between Pain & AddictionPaul Coelho, MD
This document summarizes a perspective on common brain mechanisms of chronic pain and addiction. It proposes that chronic pain involves neuroadaptations similar to those seen in addiction, including reward deficiency, impaired inhibitory control, incentive sensitization, aberrant learning, and anti-reward allostatic neuroadaptations. The document provides epidemiological context on the prevalence and costs of chronic pain. It then reviews models of reward and addiction neurobiology and discusses how chronic pain may disrupt normal hedonic homeostasis in a manner analogous to addiction through an allostatic load. The perspective aims to inform improved chronic pain treatment by drawing parallels to addiction theories and interventions.
Laura Mann Center Integrative Lecture Series: Fall 2014Cara Feldman-Hunt
The document discusses the history and impact of the Penny George Institute for Health and Healing (PGIHH) at Allina Health, an integrated health system in Minnesota. Key points:
1) PGIHH was founded in 2003 and is now the largest integrative health program integrated within a health system. It focuses on prevention, wellness, and lifestyle-related diseases.
2) Studies show PGIHH services significantly reduce patient pain, anxiety, and length of hospital stays. For example, oncology patients saw a 46.9% reduction in pain and 56.1% reduction in anxiety.
3) PGIHH aims to transform healthcare delivery through a holistic, preventative approach.
‘Neurodynamics as a therapeutic intervention; the effectiveness and scientifi...NVMT-symposium
This document discusses the evidence for neural mobilization as a treatment for nerve disorders. It begins by reviewing animal studies showing that movement such as exercise prevents neuropathic pain development, aids nerve recovery after injury, and reduces neuropathic pain. However, the evidence for neural mobilization and nerve gliding exercises in humans is limited. A systematic review found limited evidence that neural mobilization is more effective than minimal interventions for pain and disability in carpal tunnel syndrome, but not more effective than other treatments. Another review found limited evidence for the effectiveness of nerve gliding exercises in carpal tunnel syndrome. The document concludes that while movement may be beneficial, the evidence does not clearly support neural mobilization over other conservative treatments, and more high-quality research is
This document summarizes evidence from research studies on the effectiveness of biofeedback-based interventions for various health conditions, rating the level of evidence on a scale from 1 to 4. It finds level 1 evidence for biofeedback helping problems like anxiety, arthritis, asthma, chronic pain, diabetes and others. Higher levels of evidence (3-4) are found for biofeedback reducing headaches, high blood pressure, insomnia, irritable bowel syndrome and temporomandibular disorders. The strongest evidence is for randomized controlled trials comparing biofeedback to no treatment or an alternative.
Assessment and management of complex pain conditionsSaurab Sharma
This was a presentation made at NITTE University during their first Physiotherapy Conference where I was invited as a Speaker. I am posting this thinking if this will be useful revision for those who attended and may be of some use to those who could not listen.
Comparison of Passive Stretching Versus Massage on Preventing the Symptoms of...dbpublications
This study compared the effectiveness of passive stretching and massage on preventing symptoms of delayed onset muscle soreness (DOMS) in normal adults. 50 subjects performed eccentric exercises to induce DOMS in their biceps, then were randomly assigned to receive either passive stretching or massage. Pain, range of motion, and swelling were measured before and after the interventions, and at 24, 48, and 72 hours. Massage decreased pain immediately after more than stretching, and improved range of motion recovery at all timepoints compared to stretching. However, both interventions had equal effects on reducing pain at later timepoints and reducing swelling. The results show that massage may provide faster relief of DOMS symptoms than passive stretching.
Poster on Psychosocial risk factors and musculoskeletal symptoms among nursesSiti Mastura
Nurses are at high risk of developing musculoskeletal symptoms due to the physical demands of their work including lifting, awkward postures, and transferring patients. This study examined the prevalence of musculoskeletal symptoms and relationship to psychosocial risk factors among nurses at Sultanah Bahiyah Hospital in Kedah, Malaysia. The results showed the highest prevalence of symptoms was in the upper back (70.6%), lower back (58%), and shoulders (55.9%). Most nurses reported high decision latitude, high job demands, good social support, high job insecurity, and job dissatisfaction. Social support and job insecurity were significantly associated with musculoskeletal symptoms. The findings suggest improving social support through team building and addressing job insecurity to help minimize
Pautas para el manejo del dolor en perros.pdfDanielBarriga10
These updated 2022 AAHA pain management guidelines provide a practical approach to assessing and managing acute and chronic pain in dogs and cats. Key points include:
- Emphasizing proactive, preemptive pain management rather than reactive approaches.
- Using a multimodal treatment strategy to minimize reliance on any single drug and reduce side effects.
- Developing coordinated pain management plans involving the entire veterinary team and regular communication with pet owners.
- Tailoring assessment and treatment approaches to differences between canine and feline patients.
This document provides an overview of day 2 of a course on integrating whole health approaches for pain and suffering. The day includes sessions on integrative health and whole health in practice, as well as mind-body skills training. Specific mind-body skills covered are diaphragmatic breathing, progressive muscle relaxation, autogenic training, guided imagery, and biofeedback training. The benefits of these skills for reducing pain and stress are discussed. Manual therapies like chiropractic, osteopathic medicine, massage, and physical therapy are presented as professional care approaches. Complementary therapies like acupuncture are also explored, including evidence for their effectiveness in treating low back pain and other conditions.
This randomized controlled trial examined whether cognitive behavioral therapy for insomnia (CBT-I) delivered by a therapist is more effective than self-help CBT-I materials at reducing insomnia and depression in individuals with comorbid insomnia and depression being treated with antidepressants. 41 participants were randomized to receive either 4 sessions of CBT-I or self-help materials over 8 weeks. Compared to the self-help group, the CBT-I group showed significantly greater reductions in both insomnia and depression scores post-treatment and at 3-month follow-up. The results suggest that targeting insomnia through CBT-I can effectively treat comorbid insomnia and depression and should be considered an important adjunct treatment for patients whose depression has not fully
Comparison of Passive Stretching Versus Massage on Preventing the Symptoms of...dbpublications
OBJECTIVE: To compare the effectiveness of passive stretching versus massage on preventing the symptoms of delayed onset muscle soreness in normal adults. STUDY DESIGN: Quasi- Experimental study design. SUBJECTS: 50subjects, with the age group of 18-21 years of both the genders were selected. INTERVENTION: Subjects were randomly divided into 2 groups (Group A& Group B), 25 subjects in Group A received passive stretching and 25 subjects in Group B received Massage after 3 hours of inducing DOMS. OUTCOME MEASURE: Pain, Elbow Range of Motion and swelling were assessed by Visual analogue scale, goniometer, Inch tape. RESULTS: Statistical analysis was done by using independent ‘t’ test and paired ‘t’ test which showed there is no statistical significant difference between Group A(Passive stretching) and Group B(Massage). CONCLUSION: The result of this study concludes that massage decreased the pain immediately after intervention and regained the Elbow Range of Motion at immediately at 24 hours, at 48 hours and 72 hours than passive stretching. But massage and passive stretching has equal effect on pain reduction at 24hours, 48 hours and 72 hours after intervention. Similarly they both have equal effect on Arm Circumference.
This document discusses pain assessment and management for people with advanced dementia. It notes that pain is underreported and undertreated in cognitively impaired older adults due to challenges in assessment. It recommends using behavioral observation scales to assess pain in people with dementia, and provides examples of assessment tools like the Doloplus-2 scale and Abbey Pain Scale. It also provides guidance on managing chronic pain in older adults with dementia, including starting low-dose regular analgesics and considering transdermal patches to provide steady doses.
This document discusses pain, including definitions of pain, types of pain, factors influencing pain, effects of pain, individual variations in pain response, and pain assessment tools. It also covers postoperative pain management principles like the WHO pain ladder, pharmacological and non-pharmacological interventions for pain control, preemptive analgesia using local anesthetics or other drugs before a painful stimulus to reduce later pain, and techniques like patient-controlled analgesia and epidural analgesia. The goal of pain management is to prevent pain from interfering with recovery through adequate assessment and treatment.
1) Exercise has been shown to have significant mental health benefits such as reducing symptoms of depression and anxiety. However, psychologists have been slow to incorporate exercise into treatment plans.
2) Research shows that both short-term and long-term exercise can help alleviate symptoms of depression and may be comparable to antidepressant medication. Exercise is also associated with reduced risk of relapse.
3) Exercise has benefits for reducing anxiety as well. Regular physical activity can help those prone to anxiety become less sensitive to fight-or-flight symptoms that could trigger panic attacks.
La Navidad es una festividad cristiana que celebra el nacimiento de Jesucristo. Se celebra el 25 de diciembre y es una ocasión para reunirse con la familia y los amigos, intercambiar regalos y mostrar afecto.
Incident opioid abuse and dependence sullivan 2014Paul Coelho, MD
This study investigated the association between prescription opioid exposure and risk of opioid use disorder (OUD) among individuals with chronic noncancer pain (CNCP). The study used claims data from 2000-2005 for over 500,000 individuals with a new CNCP diagnosis and no recent opioid use or OUD. The results showed significantly higher rates of OUD among those prescribed opioids compared to those not prescribed opioids. Risk increased with longer duration of therapy and higher daily doses. Chronic opioid therapy, even at low doses, was associated with substantially increased risk of OUD compared to acute therapy or no opioids. Duration of opioid therapy was more important than daily dose in determining OUD risk.
La Navidad es una festividad cristiana que celebra el nacimiento de Jesucristo. Se celebra el 25 de diciembre y es una ocasión para reunirse con la familia y los amigos, intercambiar regalos y disfrutar de la comida y las decoraciones.
La Navidad es una festividad cristiana que celebra el nacimiento de Jesucristo. Se celebra el 25 de diciembre y es una ocasión para reunirse con la familia y los amigos, intercambiar regalos y disfrutar de la comida y las decoraciones.
This document summarizes a study examining the relationships between pain, catastrophizing, pain behaviors, and their influence on patient-provider interactions. The study found that a patient's level of catastrophizing when entering a medical exam predicted the dynamics between the patient and provider during the exam and the patient's satisfaction afterwards. Patients with higher catastrophizing may express their pain perceptions through exaggerated pain behaviors, which can influence provider attitudes and behavior. Identifying factors that improve patient-provider communication may help advance chronic pain treatment and reduce associated costs.
Este documento resume que la Navidad es una de las festividades más importantes del cristianismo que conmemora el nacimiento de Jesucristo en Belén el 25 de diciembre en la mayoría de iglesias cristianas. Algunas iglesias ortodoxas lo celebran el 7 de enero debido a diferencias en el calendario. La Navidad busca celebrar el nacimiento de Jesús a través de diversas tradiciones en diferentes lenguas.
32 Ways a Digital Marketing Consultant Can Help Grow Your BusinessBarry Feldman
How can a digital marketing consultant help your business? In this resource we'll count the ways. 24 additional marketing resources are bundled for free.
This randomized clinical trial compared the effectiveness of mindfulness-based stress reduction (MBSR), cognitive behavioral therapy (CBT), and usual care for treating chronic low back pain. 342 adults with chronic low back pain were randomly assigned to receive MBSR, CBT, or usual care. At 26 weeks, participants receiving MBSR or CBT reported significantly greater improvement in back pain and functional limitations compared to usual care. There were no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for chronic low back pain.
This study examined the prognosis of 118 patients with chronic low back pain who participated in a private, community-based group exercise program over 12 months. The patients experienced substantial improvements in pain intensity, disability, function and bothersomeness during the study period. Pain intensity and bothersomeness improved most in the first 6 months, while disability and function continued improving throughout the full year. At 12 months, 25% of patients were fully recovered from their back pain. Baseline pain intensity predicted 10% of the variation in pain outcomes at 12 months, while duration of current episode, disability, and education level together predicted 15% of the variation in disability outcomes.
Pilot Study of Massage in Veterans with Knee OsteoarthritisMichael Juberg
This pilot study assessed the feasibility and preliminary efficacy of Swedish massage therapy for 25 veterans with knee osteoarthritis. The study found high retention and adherence rates, suggesting massage was feasible and acceptable for veterans. Veterans receiving 8 weekly one-hour massage sessions experienced statistically significant improvements in self-reported knee pain, stiffness, function, and quality of life, as well as trends toward improved range of motion. The results support further study of massage as a treatment approach for knee osteoarthritis in veterans.
This document summarizes the results of moderator analyses from a large randomized controlled trial testing the effectiveness of cognitive behavioral therapy (CBT) for chronic pain from osteoarthritis. The trial compared 10 sessions of Pain Coping Skills Training (PCST), a form of CBT, delivered by nurse practitioners to a usual care control group. Several demographic and clinical variables were examined as potential moderators of treatment response. The analyses found that patients' pain coping style, expectations for treatment, disease severity, age, and education level significantly moderated outcomes, with some subgroups showing stronger responses to PCST. Sex, race, BMI, and depression did not impact treatment response. Specifically, patients with interpersonal pain coping problems did not benefit much from
This document summarizes evidence from randomized controlled trials on the use of complementary health approaches for pain management in the United States. It examines trials of acupuncture, massage therapy, osteopathic manipulative therapy, relaxation techniques, natural supplements, tai chi, and yoga for managing chronic low back pain, osteoarthritis, neck pain, and headaches. The trials generally found modest benefits of these approaches for pain relief and functional improvement compared to usual care or placebo, with few reported adverse effects. Larger and longer trials are still needed to provide more definitive evidence.
This document summarizes a study examining differences between individuals granted versus denied insurance coverage for chronic pain treatment after being recommended for an interdisciplinary pain management program. The study found no clinically meaningful differences between the groups on various pain-related measures, suggesting insurance denials were not based on patient need. This implies insurance funding decisions are made on non-clinical criteria rather than patient need. The document provides background on chronic pain, the effectiveness of interdisciplinary treatment, and barriers to treatment access when insurance coverage is denied.
Healing Touch and Cancer Pain and Stress PPTTrinh Diep
This document outlines a proposed research study that will examine the effectiveness of Healing Touch therapy in treating cancer pain and reducing stress levels. The study will involve recruiting 50 cancer patients to receive Healing Touch therapy sessions for one hour per day over three weeks, and comparing their reported pain and stress levels to a control group receiving standard care only. Pain and stress will be measured before, during, and after treatment using pain scales and an inventory of life stressors. The results will be analyzed to determine if Healing Touch provides benefits and how long any effects may last.
This document provides an overview of pain assessment and management strategies. It defines pain and describes the physiology and types of pain. Components of a comprehensive pain assessment are outlined, including history, physical exam, functional assessment, and use of pain scales. Both pharmacological and non-pharmacological approaches for pain management are discussed. The WHO analgesic ladder is presented as a framework for treating pain with medications. Considerations for using opioids and other pharmacological therapies are also reviewed.
Rethinking chronic pain in a primary care settingPaul Coelho, MD
This article discusses rethinking chronic pain management in primary care settings. It highlights that chronic pain is a complex biopsychosocial condition influenced by multiple factors. While guidelines exist, key aspects are often overlooked including understanding the underlying pain mechanism, incorporating psychosocial factors, and systematically tracking patient data. The article recommends clinicians identify the likely nociceptive, neuropathic, or central sensitization mechanisms driving a patient's pain to guide treatment selection. It also stresses the importance of a multidisciplinary approach incorporating psychological support to supplement pharmacological treatments. Tracking comprehensive pain data in electronic records can improve outcomes by monitoring treatment effectiveness over time.
This study examined whether early improvement in neck function predicted overall response to a cervical strengthening program for chronic neck pain. 214 patients completed a 3-week strengthening program and were assessed for changes in neck disability index (NDI) scores. Patients with a positive change in NDI scores after 3 weeks had a 25 times greater odds of overall improvement. Early improvement likely reflects motor skill acquisition rather than muscle hypertrophy. While early responders saw small additional gains, continued strengthening may provide further benefits like reduced muscle co-activation.
Brough et al perspectives on the effects and mechanisms of CST a qualitative ...Nicola Brough
This document summarizes a qualitative study on the effects and mechanisms of craniosacral therapy according to users' views. 29 participants were interviewed about their experiences with craniosacral therapy. Most participants reported improvements in at least two dimensions of holistic wellbeing: body, mind and spirit. Experiences during therapy included altered perceptual states and specific sensations and emotions. Participants emphasized the importance of the therapeutic relationship. The emerging theory from the study suggests that the trusting relationship in craniosacral therapy allows clients to experience altered states of awareness, which facilitates a new understanding of the interrelatedness of body, mind and spirit and an enhanced ability to care for oneself and manage health problems.
This study compared patient pain scores to those assessed by emergency healthcare providers (doctors and triage nurses) in the emergency department of a large Malaysian hospital. The mean patient pain score on arrival was 6.8 out of 10, significantly higher than scores assessed by doctors (5.6) and triage nurses (4.3). Significant differences were found for 5 specific conditions: soft tissue injury, headache, abdominal pain, fracture, and abscess/cellulitis. Upon discharge or admission, nearly half of patients still reported moderate pain, suggesting undertreatment of pain in the emergency department. Accurately assessing patient-reported pain scores is important for effective pain management in emergency medicine.
Experience of a comprehensive pain care (cpc) clinic from a provincial gener...Rohitha Jayamaha
1) The document describes the experience of establishing a Comprehensive Pain Care (CPC) Clinic at a Provincial General Hospital in Sri Lanka. A survey found that chronic pain was a major complaint for many outpatients.
2) In response, the hospital set up a CPC Clinic using a multidisciplinary approach to assess, treat, and manage chronic pain through both invasive and non-invasive methods.
3) Over 25 months, the CPC Clinic treated over 2,000 patients, with around 22% receiving interventional pain procedures. The holistic CPC model focused on patient-centered care and lifestyle changes rather than individual treatment approaches.
NURS 4435 TUTA Critically Read and Critique Nursing Research Articles.docxstirlingvwriters
This study examined differences in illness perceptions between injured patients and their caregivers 3-6 months after hospital discharge. A total of 127 patient-caregiver pairs completed questionnaires assessing their perceptions of the patient's injury. The study found that both patients and caregivers held negative views of the injury. Patients perceived more physical symptoms than caregivers. Caregivers of more severely injured patients or those admitted to the ICU had more negative perceptions than other caregivers. Caregivers who did not share care responsibilities also had more negative views than those who did share responsibilities. The results suggest clinicians should explore perceptions to better meet the individual needs of patients and caregivers after injury.
Motivational Enhancement Therapy in Addition to Physical
Therapy Improves Motivational Factors and Treatment
Outcomes in People With Low Back Pain: A Randomized
Controlled Trial
Work related musculoskeletal disorders in physical therapistsTuğçehan Kara
This study examined work-related musculoskeletal disorders (WMSDs) in physical therapists through a prospective cohort study with 1-year follow up. The study found that 57.5% of physical therapists reported a WMSD in the follow up year, with a 1-year prevalence rate of 28% and incidence rate of 20.7%. Risk factors for low back WMSDs included patient transfers, repositioning, bent/twisted postures, and job strain. Risk factors for wrist/hand WMSDs included soft tissue work, joint mobilization, and manual therapy techniques. The study recommends safer patient handling policies and further research to examine the link between physical therapy exposures and WMSDs.
This document summarizes a research proposal that investigates the effects of different rehabilitation methods on pain levels after spinal decompression surgery. The study will compare self-managed rehabilitation, physical therapy, and medication therapy over 2 years using patient surveys to track pain frequency and recovery. Based on previous literature, physical therapy is expected to result in the lowest pain scores and best performance on daily activity tests compared to home therapy and medication management alone. The results will help identify the most effective approach to rehabilitation for improving patient outcomes after back surgery.
This study examined psychological factors that may predict problematic outcomes following total knee arthroplasty (TKA). 75 patients completed measures of pain catastrophizing, pain-related fears, depression, and pain/function before and 6 weeks after TKA surgery. Results showed that pre-surgical pain and pain catastrophizing uniquely predicted greater post-surgical pain severity. Pre-surgical pain-related fears predicted worse function at follow-up in initial analyses but not when accounting for other medical factors. The findings suggest different psychological factors may influence post-surgical pain versus function. Targeting psychological risk factors could potentially improve outcomes after TKA.
A team of nurses at an adult acute medicine unit conducted a quality improvement project to improve patients' pain management experiences and satisfaction scores. They assessed nurses' knowledge and attitudes around pain management and found gaps. The team implemented strategies like providing education to nurses, creating a Comfort Menu for patients, and involving patients in their pain plans. Patient surveys showed these interventions helped patients feel included in their care and had their pain needs met at higher rates. The unit's patient satisfaction scores on pain control increased from 81.4 to 85.2 over 12 months.
This document contains summaries of several research papers on topics related to chronic pain, suicide risk, and bipolar disorder:
1) One study found that tapering opioid doses for chronic pain patients was associated with increased risks of overdose and mental health crisis compared to patients who did not taper. Higher tapering speeds were linked to even greater risks.
2) Another study observed chronic pain patients undergoing opioid tapering or transition to buprenorphine treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine use predicted dropout. Pain levels varied after treatment.
3) Research on combat veterans found that those exposed to combat had higher rates of PTSD, suicide attempts, strokes and chronic pain
Labeling Woefulness: The Social Construction of FibromyalgiaPaul Coelho, MD
This document discusses the social construction of fibromyalgia and how it has been established as a legitimate disease label despite a lack of clear biological or clinical evidence. It argues that fibromyalgia serves social and economic purposes for various groups, including patients, doctors, pharmaceutical companies, and the media, but poses risks by medicalizing psychosocial problems. The document proposes that widespread pain is a normal human experience for some that is best addressed by exploring psychosocial factors rather than believing the solution lies in neurobiology. Examining fibromyalgia as a social construct may be more helpful for patients than continuing to medicalize their experiences.
Outcomes in Long-term Opioid Tapering and Buprenorphine Transition: A Retrosp...Paul Coelho, MD
This study analyzed outcomes for 240 patients with chronic pain who were prescribed long-term opioid therapy above 90 mg morphine-equivalent daily doses. Patients were offered an outpatient opioid taper or transition to buprenorphine if taper was not tolerated. 44.6% successfully tapered, 18.8% transitioned to buprenorphine, and 36.6% dropped out of treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine/z-drug use predicted greater dropout. Pain intensity changes after treatment were mixed, with over half of tapered patients reporting increased pain and about half of transitioned patients reporting decreased pain.
This document appears to be a questionnaire assessing symptoms of widespread pain and calculating a WPI (Widespread Pain Index) score and SS (Symptom Severity) score. It asks the respondent to indicate areas of pain on a diagram and rate the severity of symptoms like fatigue, thinking difficulties, and unrefreshed sleep. It also inquires about additional symptoms like abdominal pain, depression, and headaches. The final section rates pain-related worry and fear on a scale. Additional questions determine if the respondent has a workers compensation or disability claim related to their pain complaint.
Fibromyalgia is a condition that causes chronic aches and pains all over the body, fatigue, and often a sleep disorder. The doctor diagnosed the patient with fibromyalgia based on a score of 13 or more on the fibromyalgia questionnaire from the American College of Rheumatology, which is consistent with the syndrome. By focusing on and managing the diagnosis of fibromyalgia, the patient's other pain symptoms can decrease.
This document contains two studies related to psychological treatments for chronic conditions:
1) A study of chronic fatigue syndrome patients found that poorer outcomes were predicted by membership in a self-help group, receiving sickness benefits, and symptoms of dysphoria. Severity and duration of symptoms did not predict response.
2) A randomized controlled trial of 125 fibromyalgia patients compared operant behavioral therapy, cognitive behavioral therapy, and attention placebo. Both behavioral therapies significantly reduced pain intensity while cognitive therapy improved cognitive and affective variables and operant therapy improved physical functioning and behaviors. The attention placebo resulted in no improvement or deterioration.
This document summarizes three studies on the risks and efficacy of opioids for chronic non-cancer pain (CNP). The first study finds that while opioids were associated with small improvements in pain and physical functioning compared to placebo, they also increased the risk of vomiting. Comparisons to other medications found similar benefits to pain and functioning. The second study finds no difference in pain-related function between opioid and non-opioid groups over 12 months, and higher rates of adverse effects and pain intensity in the opioid group. The third study finds limited effectiveness of opioids for CNP, as opioid users did not report improvements in outcomes after 2 years. Regarding risks, higher opioid doses are associated with increased overdose risk across several patient groups in
1) This randomized clinical trial compared opioid vs nonopioid medication therapy over 12 months for patients with chronic back, hip, or knee pain.
2) It found no significant difference in pain-related function between the two groups, but pain intensity was significantly better in the nonopioid group. Adverse effects were significantly more common in the opioid group.
3) The study concludes that opioid therapy was not superior to nonopioid medications for improving pain-related function over 12 months, and the results do not support initiating opioids for moderate to severe chronic musculoskeletal pain.
Mortality quadrupled among opioid-driven hospitalizations notably within lowe...Paul Coelho, MD
This study analyzed national hospitalization data from 1993-2014 to examine trends in mortality and characteristics of hospitalizations related to opioids compared to other drug and non-drug hospitalizations. The key findings were:
1) Mortality among opioid-related hospitalizations quadrupled from 0.43% before 2000 to 2.02% in 2014, increasing 0.12 percentage points per year relative to other drug hospitalizations.
2) While total opioid-related hospitalizations remained stable, diagnoses shifted from opioid dependence/abuse to opioid/heroin poisoning, which have higher mortality rates. Hospitalizations for poisoning grew by 0.01 per 1,000 people annually after 2000.
3) Patients hospitalized for opioid/
Prescriptions filled following an opioid-related hospitalization.Paul Coelho, MD
This study analyzed prescription drug fills within 30 days of discharge for 36,719 patients hospitalized for opioid misuse. Only 16.7% received medications approved for opioid dependence, while 40.3% filled antidepressant prescriptions and 22.4% filled opioid pain medication prescriptions. Concurrently, 13.9% filled benzodiazepine prescriptions and 7.4% filled both benzodiazepine and opioid prescriptions, indicating a need for improved education on risks. Overall, more effort is required to ensure patients receive recommended post-hospitalization treatment and support services.
This study examined the risk of psychiatric hospitalization in the offspring (second generation) of Finns who were evacuated to Sweden without parents during World War II (first generation), compared to offspring of Finns who were not evacuated. The study found that daughters of mothers who were evacuated during childhood had an elevated risk of psychiatric hospitalization, especially for mood disorders. However, there was no increased risk found for offspring of evacuated fathers or for male offspring of evacuated mothers. This suggests that early childhood adversity experienced by the first generation, such as war-related trauma, may be associated with mental health problems that persist into the second generation.
Correlation of opioid mortality with prescriptions and social determinants -a...Paul Coelho, MD
This study analyzed Medicare Part D data from 2013-2014 to examine the relationship between opioid prescription rates, socioeconomic factors, and opioid-related mortality rates at the county level in the United States. The results showed that higher county-level opioid prescription rates, especially those from emergency medicine, family medicine, internal medicine, and physician assistants, were associated with higher opioid-related mortality rates. Higher poverty levels and proportions of white populations in counties also correlated with increased mortality. Additionally, prescribers in the highest quartile of opioid prescription rates had a disproportionate impact on mortality compared to the remaining 75% of prescribers.
This report examines CMS's oversight of Medicare Part D beneficiaries who receive opioid prescriptions and providers who prescribe opioids to these beneficiaries. It finds that while CMS provides guidance to Part D plan sponsors on monitoring beneficiaries at high risk of opioid overuse, it lacks complete data on the full population of beneficiaries at risk. It also finds that CMS oversees prescribing through its contractor NBI MEDIC but does not specifically analyze opioid prescription data or require reporting on actions taken regarding inappropriate opioid prescribing. The report concludes that CMS needs more comprehensive oversight to reduce the risks of opioid misuse, overdose, and inappropriate prescribing among Medicare beneficiaries.
This study analyzed opioid prescription trends among medical specialties in the U.S. from 2007-2012 using a national prescription database. The key findings were:
- Primary care specialties (family practice, internal medicine, general practice) accounted for nearly half of all dispensed opioid prescriptions in 2012.
- Specialties treating pain conditions like pain medicine, surgery, and physical medicine had the highest rates of opioid prescribing.
- Overall opioid prescribing rates increased from 2007-2010 but stabilized from 2010-2012 as most specialties reduced rates.
- The greatest increase in opioid prescribing was among physical medicine specialists, while the largest decreases were in emergency medicine and dentistry.
The place-of-antipsychotics-in-the-therapy-of-anxiety-disorders-and-obsessive...Paul Coelho, MD
This document summarizes a research article about the use of antipsychotic drugs in the treatment of anxiety disorders and obsessive-compulsive disorders. The review finds evidence that certain second-generation antipsychotics (SGAPs), like quetiapine, risperidone, and aripiprazole, can be effective for generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). Quetiapine in particular receives a recommendation as a first-line treatment for GAD. However, the review finds insufficient evidence for SGAPs in the treatment of social anxiety disorder and panic disorder. First-generation antipsychotics are not recommended for any anxiety disorders based on their side effect profiles
Structured opioid refill clinic epic smartphrases Paul Coelho, MD
#*** I explained to the patient the risks of combining opioids and benzodiazepines based on medical literature. We agreed to slowly taper the patient off benzodiazepines and trial safer alternatives for sleep and anxiety issues.
#*** I showed the patient their fibromyalgia screening questionnaire results, which were consistent with a fibromyalgia diagnosis. Fibromyalgia can amplify other painful conditions and is often the primary source of morbidity when present with other chronic pain diagnoses.
#*** We discussed the patient's high risk opioid regimen based on their dose exceeding CDC guidelines. While willing to work on a harm reduction plan, it will require a taper or switching to buprenorphine due to safety concerns.
Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, an...Paul Coelho, MD
This document summarizes the key issues regarding the use of opioids for chronic pain treatment:
1) An overreliance on opioids to treat chronic pain has contributed to the prescription opioid abuse epidemic in the US, as outpatient use allows for abuse and diversion of these addictive drugs.
2) While clinical trials show opioids effectively treat acute pain and are initially effective for chronic pain, real-world use reveals increased risks of abuse, addiction, and poor functional outcomes over the long-term.
3) The evidence supporting chronic opioid therapy was limited and observational in nature, yet convinced the medical community until larger population studies showed increased abuse rates contrary to initial assumptions.
The potential adverse influence of physicians’ words.Paul Coelho, MD
The physician's words can inadvertently amplify patients' symptoms and increase somatic distress if not carefully considered. Learning about potential side effects from medications, procedures, or test results can lead patients to experience and report those effects more frequently through psychological mechanisms like misattribution and increased attention to bodily sensations. Discussing concepts like nocebo and viscerosomatic amplification with patients can help provide reassuring explanations for symptoms and make them feel less intrusive. Physicians should thoughtfully consider their word choices and focus on benefits as well as side effects to minimize undue distress.
This document is an evidence report published by the Institute for Clinical and Economic Review (ICER) that evaluates the comparative clinical effectiveness and value of cognitive and mind-body therapies for chronic low back and neck pain. It was authored by Jeffrey Tice and others from ICER. The report assesses the clinical evidence on therapies such as cognitive behavioral therapy and mindfulness-based stress reduction and presents economic analyses of the long-term cost-effectiveness and potential budget impact of these therapies. It also incorporates input from clinical experts and stakeholders.
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Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...DrDevTaneja1
Digital India will need a big trained army of Health Informatics educated & trained manpower in India.
Presently, generalist IT manpower does most of the work in the healthcare industry in India. Academic Health Informatics education is not readily available at school & health university level or IT education institutions in India.
We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
Ensure the highest quality care for your patients with Cardiac Registry Support's cancer registry services. We support accreditation efforts and quality improvement initiatives, allowing you to benchmark performance and demonstrate adherence to best practices. Confidence starts with data. Partner with Cardiac Registry Support. For more details visit https://cardiacregistrysupport.com/cancer-registry-services/
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...Media Logic
When it comes to creating marketing strategies that target older adults, it is crucial to have insight into their media habits and preferences. Understanding how older adults consume and use media is key to creating acquisition and retention strategies. We recently conducted our seventh annual survey to gain insight into the media preferences of older adults in 2024. Here are the survey responses and marketing implications that stood out to us.
Cancer treatment has advanced significantly over the years, offering patients various options tailored to their specific type of cancer and stage of disease. Understanding the different types of cancer treatments can help patients make informed decisions about their care. In this ppt, we have listed most common forms of cancer treatment available today.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
The story of Dr. Ranjit Jagtap's daughters is more than a tale of inherited responsibility; it's a narrative of passion, innovation, and unwavering commitment to a cause greater than oneself. In Poulami and Aditi Jagtap, we see the beautiful continuum of a father's dream and the limitless potential of compassion-driven healthcare.
Sectional dentures for microstomia patients.pptxSatvikaPrasad
Microstomia, characterized by an abnormally small oral aperture, presents significant challenges in prosthodontic treatment, including limited access for examination, difficulties in impression making, and challenges with prosthesis insertion and removal. To manage these issues, customized impression techniques using sectional trays and elastomeric materials are employed. Prostheses may be designed in segments or with flexible materials to facilitate handling. Minimally invasive procedures and the use of digital technologies can enhance patient comfort. Education and training for patients on prosthesis care and maintenance are crucial for compliance. Regular follow-up and a multidisciplinary approach, involving collaboration with other specialists, ensure comprehensive care and improved quality of life for microstomia patients.
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2. recovery expectancies, further compromising an individual’s
recovery potential.14
From a theoretical perspective, increased
knowledge about the time-dependent and sequential relations
among pain symptoms and psychosocial factors will bring greater
precision and predictive power to biospychosocial models of pain
and disability.13,33,47
The present study explored the relation between posttreatment
scores on pain-related psychosocial risk factors and the mainte-
nance of treatment gains. Work-disabled individuals participating
in a rehabilitation intervention for musculoskeletal injury completed
pretreatment and posttreatment measures of pain severity, pain
catastrophizing, and fear of pain. Maintenance of treatment gains
was assessed at 1-year follow-up. It was hypothesized that
individuals whose posttreatment scores on measures of pain
catastrophizing and fear of pain remained elevated would be at
increased risk for failure to maintain the treatment gains made
through their participation in a rehabilitation intervention.
2. Methods
2.1. Participants
The participant sample consisted of 310 individuals (163 women,
147 men) with work-related musculoskeletal conditions who were
referred for treatment at 1 of the 5 collaborating pain rehabilitation
clinics in the province ofQuebec, Canada. At the time of evaluation,
all participants were receiving wage indemnity benefits from the
provincial worker’s compensation board (Commission de la sant´e
et de la s ´ecurit ´e du travail [CSST]). Most the participants were
married or living common law (87%) and had completed high
school (83%). Sample characteristics are presented in Table 1.
2.2. Procedure
The research program was approved by the research ethics
committee of McGill University. Individuals were considered for
participation if they had been referred to 1 of 5 collaborating
rehabilitation clinics specializing in the treatment of musculoskel-
etal injury. Individuals were only considered for participation if they
had sustained their injury no more than 12 months before the date
of referral.
Participants signed a consent form before completing the
study procedures. Participants were asked to complete meas-
ures of pain severity, pain catastrophizing, and fear of pain as part
of their initial assessment. The same measures were readminis-
tered at termination of treatment. One year after the initial
assessment, participants were contacted by telephone and were
asked to answer questions relevant to their current symptoms.
Participants were compensated $50 for completing the ques-
tionnaires and the telephone interview.
2.2.1. Rehabilitation intervention
The specific elements of the rehabilitation interventions varied at
the clinicians’ discretion. However, all interventions conformed to
practice guidelines for early intervention for musculoskeletal
problems consistent with reimbursement policies of the workers’
compensation board emphasizing mobilization and activity.32
All
interventions were characterized by a functional restoration
orientation consisting primarily of medical management, physical
therapy, education, and instruction in self-management skills. The
intervention teams consisted of a physician, physiotherapist,
occupational therapist, and psychologist. The exercise intervention
was individually tailored to clients’ needs, whereas the education
and instruction in self-management intervention were provided in
group format. Treatment duration varied from 4 to 7 weeks.
2.3. Measures
2.3.1. Pain severity
Participants were asked to rate the severity of their current pain on
a numerical rating scale with the endpoints (0) no pain at all and
(10) excruciating pain.
2.3.2. Catastrophizing
The Pain Catastrophizing Scale (PCS)39
was used to assess
catastrophic thinking related to pain. The PCS consists of 13 items
describing different thoughts and feelings that individuals might
experience when they are in pain. The PCS has been shown to
have high internal consistency (coefficient alpha 5 0.87) and to be
associated with heightened pain, disability, as well as employment
status.39,43,44
On the basis of previous research on meaningful cut
scores on the PCS, participants with PCS scores greater than or
equal to 24 were classified as high catastrophizers.35
2.3.3. Fear of pain
The Tampa Scale for Kinesiophobia (TSK)21
was used as
a measure of fear of pain. The TSK is a 17-item questionnaire
that assesses fear of (re)injury due to movement. The TSK has
been shown to be internally reliable (coefficient alpha 5 0.77).51
The TSK has been associated with various indices of behavioral
avoidance and disability.6,28,44
On the basis of previous research
on meaningful cut scores on the TSK, participants with TSK
scores greater than or equal to 40 were classified as high fear.2,28
2.3.4. Follow-up interview
One year after termination of the rehabilitation treatment,
participants were contacted by telephone and were interviewed
Table 1
Characteristics of the study sample (N 5 310).
Characteristics n (%) or mean (SD)
Sex (M/F) 147 (47%)/163 (53%)
Education
Less than high school 53 (17%)
High school 88 (28%)
Trade school 61 (20%)
College 68 (22%)
University 40 (13%)
Occupation
Laborer 102 (33%)
Nursing 81 (26%)
Clerical 55 (18%)
Driver 18 (6%)
Trade 35 (11%)
Sales 19 (6%)
Pain site (categories are not mutually exclusive)
Back 288 (93%)
Neck 258 (83%)
Upper extremity 194 (63%)
Lower extremity 76 (24%)
Pretreatment
Pain severity (0/10) 5.4 (1.4)
Pain duration, wk 10.5 (5.6)
PCS 21.3 (10.6)
TSK 42.6 (6.1)
SD, standard deviation.
2 E. Moore et al.
·1 (2016) e567 PAIN Reports®
3. about their current symptoms. Participants were asked to verbally
report their pain intensity on a numerical rating scale with the
endpoints (0) no pain at all and (10) excruciating pain.
2.4. Data analytic approach
There were no significant differences due to clinical site on any of
the study variables. As such, all analyses are reported with data
collapsed across the 5 rehabilitation clinics that served as sites of
recruitment.
All participants reported at least moderate pain (pain rating $4/
10) at initial assessment. Participants were classified as having
“recovered” if (1) their pain score decreased by 2 points or more
from admission to discharge, and (2) their pain score was less
than 4/10 at discharge. The approach to defining successful
response to treatment is consistent with research on meaningful
cut scores on pain severity scales and IMMPACT recommenda-
tions for interpreting pain treatment outcomes.9,17
T tests for
independent samples and x2
analyses were used to compare
recovered and nonrecovered participants on study measures.
Cohen’s d values are reported as estimates of effect size for mean
comparisons.
Recovered participants were considered to have failed to
maintain treatment gains if (1) their follow-up pain rating had
increased by at least 2 points, relative to the discharge evaluation,
and (2) their 1-year follow-up pain score was in the moderate to
severe range (pain rating $4/10). Logistic regression was used to
assess the value of posttreatment PCS and TSK scores in
predicting failure to maintain treatment gains. These analyses
were conducted with PCS and TSK scores used as continuous
variables and dichotomized on recommended cut scores.
Tolerance coefficients were greater than 0.60 indicating no
problem of multicollinearity. All analyses were conducted with
SPSS Version 21.
3. Results
3.1. Sample characteristics
Demographic information and mean scores on measures of
pain severity, pain catastrophizing, and fear of movement are
presented in Table 1. The mean scores on pain catastrophizing
and fear of movement were comparable (within 1 SD) with those
reported in previous research on work-disabled participants
with musculoskeletal pain.3,7,38
Pain ratings at admission
ranged from 4/10 to 9/10 indicating that participants were
experiencing moderate to severe pain at initial assessment.
3.2. Variables associated with recovery outcomes
Participants were considered to have recovered if they showed at
least 2-point reduction in pain through the course of the
rehabilitation intervention, and their posttreatment pain rating
was below 4/10. On the basis of this definition, 185 participants
(60%) recovered. Likelihood of recovery did not vary significantly
as a function of sex, x2
5 2.3, ns; marital status, x2
5 1.5, ns;
education, x2
5 2.1, ns; occupation, x2
5 2.2, ns; or number of
weeks of treatment, x2
5 1.7, ns.
Table 2 shows the results of independent t tests comparing
recovered and nonrecovered participants on various study
measures. Participants classified as recovered had a shorter
duration of their current pain episode, t(308) 5 3.2, P , 0.001
(d 5 0.35, 95% confidence interval [CI] 5 0.12–0.57), rated their
pain as less intense at admission, t(308) 5 3.1, P , 002 (d 5 0.44,
95% CI 5 0.21–0.67), reported fewer pain sites, t(308) 5 2.0, P 5
0.04 (d 5 0.22, 95% CI 5 0.01–0.44), and obtained lower
posttreatment scores on the PCS, t(308) 5 3.8, P , 0.001 (d 5
0.43, 95% CI 5 0.21–0.66), and TSK, t(308) 5 2.7, P , 0.006
(d 5 0.33, 95% CI 5 0.10–0.55).
3.3. Variables associated with maintenance of
treatment gains
Participants were considered to have failed to maintain treatment
gains if they were classified as recovered at posttreatment, if their
pain ratings increased by at least 2 points from posttreatment
assessment to 1-year follow-up, and they rated their pain as 4/10
or greater at 1-year follow-up. On the basis of this definition, 70
participants (38%) failed to maintain treatment gains.
Table 3 shows the results of t tests comparing participants
who did and did not maintain treatment gains on various study
measures. Participants who failed to maintain treatment gains
reported more intense pain at admission, t(183) 5 4.7, P , 0.001
(d 5 0.74, 95% CI 5 0.44–1.0), reported more pain sites, t(183) 5
3.3, P 5 0.001 (d 5 0.58, 95% CI 5 0.29–0.88), and obtained
higher pretreatment and posttreatment PCS and TSK scores
(PCS pre, t(183) 5 4.4, P , 0.001 (d 5 0.68, 95% CI 5
0.38–0.97): PCS post, t(183) 5 8.3, P , 0.001 (d 5 1.2, 95%
CI 5 0.86–1.5): TSK pre, t(183) 5 2.8, P , 0.005 (d 5 0.42, 95%
CI 5 0.13–0.71): TSK post, t(183) 5 6.0, P , 0.001 (d 5 0.94,
95% CI 5 0.63–1.2)).
Table 2
Variables associated with recovery outcomes (N 5 310).
Recovered
(N 5 185)
Not recovered
(N 5 125)
P
Age 36.0 (10.1) 36.6 (9.8) 0.60
Pain duration 10.2 (5.4) 12.7 (8.9) 0.001
Initial pain severity 5.0 (1.3) 5.6 (1.4) 0.002
Number of pain sites 2.5 (0.8) 2.8 (0.9) 0.04
Pretreatment PCS 20.8 (9.6) 21.6 (11.3) 0.52
Posttreatment PCS 10.7 (10.0) 15.4 (11.5) 0.001
Pretreatment TSK 42.2 (6.2) 43.3 (6.2) 0.14
Posttreatment TSK 37.5 (7.4) 39.7 (5.8) 0.006
Values in parentheses are standard deviations.
Table 3
Variables associated with maintenance of treatment gains
(N 5 183).
Treatment gains P
Gains maintained
(N 5 115)
Gains not
maintained (N 5 70)
Age 35.8 (9.8) 36.4 (10.5) 0.63
Pain duration 9.6 (5.2) 10.5 (8.9) 0.25
Initial pain severity 5.2 (1.3) 6.2 (1.4) 0.001
Number of pain sites 2.3 (0.9) 2.8 (0.8) 0.001
Pretreatment PCS 18.9 (10.9) 26.2 (10.6) 0.001
Posttreatment PCS 6.6 (6.7) 17.5 (11.1) 0.001
Pretreatment TSK 41.2 (6.1) 43.9 (6.2) 0.003
Posttreatment TSK 35.1 (6.8) 41.5 (6.8) 0.001
Values in parentheses are standard deviations.
1 (2016) e567 www.painreportsonline.com 3
4. 3.4. Predictors of failure to maintain treatment gains
A logistic regression was conducted to assess the unique
contribution of posttreatment predictors of failure to maintain
treatment gains at 1-year follow-up. As shown in Table 4,
pretreatment pain severity and number of pain sites were entered
in the first step of the analysis and contributed significantly to the
prediction of failure to maintain treatment gains, x2
5 25.3, P ,
0.001. Pretreatment PCS and TSK scores were entered in the
second step of the analysis and contributed significant variance
beyond the variance accounted for by pretreatment pain severity
and number of pain sites x2
5 7.9, P , 0.001. Posttreatment PCS
and TSK scores were entered in the third step of the analysis and
contributed significantly to the prediction of failure to maintain
treatment gains, x2
5 42.2, P , 0.001. In the final regression
equation,both the posttreatment PCS (odds ratio [OR] 5 1.14; CI 5
1.0–1.2) and the TSK (OR 5 1.08; CI: 1.0–1.1) made significant
unique contributions to the prediction of failure to maintain
treatment gains. In other words, participants who obtained high
posttreatment scores on measures of catastrophizing and fear
were at increased risk of failing to maintain treatment gains. The
classification rate for the final regression equation was 77%.
A second logistic regression was conducted where scores on
the PCS and TSK were dichotomized according to recommen-
ded clinically meaningful cut scores. A similar pattern of findings
was obtained. Using dichotomized scores to predict failure to
maintain treatment gains, high posttreatment PCS scores were
associated with an OR of 12.0 (CI 5 3.9–36.6) and high
posttreatment TSK scores were associated with an OR of 3.3
(CI 5 1.5–7.3).
4. Discussion
The findings of the present study are consistent with previous
research showing that treatment gains are not maintained by
a substantive proportion of work-injured individuals participat-
ing in physical rehabilitation interventions.10,28
The findings are
also consistent with previous research showing that psychoso-
cial risk factors are significant determinants of delayed recovery
following musculoskeletal injury.24,30,41
The results of the
present study extend previous research in showing that high
posttreatment scores on measures of pain catastrophizing and
pain-related fear are associated with increased risk of failing to
maintain treatment gains. To our knowledge, this is the first
study to show that psychosocial risk factors influence whether
treatment gains will be maintained following physical rehabili-
tation for musculoskeletal pain.
In the present study, response to treatment was dichotomized
as recovered or not recovered on the basis of the magnitude of
pretreatment to posttreatment reductions in pain, and the
posttreatment pain severity score. Recovery was operationally
defined as a reduction in pain of 2 points or more on an 11-point
numerical rating scale, and a posttreatment pain score less than
4/10. On the basis of this operational definition, 60% of
participants were classified as recovered at the end of treatment.
Findings were consistent with previous research showing that
poor recovery was associated with higher initial pain scores,
longer duration of work disability at the time of admission, and
multiple pain sites.18,23,53,54
Failure to maintain treatment gains was operationally defined
as evidence of clinically significant increase in pain from treatment
termination to 1-year follow-up, and pain ratings at 1-year follow-
up in the moderate or severe range. On the basis of this definition,
38% of subjects failed to maintain treatment gains at 1-year
follow-up. Consistent with predictions, posttreatment scores on
the PCS and TSK were significant and independent predictors of
failure to maintain treatment gains.
The processes by which catastrophizing and fear of pain
influence the probability of maintaining treatment gains are likely
similar to the processes by which these psychosocial risk factors
contribute to problematic recovery. Pathophysiological and
psychological factors have been implicated as the basis for the
relation between catastrophizing and adverse pain outcomes.
There are indications that pain catastrophizing might interfere
with descending pain-inhibitory systems, facilitate neuroplastic
changes in the spinal cord, and contribute to pain sensitization in
the central nervous system.15,31
Psychological explanations of
the relation between catastrophizing and adverse pain outcomes
have addressed the possible roles of exaggerated threat
appraisals,27
negative expectancies,42
attentional factors,49
and
ineffective coping strategies.45
The basis for the relation between
fear of pain and adverse pain outcomes has been addressed
primarily in activity avoidance, maladaptive alterations in motor
function, deconditioning, and hypervigilance to pain-related
stimuli.
There are important clinical implications to the findings of the
present study. If levels of catastrophic thinking and fear of pain
remain elevated at the completion of a pain rehabilitation
program, there is the risk that treatment gains will not be
maintained. The predictive value of posttreatment PCS and TSK
scores was examined using scale scores as continuous variables
and as dichotomous variables. Both approaches yielded
comparable results. The stronger predictive power of the PCS
and TSK when dichotomized suggests that previously
Table 4
Predictors of failure to maintain treatment gains (N 5 185).
Step Variables added at each step Statistical summary
Dx2
Ddf R2
22LL OR 95% CI P
1 Initial pain 25.3 2 0.17 221.8 0.001
Pretreatment pain severity (0–10) 1.4 1.2–1.9 0.01
Number of pain sites 1.5 0.92–2.50 0.10
2 Pretreatment questionnaire scores 7.9 2 0.22 212.4 0.15
PCS 0.95 0.90–1.0 0.08
TSK 1.0 0.93–1.0 0.79
3 Posttreatment questionnaire scores 43.2 2 0.46 169.1 0.001
PCS 1.14 1.0–1.2 0.001
TSK 1.08 1.0–1.2 0.05
ORs and 95% CIs are adjusted for other variables. 22LL 5 22 times the log likelihood. Dx2
and Ddf are the change in x2
and associated degrees of freedom resulting from the addition of predictor variables, and P is the
statistical significance of the change of the OR for a variable. R2
is the Nagelkerke (56) R2
. ORs, 95% CIs, and P values are from the final regression equation.
OR, odds ratio; CI, confidence interval.
4 E. Moore et al.
·1 (2016) e567 PAIN Reports®
5. recommended cut scores for the PCS and the TSK could be used
as clinical guides for treatment targets and the evaluation of
treatment outcomes.
Numerous clinical cohort studies have provided evidence
suggesting that participation in rehabilitation interventions is
associated with reductions in scores on measures of catastroph-
izing and fear of pain.37
Reports of statistically significant
reductions in scores on measures of catastrophizing or fear
following rehabilitation confer the impression that these pain-
related psychosocial risk factors are amenable to change through
a wide range of available treatments. The results of the present
study invite caution in making such inferences. It is not clear that
the reductions in catastrophizing and fear of pain that have been
reported in many clinical cohort studies are of sufficient
magnitude to influence important clinical outcomes. Emerging
research suggests that the magnitude of change in pain-related
psychosocial risk factors must exceed a certain threshold to
impact in a meaningful way on clinical outcomes such as pain
relief, medication reduction, or return to work.34
The present
research further suggests that unless scores on pain-related
psychosocial risk factors can be brought below the risk range by
the end of treatment, gains made in treatment might not be
maintained in the long term. A literature search revealed no study
reporting the percentage of participants with posttreatment
catastrophizing scores or fear of pain scores falling below the
risk range. Such a metric might need to be considered in future
research to evaluate the clinical significance of treatment gains.
Although there have been calls for greater attention to the
management of catastrophizing and fear of pain in the treatment of
persistent pain conditions, the degree to which these calls for
action have been answered by the clinical practice community is
unclear. While it is now commonplace to incorporate measures of
catastrophizing and fear of pain in clinical assessment protocols for
patients presenting with pain conditions, what is less clear is
whether treatment approaches are tailored in any way to an
individuals’ psychosocial risk profile when scores on these
measures are elevated. In the documented literature, there is little
indication that treatment approaches are tailored to psychosocial
risk profiles. This would appear to be an area deserving increased
attention if the goal is ultimately toincreasetreatmentsuccesses for
individuals with persistent pain conditions.
In recent years, risk-targeted activity reintegration programs
have emerged as an approach to rehabilitation where treatment is
tailored to individuals’ psychosocial risk profile.5,40
What distin-
guishes these interventions from traditional rehabilitation inter-
ventions is the use of techniques specifically designed to target
pain-related psychosocial risk factors, matching treatment
techniques to psychosocial risk profile, and where the primary
treatment focus is on improving function as opposed to symptom
management. An important additional objective of risk-targeted
interventions is to reduce pain-related psychosocial risk factors. A
number of techniques have been discussed as potentially useful
in targeting catastrophic thinking and fear of pain.55
Some of
these include education, guided disclosure, thought monitoring,
role-relevant activity reintegration, and exposure.41
Although
comparison trials have yet to be conducted, risk-targeted
approaches appear to yield reductions in pain-related psycho-
social risk factors of greater magnitude than those associated
with traditional rehabilitation approaches.
Caution must be exercised in the interpretation of the findings of
this study. The study used operational definitions of “recovery” and
“failure to maintain treatment gains” based on the magnitude of
change in pain scores. Although the definitions used would be
considered evidence-based recommendations, using more liberal
or conservative criteria would have altered the pattern of findings.
Also, pain relief was the criterion on which definitions of “recovery”
and “failure to maintaintreatment gains” was based. There are other
important outcomes of rehabilitation interventions such as func-
tional improvement, reduced medication intake, and return-to-
work that were not considered in this study. It is possible that
a different set of predictors might have emerged had recovery
and relapse definitions been based on other outcome criteria. It is
also important to consider that there were differences in treatment
protocol across clinics and across clinicians. In rehabilitation
interventions, it is not possible to provide a standardized in-
tervention for all individuals receiving treatment. Although all
clinicians adhered to the same clinical practice guidelines,
differences in treatments offered could have played a role in the
magnitude of symptom reduction and the probability of maintain-
ing treatment gains. The CIs around the ORs for dichotomized
posttreatment PCS and TSK scores were also large, further
inviting caution in the interpretation of the findings. Given that the
study was an exploratory secondary analysis of a preexisting data
set as opposed to a test of theory-driven hypotheses, confirma-
tion of the reliability of the findings reported in this paper awaits
replication in an independent sample.
Despite these limitations, the findings of the present study
highlight the importance of reducing scores on pain-related
psychosocial risks factors to ensure that treatment gains are
maintained. If replicated, the findings would argue for the
inclusion of measures of psychosocial risk as part of posttreat-
ment evaluations as an additional indicator of treatment outcome.
The proportion of individuals falling below the risk range on pain-
related psychosocial risk factors might be an important metric in
determining whether treatments will yield meaningful long-term
gains. The present findings also argue for the development of
intervention programs that are tailored to individuals’ risk profile.
Emerging research suggests that risk-targeted interventions
might yield superior outcomes compared with traditional
approaches to rehabilitation.
Conflict of interest statement
M.J.L. Sullivan receives royalties from the sale to the treatment
manual associated with one of the intervention programs
described in this article. The remaining authors have no conflicts
of interest to declare.
Acknowledgements
The authors thank Nicole Davidson, Beatrice Garfinkiel and Elena
Bernier for their assistance in data collection and data entry. This
research was supported by funds from the Canadian Institutes of
Health Research (CIHR), and the Institut de recherche Robert-
Sauv ´e en sant ´e et en s ´ecurit ´e du travail (IRSST).
Article history:
Received 12 May 2016
Received in revised form 11 June 2016
Accepted 13 June 2016
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