Chronic Pain Disability Research Articles

Changes in spinal motor behaviour are associated with reduction in disability in chronic low back pain: A longitudinal cohort study with 1-year follow-up.

The need to improve spinal motor behaviour in chronic low back pain (CLBP) rehabilitation remains unclear. The objective of this study was to test if changes in spinal motor behaviour were associated with changes in disability after an interdisciplinary rehabilitation program (IRP) in patients with CLBP. Seventy-one patients with CLBP participating in an IRP were included. Spinal motor behaviour was assessed with biomechanical (lumbar angular amplitude and velocity, erector spinae muscle activity and duration of the task), cognitive-emotional (task-specific fear [PRF]) and pain-related (movement-evoked pain [MEP]) measures during a lifting task before and after the IRP. Disability was measured before and after the IRP, and at 3-month and 1-year follow-ups. After adjusting for confounders, changes in disability were significantly associated with MEP changes (β adj. = 0.49, p < 0.001) and PRF changes (β adj. = 0.36, p = 0.008), but not with changes in any of the biomechanical measures. MEP at the end of IRP was also associated with disability at 3 months (β adj. = 0.37, p = 0.001) and 1 year (β adj. = 0.42, p = 0.01). Biomechanical measures at the end of the IRP were not associated with disability, except for the duration of the task that was significantly associated with reduction of disability at 3 months (β non-adj = 0.5, p < 0.001). Pain-related and cognitive-emotional measures of spinal motor behaviour were associated with reduction in disability following an IRP. Future research is needed to further investigate causal relationships between spinal motor behaviour and disability. This study supports a multidimensional understanding and analysis of spinal motor behaviour, integrating the cognitive-emotional, pain-related and biomechanical domains. It also supports the consideration of spinal motor behaviour as a potentially important treatment target in chronic low back pain management. Moreover, it suggests that reducing movement-evoked pain and task-specific fear may have more influence on disability than changing lumbar amplitude, lumbar angular velocity or erector muscle activity, which may have important implications for rehabilitation.

Effects of scapular stabilization program on pain, range of motion, and disability in patients with chronic non-specific neck pain

Objectives: The objective of this study was to analyze the impacts of the scapular stabilization program (SSP) on pain, range of motion (ROM), and disability in chronic non-specific neck pain (NNP). Methods: It was a randomized clinical trial. The study was conducted at University Medical Centre, Lahore. According to eligibility criteria, 28 participants were randomly allocated to the experimental and control groups through the lottery method. While the control group received only relaxation exercises, the experimental group received SSP exercises along with the relaxation exercises on the cervicoscapular region. Three sessions of 45 min each, three times/week, on alternating days for three weeks were given. The outcome measures for pain, ROM, and disability were the numeric pain rating scale (NPRS), goniometer, and neck disability index (NDI), respectively. These were assessed before the intervention and at the end of the third week. Results: The mean age of Groups A and B was 24.76 ± 4.53 and 27.76 ± 4.62, respectively. Within-group analysis of NPRS, NDI, and cervical flexion and extension ROM showed significant improvement in both groups. Between-group analysis showed post-treatment NPRS (P = 0.000), NDI (P = 0.000), cervical flexion (P = 0.004), and extension (P = 0.000). A significant improvement (P &lt; 0.05) in pain, disability, and flexion and extension was observed in the experimental group. Conclusion: Both groups showed improved outcomes, but a significant difference was found in the control and experiment groups. The trial concluded that in treating NNP, the SSP effectively alleviates pain and improves disability and mobility.

Immigration background as a risk factor of chronic pain and high-impact chronic pain in children and adolescents living in Spain: differences as a function of age.

The number of people immigrating from one country to another is increasing worldwide. Research has shown that immigration background is associated with chronic pain (CP) and pain disability in adults. However, research in this issue in children and adolescents has yielded inconsistent results. The aims of this study were to examine (1) the association between immigration background, CP, high-impact chronic pain (HICP) in a community sample of children and adolescents; and (2) the extent these associations differed as a function of sex and age. Participants of this cross-sectional study were 1115 school children and adolescents (mean age = 11.67; 56% girls). Participants were asked to provide sociodemographic information and respond to a survey including measures of pain (location, extension, frequency, intensity, and interference). Results showed that having an immigration background was associated with a greater prevalence of CP (OR = 1.91, p <.001) and HICP (OR = 2.55, p <. 01). Furthermore, the association between immigration background and CP was higher in children (OR = 6.92, p <.001) and younger adolescents (OR = 1.66, p <.05) than in older adolescents. Children and adolescents with an immigration background are at higher risk for having CP -especially younger children- and HICP. More resources should be allocated in the prevention of CP and HICP in children and adolescents with an immigration background.

Investigating the effect of an Orem-based self-care educative supportive nursing system on the joint function of patients with knee osteoarthritis.

Osteoarthritis is the most common form of arthritis. It is a common progressive joint disease characterized by chronic pain and functional disability, which disturbs functional movements, body balance, and quality of life in patients with knee osteoarthritis. This study investigates the effect of an Orem-based self-care educative supportive nursing system on the joint function of patients with knee osteoarthritis. This semi-experimental paper studies 130 patients with knee osteoarthritis. The patients are selected using convenience sampling and randomly assigned to intervention and control groups equally. The K00S questionnaire was used to collect patients' demographic information and other information relating to their knees' function. We carried out interventions for six weeks, with a session of 45 to 60 minutes each week. Data were collected before the intervention and three months after the intervention. SPSS 21.0 and descriptive and inferential statistics were used to analyze the collected data at the significance level of 0.05. The results show significant differences between the two groups in terms of joint symptoms (P = 0.001), pain (P = 0.001), daily activities (P = 0.001), sports and recreational activities (P = 0.001), and quality of life (P = 0.02). In other words, there was a significant difference in the average subscale scores of activities in all five dimensions between the intervention and control groups (P < 0.05). Orem's self-care model has a positive and significant effect on the functional movement of patients with knee osteoarthritis and improves their joint function.

Lower limb muscle strength is associated with disability in non-specific chronic low back pain

Low back pain is one of the most common health problems that affects daily living activities of most people at some time in their lifetime. Non-specific chronic low back pain (NS-CLBP) can be seen in 85-95% of the population. Although it is known that disability and lower limb muscle strength are affected in patients with NS-CLBP, no study investigated the relationship between these variables. The aim of this study was to identify association between disability and lower limb muscle strength in these patients. 79 patients with NS-CLBP were enrolled. The strength of knee extensor and ankle dorsiflexor muscles were measured using a hand-held dynamometer. The disability was assessed using Oswestry Disability Index. Spearman correlation analysis revealed that there were negative significant correlations between Oswestry Disability Index score and right knee extensor muscle strength, left knee extensor muscle strength and left ankle dorsiflexor muscle strength (r=-0.290, p=0.009; r=-0.408, p

Examining Psychological Factors as Contributors to Pain, Disability, and Physical Function in Geriatric Chronic Low Back Pain: A Prospective Analysis of the Delaware Spine Studies Cohort

In younger populations, risk factors from psychologically-focused theoretical models have become accepted as primary drivers behind the persistence of low back pain (LBP), but these risk factors have not been thoroughly assessed in older adult populations (60–85 years). To address this knowledge gap, we sought to examine longitudinal associations between both general and pain-related psychological risk factors and future pain intensity, LBP-related disability, and physical function (gait speed) outcomes in older adults with chronic LBP (n = 250). Questionnaires for general (ie, depressive symptoms) and pain-related psychological risk factors (ie, fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were collected at baseline. Questionnaire values were entered into principal component analysis to yield a combined psychological component score. LBP intensity (pain thermometers), LBP-related disability (Quebec Back Pain Disability Scale), and gait speed were measured at baseline and 12-month follow-up. Multiple linear regression was used to examine adjusted associations between baseline psychological component scores and each prospective outcome. The baseline psychological component score failed to independently predict 12-month LBP-related disability and gait speed after adjustment for baseline outcomes. Though the psychological component score was associated with 12-month LBP intensity after adjusting for baseline LBP intensity, this association diminished with full adjustment for other baseline characteristics. Cumulatively, general and pain-related psychological risk factors did not independently predict longitudinal pain, disability, and physical function outcomes in this cohort. Compared to younger populations with this condition, general and pain-related psychological risk factors may have less influence on the maintenance of chronic LBP in older adults. PerspectiveThis article failed to establish consistent independent relationships between psychological factors and worse longitudinal pain, disability, and physical function outcomes in older adults with chronic LBP. The findings highlight a need to determine other age-specific biopsychosocial risk factors that may impact the maintenance of chronic pain in this patient population.

Effects of Multidisciplinary Biopsychosocial Rehabilitation on Short-Term Pain and Disability in Chronic Low Back Pain: A Systematic Review with Network Meta-Analysis

Chronic low back pain (CLBP) is a significant public health issue, with prevalence intensifying due to an ageing global population, amassing approximately 619 million cases in 2020 and projected to escalate to 843 million by 2050. In this study, we analyzed the effects of multidisciplinary biopsychosocial rehabilitation (MBR) on pain and disability. To address this question, we conducted a PRISMA-guided systematic review and random-effect network meta-analysis on studies collected from six electronic databases. The network comprised diverse MBR modalities (behavioral, educational, and work conditioning) alongside exercise therapy (ET), minimal intervention, and usual care, with pain and disability as outcomes. Ninety-three studies were included, encompassing a total of 8059 participants. The NMA substantiated that both ET and MBR modalities were effective in alleviating CLBP, with education-oriented MBR emerging as the most efficacious for pain mitigation (MD = 18.29; 95% CI = 13.70; 22.89) and behavior-focused MBR being the most efficacious for disability reduction (SMD = 0.88; 95% CI = 0.46; 1.30). Nevertheless, the discerned differences amongst the treatments were minimal and uncertain, highlighting that no modality was definitively superior to the others. Given the intricate nature of CLBP, embodying various facets, our findings advocate for a combined therapeutic approach to optimize treatment efficacy.

Psychological Treatment Targeting Acceptance and Compassion in Chronic Pain Patients: A Randomized Controlled, Internet Delivered, Treatment Trial.

Chronic pain is often associated with lower function. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing acceptance and commitment therapy (ACT) and compassion focused therapy (CFT), could improve psychological wellbeing and disability in chronic pain patients with high levels of self-criticism in comparison to a wait-list control group. Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition. Primary treatment outcomes were Chronic Pain Acceptance Questionnaire, Self-Compassion Scale, and Pain Disability Index. Secondary outcomes were Montgomery Åsberg Depression Rating Scale, Anxiety Sensitivity Index, Quality of Life Inventory, Multidimensional Pain Inventory and Perseverative Thinking Questionnaire. Missing data at post-intervention was 22.5%. Intention to treat (ITT) analyses were conducted using linear mixed-models. Results revealed greater levels of acceptance and self-compassion for the treatment group, which were primary outcomes, with effect sizes ranging from small to large and these results were maintained at six-month follow-up. Rates of clinically significant improvements were also greater for the treatment group in comparison to the wait-list control group on acceptance and compassion. The treatment group also improved in the third primary outcome, pain disability. Significant differences were found in several of the secondary outcomes, in favour for the treatment group. Internet-based ACT with CFT components shows promise as a viable treatment option in the management of chronic pain.

Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty.

Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly. To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults. Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05. Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities. The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.

Risk Factors for Joint Bleeding in Severe Hemophilia a and B: Analysis of the Community Counts Longitudinal Surveillance Cohort

Background: One of the most devastating complications of Hemophilia A or B (HemA, HemB) is end-stage joint damage characterized by chronic pain and functional disability. Joint bleeding is the best predictor of joint damage in hemophilia. A wide range of new therapeutics from extended half-life factor (EHL) concentrates to non-factor therapies such as factor VIII mimetics, hemostatic rebalancers and gene therapy have been recently approved or are in late-stage clinical trials that hold the promise of decreased joint disease in severe hemophilia. Specific Aim: Given the progressive improvements in the therapeutic armamentarium of hemophilia care, this study aimed to determine current predictors of joint bleeding in individuals with severe hemophilia on continuous prophylaxis in the context of a national surveillance project. Methods: Eligible participants were males with severe HemA or HemB, aged 2 to 44 years, on continuous prophylaxis therapy and participating in Community Counts (CC) during the period December 2013 to November 30, 2022. CC is a bleeding disorders surveillance project funded by the Centers for Disease Control and Prevention and administered through the American Thrombosis and Hemostasis Network in 141 federally funded Hemophilia Treatment Centers across the United States. CC collects data on sociodemographics, bleeding episodes, treatment products, and health outcomes during patients' annual comprehensive care visits. Data were analyzed using annualized joint bleeding rates (AJBR), calculated using the number and location of all joint bleeds occurring in 10 joints (shoulders, elbows, hips, knees, ankles) during the year since the last surveillance visit based on infusion logs and/or other patient records. Age and other demographic subgroups were compared via rate ratios (RR) and 95% confidence intervals (CI). Methods accounting for multiple measurements from the same individuals over time were used for multivariate analyses. AJBR differences according to demographic and clinical variables were assessed via p values comparing Beta coefficients from these models. Results: The HemA cohort included 2505 persons, 8542 observations years and 13,224 joint bleeds for an overall AJBR of 1.55. The HemB cohort included 439 persons, 1488 observation years and 1326 joint bleeds for an overall AJBR of 0.89. Joint bleeding increased with age. In comparison to those ages 2-9 years, RRs were significantly increased for ages 10-19 and 20-44 for both HemA (1.23 [CI 1.1-1.3]) and 3.17 [CI 3-3.4], respectively), and HemB (2.2 [1.8-2.7] and 5.8 [4.8-7], respectively). Uninsured persons had higher AJBR than insured (HemA, RR 1.8 [1.6-2.1] and HemB, RR 6.9 [5.2-9.]. Table 1 compares characteristics associated with AJBR in multivariate analysis. The use of the FVIII mimetic in persons with HemA was associated with fewer joint bleeds (-1.00 joint bleeds per year). Persons with HemA showed modest decreases in AJBR with EHL therapies (-0.26), a finding not observed in persons with HemB. Worse AJBR outcomes were associated with missed doses for persons with both HemA and HemB. Joint bleeding was significantly associated with unemployment with disability for persons with HemA but not HemB. Trends in AJBR were similar between HemA and HemB for the following: adults had more joint bleeding than children, including adolescents aged 10-19 who are often engaged in team sports; compared with the Northeast, AJBR were higher in all other geographic regions; persons on Government insurance had higher AJBR than persons on Commercial insurance. Discussion: In a multivariate analysis of data on a large longitudinal cohort of persons with severe hemophilia on prophylaxis, use of the FVIII mimetic, ≥90% treatment adherence and treatment in the Northeast United States were associated with significantly lower AJBR. The increased joint bleeding rate in adults compared with children and adolescents may be related to pre-existing joint disease, less intense prophylactic regimens or decreased activity and fitness. Additional studies can further inform optimal hemophilia therapy regimens.

Guarding and flow in the movements of people with chronic pain: A qualitative study of physiotherapists' observations.

Among the adaptations of movement consistently associated with disability in chronic pain, guarding is common. Based on previous work, we sought to understand better the constituents of guarding; we also used the concept of flow to explore the description of un/naturalness that emerged from physiotherapists' descriptions of movement in chronic pain. The aim was to inform the design of technical systems to support people with chronic pain in everyday activities. Sixteen physiotherapists, experts in chronic pain, were interviewed while repeatedly watching short video clips of people with chronic low back pain doing simple movements; physiotherapists described the movements, particularly in relation to guarding and flow. The transcribed interviews were analysed thematically to elaborate these constructs. Moderate agreement emerged on the extent of guarding in the videos, with good agreement that guarding conveyed caution about movement, distinct from biomechanical variables of stiffness or slow speed. Physiotherapists' comments on flow showed slightly better agreement, and described the overall movement in terms of restriction (where there was no flow or only some flow), of tempo of the entire movement, and as naturalness (distinguished from normality of movement). These qualities of movement may be useful in designing technical systems to support self-management of chronic pain. Drawing on the descriptions of movements of people with chronic low back pain provided by expert physiotherapists to standard stimuli, two key concepts were elaborated. Guarding was distinguished from stiffness (a physical limitation) or slowness as motivated by fear or worry about movement. Flow served to describe harmonious and continuous movement, even when adapted around restrictions of pain. Movement behaviours associated with pain are better understood in terms of their particular function than aggregated without reference to function.

High-Anxious People Generalize Costly Pain-Related Avoidance Behavior More to Novel Safe Contexts Compared to Low-Anxious People

Pain-related avoidance is adaptive when there is a bodily threat, but when it generalizes to safe movements/situations, it may become disabling. Both subclinical anxiety—a vulnerability marker for chronic pain—and chronic pain are associated with excessive fear generalization to safe stimuli/situations. Previous research focused mainly on passive fear correlates (psychophysiological arousal and self-reports) leaving avoidance behavior poorly understood. Therefore, we tested whether high-anxious individuals generalize their pain-related avoidance behavior more to novel, safe contexts than low-anxious people. In a robotic-arm-reaching task, both groups (low vs high trait anxiety) performed 1 of 3 movements to reach a target. In the threat context (black background), a painful stimulus could be partly/completely prevented by performing more effortful trajectories (longer and more force needed); in the safe context (white background), no pain occurred. Generalization of avoidance was tested in 2 novel contexts (light/dark gray backgrounds). We assessed pain expectancy, pain-related fear, startle eyeblink responses for all trajectories, and avoidance behavior (ie, maximal deviation from shortest trajectory). Results indicated that differential fear and expectancy selectively generalized to the novel context resembling the original threat context in both groups. Interestingly and in contrast with the verbal reports, high-anxious participants avoided more in the novel context resembling the original safe context, but not in the 1 resembling the threat context. No generalization emerged in the startle data. Because excessive pain-related avoidance specifically may cause withdrawal from daily life activities, these findings suggest that high-anxious individuals may be vulnerable to developing chronic pain disability. PerspectiveThis paper shows that high-anxious people do not overgeneralize pain-related fear and pain expectancy learned in a threat context more to novel, safe contexts than low-anxious individuals, but that they do avoid more in those contexts. These findings suggest that high-anxious individuals may be vulnerable to developing chronic pain disability.

Normal Variation of the Lisfranc Joint: Tridimensional Analysis using Weight-Bearing Computed Tomography Imaging

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Untreated Lisfranc injuries can lead to chronic pain, midfoot arthritis, and functional disability 1,2,5. Approximately 20% of Lisfranc injuries are misdiagnosed or completely missed on initial evaluation, which can be attributed to a lack of parameters of what is within normal limits for subjects without injury in the Lisfranc complex3,4. The purpose of this study is to identify anatomic variations of unidimensional, bidimensional, and tridimensional (1D, 2D, 3D) measurements of the Lisfranc complex of normal individuals using weight-bearing computed tomography (WBCT) imaging. Our hypothesis is that there is some variation among individuals with a difference between right and left of the same individual of less than 10%. Methods: A total of 191 subjects with bilateral WBCT scans of the foot were collected from three tertiary medical centers from 2019-2022. Exclusion criteria included: history of Lisfranc injury, first to fourth metatarsal base fractures, Charcot arthropathy, midfoot arthritis, cuneiform fractures, and forefoot surgery proximal to the metatarsal neck region. The following Lisfranc joint measurements were collected6 bilaterally: joint volume (3D), area of the joint on a consistent axial slice (2D), and distance between the second metatarsal and medial cuneiform (1D). Foot alignment was assessed using lateral talar-first metatarsal angle (Meary’s Angle). Patient demographics (age, sex, weight, height, BMI) were also collected. Descriptive statistics were calculated for quantitative variables. Percent difference was used to assess volume, area, and distance variation between sides.7 Correlation between demographic data and Lisfranc measurements was assessed using Pearson Correlation tests. A T-test was used for categorical variables. A p-value &lt; 0.05 was considered statistically significant. Results: The cohort included 61% female and 39% male with an average age of 45.2±17.3 years. The mean volume, area, and distance measurements of the Lisfranc joint for both left and right sides are shown in Figure 1. Overall, the mean percent difference between left and right sides were 11.9%, 14.9% and 13.9% for volume, area and diastasis, respectively (Figure 1). No association was found between age, BMI, or weight and the volume, area or distance measurements. A correlation (r=0.48, p= &lt; 0.001) was found between height and left Lisfranc joint volume, but no other measurements. Significant difference between sex in volume (p &lt; 0.001) and area (p &lt; 0.001) measurements were found. Foot alignment did not have a correlation with a variation of the Lisfranc complex measurements. Conclusion: This study provides an objective characterizing of the anatomic variations of the Lisfranc joint amongst healthy individuals. Differences in the measurements and the large standard deviation in absolute measurements of volume, area, and distance suggests that percent difference with the contralateral side may be a better metric to use to diagnose Lisfranc instability. Our results showed that the difference between bilateral sides in a patient is less than 15% for volume, area, and diastasis. The results of this study can set the foundation for future studies to determine the cut-off value for the diagnosis of Lisfranc instability using WBCT imaging.

Inflammatory mechanisms in post-traumatic osteoarthritis: a role for CaMKK2.

Post-traumatic osteoarthritis (PTOA) is a multifactorial disease of the cartilage, synovium, and subchondral bone resulting from direct joint trauma and altered joint mechanics after traumatic injury. There are no current disease-modifying therapies for PTOA, and early surgical interventions focused on stabilizing the joint do not halt disease progression. Chronic pain and functional disability negatively affect the quality of life and take an economic toll on affected patients. While multiple mechanisms are at play in disease progression, joint inflammation is a key contributor. Impact-induced mitochondrial dysfunction and cell death or altered joint mechanics after trauma culminate in inflammatory cytokine release from synoviocytes and chondrocytes, cartilage catabolism, suppression of cartilage anabolism, synovitis, and subchondral bone disease, highlighting the complexity of the disease. Current understanding of the cellular and molecular mechanisms underlying the disease pathology has allowed for the investigation of a variety of therapeutic strategies that target unique apoptotic and/or inflammatory processes in the joint. This review provides a concise overview of the inflammatory and apoptotic mechanisms underlying PTOA pathogenesis and identifies potential therapeutic targets to mitigate disease progression. We highlight Ca2+/calmodulin-dependent protein kinase kinase 2 (CaMKK2), a serine/threonine protein kinase that was recently identified to play a role in murine and human osteoarthritis pathogenesis by coordinating chondrocyte inflammatory responses and apoptosis. Given its additional effects in regulating macrophage inflammatory signaling and bone remodeling, CaMKK2 emerges as a promising disease-modifying therapeutic target against PTOA.

Instrument Assisted Soft Tissue Mobilization versus Integrated Neuromuscular Inhibition Technique in Nonspecific Chronic Neck Pain: Single-blinding Randomized Trial

ObjectiveThis study aimed to compare the effects of instrument-assisted soft tissue mobilization (IASTM) vs integrated neuromuscular inhibition technique (INIT) on pain intensity, pressure pain threshold, neck disability, and electrophysiological properties in nonspecific chronic neck pain. MethodsWe performed a pre-post prospective randomized controlled trial on 90 participants with nonspecific chronic neck pain. The participants were chosen randomly from physical therapy out-patient clinics in the Giza governorate and allocated randomly by permuted block to the following 3 groups: Group A received INIT on the upper trapezius in addition to supervised traditional therapy (STT) as hot pack, stretching and strengthening exercises, Group B received IASTM on the upper trapezius in addition to STT, and Group C received STT only. Treatment was 3 times per week for 4 weeks. Pain intensity by visual analog scale (VAS), pressure pain threshold (PPT) by commander algometer, neck disability by Arabic Neck Disability Index (ANDI), and electrophysiological properties in the form of muscle amplitude by root mean square (RMS), and fatigue by median frequency (MDF) were measured at baseline and after 4 weeks. ResultsIn the within-group analysis, there was a statistically significant decrease in VAS, ANDI, and RMS% values within each group with favor to INIT. In PPT and MDF, there was a significant increase within each group with regard to INIT as P value <.05. In the between-group analysis at posttreatment, the results reported a statistically significant difference between INIT and STT, and also between IASTM and STT in all variables. Between INIT and IASTM, there was no statistically significant difference in VAS and NDI, but there was a statistically significant difference in PPT, RMS%, and MDF. The post hoc test reported improvement in all variables in all groups, with more favor to the INIT group in PPT and electrophysiological properties only. ConclusionIn this study, we found no statistically significant differences between INIT and IASTM in VAS and ANDI posttreatment, but there were differences between INIT and STT group and IASTM and STT group.

Deep dry needling versus muscle energy technique on pain and functional disability in chronic nonspecific neck pain.

Deep dry needling versus muscle energy technique on pain and functional disability in chronic nonspecific neck pain.

E20 Factors associated with school and work impairment in patients with Juvenile idiopathic arthritis

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common arthropathy of childhood. It is frequently associated with chronic pain and physical disability. Moreover, it can persist over many years and can lead to disability and dysfunction in adulthood. Objectives The aim of this study was to investigate the factors associated with school or work absenteeism and poor school functioning in patients with JIA. Methods We conducted a cross-sectional study including patients with JIA according to the International League of Associations for Rheumatology (ILAR). Sociodemographic data as well as disease characteristics were collected from patient’s medical records. A detailed questionnaire was completed for each participant by interviewing them about their school level and their educational and work performance. The rate of absenteeism due to health complications was noted. The data were analyzed using SPSS version 11.5. A P-value cut-off of 0,05 to determine significance was fixed. Results We studied 31 JIA patients. There were 11 males (35.5%) and 20 females (64.5%). The mean age of participants was 28.6 years [9–45]. The mean age at onset was 6.65 years [2–13]. The mean disease duration was 256.5 months [36–444]. The distribution of the different subtypes in patients was as follows: RF-positive polyarthritis (n = 10), oligoarthritis (n = 7), RF-negative polyarthritis (n = 6), Enthesitis-related arthritis (n = 4) and systemic arthritis (n = 4). Nineteen patients were receiving corticosteroids. Disease-modifying anti-rheumatic drugs were used by 18 patients: methotrexate (n = 11), sulfasalazine (n = 3), leflunomide (n = 4) and biologics (n = 13). Twelve patients developed complications: coxitis (n = 11), growth retardation (n = 9) and uveitis (n = 4). Joint replacement was required in 7cases. The mean DAS28 ESR was 2.71 [0.76–5.23] and the mean CHAQ was 0.85 [0–2.30]. The mean number of tender and swollen joints was 0.45[0–8] and 0.29 [0–5] respectively. The mean amount of CRP and ESR was respectively 12.71 mg/l [0–91] and 21.23 mm/h[0–84]. Seven patients were illiterate (26.9%), 11 had dropped out of school (42.3%). Twenty-two patients (70.9%) reported repeated absences due to illness. A year of schooling was repeated by 43.6% of patients. Fourteen out of 26 patients over the age of 20 attended university. Almost 77% of patients were exempted of physical education. Among the adult patients, 10 had an intellectual job (38.4%), 12 had a manual job (46.1%) and 4 were unemployed (15.3%). A total of 37% of the schooled patients and 18.4% of adult patients missed 2 weeks or more of school or work during the past year. A total of 26.3% of the patients had poor school functioning. A significant association was found between absenteeism and tender joints (P = 0.044). However, there were no significant association between the school-related problems, the socio-demographic characteristics and the other parameters of clinical and biological activity studied. Conclusion Our study suggested that JIA negatively affected patients schooling and adults work performances. Therefore, proper management of these patients is important to increase their academic and professional performance.

E12 Sleep disturbance among Juvenile idiopathic arthritis patients

Abstract Background Juvenile idiopathic arthritis (JIA) is a common pediatric condition that is often associated with chronic pain and physical disability. Moreover, it is also comorbid with sleep problems which considerably affects the patient’s daily functioning [1]. Objectives The aim of this study was to assess sleep disturbances among JIA patients. Methods We conducted a cross-sectional study including patients with JIA according to the International League of Associations for Rheumatology (ILAR). Sociodemographic data as well as disease characteristics were collected. Sleep disturbance was assessed by two questionnaires: the BEARS Sleep Screening algorithm and PROMIS sleep disturbance short form according to the age of the patients (&amp;lt;18 years old, &amp;gt;18 years old respectively). The BEARS is an instrument divided into major sleep domains: bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep and snoring. PROMIS is an 8-item questionnaire that assess sleep quality. A higher T score corresponds to a poorer the sleep quality. Results The study included 31 patients. The mean age of the participants was 28.67 years [9–45 years]. There was a female predominance: 35.5% males vs 64.5% females. The mean age at onset was 6.6 years [2–13] and the mean disease duration was 256.5 months [36–444]. The distribution of the different subtypes was as follows: Enthesitis-related arthritis (n = 4), RF-positive polyarthritis (n = 10), RF-negative polyarthritis (n = 6), oligoarthritis (n = 7) and systemic arthritis (n = 4). Nineteen patients were receiving corticosteroids. Disease-modifying anti-rheumatic drugs were used by 18 patients: methotrexate (n = 11), sulfasalazine (n = 3), leflunomide (n = 4), biologics (n = 13). Twelve patients developed complications: coxitis (n = 11), growth retardation (n = 9), uveitis (n = 4). The majority of the respondents (90.3%) reported using screens daily before going to sleep. Among patients aged &amp;lt;18 years, 2 had an individual bedroom while 8 shared theirs with their siblings. Among the ten patients who answered the BEARS Sleep Screening algorithm, 40% had an excessive daytime sleepiness, 20% had night awakenings and 30% suffered from a snoring problem. Regularity and duration of sleep was respected in 6 out of the 10 patients. The most common bedtime problem mentioned were refusal to go to bed (73%) as well as bedtime stalling (23%). As for the PROMIS form, the mean score was 55.52 [27–66]. None to slight, mild, moderate and severe sleep disturbance were found in 16.1%, 19.3% and 6.4% of cases respectively. There was a significant association between poor sleep quality and higher disease activity (DAS28 ESR) (P &amp;lt; 0.043). However, we did not find a significant association between the sleeping disturbances and age at onset (P = 0.08), disease duration (P = 0.073), the CHAQ score (P = 0.059), corticosteroid use (P = 0.063) and the screen use (P = 0.092). Conclusion This study highlights the high prevalence of sleep disturbance among JIA patients which may affect their physical, emotional and cognitive well-being. It is important to screen for sleep problems for a better management of the disease. [1] Owens J. Classification and epidemiology of childhood sleep disorders. Prim Care 2008; 35(3):533–46

Restorative neurostimulation for chronic mechanical low back pain - Three year results from the United Kingdom post market clinical follow-up registry.

Mechanical chronic low back pain is often associated with impaired neuromuscular control of the lumbar multifidus muscles, the most important stabilizers of the lumbar spine. Restorative neurostimulation is a modality for the treatment for this specific subset of patients aimed to facilitate restoration of neuromuscular control by bilateral stimulation of the L2 medial branches. Evidence from both prospective and randomised clinical trials to date has demonstrated substantial improvements in clinical outcomes such as pain, disability and health-related quality of life. This study is an open label prospective follow-up for the treatment of chronic mechanical low back pain of nociceptive origin with restorative neurostimulation. Patients completed assessments for pain, disability and health-related quality of life. Outcomes were collected at 45, 90 and 180days, and 1, 2 and 3years after the activation visit. Forty-two patients were implanted with the device and 33 (79%) were available at the 3-year appointment. Patients in this cohort presented with severe chronic low back pain (NRS = 7.0 ± 0.2) and severe disability (ODI 46.6 ± 12.0). The health-related quality of life was also severely impacted at baseline (EQ-5D 0.426 ± 0.061). Changes in pain, disability and quality of life at three-year follow-up demonstrated a statistically significant improvement between baseline and 1, 2 and 3years. After 3years of therapy, average NRS scores had reduced to 2.7± 0.3 and mean ODI score to 26.0 ± 3.1 while EQ-5D-5L index improved to 0.707 ± 0.036. The ongoing follow-up of this post market cohort continues to demonstrate that restorative neurostimulation provides a statistically significant, clinically meaningful and durable response across pain, disability and quality-of life scores for patients suffering chronic mechanical low back pain that has been refractory to conventional management. ClinicalTrials.gov Identifier: NCT01985230.

Kids B.E.A.R. Pain: A Pediatric Chronic Pain Protocol

Patients with chronic pain utilize health care services up to five times the rate of the general population while pediatric chronic pain admissions from 2004-2010 increased by 831% (Coffelt et al., 2013; Reddy, 2006). Further complicating this public health epidemic are co-morbid conditions resulting in poor sleep, depression, and anxiety as well as psycho-social problems related to school truancy and poor social networks. Caregiver attitude towards pain may also negatively contribute to the illness, i.e., caregivers may increase chronic pain and functional disability by promoting sedentary lifestyles due to fear avoidance behaviors (Palermo et al., 2014). Interventions are needed to assist adolescents that experience chronic pain. The following is a detailed overview of the Kids B.E.A.R. Pain intervention protocol, a support program for pediatric patients experiencing chronic pain and their caregivers.