Biopsychosocial Model Of Pain Research Articles

Psychotherapy in the Context of Interdisciplinary Multimodal Pain Therapy: Update

Interdisciplinary multimodal pain therapy (IMPT) is based on the biopsychosocial model of pain and describes an integrated treatment for patients with chronic pain. IMPT incorporates a close cooperation of different disciplines, including physicians, psychotherapists, physiotherapists, and others. IMPT mainly aims to restore and increase patients' physical, social and psychological functional capacity. The efficacy of IMPT has been evidenced by systematic reviews and meta-analyses. A number of studies further indicate IMPT's cost-efficiency. Psychotherapy is an essential component of IMPT. Its main goal within the framework of IMPT is to identify and modify dysfunctional patterns of pain coping, and to diagnose and potentially treat psychological comorbidities. Pain psychotherapy comprises mostly cognitive-behavioral interventions which address dysfunctional coping at the three levels of the pain experience (i.e., cognitive, emotional, and behavioral). Research into the efficacy of pain psychotherapy is rather sparse and studies have mostly focused on chronic back pain, yet existing results show promising evidence both for psychotherapy within IMPT and for psychotherapy as a monotherapy. This paper aims at providing an overview of (a) commonly employed cognitive-behavioral psychotherapeutic approaches and strategies in the treatment of chronic pain, and (b) the existing empirical evidence of pain psychotherapy both within the framework of IMPT and as a monotherapy. Future research should include a wider range of pain diagnoses and also investigate the potential benefit of individually-tailored treatments.

Treating Temporomandibular Disorders in the 21st Century: Can We Finally Eliminate the "Third Pathway"?

Within the orofacial pain discipline, the most common group of afflictions is temporomandibular disorders (TMD). The pathologic and functional disorders included in this condition closely resemble those that are seen in the orthopedic medicine branch of the medical profession, so it would be expected that the same principles of orthopedic diagnosis and treatment are applied. Traditional orthopedic therapy relies on a "Two Pathway" approach involving conservative and/or surgical treatments. However, over the course of the 20th century, some members of the dental community have created another way of approaching these disorders- referred to in this paper as the "Third Pathway"-based on the assumption that signs and symptoms of TMD are due to a "bad" relationship between the mandible and skull, leading to a variety of irreversible occlusal or surgical corrective treatments. Since no other human joint is discussed in these terms within the orthopedic medicine communities, it has become progressively clear that the Third Pathway is a unique and artificial conceptual creation of the dental profession. However, many clinical studies have utilized the medically oriented conservative/surgical Two-Pathway model to diagnose and treat TMD within a biopsychosocial model of pain. These studies have shown that TMD comprise another domain of orthopedic illness that requires a medically oriented approach for good outcomes while avoiding the irreversible aspects of the Third Pathway. This review presents historical and current evidence that the Third Pathway is an example of unorthodox medicine that leads to unnecessary overtreatment and further proposes that it is time to abandon this approach as we move forward in the TMD field.

Factors Associated With Posttraumatic Stress Disorder Among Veterans of Recent Wars Receiving Veterans Affairs Chiropractic Care

ObjectivesPost-traumatic stress disorder (PTSD) is thought to complicate pain management outcomes, which is consistent with the impact of other psychosocial factors in the biopsychosocial model of pain. This study aimed to identify patient sociodemographic and clinical characteristics associated with PTSD prevalence among veterans of Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) who received Veterans Affairs (VA) chiropractic care. MethodsA cross-sectional analysis of electronic health record data from a national cohort study of OEF/OIF/OND veterans with at least 1 visit to a VA chiropractic clinic from 2001 to 2014 was performed. The primary outcome measure was a prior PTSD diagnosis. Variables including sex, race, age, body mass index, pain intensity, alcohol and substance use disorders, and smoking status were examined in association with PTSD diagnosis using logistic regression. ResultsWe identified 14,025 OEF/OIF/OND veterans with at least 1 VA chiropractic visit, with a mean age of 38 years and 54.2% having a diagnosis of PTSD. Male sex (adjusted odds ratio [OR] = 1.23, 95% CI = 1.11-1.37), younger age (OR = 0.99, CI = 0.98-0.99), moderate-to-severe pain intensity (numerical rating scale ≥ 4) (OR = 1.72, CI = 1.59-1.87), body mass index ≥ 30 (OR = 1.34, CI = 1.24-1.45), current smoking (OR = 1.32, CI = 1.20-1.44), and having an alcohol or substance use disorder (OR = 4.51, CI = 4.01-5.08) were significantly associated with a higher likelihood of PTSD diagnosis. ConclusionPost-traumatic stress disorder is a common comorbidity among OEF/OIF/OND veterans receiving VA chiropractic care and is significantly associated with several patient characteristics. Recognition of these factors is important for the appropriate diagnosis and management of veterans with PTSD seeking chiropractic treatment for pain conditions.

Two Patient Cases Illustrating the Importance of Addressing Physical and Mental Trauma as a Cause of Pain in Refugee Women

Refugees, and more so women than men, are often seeking medical care for a wide range of health-related problems, among which persistent pain has long been recognized as a defining feature. When treating refugee women for any condition, pain and its consequences need to be addressed in the rehabilitation efforts. It is therefore essential that health professionals engaged in the care of refugee women are familiar with the physiology of pain mechanisms, including the biopsychosocial model of pain, as well as the best evidence-based practice in managing pain, acute as well as chronic. Persistent or chronic pain not only causes disability and restricted functioning but also produces psychological impairments, compounding the impact on overall personal and social functioning. Yet, the research literature on health regarding refugees is predominantly targeted at mental health problems without specific reference to pain and pain as a significant cause of distress and disability due to migration (pre-and post). Pain as a consequence of torture is also an issue that is under-assessed when refugees are seeking medical aid for pain-related problems. When aiming at treating refugee women with disabling pain, one can use the same intervention methods that are being used for other chronic pain states. Professionals need, however, to be able to work with less written information and in close co-operation with interpreters. Reviews of the rehabilitation literature have noted a lack of scientifically rigorous studies of multicomponent interventions for refugees. Only few studies have evaluated outcomes of pain management, and the quality of the evidence they provide is very low. The small number of randomized controlled trials and the resulting paucity of information means that recommendations amounting to good clinical practice for refugee women with persistent pain are lacking. The aim of this article, illustrated by two patient cases, is to point out important areas that need to be addressed within the health care system in order to improve health care for refugee women. Pain is a common reason for refugee women to seek medical aid, is a costly burden for the society, and decreases quality of life for these women.

Temporomandibular disorders in head and neck cancers: Overview of specific mechanisms and management

Diagnosis classification system of Temporomandibular disorders (TMD) is based on the biopsychosocial model of pain. The pathogenesis is poorly understood, leading to difficulties in treating these multifactorial conditions. The predisposing factors are pathophysiological, psychological or structural processes that alter the masticatory system and lead to an increase in the risk of development of TMD. The purpose of this integrative review was then to point out the specific mechanisms of TMD in the oral oncologic context to optimize the TMJ functional results in the management of patients with oral oncologic conditions. We explored in this paper the role of Axis II assessment of the biopsychosocial model of pain, the involvement of mechanical concepts such as dental occlusion, mandibular condyle positioning and related-structures reconstruction, and the stomatognathic changes induced by radiation.

Psychosocial factors and chronic pain after breast cancer surgery

Chronic pain is one of the important factors that reduces the quality of life in breast cancer patients. With the development of biopsychosocial models of pain, the role of psychosocial factors has gradually attracted the attention of researchers. This article summarizes the latest studies concerning the psychosocial factors of breast cancer patients, reviews the psychosocial risk factors and protective factors related to chronic pain after breast cancer surgery, and introduces physiological mechanisms by which pain is closely associated with social psychology. At last, the psychotherapy currently used in clinical practice were mentioned as well. It is expected that clinicians pay more attention to the abnormal psychological condition of breast cancer patients, so as to reduce the occurrence of chronic pain and improve the overall prognosis of patients by adopting active and effective psychological interventions. Key words: Breast cancer; Chronic pain; Psychosocial; Psychotherapy

Patients’ and primary healthcare professionals’ perceptions regarding chronic low back pain and its management in Spain: a qualitative study

Purpose This study aimed to explore and compare the perceptions of patients and primary healthcare professionals regarding the management of chronic low back pain. Methods Qualitative study using 26 semi-structured individual interviews, and one discussion group, carried out in primary care in Lleida, Spain. Results Patients and primary healthcare professionals both had assumptions pertaining to: (1) the diagnosis and meaning of chronic low back pain, (2) expectations regarding treatment for pain reduction, and (3) communication between primary healthcare professionals and patients with chronic low back pain. Results suggest a mutual dissatisfaction with the diagnosis of chronic low back pain and a lack of understanding between primary healthcare professionals and patients. Some contradictions between them were also noted: the patients wanted quick solutions to reduce their pain, but the primary healthcare professionals required an accurate etiology to prescribe treatment, and the patients did not always follow the primary healthcare professionals’ recommendations. Conclusions Diagnosing and treating chronic low back pain is compromised due to differing expectations and the communication barriers that exist between healthcare professionals and their patients. Primary healthcare professionals should be aware of the power of their explanations and recommendations to patients. Implications for Rehabilitation Primary healthcare professionals should negotiate treatments with patients and adapt them to their individual needs, according to a Patient-Centered approach and the biopsychosocial model of pain. Primary healthcare professionals should explain to patients the underlying mechanisms and multifactorial nature of chronic low back pain. Primary healthcare professional-patient communication needs to be improved to help patients to better understand their chronic condition. The healthcare professionals in Spain should be more trained into the (bio)psychosocial model of long-term pain, stop searching for non-evident pathologies and change their biomedical beliefs.

THE ASSOCIATION OF LONELINESS AND CHRONIC CLINICALLY SIGNIFICANT PAIN AMONG AFRICAN AMERICAN AND WHITE OLDER ADULTS

Loneliness and pain are significant public health problems in later life, yet limited research has examined how these factors interact among racially diverse older adults. Guided by the Biopsychosocial Model of Pain, we used data from Waves 2 and 3 of the National Social Life, Health, and Aging Project to investigate the relationship between loneliness and chronic pain among 1,102 African-American and White adults aged 50 and over. Using logistic regression analyses, our final models considered demographics, physical and mental health, functioning, medication, health behaviors and social factors. Approximately 32% of African Americans and 28% of Whites reported chronic loneliness. Compared to Whites African-Americans were 2.5 times more likely to experience chronic pain. Among White participants, loneliness was not associated with chronic pain; however, the interaction of being African-American and lonely was associated with decreased odds of chronic pain in main and gendered analyses. African American women were 4 times more likely than White women to report chronic pain. Our results address the objectives of the National Pain Strategy (2016) to elucidate the experiences of chronic pain among diverse elders in the US. Future work should seek a deeper understanding of loneliness and chronic pain among African Americans elders and how cultural dynamics may help explain our counter intuitive findings (e.g., “Superwoman Schema”).

"Puttin' on": Expectations Versus Family Responses, the Lived Experience of Older African Americans With Chronic Pain.

The lack of family research documenting the changes that occur and the capacity of families to support individuals with chronic pain effectively is a major limitation in the application of the biopsychosocial model of pain. This study investigated the lived experience of older African Americans (N = 18) with chronic pain and explored their expectations and perceptions of familial support. A descriptive phenomenology framework revealed an existential theme: "puttin' on," a phenomenon that potentiates the power of pain to disrupt roles and relationships and discourages the family from meeting the expected needs of older African Americans. We uncovered new information into the actual support mechanisms that are missing or, when present, are not as positive and strong as would be expected in the African American culture, at least in the context of chronic pain management. Interventions should target family-based education, chronic pain destigmatization, and intergenerational empathy in the African American community.

Acute and Chronic Pain in Children and Adolescents With Cerebral Palsy: Prevalence, Interference, and Management

ObjectiveTo determine the prevalence, interference, and management of acute and chronic pain among youth with cerebral palsy (CP) aged 5-18 years attending outpatient rehabilitation services. DesignA cross-sectional study using the Faces Pain Scale-Revised, Patient Reporting Outcomes Measurement Information System Pediatric Pain Interference Scale, and the Cerebral Palsy Quality of Life questionnaire. Where children were unable to self-report, parent or caregiver proxy was obtained. SettingOutpatient rehabilitation. ParticipantsParticipants (N=280) with CP aged 5-18 years and their parent or caregiver. Self-report was obtained by 45.7% (n=128) and proxy-report was obtained by 54.3% (n=152) of the cohort. InterventionsNot applicable. Main Outcome MeasuresPresence or absence of acute pain and chronic pain. Secondary measures were pain intensity, pain interference, pain management, and quality of life. ResultsAcute pain and chronic pain were reported by 67.1% and 31.4% of participants, respectively. Of those reporting acute pain, 42% also experienced chronic pain. Factors that increased the odds of chronic pain were: predominately dyskinesia (odds ratio [OR]=3.52; 95% confidence interval [CI], 1.64-7.55); mixed spasticity-dyskinesia (OR=1.93; 95% CI, 1.07-3.47); bilateral involvement (OR=3.22; 95% CI, 1.844-5.61) and Gross Motor Function Classification System level IV (OR=2.32; 95% CI, 1.02-5.25), and V (OR=3.73; 95% CI, 1.70-8.20). Pain frequently interferes with sleep, attention, ability to have fun, and quality of life. Short-acting pharmacologic analgesics, thermotherapy, hydrotherapy, and massage were commonly used for pain management. ConclusionsRoutine screening for pain is critical for early identification and intervention. Multimodal interventions are needed to address the biopsychosocial model of pain, and should be tailored for all abilities across the CP spectrum.

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

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

The ACTTION Guide to Clinical Trials of Pain Treatments: standing on the shoulders of giants.

The ACTTION Guide to Clinical Trials of Pain Treatments: standing on the shoulders of giants.

(250) The Relationship between Beta-Endorphin and Experimental Pain Sensitivity in Older Adults with Knee Osteoarthritis Pain

Osteoarthritis (OA) is the most common arthritic condition and a leading cause of pain and disability in people 45 years and older. As the biopsychosocial model of pain hypothesizes that pain is dynamically affected by multidimensional factors, there is a growing interest to understand the biological factors that influence pain among older adults. Beta-endorphin is suggested to be involved in pain sensitivity, but few studies have examined the relationship between beta-endorphin and experimental pain sensitivity in older adults. Thus, we sought to investigate the relationship between beta-endorphin and experimental pain sensitivity in 40 adults with knee OA pain. Pressure pain thresholds were measured by a handheld Medoc digital pressure algometer. Also, a calibrated nylon monofilament delivering a target force of 300 grams was applied and verbal ratings of the pain intensity on a scale of 0 to 100 following 10 contacts were obtained to assess their sensitivity to punctate mechanical stimuli. The mean age was 59 years (SD = 9 years), and 53% were female. Results showed that beta-endorphin is negatively related to pressure pain threshold (beta = -0.35, t = -2.40, p = 0.02) and positively related to punctate mechanical pain (beta = 0.34, t = 2.14, p = 0.04), after controlling for age, gender, and OA severity. These results suggest that higher circulating beta-endorphin at rest is associated with increased sensitivity to mechanical pain in older adults with knee OA. Further studies are needed to explore these paradoxical associations and to identify variables mediating the relationship between endorphin and pain sensitivity.

ACC Research Agenda Conference 2019: Peer Reviewer Acknowledgments and Abstracts of Proceedings.

ACC Research Agenda Conference 2019: Peer Reviewer Acknowledgments and Abstracts of Proceedings.

A preliminary biopsychosocial analysis of online information on causes of neck pain.

The aim of the present study was to analyse the freely available online information on the causes of neck pain based on the biopsychosocial model of pain. A preliminary biopsychosocial analysis tool was developed, after an extensive literature review of the pathoanatomical and psychosocial contributors for neck pain. The websites that commonly appeared after the search term "causes of neck pain" in the first two pages of the search engines (Google, Yahoo and Bing) were selected for the biopsychosocial analysis. In addition, the websites were reviewed for Health on Net (HON) certification. Ten websites were analysed, of which eight were identified to contain a predominant biomedical orientation, as they reported only the pathoanatomical causes of neck pain. The remaining two websites were determined to represent limited psychosocial information and described only two psychological contributors to the neck pain. The online information on the causes of neck pain appears to contain limited biopsychosocial orientation. Further detailed analysis is essential to obtain firm conclusions on the content validity of online information on neck pain.

Chronic Pediatric Pain Management: a Review of Multidisciplinary Care and Emerging Topics

Chronic pain is a prevalent, disabling, and expensive pediatric condition. Specific treatment options have limited evidence and are often extrapolated from adult care. This review evaluates pain outcome measures, psychological treatment, pharmacologic management, multidisciplinary treatment models, and emerging topics in pediatric pain medicine. Multimodal cognitive behavioral therapy and intensive interdisciplinary pain treatment have the strongest evidence for improving pain and function while decreasing healthcare utilization. There is emerging evidence that parental involvement in care is an important factor in pediatric outcomes. While there is increased interest in emerging topics such as use of marijuana-derived products, acupuncture, and virtual reality, the evidence behind such interventions remains limited. Pediatric chronic pain treatment centers on the biopsychosocial model of pain and multidisciplinary treatment. Recent research shows that intensive interdisciplinary pain treatment can improve pain, function, and healthcare utilization. Long-term benefits and risks of emerging treatments in pediatric chronic pain remain poorly understood.

The experience of living with patellofemoral pain: loss, confusion and fear-avoidance - a UK qualitative study

Purpose: Contemporary models of persistent pain have identified the importance of thinking beyond muscles and joints, and qualitative inquiry can provide an insight that may lead to development of ideas and hypothesis generation within the context of the biopsychosocial model of pain. No study using qualitative methods has been published regarding patellofemoral pain. Therefore the aim of this study was to give a more detailed account of the experience of people living with patellofemoral pain, seeking secondary care within the UK.

The biopsychosocial model of pain in the context of pediatric burn injuries.

Burns are a common and traumatic source of childhood injury in the United States. The treatment and recovery from burn injuries can be significantly painful and may lead to chronic or persistent pain for years following the initial incident. Further, burn injuries in youth have been found to increase the potential for significant psychosocial (e.g., anxiety, depression, PTSD) and physical (e.g., decreased mobility) impairment. Relatedly, the general experience and processing of pain in youth can also be associated with greater psychosocial (e.g., anxiety, depression) impairment and functional disability over time. However, the phenomenology and associated characteristics of the pain experience following burn injury and, in particular, the potential for combined impact on physical and psychosocial outcomes in youth with severe and/or prolonged pain and a history of burn injury is poorly understood. A review of the literature was performed in the areas of burn injuries and outcomes associated with both acute and chronic pain with youth and adult populations. The current review highlights current gaps in the literature in important areas of function in youth with a history of burn injuries using the biopsychosocial model of pain. Future research and considerations for practice are also outlined. Gaining a greater understanding of the relationship between pain, physical impairment, and psychosocial functioning in these youth is significantly important in order to provide greater preventative and treatment-related intervention going forward. Using a biopsychosocial framework, this review highlights the need for a greater understanding of pain processing and the long-term potential for persistent pain and pain-related impairment (e.g., functional disability) in youth with a history of burn injuries.

Measuring the Quality of Mobile Apps for the Management of Pain: Systematic Search and Evaluation Using the Mobile App Rating Scale.

BackgroundChronic pain is a major health issue requiring an approach that not only considers medication, but also many other factors included in the biopsychosocial model of pain. New technologies, such as mobile apps, are tools to address these factors, although in many cases they lack proven quality or are not based on scientific evidence, so it is necessary to review and measure their quality.ObjectiveThe aim is to evaluate and measure the quality of mobile apps for the management of pain using the Mobile App Rating Scale (MARS).MethodsThis study included 18 pain-related mobile apps from the App Store and Play Store. The MARS was administered to measure their quality. We list the scores (of each section and the final score) of every app and we report the mean score (and standard deviation) for an overall vision of the quality of the pain-related apps. We compare the section scores between the groups defined according to the tertiles via analysis of variance (ANOVA) or Kruskal-Wallis test, depending on the normality of the distribution (Shapiro-Wilk test).ResultsThe global quality ranged from 1.74 (worst app) to 4.35 (best app). Overall, the 18 apps obtained a mean score of 3.17 (SD 0.75). The best-rated sections were functionality (mean 3.92, SD 0.72), esthetics (mean 3.29, SD 1.05), and engagement (mean 2.87, SD 1.14), whereas the worst rated were app specific (mean 2.48, SD 1.00), information (mean 2.52, SD 0.82), and app subjective quality (mean 2.68, SD 1.22). The main differences between tertiles were found on app subjective quality, engagement, esthetics, and app specific.ConclusionsCurrent pain-related apps are of a certain quality mainly regarding their technical aspects, although they fail to offer information and have an impact on the user. Most apps are not based on scientific evidence, have not been rigorously tested, and the confidentiality of the information collected is not guaranteed. Future apps would need to improve these aspects and exploit the capabilities of current devices.

The inherent role of the multidisciplinary palliative care team on pain management: A critical review

Cancer pain and palliative care (PC) are recognized as significant international health issues. Treatment of pain and rehabilitation programs in PC are challenging. Rehabilitation is the process that helps a person to reach physical, psychologic, social and educational potential with physiologic, anatomic impairment, desires and life ambitions. Rehabilitation improves patients physical function, independence and pain management to improve quality of life and patients’ dignity. Update on the role of rehabilitation in PC by detailed view of rehabilitation treatment methods and their evidence for application into PC conditions. Databases of Cochrane Library, Google Scholar and Pubmed were search from January 2005–December 2016. There is few evidence that rehabilitation can impact function and pain management in PC. However, experience suggests that physical modalities should be applied early to minimize the generalized deconditioning and aid in the pain management, decreasing the need for pain medications. Physical modalities can be applied by health care providers. Passive, active, and active-assisted motion exercises and gentle strengthening exercises can aid in the maintenance of strength and joint range of motion. The prescription of assistive devices, and the teaching of compensatory techniques for mobility can aid in ambulation. There is also evidence that immune function may be improved by moderate exercise. A rehabilitation team has the ability to integrate physical aspects of treatment in a biopsychosocial model of pain into a comprehensive rehabilitation program for cancer patients. More research should focus on the role of rehabilitation and defining appropriate interventions.