Chronic Musculoskeletal Pain Patients Research Articles

Pain Sensitivity Questionnaire: Cross-cultural adaptation and validation of the Greek version.

The Pain Sensitivity Questionnaire (PSQ) was developed to assess general pain sensitivity. This study aimed to validate the Greek version of PSQ. The questionnaire was translated into Greek (PSQ-GR) and piloted in a small sample of patients with chronic pain (n=35). A total of 146 chronic pain patients and healthy volunteers completed the PSQ-GR, the Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS) and Central Sensitization Inventory (CSI). To evaluate the test-retest reliability, 36 volunteers completed the PSQ-GR twice over 7±2days. Internal consistency was excellent (Cronbach's alpha 0.90-0.96) for PSQ-total, PSQ-minor, and PSQ-moderate. The Intraclass Correlation Coefficient was estimated at 0.90-0.96 for PSQ-total, PSQ-minor and PSQ-moderate and the SEM was 0.59-0.90 for PSQ-total, PSQ-minor and PSQ-moderate approximately. The smallest detectable change was 0.48 for PSQ-total, 0.47 for PSQ-minor and 0.44 for PSQ-moderate. Positive and significant correlations were observed between PSQ-GR and HADS (r=0.38, p<0.01), PCS (r=0.41, p<0.01) and CSI (r=0.30, p<0.01). Statistically significant differences in PSQ-GR scores were identified between the healthy volunteers and the chronic pain patients. The PSQ-GR is a reliable and valid tool that can assess pain sensitivity in healthy individuals and chronic musculoskeletal pain patients.

What Predicts a Longer Period of Pain in Patients Referred to an Interdisciplinary Center for Pain Care?

Chronic musculoskeletal pain (CMP) is a global health condition that affects thousands of people. CMP can substantially affect the functional capacity and quality of life of the people impacted, resulting in high costs for health care and social security systems. Sociodemographic factors may play a significant role in pain chronification prevention and control programs. Thus, current risk factors for CMP must be seriously considered as part of an interdisciplinary management strategy. The purpose of the study was to identify the primary sociodemographic characteristics of CMP patients at a multidisciplinary and specialized center for chronic pain. This is a retrospective investigation based on a review of medical records. Age, gender, income, and the time of onset of pain symptoms were among the variables included in the analyzed data. To analyze variables related to the duration of discomfort, a multiple regression model was utilized. Sociodemographic factors explained 37.94% of experiencing prolonged pain, according to the study's findings. Being female and having a family income above the minimum wage were variables that were directly proportional to discomfort duration. Age was not associated with a prolonged duration of pain perception.

Outpatient interdisciplinary multimodal pain treatment programme for patients with chronic musculoskeletal pain: a longitudinal cohort study

Purpose To describe the outcomes of an interdisciplinary multimodal pain treatment (IMPT) for chronic musculoskeletal pain (CMP) patients up until 12 months post-treatment. Materials and Methods Data were gathered during routine clinical practice during a 3-year period (2019–2021) at six Dutch rehabilitation centres. Assessments included patient-reported outcome measures for multiple domains including disability, pain and fatigue. Longitudinal data were analysed using repeated-measures models and by quantifying responder rates. Results Included were 2309 patients with a mean age of 43.7 (SD 12.9) years, of which 73% female. All outcomes showed significant improvements at each timepoint. At discharge, large effect sizes were found for disability, average and worst pain, fatigue and health-related quality of life. Improvements were largely sustained at 12-months. Relatively large proportions of patients had clinically relevant improvements after treatment (pain-related disability: 60%; average pain: 52%; worst pain: 37.4%; work capacity: 50%; concentration: 50%; fatigue: 46%). Patients who received a treatment extension showed further improvements for all outcome measures, except average pain. Conclusions At group level, all outcomes significantly improved with mainly large effect sizes. The results were mostly sustained. The proportion of patients showing clinically relevant improvements tends to be larger than previously reported for mixed CMP patients.

The Clinical Study of DRG Pulsed Radiofrequency Treatment for Chronic Musculoskeletal Disease

Objective: To observe the clinical effect of Chronic Musculoskeletal Pain (CMP). Methods: 80 CMP patients admitted to our department from January 2022 to June 2023 were selected as the pain improvement after pulse radiofrequency treatment. Results: The total response rate at 1 week and 4 weeks was 91.25% and 97.50%, respectively. The excellent rate at 4 weeks after treatment was significantly higher than at 1 week after treatment. VAS scores were significantly lower at 1 week and 4 weeks after treatment than before treatment (P&lt;0.05). Conclusion: Pulsed radiofrequency therapy for CMP has a significant clinical effect, significant pain improvement, and significantly improved quality of life. It is a widely used interventional therapy in chronic pain.

Prevalence of Musculoskeletal Pain in Patients Following Cardiac Surgery in Peshawar: A Cross Sectional Study

Background: Cardiovascular diseases causes more deaths and disability in developing countries than any other disease in the world, for these diseases, CABG (Coronary artery bypass grafting) and VR (valvular replacement) are the best treatment options, although, these surgeries improve the chances of survival but they may cause chronic post operative musculoskeletal pain. Musculoskeletal pain can arise from different body musculoskeletal structures such as muscles, tendons, ligaments and joints and knowing the exact cause of this musculoskeletal pain is very difficult and challenging. Chronic musculoskeletal pain patients may have different signs of pain and spread of pain to degrees which are related to pain intensity and duration, so in management, it is very important to reduce duration and intensity of pain. Methods: A cross-sectional survey design was conducted among 199 cardiac patients in Peshawar from both genders, from June 2018-November 2018 among patients at RMI, KTH.,LRH and at other private clinics. Tool used for data collection named as Orebro musculoskeletal pain questionnaire and self- made questionnaire was used in this study. Results: Patients mean age was 53.49±11.88, 69.8% were males and 30.2% were females. The results showed that most common MSK pain site is upper back 27.6% and most common surgery is CABG. This study analyzed that different surgical procedure through which participants had been undergone. The surgical procedures were categorized into 4 main domains as shown in table 8 and frequency analysis was done which shows that most common surgical procedure is CABG (Coronary artery bypass grafting) 64.3%. The result of this study shows that diagnosis domain descriptive analysis was done to find out the frequency of the present pain conditions of the participants which exhibits that most common pain occurs in the back 27.6% and in the shoulder 25.1% Conclusion: Results among patients of Peshawar showed that most common surgery performed is CABG while PCI intervention is the next. Most of the patients are suffered from upper back pain while leg pain and cervical pain is not so common.

Cross-cultural adaptation and validation of the Mental Health Quality of Life (MHQoL) questionnaire in a Chinese-speaking population with chronic musculoskeletal pain

BackgroundThe Mental Health Quality of Life (MHQoL) questionnaire is concise and suitable for rapid assessment of CMP (chronic musculoskeletal pain) patients in primary care. However, there is a lack of Chinese versions of the MHQoL.ObjectiveTo cross-culturally translate the MHQoL into Chinese and to assess its psychometric properties in Chinese-speaking patients with CMP.MethodsThe MHQoL was translated into Chinese according to the International Guidelines for the Cross-Cultural Adaptation of Self-Report Measures. 171 CMP patients were recruited to receive the Chinese versions of the MHQoL, SF-36, and HADS tests, and the MHQoL was retested seven days later.ResultThe Chinese version of MHQoL had good retest reliability (MHQoL-7D: ICC = 0.971; MHQoL-VAS: ICC = 0.988) and internal consistency (Cronbach’s alpha = 0.829). It showed a moderate correlation with the SF-36 total score (r=-0.509); the MHQoL-VAS moderately correlated with the Hospital Anxiety Depression Scale (r=-0.548). The MHQoL-7D showed no correlations with the SF-36’s PF (r=-0.083) and BP (r=-0.170), weak correlations with RP (r=-0.284), RE (r=-0.298), and SF (r=-0.380), and moderate-to-strong correlations with GH (r=-0.638), VT (r=-0.480), and MH (r=-0.632).ConclusionThe Chinese version of the MHQoL can be used in clinical practice and research in Chinese-speaking CMP patients.

The clinical observation of DRG pulsed radiofrequency treatment for chronic musculoskeletal disease

Objective: To observe the clinical effect of Chronic Musculoskeletal Pain (CMP). Methods: 80 CMP patients admitted to our department from January 2022 to June 2023 were selected as the pain improvement after pulse radiofrequency treatment. Results: The total response rate at 1 week and 4 weeks was 91.25% and 97.50%, respectively. The excellent rate at 4 weeks after treatment was significantly higher than at 1 week after treatment. VAS scores were significantly lower at 1 week and 4 weeks after treatment than before treatment (P&lt;0.05). Conclusion: Pulsed radiofrequency therapy for CMP has a significant clinical effect, significant pain improvement, and significantly improved quality of life. It is a widely used interventional therapy in chronic pain.

Virtual Reality-Based Exercise Therapy for Patients with Chronic Musculoskeletal Pain: A Scoping Review.

This scoping review aimed to identify interventions utilizing virtual-reality-based exercise therapy in patients with chronic musculoskeletal pain. Searches were conducted in four databases using descriptors related to virtual reality, exercise, and chronic musculoskeletal pain. Two reviewers screened the titles and abstracts of the studies to assess eligibility, with a third author resolving any discrepancies. Data were extracted and summarized in a narrative format by three independent raters. Clinical trials were evaluated using the PEDro scale to assess the effectiveness of virtual-reality-based exercise therapy in chronic musculoskeletal pain patients. A total of 162 articles were identified from the databases. After applying the inclusion criteria, nine articles were considered suitable for analysis, including six randomized clinical trials. The selected articles were categorized based on study characteristics, virtual-reality-based exercise therapy interventions (including technologies and equipment used), exercise interventions, outcome measures, and effectiveness. The findings indicate that virtual-reality-based exercise therapy shows promising results in reducing pain, improving disability, enhancing range of motion, and increasing treatment satisfaction in patients with chronic musculoskeletal pain. However, it is not possible to conclude that virtual-reality-based exercise therapy is superior to other treatments due to the limited number of available studies, heterogeneity in application protocols, and varying methodological quality. Further research is needed to draw more definitive conclusions.

Do the instruments used to assess fibromyalgia symptoms according to American College of Rheumatology criteria generate similar scores in other chronic musculoskeletal pain?

BackgroundAs with fibromyalgia, several musculoskeletal disorders are characterized by chronic pain, raising a clinical question – do the instruments used to assess fibromyalgia symptoms according to ACR criteria (ACR criteria) generate similar scores in other chronic musculoskeletal pain?ObjectiveTo compare the symptoms among fibromyalgia and other chronic musculoskeletal pain. Additionally, we also compared the most researched outcomes in fibromyalgia (i.e., present pain at rest and after movement; fatigue; pain severity and impact; function, global impact, and fibromyalgia symptom).MethodsA cross-sectional study. Participants over 18 years old were included if they presented report of chronic musculoskeletal pain (≥ 3 months) and after that, they were divided into two groups (fibromyalgia and chronic pain). They answered the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), Brief Pain Inventory (BPI), Numerical Pain Rating Scale (NPRS) for pain and fatigue, WPI, and SSS.ResultsA total of 166 participants were included in this study into two independent groups (chronic pain, n = 83; fibromyalgia, n = 83). We observed significant differences (p < 0.05) and large effect sizes (Cohen’s d, ≥ 0.7) in clinical outcomes comparisons between groups (i.e., widespread pain; symptom severity; present pain at rest and after movement; fatigue; pain severity and impact; function, global impact, and fibromyalgia symptoms).ConclusionFibromyalgia patients (2016 ACR criteria) compared to other chronic musculoskeletal pain patients have higher levels of pain (at rest or after movement) and fatigue, greater impairment in both functionality and global impact, and worse symptoms. Therefore, the WPI and SSS instruments should be used exclusively to assess fibromyalgia symptoms.

The Relationship Between Pain Intensity and Pain-Related Activity Patterns in Older Adults with Chronic Musculoskeletal Pain: Mediating Roles of Pain Resilience and Pain Catastrophizing.

To explore the relationship between pain intensity, pain resilience, pain catastrophizing, and pain-related activity patterns in older adults with chronic musculoskeletal pain (CMP). A total of 220 elderly Chinese with chronic musculoskeletal pain were recruited from a tertiary general hospital. Participants completed several measures including a demographic questionnaire, Brief Pain Inventory (BPI), Pain Resilience Scale (PRS), Pain Catastrophizing Scale (PCS), and Patterns of Activity Measure-Pain (POAM-P). Moreover, Process version 3.5 plug-in SPSS26 was used to test the mediation effect between variables. The scores of POAM-P in older adults with CMP from high to low were: avoidance (27.39 ± 8.10), pacing (24.25 ± 9.48), and overdoing (16.65 ± 10.95). Mediation analysis revealed that pain resilience and pain catastrophizing mediated the relationship between pain intensity and pain-related activity patterns (avoidance and pacing) in older adults with CMP. These results provide evidence for the role of pain resilience and pain catastrophizing in the relationship between pain intensity and pain-related activity patterns. Interventions targeting these factors should be included in activity management programs for elderly CMP patients. It may be possible to reduce the negative impact of pain intensity on activity patterns by improving pain resilience and reducing pain catastrophizing.

Emotion regulation mediates the relationship between family caregivers' pain-related beliefs and patients' coping strategies.

Background: In order to tailor more effective interventions and minimize the burden of chronic pain, it is critical to identify the interaction and contribution of social and psychological factors in pain. One of the important psychological factors in pain management is related to the choice of pain coping strategies in chronic pain patients. Social resources, including family caregivers' pain attitudes-beliefs, can influence pain coping strategies in chronic pain patients. Moreover, one key factor that may intervene in the relationship between caregivers' pain attitudes-beliefs and the patients' coping strategies is the emotion regulation strategies. Therefore, the present study aimed to investigate the mediating role of emotion regulation strategies of chronic pain patients and their family caregivers on the association between caregivers' pain attitudes-beliefs and pain coping strategies of chronic pain patients. Methods: We recruited 200 chronic musculoskeletal pain patients and their family caregivers. Chronic pain patients responded to measures of pain coping and emotion regulation strategies while family caregivers completed questionnaires related to their attitude toward pain and emotion regulation of themselves. Results: There is an association between caregivers' pain attitudes-beliefs and pain coping strategies in patients with chronic musculoskeletal. Moreover, the structural equation modeling revealed that the emotion regulation of both patients and family caregivers mediate the relationship between the caregivers' pain attitudes-beliefs and pain coping strategies of patients with chronic musculoskeletal. Conclusions: The social context of pain, including the effect of family caregivers' responses to the patient's pain, is a critical pain source that is suggested to affect coping strategies in patients. These findings suggest an association between pain attitudes-beliefs in family caregivers and pain coping strategies in patients. Moreover, these results showed that the emotion regulation of both patients and their family caregivers mediates this association.

Association of phase angle with sarcopenia in chronic musculoskeletal pain patients: a retrospective study

BackgroundIn chronic musculoskeletal pain patients, detection of sarcopenia is of significant clinical interest. Phase angle, which can be measured through bioelectrical impedance analysis (BIA), can detect sarcopenia; however, the evidence in chronic musculoskeletal pain patients is limited. This study aimed to assess the relationship between phase angle and sarcopenia in patients with chronic musculoskeletal pain. Our hypothesis was that phase angle would be a useful indicator to identify sarcopenia in patients with chronic musculoskeletal pain.MethodsA total of 190 patients (51 men and 139 women) with chronic musculoskeletal pain were included in this retrospective cross-sectional study. Patient data of backgrounds, numeric rating scale score for pain, skeletal muscle index, and phase angle assessed using BIA were retrospectively reviewed. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria 2019.ResultsA total of 51 patients (26.7%), including 10 men (19.6%) and 41 women (29.5%), were diagnosed with sarcopenia. Phase angle, sarcopenia-related factors, age, and body mass index (BMI) differed significantly in patients with and without sarcopenia. On multiple logistic regression analysis, the prevalence of sarcopenia was significantly correlated with phase angle and BMI. The areas under the curve exhibited high accuracy in discriminating sarcopenia in men and moderate accuracy in both sexes and in women.ConclusionsPhase angle may be a valid discriminator of sarcopenia in patients with chronic musculoskeletal pain.

Effect of Different Physical Therapy Interventions on Brain-Derived Neurotrophic Factor Levels in Chronic Musculoskeletal Pain Patients: A Systematic Review.

The main objectives of this review were, firstly, to study the effect of different physiotherapy interventions on BDNF levels, and, secondly, to analyze the influence of physiotherapy on pain levels to subsequently draw conclusions about its possible relationship with BDNF. Based on the theory that neurotrophic factors such as BDNF play a fundamental role in the initiation and/or maintenance of hyperexcitability of central neurons in pain, it was hypothesized that the levels of this neurotrophic factor may be modified by the application of therapeutic interventions, favoring a reduction in pain intensity. A literature search of multiple electronic databases (Pubmed, PsycINFO, Medline (Ebsco), Scopus, WOS, Embase) was conducted to identify randomized control trials (RCTs) published without language restrictions up to and including March 2022. The search strategy was based on the combination of medical terms (Mesh) and keywords relating to the following concepts: "pain", "chronic pain", "brain derived neurotrophic factor", "BDNF", "physiotherapy", and "physical therapy". A total of seven papers were included. There were two studies that showed statistically significant differences in pain intensity reduction and an increase in the BDNF levels that used therapies such as rTMS and EIMS in patients with chronic myofascial pain. However, the same conclusions cannot be drawn for the other physical therapies applied. rTMS and EIMS interventions achieved greater short-term reductions in pain intensity and increased BDNF over other types of interventions in chronic myofascial pain patients, as demonstrated by a moderate amount of evidence. In contrast, other types of physical therapy (PT) interventions did not appear to be more effective in decreasing pain intensity and increasing BDNF levels than placebo PT or minimal intervention, as a low amount of evidence was found.

Development and Validation of Short Forms of the Pain Catastrophizing Scale (F-PCS-5) and Tampa Scale for Kinesiophobia (F-TSK-6) in Musculoskeletal Chronic Pain Patients.

Chronic pain is a complex phenomenon. Understanding its multiple dimensions requires the use of a combination of several patient-reported outcome measures (PROMs). However, completing multiple PROMs is time-consuming and can be a burden for patients. The objective of our study was to simultaneously reduce the French versions of the Pain Catastrophizing Scale (PCS) and Tampa Scale for Kinesiophobia (TSK) questionnaires to enable their use in an ambulatory and clinical settings. We conducted a clinical study between May 2014 and August 2020 in our rehabilitation center. 1428 chronic musculoskeletal pain patients (CMSP) were included. The originality of our approach is that the reduction method included qualitative as well as quantitative analyses. The study was divided into two parts: 1) reduction of the questionnaires (n=1363) based on internal consistency (item-to-total correlation), principal component analysis (item loadings), Rasch analysis (infit/outfit), floor and ceiling effect (quantitative analyses) and expert judgment of items (qualitative analysis), and 2) validation of the reduced questionnaires (n=65), including test-retest reliability (intraclass correlation coefficient [ICC]), homogeneity (Cronbach α), criterion validity (Pearson correlation [r] with the long-version score), determination of the pathological cutoff and Minimal Clinically Important Difference (MCID). The two full-length questionnaires include 30 items in total. The reduction resulted in a 5-item PCS (score 0-20) and 6-item TSK (score 0-24). Psychometric properties of the reduced questionnaires were all acceptable as compared with other version (α=0.89 and 0.71, ICC=0.75 and 0.60, r=0.86 and 0.70, MCID=2 and 2 for PCS and TSK, respectively) while keeping the structure and coherence of the long versions. The two reduced versions of the PCS and TSK can be used in CMSP patient. As their administration only requires a few minutes, they can be implemented in outpatient consultation as well as in clinical settings.

The PerPAIN trial: a pilot randomized controlled trial of personalized treatment allocation for chronic musculoskeletal pain-a protocol.

The therapy of chronic musculoskeletal pain (CMSP) is complex and the treatment results are often insufficient despite numerous therapeutic options. While individual patients respond very well to specific interventions, other patients show no improvement. Personalized treatment assignment offers a promising approach to improve response rates; however, there are no validated cross-disease allocation algorithms available for the treatment of chronic pain in validated personalized pain interventions. This trial aims to test the feasibility and safety of a personalized pain psychotherapy allocation with three different treatment modules and estimate initial signals of efficacy and utility of such an approach compared to non-personalized allocation. This is a randomized, controlled assessor-blinded pilot trial with a multifactorial parallel arm design. CMSP patients (n = 105) will be randomly assigned 1:1 to personalized or non-personalized treatment based on a cluster assignment of the West Haven-Yale Multidimensional Pain Inventory (MPI). In the personalized assignment condition, patients with high levels of distress receive an emotional distress-tailored intervention, patients with pain-related interference receive an exposure/extinction-tailored treatment intervention and patients who adapt relatively well to the pain receive a low-level smartphone-based activity diary intervention. In the control arm, patients receive one of the two non-matching interventions. Effect sizes will be calculated for change in core pain outcome domains (pain intensity, physical and emotional functioning, stress experience, participant ratings of improvement and satisfaction) after intervention and at follow-up. Feasibility and safety outcomes will assess rates of recruitment, retention, adherence and adverse events. Additional data on neurobiological and psychological characteristics of the patients are collected to improve treatment allocation in future studies. Although the call for personalized treatment approaches is widely discussed, randomized controlled trials are lacking. As the personalization of treatment approaches is challenging, both allocation and intervention need to be dynamically coordinated. This study will test the feasibility and safety of a novel study design in order to provide a methodological framework for future multicentre RCTs for personalized pain psychotherapy. German Clinical Trials Register, DRKS00022792 ( https://www.drks.de ). Prospectively registered on 04/06/2021.

Electroencephalographic characteristics of children and adolescents with chronic musculoskeletal pain.

The pathophysiology of pediatric musculoskeletal (MSK) pain is unclear, contributing to persistent challenges to its management. This study hypothesizes that children and adolescents with chronic MSK pain (CPs) will show differences in electroencephalography (EEG) features at rest and during thermal pain modalities when compared with age-matched controls. One hundred forty-two CP patients and 45 age-matched healthy controls (HCs) underwent a standardized thermal tonic heat and cold stimulations, while a 21-electrode headset collected EEG data. Cohorts were compared with respect to their EEG features of spectral power, peak frequency, permutation entropy, weight phase-lag index, directed phase-lag index, and node degree at 4 frequency bands, namely, delta (1-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz), at rest and during the thermal conditions. At rest, CPs showed increased global delta (P = 0.0493) and beta (P = 0.0002) power in comparison with HCs. These findings provide further impetus for the investigation and prevention of long-lasting developmental sequalae of early life chronic pain processes. Although no cohort differences in pain intensity scores were found during the thermal pain modalities, CPs and HCs showed significant difference in changes in EEG spectral power, peak frequency, permutation entropy, and network functional connectivity at specific frequency bands (P < 0.05) during the tonic heat and cold stimulations. This suggests that EEG can characterize subtle differences in heat and cold pain sensitivity in CPs. The complementation of EEG and evoked pain in the clinical assessment of pediatric chronic MSK pain can better detect underlying pain mechanisms and changes in pain sensitivity.

Exploring the feasibility of a network of organizations for pain rehabilitation: What are the lessons learned?

Integration of care is lacking for chronic musculoskeletal pain patients. Network Pain Rehabilitation Limburg, a transmural health care network, has been designed to provide integrated rehabilitation care from a biopsychosocial perspective to improve patients' levels of functioning. This feasibility study aims to provide insight into barriers and facilitators for the development, implementation, and transferability. This study was conducted with a three-phase iterative and incremental design from October 2017 to October 2018. The network comprises two rehabilitation practices, and three local primary care networks, with a general practitioner together with, a mental health practice nurse, and a physiotherapist or exercise therapist. These stakeholders with a random sample of participating patients took part in evaluations, consisting of interviews, focus groups, and observations. Field notes and observations were recorded during meetings. The Consolidated Framework for Implementation Research guided data collection and analysis. Results were used to refine the next phase. According to health care professionals, guidelines and treatment protocols facilitate consistency and transparency in collaboration, biopsychosocial language, and treatment. One mentioned barrier is the stigmatization of chronic pain by the general population. In regular care, approaches are often more biomedical than biopsychosocial, causing patients to resist participating. The current organization of health care acts as a barrier, complicating implementation between and within practices. Health care professionals were enthusiastic about the iterative, bottom-up development. A critical mass of participating organizations is needed for proper implementation. Network Pain Rehabilitation Limburg is feasible in daily practice if barriers are overcome and facilitators of development, implementation, and transferability are promoted. These findings will be used to refine Network Pain Rehabilitation Limburg. A large-scale process and effect evaluation will be performed. Our implementation strategies and results may assist other health care organizations aspiring to implement a transmural network using a similar model. Registration number: NTR6654 or https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6654.

On the body-mind nexus in chronic musculoskeletal pain: A scoping review.

Bodily experience disturbances are frequent among chronic musculoskeletal pain patients and associated with important pain-related psychosocial outcomes (e.g., disability, quality of life). However, the relationship between bodily experience and the psychological dimensions of chronic pain (e.g., affective, cognitive) has only recently garnered attention. This scoping review aimed to identify trends and gaps in research on the nexus between body awareness, body image, and body schema, and psychological processes/outcomes in adults with chronic musculoskeletal pain to inform future directions for research and practice. This study was guided by Arksey and O'Malley's guidelines and PRISMA-ScR recommendations. Keywords related to body awareness/body image/body schema and pain were searched on PsycInfo and PubMed from database inception until 16 February 2021; 2045 articles were screened, and 41met the inclusion criteria (i.e., primary quantitative studies investigating body awareness/body image/body schema in relation to pain-related psychological outcomes/processes in chronic musculoskeletal pain). The referred bodily experience constructs have been inconsistently defined. Body awareness was the most investigated construct, with consistent operationalization strategies. The links between body schema/body image and pain-related psychological processes/outcomes are still under-investigated. Most studies examined the role of bodily experience as a correlate/predictor of psychological outcomes/processes; overall, a better relationship with one's own body was associated with better pain-related psychological outcomes/processes. Our findings emphasize the relevance of further investigating body-mind relations in musculoskeletal pain and the development of therapies designed to improve the bodily experience within multidisciplinary treatment programmes. Suggestions for future research are discussed. This scoping review identifies trends/gaps in current research on the relationship between body awareness/body image/body schema and pain-related psychological processes/outcomes in adults with musculoskeletal pain. Overall, findings suggest that better bodily experiences are associated to lower fear-avoidance beliefs, better self-regulation strategies and better chronic pain adjustment, being important targets in pain management interventions. Nonetheless, the results also emphasize the need to further investigate the causal relationships and other outcomes related to psychological resilience, as well as to develop gold standard treatments focused on bodily experience.

Opioid Prescriptions in Chronic Pain Rehabilitation. A Prospective Study on the Prevalence and Association between Individual Patient Characteristics and Opioids.

While against recommendations, long-term opioid therapy (LTOT) for chronic pain is common. This study aimed to describe the prevalence of opioid prescriptions and to study the association of patient characteristics (demographics, pain characteristics, anxiety, depressive symptoms and pain coping) with future LTOT. The sample included N = 1334 chronic musculoskeletal pain patients, aged 18–65, who were assessed for Interdisciplinary Multimodal Pain Rehabilitation (IMMR) in Swedish specialist rehabilitation. Prescriptions were tracked across a two-year target period after assessment. In total, 9100 opioid prescriptions were prescribed to 55% of the sample (Mmedian = 6, IQR = 14). Prediction of LTOT was analyzed separately for those who did (24%) and did not (76%) receive IMMR. The odds of receiving opioids was similar for these subsamples, after controlling for differences in baseline characteristics. In both samples, there were significant associations between patient characteristics and future opioid prescriptions. Dysfunctional pain coping was a unique predictor of LTOT in those who received IMMR while pain intensity and depressive symptoms were unique predictors in those who did not receive IMMR. The results underscore that opioid treatment is common among patients in chronic pain rehabilitation and relates to pain and psychological factors. Understanding in detail why these factors relate to opioid prescription patterns is an important future study area as it is a prerequisite for better management and fundamental for preventing overuse.

O encaminhamento de pacientes com dor musculoesquelética para o reumatologista é realizado corretamente?

Objetivo: O objetivo deste estudo foi determinar se o encaminhamento de pacientes com dor musculoesquelética crônica para o reumatologista é realizado corretamente. Método: Foram revistas as fichas de encaminhamento para reumatologia do Centro de Saúde Escola de Sorocaba (CSE). Apuraram-se os dados demográficos, clínicos e terapêuticos, os motivos de encaminhamento e a qualidade dos dados. Foram analisados se houve registro das variáveis mencionadas, o tempo de espera para consulta e a qualidade do preenchimento da ficha de encaminhamento. Resultados: Foram analisados 63 guias de referência e respectivos prontuários. A maioria deles é de pacientes do sexo feminino e da faixa etária entre 50 e 70 anos. Em relação às hipóteses diagnósticas, a maior prevalência nas mulheres foi de osteoartrite seguida de fibromialgia, e fibromialgia e artrite reumatoide entre os homens. Dezesseis pacientes não tinham hipótese registrada. A maior parte queixava-se de dor generalizada. Observou-se que um número importante de fichas de referência e prontuários não registrava os medicamentos nem as medidas não medicamentosas. Chamou a atenção o fato de que não houve nenhuma ficha ou prontuário considerado completo. Conclusão: O encaminhamento de pacientes com dor musculoesquelética crônica do setor primário para a especialidade reumatologia tem falhas importantes.