Chronic Nonspecific Musculoskeletal Pain Research Articles

A Systematic Review on the Efficacy of Multidisciplinary Approaches in the Management of Chronic Pain

Background: Chronic pain presents widespread challenges globally. Multidisciplinary team (MDT) interventions have emerged as comprehensive approaches involving specialists from various medical fields to address the complexities of chronic pain management. This systematic review aims to synthesize evidence about the efficacy of multidisciplinary approaches in management of chronic non-specific musculoskeletal pain. Methods: This systematic review included randomized controlled trials (RCTs) of adults with chronic non-specific musculoskeletal pain. Multidisciplinary treatments involved at least three of: psychotherapy, physiotherapy, relaxation techniques, medical treatment, patient education, or vocational therapy. Exclusions were specific pathological entities, non-English studies, and follow-up less than one month. Searches were conducted across Cochrane evidence library, PubMed, and EMBASE. Primary outcomes encompassed pain intensity, quality of life, disability, and other functional measures. Results: Of the 100 articles identified, 6 studies met the inclusion criteria. These RCTs were conducted in Western countries, published between 2008 and 2019, and their sample size ranged from 132 to 401. Their interventions included Comprehensive Symptom Management, Assistance with Pain Management, physiotherapy, and telecare management. Two studies found significant improvements in pain intensity, while one demonstrated improved social functioning. However, no study found significant differences in disability scores or mental health outcomes. None of the studies assessed patient satisfaction with the interventions. Conclusion: Multidisciplinary team interventions for chronic pain show promise in improving pain intensity, particularly with Comprehensive Symptom Management and Pain Management Assistance. To strengthen these findings and address study limitations, future research with larger sample sizes is necessary.

PREVALENCE OF CHRONIC NON-SPECIFIC MUSCULOSKELETAL PAIN IN HOUSEHOLD FEMALES, AND ITS IMPACT ON THEIR QUALITY OF LIFE

BACKGROUND AND AIM One of the most intractable clinical problems clinicians face is chronic musculoskeletal pain. The study aimed to determine the prevalence, nature, and treatment of chronic non-specific musculoskeletal regional pain among household females. METHODOLOGY In a descriptive cross-sectional study, 1100 participants aged 30-45 years were interviewed. Purposive sampling technique and Face to face interview method were integrated for data collection. The respondents were females who suffered from musculoskeletal pain >6 months and experienced pain many times during the last month. Participants who suffered from musculoskeletal pain associated with malignancy or systemic pathologies were excluded from the study. A structured questionnaire was designed that included a Modified SF-36 scale to determine the quality of life and a visual analogue scale to measure pain intensity. RESULTS Prevalence of chronic Knee pain was 34.5%, low Back 31.4%, neck 20.4%, and shoulder pain was13.7%. The intensity of back pain was (2.94±.43), knee (3.01±.54), neck (2.62±.58), and shoulder pain (2.76±.57). Only 21% of females were on prescribed treatment by Pain management specialists, and the rest were relayed on non-prescribed remedies. CONCLUSION Musculoskeletal Chronic pain of moderate to severe intensity was more prevalent in the knee joint among household females. Both back and knee pain seriously affect the quality of their physical and social life. KEYWORDS: knee, low back, neck, shoulder, pain, quality of life.

Physical activity in patients with nonspecific low back painin therapy

Introduction. Kinesitherapy (KT) – one of the leading areas of patient care with chronic nonspecific (musculoskeletal pain) low back pain. For chronic lumbar pain, a standard KT is commonly used, that includes group sessions with a medical specialist. Often not taking into account the individual characteristics of patients, their attitude to KT, does not use a backpain education program in combination with KT (extended KT). Physical activity and hypodynamia are compared in patients with chronic nonspecificlow back pain in standard KT and extended KT.Aim of study is to assess the effectiveness of the standard and extended KT in the enhancement of physical activity.Materials and methods. 71 patients were observed (17 men and 54 women, average age 55.09 ± 13 years) with chronic nonspecific low back pain. Patients received non-steroidal anti-inflammatory drugs (NSAIDs) as painkillers. 34 patients received a standard KT, 37 patients – an extended KT. Patients were asked to complete the Numeric Pain Rating Scale (NPRS), the Oswestry Low Back Pain Disability Questionnaire, and the International Physical Activity Questionnaire (IPAQ) at baseline, after 7 days and 90 days.Results and discussion. In the extended KT group, physical activity increased from 11 (7–16) points to 16 (13–19) points after 7 days (p = 0.001) and up to 23 (15–26) points after 3 months (p = 0.0002). There has been a statistically significant decrease in the proportion of patients with hypodynamy (p = 0.0015). There is no statistically significant increase in physical activity in the standard therapy group. The use of NSAIDs in non-specific low back pain is discussed, the effectiveness of the use of dexketoprofen (Dexalgin) during lumbar pain is noted.Conclusion. In the case of nonspecific low back pain, the extended KTimprovesphysical activity and reduce hypodynamy.

Split-Second Unlearning: Developing a Theory of Psychophysiological Dis-ease.

Psychophysiological “stress” underpins many conditions including anxiety, depression, phobias, chronic fatigue syndrome and non-specific musculoskeletal pain such as fibromyalgia. In this article we develop an understanding of chronic psychophysiological stress from a psychological educational perspective, by drawing on supporting evidence that significant emotional events in early life (traumatic and benign) can influence health and well-being later in life. We suggest that traumatic events instigate psychophysiological “stress” responses and the formation of emotional memory images (EMIs) within very short time frames, i.e., “split-second learning.” Once formed these emotional memories are triggered in daily living “re-playing” psychophysiological stress responses, resulting in chronic psychophysiological “dis-ease.” We describe a novel therapeutic approach to scan clients for mannerisms signifying a subconscious “freeze-like” stress response that involves the client as a curious observer within their own experience, feeding back the non-verbal cues as they arrive in the moment. By breaking down the observable fragments of their split-second Pavlovian response to the trigger, clients can detach their EMI from the psychophysiology stress response, i.e., “split-second unlearning.” Our split-second unlearning model recognizes the EMI as a barrier to moving forward and needs to be unlearned before the client can become naturally adaptive again. We argue that this approach places the client at the center of the work without the need of getting bogged down in a life-long narrative.

At my own pace, space, and place: a systematic review of qualitative studies of enablers and barriers to telehealth interventions for people with chronic pain.

Telehealth is a promising approach to support self-management with the potential to overcome geographical barriers. Understanding patient perspectives will identify practical challenges to delivering self-management strategies by telehealth. The aim of this study was to synthesize the perceptions of people with chronic musculoskeletal pain for engaging in interventions delivered using telehealth. We searched MEDLINE, Embase, CINAHL, LILACS, and PsycINFO databases. We included qualitative studies that explored perceptions or experiences or attitudes of people with chronic musculoskeletal pain engaging with telehealth. We assessed the methodological quality using the Critical Appraisal Skills Programme checklist. Meta-synthesis was guided by a thematic synthesis approach. The level of confidence of review findings was assessed using the Confidence in the Evidence from Reviews of Qualitative Studies (GRADE-CERQual). Twenty-one studies were included (n = 429). Telehealth comprised web-based, videoconference-based, telephone-based, video-based, and smartphone app-based programs delivered solely or combined. Chronic musculoskeletal conditions included people with knee or hip osteoarthritis, chronic low back pain, persistent pain (chronic joint pain or nonspecific chronic musculoskeletal pain), rheumatoid arthritis, and functional fatigue syndrome. The enablers for engaging in telehealth interventions were as follows: (1) "at my own pace, space, and place" and (2) empowered patient. Barriers to engaging in telehealth interventions were as follows: (1) impersonal, (2) technological challenges, (3) irrelevant content, and (4) limited digital (health) literacy. Telehealth interventions with well-designed interactive platforms, flexibility to fit patients' routine, and the broad availability of material may favor better engagement. Encouragement of self-efficacy is linked to successful telehealth-delivered self-management programs.

Effect of supplementation of vitamin D and calcium on patients suffering from chronic non-specific musculoskeletal pain: A pre-post study.

Background and Objective:Despite abundant sunshine, India is a country with high prevalence of vitamin D deficiency. It has been suggested that vitamin D deficiency could be a potential cause of chronic non-specific musculoskeletal pain. The study was conducted to evaluate the effect of supplementation of vitamin D and calcium on patients suffering with chronic non-specific musculoskeletal pain.Methodology:The experimental trial was a pre-post study conducted on 50 hypovitaminosis D patients aged 30–60 years visiting a local orthopedician or physician with complain of chronic non-specific musculoskeletal pain. Oral supplementation with vitamin D and calcium was given for 3 months. Before the intervention trial, pain, physical activity, serum vitamin D, serum calcium, body mass index and waist to hip ratio (WHR) of the respondents were assessed, which was statistically compared with post-intervention data of the same parameters. Assessment of pain was carried out using visual analog scale. Physical activity levels were compared pre and post the intervention. Also, fatigue, mood alteration, and sleep were compared.Results:Ninety percent of the subjects had vitamin D deficiency. Thirty-six percent of the subjects had severe chronic non-specific musculoskeletal pain, whereas 56% had moderate chronic non-specific musculoskeletal pain. The mean pain score prior to intervention was 6.22 which significantly decreased to 3.52. Mean vitamin D levels significantly rose from 17.38 ng/ml to 39.40 ng/ml. Serum vitamin D, serum calcium, and physical activity levels increased, whereas pain, weight, BMI, and WHR decreased significantly post-intervention.Conclusions:Supplementation with vitamin D and calcium decreases chronic non-specific musculoskeletal pain.

Spinal segmental sensitization as a common origin of chronic non-specific regional musculoskeletal pain: review of its pathophysiology and diagnosis

Spinal segmental sensitization as a common origin of chronic non-specific regional musculoskeletal pain: review of its pathophysiology and diagnosis

A qualitative exploration of GPs’ perspectives on managing chronic nonspecific musculoskeletal pain in Australian general practice ‐ a focus group study

Objective Chronic nonspecific musculoskeletal pain (CNMP) is a complex idiopathic condition that causes significant disruption to patients’ lives, their relationships, and functionality. The cause of CNMP is not fully understood, which makes diagnosis and management challenging. As general practitioners (GPs) are central to the management of chronic pain, their perspectives on managing CNMP are important. Purpose To explore the clinical reasoning GPs use when diagnosing and managing CNMP. Methods A qualitative study design using focus group discussion was conducted with Australian GPs. Five focus group discussion were conducted across Adelaide. All focus group discussions were audio-recorded, and transcripts were coded and analyzed thematically with the program NVivo. Results The main themes remained consistent across the five focus group discussion’s: the ambiguous cause of CNMP; sex differences; developing the “right strategy”; patient-centered care; and verifying vitamin D levels. Conclusion The findings show that GPs use a patient-centered approach tailored to individual patients’ medical history, physical examination findings, and psychosocial health. There was general concern about low levels of vitamin D in patients with CNMP, and vitamin D supplements were recommended if indicated by a patient’s history.

Efficacy of vitamin D replacement therapy on patients with chronic nonspecific widespread musculoskeletal pain with vitamin D deficiency.

The objective of this study is the evaluation of the effect of vitamin D replacement treatment on musculoskeletal symptoms and quality of life in patients with chronic widespread musculoskeletal pain (CWP) including fibromyalgia (FM) and vitamin D deficiency. Patients with nonspecific CWP and vitamin D deficiency (25-OH D3<25ng/mL) were included into the study. Replacement treatments of 50000IU/week oral vitamin D3 for 3months were given to the patients. Patients were assessed pre- and post-treatment in terms of serum levels of Ca, P, alkaline phosphatase, 25-OH D3, severity of pain (visual analogue scale [VAS]-pain), severity of asthenia (VAS-asthenia), Beck Depression Inventory (BDI), quality of life scale (Short Form [SF]-36), tender point count (TPC), severity of waking unrefreshed, headache, tenderness on tibia, meeting the criteria of FM, and level of patient satisfaction. Fifty-eight patients with a mean age of 36.9±9.2years were included into the study. 25-OH D3 levels of patients elevated from 10.6±5.1ng/mL to 46.5±24.0ng/mL after replacement treatment (P<0.001). Marked decrease in VAS-pain, VAS-asthenia, severity of waking unrefreshed, TPC, and BDI and an evident increase in subgroups of SF-36 were established in patients after treatment (P<0.001). The number of FM+ patients was 30 (52%) before treatment and regressed to 20 (34%) after treatment (P=0.013); 85% of patients stated satisfaction with the treatment. Vitamin D replacement treatment in patients with nonspecific CWP has provided improvements in musculoskeletal symptoms, level of depression and quality of life of patients. Patients with CWP should be investigated for vitamin D deficiency.

High Prevalence of Vitamin D Deficiency in Chronic Non-specific Musculoskeletal Pain.

High Prevalence of Vitamin D Deficiency in Chronic Non-specific Musculoskeletal Pain.

Case complexity in patients with chronic nonspecific musculoskeletal pain: a Delphi and feasibility study.

Assessment of case complexity in patients with chronic nonspecific musculoskeletal pain (CMP) is currently clinician based, not transparent, and with low reliability. The objective of this study was to explore case complexity and to initiate the development of a case complexity index (CCI). A three-round Delphi study among clinicians involved in multidisciplinary Pain Rehabilitation Programs was performed to identify important factors that are assumed to influence functioning in patients with CMP. The 10 most important factors were used to initiate the development of a CCI, with mean ratings of importance per factor as weights. The feasibility of the CCI was tested in a pilot study on 16 patients with CMP. In the first round, 166 factors were identified; in the second round, the 10 most important factors were selected; in the third round, relative weights of each factor were calculated, ranging from 1.75 (features of complaints) to 3.56 (psychiatric disorders) on a scale from 0 (no weight) to 4 (very heavy weight). The assessments for the factors were mainly based on clinical examination and reasoning. Clinicians could rate all patients using the CCI, which confirmed feasibility of the CCI. Ten, mainly psychosocial, factors were identified, which were assumed to be most important for the assessment of case complexity in a patient with CMP. With these factors, a CCI was created, for which feasibility was established. This CCI is transparent, easy to use, and might provide a basis for further development of a structured assessment of case complexity, which may have scientific and clinical relevance.

Does vitamin D supplementation alleviate chronic nonspecific musculoskeletal pain? A systematic review and meta-analysis.

Chronic nonspecific musculoskeletal pain (CNMP) is an idiopathic condition often seen in general practice and rheumatology clinics, the aetiology of which may include vitamin D deficiency. The objective of the present study is to evaluate the effectiveness of vitamin D supplementation in the management of CNMP through a systematic review and meta-analysis. According to PRISMA guidelines, PubMed, Embase, Web of Science, Cochrane and Scopus electronic databases were searched for randomised controlled trials comparing vitamin D supplementation to a control or placebo in CNMP patients; the search was not limited by language or date. Meta-analysis was performed using the mean and standardised mean difference which was computed with 95% confidence intervals, and overall effect size was calculated. Both fixed and random effects models were used in meta-analysis to account for heterogeneity in the studies. The initial search identified 107 studies, of which 10 were potentially relevant, with 7 studies excluded because they did not meet selection criteria. Three studies were included in the meta-analysis. We found no effect of vitamin D supplementation (standardised mean difference (SMD) 0.004; 95% confidence interval (CI) -0.248 to 0.256) on pain in CNMP patients. Forest plot is used to present the results from meta-analysis. Contrary to a widespread clinical view, there is a moderate level of evidence that vitamin D supplementation is not helpful for treating CNMP patients.

Detection of serum 25(OH)-vitamin D level in the serum of women with fibromyalgia syndrome and its relation to pain severity

ObjectiveThe aim of our study is to determine serum 25(OH)-vitamin D level in patients with fibromyalgia syndrome and its relation to pain.Patients and methodsFifty-three women with fibromyalgia syndrome diagnosed according to the American College of Rheumatology 1990 fibromyalgia diagnostic criteria and 50 age-matched healthy women as a control group were included in this study. Serum 25(OH)-vitamin D levels were determined in both the patient and the control groups. Fibromyalgia Impact Questionnaire scores and pain intensity measured by the visual analogue scale were evaluated.ResultsWe found a statistically significant decrease in serum vitamin D level in the patient group in comparison with the control group. There was a significant negative correlation (P = 0.000) between vitamin D level and Fibromyalgia Impact Questionnaire. The same results are found between vitamin D level and visual analogue scale. There was no significant correlation between vitamin D level and erythrocyte sedimentation rate or C-reactive protein.ConclusionWe found a significant association between fibromyalgia and low 25(OH)-vitamin D levels as suggested previously in other studies. Also, there was a correlation between the level of vitamin D in serum and severity of pain. We recommend vitamin D screening in every patient with chronic nonspecific musculoskeletal pain, especially fibromyalgia, and extended research in this area with large numbers of patients.

Future goals of adolescents and young adults with chronic musculoskeletal pain.

Chronic non-specific musculoskeletal pain is a common problem among adolescents. This study investigates the importance of future goals and goal frustration for adolescents and young adults with chronic musculoskeletal pain compared to healthy adolescents. It also explores the impact that pain intensity, pain catastrophizing and depressive symptoms have on goal frustration for adolescents with chronic pain. Using a cross-sectional design, we compared the importance and frustration of future goals for 42 adolescents and young adults with chronic musculoskeletal pain (41 women, 1 man) to those of 42 adolescents without pain (35 women, 7 men). For the adolescents with chronic pain, we also examined levels of pain intensity, pain catastrophizing and depressive symptoms to assess their ability to explain goal frustration levels. Statistics included t-tests, Mann-Whitney test and multivariate regression analysis. We found no differences in the importance of future goals, except for goals related to health, which were more important for adolescents with chronic pain (p=0.03). Furthermore, adolescents with chronic pain perceived higher levels of goal frustration in all domains, except that related to school (p=0.16). Depression explained goal frustration related to personal values (p=0.02), social acceptance (p<0.01), self-acceptance (p<0.01) and health (p<0.01). Dealing with chronic pain in adolescence and early adulthood does not seem to change future goals, but is associated with perceiving barriers to achieving them. The level of depressive symptoms seems to influence this relationship. Some caution is required in generalizing the results due to the relatively low number of male participants.

The meaning and the process of acceptance for patients with chronic non-specific musculoskeletal pain when participating in pain rehabilitation

Background: We know that acceptance-based therapies have evidence in the context of chronic pain. However, what is unknown is how individuals experience the meaning of acceptance before entering pain rehabilitation and howmultiprofessional teamwork influences the different meanings and processes of acceptance. Given the complexity of acceptance and adjustment to a chronic condition such as persistent pain, it is essential, for example, to further explore these processes using a bodily existential perspective. Purpose: The overall aim was to explore ways of living with chronic non-specific musculoskeletal pain and to understand the meaning and the process of acceptance in relation to the individuals’ bodily experiences and sense of self. Methods: Six women and 3 men (between 18 and 52 y/o) were interviewed at the beginning, in the middle and at the end of a sixteen week-long rehabilitation programme. To explore the embodied nature of acceptance and to bring out the diversity and variation in the individuals’ experience, interpretative phenomenological analysis (IPA) was chosen. Results:Three differentmeanings and processes of acceptance were found. First, acceptance as a process of personal empowerment, “the onlyway tomove onwith life”. The individuals expressed that the rehabilitation programme helped them to integrate the body in their sense of self – a trusting cooperation between self and body gave rise to hope. Secondly, acceptance as an equivocal project, “a possible but challenging way forward”. This placed the individuals in a challenging position of ambivalence. The hopeful insight was there, acknowledging that acceptance was the way to move forward, but there was also a feeling of uncertainty and doubt about one’s ability. In the rehabilitation programme focus should also be placed on the experiences of the ambiguous body. Thirdly, in acceptance as a threat and a personal failure, “no way forward”, the integration of the aching body in sense of self was impossible since pain was incomprehensible, unacceptable and unfair. No changes during the rehabilitation programme could be described. Conclusion(s):Acceptance canbe experienced as the only way forward, a possible but challenging way forward, or a threat and capitulation as well as a personal failure. Experiences of the lived body and the sense of self are related to the personal meaning of acceptance. Individuals with chronic pain have different ways of experiencing their body: as a guide and a resource, as something ambiguous and confusing, which is difficult but important to understand, or as something disappointing, entrapping and alien. Individuals with chronic pain have different ways of experiencing their sense of self: as pride in having accomplished difficult and necessary changes to go on with life, as uncertainty on how to manage responsibility including fear of failure, or as a feeling that pain is defining them and that they are entrapped. Implications:The study contributedwith valuable knowledge to develop clinical interventions with focus on the lived body and inspire the use of the full potential of the physiotherapists’ role in pain rehabilitation programmes.

Low serum vitamin D levels are not associated with increased postoperative pain and opioid requirements: a historical cohort study.

Vitamin D deficiency has been associated with chronic non-specific musculoskeletal pain syndromes; however, studies are lacking with respect to its relationship with postoperative pain. We tested the hypothesis that a lower preoperative vitamin D level is associated with increased postoperative pain and/or opioid consumption in morbidly obese patients who had laparoscopic bariatric surgery. Data from 185 patients who underwent laparoscopic bariatric surgery at the Cleveland Clinic from 2005-2009 and had a vitamin D level checked within three months of their surgery were included in the analysis. We assessed the relationship between vitamin D levels and the time-weighted average (TWA) of pain scores and total opioid consumption using multivariable regression models adjusted for potential confounders. As a secondary analysis, we compared the TWA of pain scores and opioid consumption between patients who were vitamin D deficient (≤ 20 ng·mL(-1)) and those who were not (vitamin D > 20 ng·mL(-1)). The mean (SD) TWA pain score was 3.8 (1.5) and the median interquartile range [IQR] total opioid consumption (morphine equivalent) was 15.6 [18.2] mg during the first 72 hr postoperatively. The median [IQR] vitamin D concentration was 21.8 [17.1] ng·mL(-1). The vitamin D level was not significantly associated with either the TWA pain score (Pearson correlation: -0.003; 97.5% confidence interval [CI]: -0.17 to 0.16) or opioid consumption (Spearman correlation: -0.13; 97.5% CI: -0.30 to 0.03). After adjusting for confounders, the estimated average change in TWA pain score was 0.01 (97.5% CI: -0.08 to 0.11) for a five-unit increase in vitamin D (P=0.77). The estimated ratio of geometric means of total opioid consumption was 0.94 (97.5% CI: 0.86 to 1.03) for a five-unit increase in vitamin D concentration (P=0.12). No difference was found between patients with vitamin D concentrations > 20 ng·mL(-1) and ≤ 20 ng·mL(-1) in either TWA pain score (P=0.91) or total opioid consumption (P=0.18). We did not find any association between preoperative vitamin D levels and postoperative pain scores/opioid consumption in morbidly obese patients undergoing bariatric surgery.

The psychometric characteristics of an assessment instrument for perceived harmfulness in adolescents with musculoskeletal pain (PHODA-youth).

Cognitive-behavioural models of chronic pain predict that dysfunctional assumptions about harmfulness of activities may maintain pain-related fear and disability. To assess perceived harmfulness in adolescents, the Photograph Series of Daily Activities for youth (PHODA-youth) was developed. Information concerning its methodological quality is currently lacking. To investigate psychometric characteristics (factor structure, test-retest reliability, construct validity) and feasibility of the PHODA-youth in adolescents with chronic musculoskeletal pain. Test-retest design. Adolescents aged 13-21 years with chronic nonspecific musculoskeletal pain. Participants filled in an electronic version of the PHODA-youth including 89 items twice with a 4-week interval. The instrument's factor structure was determined by a factor analysis. Construct validity was studied with criterion variables: catastrophizing (Pain Catastrophizing Scale for Children), pain intensity (visual analogue scale), depression (Children's Depression Inventory) and pain-related disability (Functional Disability Inventory) using regression analysis. Test-retest reliability was evaluated based on the Pearson correlation coefficient. Feasibility was studied with self-constructed questions. Seventy-one adolescents participated. Results show a three-factor structure for the PHODA-youth including 51 items with subscales labelled as: 'activities of daily life', 'intensive physical activities' and 'social activities'. Total and subscale scores showed a high internal consistency. Its test-retest reliability was good (r = 0.94) and its construct validity is supported by the finding that both catastrophizing (β = 0.25; p = 0.02) and disability (β = 0.71; p < 0.001) were uniquely related to the PHODA-youth. In addition, feasibility appeared adequate. The findings support the PHODA-youth as a valid and reliable measure of the perceived harmfulness of activities in adolescents with musculoskeletal pain.

Measuring avoidance of pain

Psychometric research on widely used questionnaires aimed at measuring experiential avoidance of chronic pain has led to inconclusive results. To test the structural validity, internal consistency, and construct validity of a recently developed short questionnaire: the Acceptance and Action Questionnaire II-pain version (AAQ-II-P). Cross-sectional validation study among 388 adult patients with chronic nonspecific musculoskeletal pain admitted for multidisciplinary pain rehabilitation in four tertiary rehabilitation centers in the Netherlands. Cronbach's α was calculated to analyze internal consistency. Principal component analysis was performed to analyze factor structure. Construct validity was analyzed by examining the association between acceptance of pain and measures of psychological flexibility (two scales and sum), pain catastrophizing (three scales and sum), and mental and physical functioning. Interpretation was based on a-priori defined hypotheses. The compound of the seven items of the AAQ-II-P shows a Cronbach's α of 0.87. The single component explained 56.2% of the total variance. Correlations ranged from r=-0.21 to 0.73. Two of the predefined hypotheses were rejected and seven were not rejected. The AAQ-II-P measures a single component and has good internal consistency, and construct validity is not rejected. Thus, the construct validity of the AAQ-II-P sum scores as indicator of experiential avoidance of pain was supported.

Nonspecific pain is a marker for hypovitaminosis D in patients undergoing evaluation for sleep disorders: a pilot study

BackgroundThe purpose of this cross-sectional study was to test the hypothesis that serum vitamin D levels are abnormally low in sleep clinic patients admitting to chronic nonspecific musculoskeletal pain and to assess the associated risk factors. A secondary purpose was to identify a clinical biomarker for vitamin D deficiency.MethodsWe enrolled 153 consecutive patients who admitted to the presence of chronic nonspecific musculoskeletal pain during a comprehensive sleep evaluation at a specialist sleep medicine clinic within an academic center. Venous blood sampling was performed for determination of serum 25-hydroxyvitamin D. Risk factors for vitamin D deficiency (25-hydroxyvitamin D < 20 ng/mL) were identified by odds ratios. Receiver-operating characteristic curve analysis was performed with 10-fold cross-validation to identify a biomarker for vitamin D deficiency calculated by linear discriminant analysis.ResultsThe mean serum 25-hydroxyvitamin D level was 19.8 ± 11.1, with 54% of the study population having vitamin D deficiency. This mean 25-hydroxyvitamin D level was lower than that observed historically in healthy controls, and was either similar or lower than in all but one representative historical cohort formed on the basis of chronic nonspecific musculoskeletal pain. Risk factors for vitamin D deficiency were black ethnicity, age < 60 years, and obesity. These risk factors were identified both in the entire cohort and separately in subgroups with and without obstructive sleep apnea. The biomarker (based on race, age, and body mass index) had a sensitivity and specificity for predicting vitamin D deficiency of 0.73 and 0.74, respectively.ConclusionVitamin D deficiency was prevalent in patients with sleep disorders and chronic nonspecific musculoskeletal pain on evaluation in a sleep medicine clinic. Vitamin D deficiency was reliably estimated in the study population using a biomarker derived from common demographic characteristics.

Effects of nurse-led motivational interviewing of patients with chronic musculoskeletal pain in preparation of rehabilitation treatment (PREPARE) on societal participation, attendance level, and cost-effectiveness: study protocol for a randomized controlled trial

BackgroundNon-adherence and drop-out are major problems in pain rehabilitation. For patients with various health problems, motivational interviewing (MI) has shown promising effects to tackle these problems. In chronic pain patients, the effectiveness of MI is however unknown. Therefore, a MI-based pre-pain rehabilitation intervention (MIP) addressing motivation, expectations, and beliefs has been developed to prepare eligible patients for rehabilitation treatment.Methods/designStudy design: A parallel randomized controlled trial including two interventions: a motivational interviewing pre-pain rehabilitation intervention (MIP) and a usual care (UC) control arm. Follow-up will be 6 months after completion of rehabilitation treatment.Study population: One hundred and sixty (n = 80 per arm) patients with chronic non-specific musculoskeletal pain visiting an outpatient rehabilitation department, who are eligible to participate in an outpatient cognitive behavioral pain rehabilitation program.Intervention: MIP consists of two sessions to prepare and motivate the patient for pain rehabilitation treatment and its bio psychosocial approach. UC consists of information and education about the etiology and the general rehabilitation approach of chronic pain. Both the MIP and UC contain two sessions of 45 to 60 minutes each.Objective: The aim of the current study is to evaluate the effectiveness of MIP compared to UC in terms of an increase in the long-term level of societal participation and decrease of drop-out during rehabilitation treatment.Main study endpoints: Primary outcome is the change in level of participation (according to the ICF-definition: ‘involvement in a life situation’) 6 months after completion of rehabilitation treatment. Secondary outcomes are adherence and treatment drop-out, disability, pain intensity, self-reported main complaints, (pain-specific) self-efficacy, motivation, and quality of life. Costs are calculated including the costs of the pre-treatment intervention, productivity losses, and healthcare utilization. Potential moderators and active ingredients of MI are explored. For the process evaluation, parameters such as MI fidelity, feasibility, and experiences are explored.DiscussionThe results of this study will provide evidence on the effectiveness of this MI-based pre-treatment in pain rehabilitation. Furthermore, a cost-effectiveness analysis and exploration of moderating and working mechanisms of MI and an extensive process evaluation takes place.Trial registrationNederlands trial register NTR3065