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  1 / 858 MEDLINE  
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PMID:29186635
Autor:Mansell G; Storheim K; Løchting I; Werner EL; Grotle M
Dirección:Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire ST5 5BG, United Kingdom.
Título:Identification of Indirect Effects in a Cognitive Patient Education (COPE) Intervention for Low Back Pain.
Fuente:Phys Ther; 97(12):1138-1146, 2017 Dec 01.
ISSN:1538-6724
País de publicación:United States
Idioma:eng
Resumen:Background: Many interventions for the treatment of low back pain exist, but the mechanisms through which such treatments work are not always clear. This situation is especially true for biopsychosocial interventions that incorporate several different components and methods of delivery. Objective: The study objective was to examine the indirect effects of the Cognitive Patient Education (COPE) intervention via illness perceptions, back pain myths, and pain catastrophizing on disability outcome. Design: This study was a secondary analysis of the COPE randomized controlled trial. Methods: Mediation analysis techniques were employed to examine the indirect effects of the COPE intervention via residualized change (baseline - posttreatment) in the 3 variables hypothesized to be targeted by the COPE intervention on posttreatment disability outcome. Pain intensity at baseline, pain duration, clinician type, and a treatment-mediator interaction term were controlled for in the analysis. Results: Preliminary analyses confirmed that changes in pain catastrophizing and illness perceptions (not back pain myths) were related to both allocation to the intervention arm and posttreatment disability score. The treatment exerted statistically significant indirect effects via changes in illness perceptions and pain catastrophizing on posttreatment disability score (illness perceptions standardized indirect effect = 0.09 [95% CI = 0.03 to 0.16]; pain catastrophizing standardized indirect effect = 0.05 [95% CI = 0.01 to 0.12]). However, the inclusion of an interaction term led to the indirect effects being significantly reduced, with the effects no longer being statistically significant. Limitations: This study presents a secondary analysis of variables not identified a priori as being potentially important treatment targets; other, unmeasured factors could also be important in explaining treatment effects. Conclusions: The finding that small indirect effects of the COPE intervention via changes in illness perceptions and pain catastrophizing on posttreatment disability could be estimated indicates that these variables may be viable treatment targets for biopsychosocial interventions; however, this finding must be viewed in light of the adjusted analyses, which showed that the indirect effects were significantly reduced through the inclusion of a treatment-mediator interaction term.
Tipo de publicación:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL


  2 / 858 MEDLINE  
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PMID:28460690
Autor:Ross GB; Sheahan PJ; Mahoney B; Gurd BJ; Hodges PW; Graham RB
Dirección:School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; School of Kinesiology and Health Studies, Faculty of Arts & Science, Queen's University, Kingston, Ontario, Canada.
Título:Pain catastrophizing moderates changes in spinal control in response to noxiously induced low back pain.
Fuente:J Biomech; 58:64-70, 2017 06 14.
ISSN:1873-2380
País de publicación:United States
Idioma:eng
Resumen:It is generally accepted that spine control and stability are relevant for the prevention and rehabilitation of low back pain (LBP). However, there are conflicting results in the literature in regards to how these variables are modified in the presence of LBP. The aims of the present work were twofold: (1) to use noxious stimulation to induce LBP in healthy individuals to assess the direct effects of pain on control (quantified by the time-dependent behavior of kinematic variance), and (2) to assess whether the relationship between pain and control is moderated by psychological features (i.e. pain catastrophizing (PC) and kinesiophobia). Participants completed three conditions (baseline, pain, recovery) during a task involving completion of 35 cycles of a repetitive unloaded spine flexion/extension movement. The neuromuscular control of spine movements was assessed during each condition using maximum finite-time Lyapunov exponents (λ ). Nociceptive stimulus involved injection of hypertonic saline into the interspinous ligament, eliciting pain that was greater than baseline and recovery (p<0.001). Although there was no overall main effect of the nociceptive stimulation (i.e. pain) on λ when the whole group was included in the statistical model (p=0.564), when data were considered separately for those with high and low PC, two distinct and well established responses to the pain were observed. Specifically, those with high PC tightened their control (i.e. stabilized), whereas those with low PC loosened their control (i.e. destabilized). This study provides evidence that individuals' beliefs and attitudes towards pain are related to individual-specific motor behaviors, and suggests that future research studying spine control/stability and LBP should account for these variables.
Tipo de publicación:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T


  3 / 858 MEDLINE  
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PMID:27771534
Autor:Jacobs JV; Roy CL; Hitt JR; Popov RE; Henry SM
Dirección:Department of Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building, 106 Carrigan Dr., Burlington, VT 05405, USA; Center for Physical Ergonomics, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA. Electronic address: jesse.jacobs@libe
Título:Neural mechanisms and functional correlates of altered postural responses to perturbed standing balance with chronic low back pain.
Fuente:Neuroscience; 339:511-524, 2016 Dec 17.
ISSN:1873-7544
País de publicación:United States
Idioma:eng
Resumen:This study sought to determine the effects of chronic low back pain (LBP) on the cortical evoked potentials, muscle activation, and kinematics of postural responses to perturbations of standing balance. Thirteen subjects with chronic, recurrent, non-specific LBP and 13 subjects without LBP participated. The subjects responded to unpredictably timed postural perturbations while standing on a platform that randomly rotated either "toes up" or "toes down". Electroencephalography (EEG) was used to calculate the negative peak (N1) and subsequent positive peak (P2) amplitudes of the perturbation-evoked cortical potentials. Passive-marker motion capture was used to calculate joint and center-of-mass (CoM) displacements. Surface electromyography was used to record muscle onset latencies. Questionnaires assessed pain, interference with activity, fear of activity, and pain catastrophizing. Results demonstrated that subjects with LBP exhibited significantly larger P2 potentials, delayed erector spinae, rectus abdominae, and external oblique onset latencies, as well as smaller trunk extension yet larger trunk flexion, knee flexion, and ankle dorsiflexion displacements compared to subjects without LBP. For the subjects with LBP, CoM displacements significantly and positively correlated with knee displacements as well as activity interference and fear scores. The P2 potentials significantly and negatively correlated with CoM displacements as well as activity interference, catastrophizing, and fear scores. These results demonstrate that people with LBP exhibit altered late-phase cortical processing of postural perturbations concomitant with altered kinematic and muscle responses, and these cortical and postural response characteristics correlate with each other as well as with clinical reports of pain-related fears and activity interference.
Tipo de publicación:JOURNAL ARTICLE


  4 / 858 MEDLINE  
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PMID:28968914
Autor:Estévez-López F; Segura-Jiménez V; Álvarez-Gallardo IC; Borges-Cosic M; Pulido-Martos M; Carbonell-Baeza A; Aparicio VA; Geenen R; Delgado-Fernández M
Dirección:Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.
Título:Adaptation profiles comprising objective and subjective measures in fibromyalgia: the al-Ándalus project.
Fuente:Rheumatology (Oxford); 56(11):2015-2024, 2017 Nov 01.
ISSN:1462-0332
País de publicación:England
Idioma:eng
Resumen:Objectives: The aim of this study was to identify subgroups in terms of adaptation to FM and to test differences in FM severity between these subgroups. Methods: The al-Ándalus project made it possible to perform a comprehensive population-based cross-sectional study in 486 FM patients including multiple assessments of modifiable (could be targeted in therapy) resilience and vulnerability factors, measured by objective and subjective assessments, related to psychological and physical function. FM severity was assessed by means of FM impact (total score of the Revised Fibromyalgia Impact Questionnaire) and distress (Polysymptomatic Distress Scale of the modified 2011 preliminary criteria for FM). Exploratory factor analysis, cluster analysis and analysis of variance were conducted. Results: Factor analysis yielded eight factors: three included objective measures (declarative memory, active lifestyle and objective physical fitness) and five included subjective measures (fatigue, psychological distress, catastrophizing, resilience and subjective physical fitness). Cluster analysis based on these eight factors identified five profiles: Adapted (16%), Fit (18%), Poor performer (20%), Positive (20%) and Maladapted (26%). Most profile comparisons revealed different levels of FM severity varying from Adapted (the most favourable profile) to Maladapted (the most unfavourable profile) with Fit, Poor performer and Positive obtaining intermediate positions. Conclusions: Heterogeneity of FM was shown by five clinically meaningful profiles of modifiable factors that were associated with FM severity. It is of clinical interest to examine whether these profiles are associated with FM prognosis and the effectiveness of interventions, which would enhance the development of customized interventions based on adaptation profiles in FM.
Tipo de publicación:JOURNAL ARTICLE


  5 / 858 MEDLINE  
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PMID:28735950
Autor:Balderman J; Holzem K; Field BJ; Bottros MM; Abuirqeba AA; Vemuri C; Thompson RW
Dirección:Department of Surgery, Center for Thoracic Outlet Syndrome and the Section of Vascular Surgery, Washington University School of Medicine in St. Louis, St. Louis, Mo.
Título:Associations between clinical diagnostic criteria and pretreatment patient-reported outcomes measures in a prospective observational cohort of patients with neurogenic thoracic outlet syndrome.
Fuente:J Vasc Surg; 66(2):533-544.e2, 2017 Aug.
ISSN:1097-6809
País de publicación:United States
Idioma:eng
Resumen:OBJECTIVE: Neurogenic thoracic outlet syndrome (NTOS) is caused by dynamic compression of the brachial plexus at the level of the supraclavicular scalene triangle or the subcoracoid (pectoralis minor) space, or both. The purpose of this study was to characterize relationships between 14 clinical diagnostic criteria (CDC) and seven pretreatment patient-reported outcomes measures (PROMs) in a prospective cohort of patients with NTOS. METHODS: There were 183 new patient referrals between July 1 and December 31, 2015, with 150 (82%) meeting an established set of predefined CDC for NTOS. PROMs were evaluated across five domains: pain severity, functional disability, depression, quality of life, and pain catastrophizing. Linear regression and Pearson correlation statistics were used to analyze associations between CDC and PROMs. RESULTS: Mean ± standard error patient age was 37.1 ± 1.1 years (range, 12-66 years), and 107 (71%) were women. Five (3%) had a cervical rib, and 15 (10%) had recurrent NTOS. The most frequently positive CDC were neck or upper extremity pain (99%), upper extremity or hand paresthesia (94%), symptom exacerbation by arm elevation (97%), localized supraclavicular or subcoracoid tenderness to palpation (96%), and a positive 3-minute elevated arm stress test (94%; mean duration, 102.0 ± 5.1 seconds). The number of positive CDC (mean, 9.6 ± 0.1) correlated with the degree of tenderness to palpation and the duration of elevated arm stress test, as well as with PROMs for pain severity, functional disability, depression, physical quality of life, and pain catastrophizing (all P < .0001). PROMs across multiple domains were also strongly correlated with each other. Patients with clinically significant pain catastrophizing exhibited a greater level of functional disability than noncatastrophizing patients (P < .0001). CONCLUSIONS: This study illustrates the relative strengths of 14 CDC and seven PROMs to evaluate patients with NTOS, helping validate the selected CDC and highlighting the potential role of pain catastrophizing in functional disability. This cohort will provide valuable information on the utility of different CDC and PROMs to predict treatment outcomes.
Tipo de publicación:JOURNAL ARTICLE; OBSERVATIONAL STUDY


  6 / 858 MEDLINE  
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PMID:28735832
Autor:Day MA; Thorn BE
Dirección:School of Psychology, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: m.day@uq.edu.au.
Título:Mindfulness-based cognitive therapy for headache pain: An evaluation of the long-term maintenance of effects.
Fuente:Complement Ther Med; 33:94-98, 2017 Aug.
ISSN:1873-6963
País de publicación:Scotland
Idioma:eng
Resumen:OBJECTIVES: This study aimed to examine the durability of gain patterns following an 8-week Mindfulness-Based Cognitive Therapy (MBCT) for headache pain program. DESIGN: A secondary analysis of a randomized controlled trial was conducted. Participants (N=19) were individuals with headache pain who completed both the MBCT program as well as a 6-month follow-up assessment at a headache clinic or a university psychology clinic. Standardized measures of the primary outcomes (pain intensity and pain interference) and secondary outcomes (pain catastrophizing, mindfulness, activity engagement, pain willingness, and self-efficacy) were administered. Paired-samples t tests and effect sizes were examined. RESULTS: Significant (uncorrected ps<.05) pre- to post-treatment gains were found for pain intensity, pain interference, pain catastrophizing, activity engagement and self-efficacy, and these gains were maintained at 6-months post-treatment. Effect sizes for the significant changes from pre- to post-treatment, and from pre-treatment to follow-up were mostly consistent across epochs (.62≤ds≤-1.40), indicating steady maintenance of effects. Improvement in mindfulness and pain willingness was non-significant immediately post-treatment and at follow-up, with small effects observed. CONCLUSIONS: This study adds to a growing body of literature supporting the durability of MBCT for painful conditions. Results indicated a consistent pattern of maintenance of treatment-related gains across a number of key pain-related outcomes. Future research with a larger sample is needed to investigate the mechanisms underlying these continued gains in order to optimize targeted relapse-prevention.
Tipo de publicación:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL


  7 / 858 MEDLINE  
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PMID:28686644
Autor:Marshall PWM; Schabrun S; Knox MF
Dirección:School of Science and Health, Western Sydney University, Penrith South, New South Wales, AUSTRALIA.
Título:Physical activity and the mediating effect of fear, depression, anxiety, and catastrophizing on pain related disability in people with chronic low back pain.
Fuente:PLoS One; 12(7):e0180788, 2017.
ISSN:1932-6203
País de publicación:United States
Idioma:eng
Resumen:BACKGROUND: Chronic low back pain is a worldwide burden that is not being abated with our current knowledge and treatment of the condition. The fear-avoidance model is used to explain the relationship between pain and disability in patients with chronic low back pain. However there are gaps in empirical support for pathways proposed within this model, and no evidence exists as to whether physical activity moderates these pathways. METHODS: This was a cross-sectional study of 218 people with chronic low back pain. Multiple mediation analyses were conducted to determine the role of fear, catastrophizing, depression, and anxiety in the relationship between pain and disability. Separate analyses were performed with physical activity as the moderator. Individuals were classified as performing regular structured physical activity if they described on average once per week for > 30-minutes an activity classified at least moderate intensity (≥ 4-6 METs), activity prescribed by an allied health professional for their back pain, leisure time sport or recreation, or self-directed physical activity such as resistance exercise. RESULTS: Fear, catastrophizing, and depression significantly mediated the relationship between pain and disability (p<0.001). However the mediating effect of catastrophizing was conditional upon weekly physical activity. That is, the indirect effect for catastrophizing mediating the relationship between pain and disability was only significant for individuals reporting weekly physical activity (B = 1.31, 95% CI 0.44 to 2.23), compared to individuals reporting no weekly physical activity (B = 0.21, 95% CI -0.50 to 0.97). Catastrophizing also mediated the relationship between pain and fear (B = 0.37, 95% CI 0.15 to 0.62), with higher scores explaining 53% of the total effect of pain on fear. CONCLUSIONS: These results support previous findings about the importance of fear and depression as factors that should be targeted in low back pain patients to reduce back pain related disability. We have also extended understanding for the mediating effect of catastrophizing on back pain related disability. Back pain patients engaged with regular physical activity may require counselling with regards to negative pain perceptions.
Tipo de publicación:JOURNAL ARTICLE


  8 / 858 MEDLINE  
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PMID:28650969
Autor:Nishigami T; Mibu A; Tanaka K; Yamashita Y; Yamada E; Wand BM; Catley MJ; Stanton TR; Moseley GL
Dirección:Department of Nursing and Physical Therapy, Konan Woman's University, Kobe, Hyogo, Japan.
Título:Development and psychometric properties of knee-specific body-perception questionnaire in people with knee osteoarthritis: The Fremantle Knee Awareness Questionnaire.
Fuente:PLoS One; 12(6):e0179225, 2017.
ISSN:1932-6203
País de publicación:United States
Idioma:eng
Resumen:BACKGROUND: Recent systematic reviews have demonstrated that pain associated with knee osteoarthritis (OA) is a complex phenomenon that involves various contributors. People with knee OA exhibit symptoms of impaired body-perception, including reduced tactile acuity, impairments in limb laterality recognition, and degraded proprioceptive acuity. The Fremantle Back Awareness Questionnaire (FreBAQ) was developed to assess body-perception specific to the back in people with chronic low back pain. The aim of this study was to develop and assess the psychometric properties of a knee-specific version of the FreBAQ-J (FreKAQ-J), determine whether people with knee pain experience perceptual impairments and investigate the relationship between disturbed self-perception and clinical status. METHODS: Sixty-five people with knee OA completed the FreKAQ-J. A subset of the participants completed the FreKAQ-J again two-weeks later. Rasch analysis was used to assess item order, targeting, category ordering, unidimensionality, person fit, internal consistency, and differential item functioning. Validity was investigated by examining the relationship between the FreKAQ-J and clinical valuables. RESULTS: The FreKAQ-J had acceptable internal consistency, unidimensionality, good test-retest reliability, and was functional on the category rating scale. The FreKAQ-J was significantly correlated with pain in motion, disability, pain-related catastrophizing, fear of movement, and anxiety symptomatology. CONCLUSIONS: We developed FreKAQ-J by modifying the FreBAQ-J. The FreKAQ-J fits the Rasch measurement model well and is suitable for use in people with knee OA. Altered body perception may be worth evaluating when managing people with knee OA.
Tipo de publicación:JOURNAL ARTICLE; VALIDATION STUDIES


  9 / 858 MEDLINE  
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PMID:28614083
Autor:Sharifzadeh Y; Kao MC; Sturgeon JA; Rico TJ; Mackey S; Darnall BD
Dirección:From Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Palo Alto, California.
Título:Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription: Nonlinear Sex Differences Revealed Using a Learning Health System.
Fuente:Anesthesiology; 127(1):136-146, 2017 Jul.
ISSN:1528-1175
País de publicación:United States
Idioma:eng
Resumen:BACKGROUND: Pain catastrophizing is a maladaptive response to pain that amplifies chronic pain intensity and distress. Few studies have examined how pain catastrophizing relates to opioid prescription in outpatients with chronic pain. METHODS: The authors conducted a retrospective observational study of the relationships between opioid prescription, pain intensity, and pain catastrophizing in 1,794 adults (1,129 women; 63%) presenting for new evaluation at a large tertiary care pain treatment center. Data were sourced primarily from an open-source, learning health system and pain registry and secondarily from manual review of electronic medical records. A binary opioid prescription variable (yes/no) constituted the dependent variable; independent variables were age, sex, pain intensity, pain catastrophizing, depression, and anxiety. RESULTS: Most patients were prescribed at least one opioid medication (57%; n = 1,020). A significant interaction and main effects of pain intensity and pain catastrophizing on opioid prescription were noted (P < 0.04). Additive modeling revealed sex differences in the relationship between pain catastrophizing, pain intensity, and opioid prescription, such that opioid prescription became more common at lower levels of pain catastrophizing for women than for men. CONCLUSIONS: Results supported the conclusion that pain catastrophizing and sex moderate the relationship between pain intensity and opioid prescription. Although men and women patients had similar Pain Catastrophizing Scale scores, historically "subthreshold" levels of pain catastrophizing were significantly associated with opioid prescription only for women patients. These findings suggest that pain intensity and catastrophizing contribute to different patterns of opioid prescription for men and women patients, highlighting a potential need for examination and intervention in future studies.
Tipo de publicación:JOURNAL ARTICLE; OBSERVATIONAL STUDY
Nombre de substancia:0 (Analgesics, Opioid)


  10 / 858 MEDLINE  
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PMID:28591044
Autor:Hirase T; Kataoka H; Inokuchi S; Nakano J; Sakamoto J; Okita M
Dirección:aDepartment of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences bDepartment of Locomotive Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto cDepartment of Rehabilitation, Nagasaki Memorial Hospital, Hukahori, Nagasaki, Japan.
Título:Factors associated with chronic musculoskeletal pain in Japanese community-dwelling older adults: A cross-sectional study.
Fuente:Medicine (Baltimore); 96(23):e7069, 2017 Jun.
ISSN:1536-5964
País de publicación:United States
Idioma:eng
Resumen:Identifying older adults with chronic musculoskeletal pain (CMP) earlier is urgent because CMP is reportedly associated with deterioration in physical function, poor psychological status, and low physical activity level. The objective of this study was to identify factors that were most strongly associated with CMP in Japanese community-dwelling older adults.Using a cross-sectional design, we assessed 263 older adults (mean age = 79.1 ±â€Š5.9 years, 85.9% women) who participated in community exercise classes. Participants' physical function, psychological status, and activity levels were evaluated as outcome measures using a variety of tests and instruments. These assessments were conducted prior to beginning the exercise intervention program and compared participants with and without CMP. Additionally, relevant participant characteristics were collected and analyzed. In this study, CMP was defined as the presence of related symptoms within the past month that continued for at least 6 months and corresponded to a numerical rating scale of at least 5 or more at the site of maximum pain.A total of 143 (54.4%) participants met the criteria for CMP, and a high number of them had chronic lower back pain (64.3%). Outcome measures for the CMP group were significantly worse than for the non-CMP group (P < .05). Logistic regression analysis revealed that the Pain Catastrophizing Scale helplessness domain scores (odds ratio: 1.20, 95% confidence interval: 1.09-1.32) with an estimated value of 10 points was the factor most significantly associated with the presence of CMP.These findings suggest that assessment of the helplessness associated with pain-related catastrophizing is important for identification and the creation of interventions for older adults with CMP.
Tipo de publicación:JOURNAL ARTICLE; OBSERVATIONAL STUDY



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