Chronic Pain Grade Questionnaire Research Articles

Rumination-Focused Cognitive-Behavioral Therapy for Chronic Low Back Pain: A Randomized Controlled Trial

Background: Chronic pain remains or reappears for more than 3 to 6 months, and it is influencing 20% of the global population. The pain catastrophizing affects pain intensity and psychological conditions of patients with chronic pain. Rumination-focused cognitive-behavioral therapy (RFCBT) targets rumination as the key component of pain catastrophizing. The aim of this study was to determine the effectiveness of RFCBT on depression, anxiety, and pain severity of individuals with chronic low back pain (LBP). Materials and Methods: In a randomized controlled trial, 30 patients aged between 20-55 years with diagnosed chronic LBP were chosen by convenience sampling and randomly allocated into intervention and control groups. All patients used their prescribed medications for pain management, but the intervention group received 12 weekly sessions of RFCBT, which was manualized psychotherapy to change unconstructive rumination to constructive rumination. Depression Anxiety and Stress scale-21 and chronic pain grade questionnaire were administered as pre-tests and re-administered after 3 and 6 months as post-test and follow-up assessments, respectively. Results: RFCBT significantly reduced depression (F1=23.01, P=0.001), anxiety (F1=25.7, P=0.001) and pain severity (F1=7.17, P=0.012) in patients with chronic LBP. Conclusion: RFCBT may offer benefits for treating patients with chronic low back pain when added to their usual pharmacological treatment. This benefit may be the result of targeting rumination as the key element of pain catastrophizing. [GMJ.2020;9:e1722]

Incidence of Recurrent Low Back Pain as a Side Effect of Decompressive Surgery for Lumbar Spinal Stenosis in Obese Versus Non-Obese Patients

Studies have reported an increased incidence of recurrent post-decompression-associated lower back pain (LBP) among obese patients after Lumbar spinal stenosis (LSS) surgery. Higher prevalence of lower back pain (LBP) associated with post-decompression surgical treatment among obese or overweight female patients compared to male patients. The current study has aimed to examine the relationship between body composition and long-duration consequences of post-spinal decompression among the Saudi population. This retrospective, longitudinal study was conducted at Taif Hospital, Kingdom of Saudi Arabia (KSA), throughout ____2010-till 2015 ____. Chronic pain grade questionnaire for assessing lower back pain and any disability among post-decompression participants. The chi-square test was used to analyze independent variables, and an independent t-test was employed to detect variances between mobility, age, education, body composition, and emotional disorders. The adjustment of age, education, mobility, emotional disorder, and BMI was examined through multivariate analysis. Highly a statistically substantial difference between obese and non-obese with regard to age, emotional distress, low mobility, Body mass index (BMI), mean estimated flow of blood (p-value <0.000), and hospitalization (p-value <0.002). The results showed a statistically substantial relationship between the degree of pain and disability with patient weight (p-value: 0.05), body mass index (p-value: 0.03), and Fat mass/fat-free mass ratio (p-value: 0.05). Clinical improvement is observed in obese patients post decompression surgical intervention, but the percentage of improvement was significantly higher among the male gender compared to female obese patients.

Efficacy of emotion regulation training on pain intensity and life quality in patients with peptic ulcer disease (PUD).

Because gastric ulcer is a psychosomatic disease involving many psychological factors like assertiveness and cognitive beliefs, this study aimed to investigate the effectiveness of emotion regulation training on pain intensity and quality of life in patients with peptic ulcer disease. Gastric ulcer, a recurrent and common disease worldwide, is associated with gastrointestinal symptoms and lower health-related quality of life. Psychological factors and stress have been recognized as important contributors to the onset and duration of gastric ulcer, highlighting the need for effective psychological interventions to improve pain intensity and quality of life in patients. The research method was semi-experimental and based on the pretest-posttest control group design, with follow-up after three months. The sample included 46 participants selected by a Purposive Sampling method and placed randomly in the experimental and control groups. At first, simultaneously, and under the same conditions, all the participants responded to the Chronic Pain Grade Questionnaire (CPG) and Quality of Life Questionnaire (SF-12). The emotion regulation training was performed on the experimental group. In the end, both groups were evaluated by posttests, and then they were tracked after three months. To analyze data, the ANCOVA test was applied through SPSS 22. Findings showed that emotion regulation training was meaningfully effective in decreasing pain intensity and increasing life quality (p<0.01), but after three months interval, no significant changes were found in the results. Due to the results about emotion regulation training protocol that has successfully reduced pain intensity symptoms in PUD patients and increased life quality, it is suggested that this protocol can be added to other treatments for PUD patients.

Association Between Sleep Quality, Musculoskeletal Pain and Physical and Psychosocial Well-Being Among Employees Working from Home

COVID-19 has perplexed the world into an unexpected state of affairs. With the implementation of nationwide lockdown, people have begun to ‘Work for Home’ in many employment sectors. Though the policy has managed to keep people safe from the devastating effects of the virus, it has, however, imposed most employees into a sedentary lifestyle. The current situation has resulted in disordered sleep, musculoskeletal pain, physical and psychosocial well-being decline due to irregular work hours, and mental health issues due to corona phobia. The current study aims to find the correlation between sleep duration, musculoskeletal pain, and physical and psychosocial well-being in employees working from home during the COVID-19 pandemic lockdown. One hundred fifty-three samples from the North India region were studied in a correlation study. Subjects working from home for at least one month or more and only due to COVID-19 lockdown were excluded, while those with any musculoskeletal, cardiovascular or neurological disorder were excluded. Questionnaires employed were Pittsburg Sleep Quality Index (PSQI) (for sleep quality), Chronic Pain Grade Questionnaire (CPGQ) (for pain intensity), and Short Form-12 (SF-12) Questionnaire (for physical and psychosocial well-being). Scores were calculated, and Pearson’s correlation was found. One hundred fifty-three samples (mean age= 32.73±5.55, mean height=167±9.22, mean weight=67.2±13.7, mean BMI=23.9±3.97) were evaluated, which revealed a higher negative correlation coefficient value between MSK pain intensity and PCS value (-0.535) describing that the pain increased with deterioration in sleep, and sleep quality and MCS value (-0.423) stating that the psychosocial well-being worsened with the decline in sleep quality; while a highly positive correlation was established with the sleep quality and pain intensity scores (0.420) depicting that pain degraded the physical well-being. A weak correlation was reported in the relationship between the intensity of MSK pain with sleep quality (-0.218) and PCS score (-0.323), suggesting no significant impact (significant at the 0.01 level (2-tailed). A significant correlation has been established between sleep quality, the intensity of musculoskeletal pain, and the physical and psychosocial well-being of employees working from home during the COVID-19 pandemic lockdown.

Fibromyalgia syndrome in medical students

Aim of the workTo investigate the frequency of fibromyalgia syndrome (FMS) among medical students and its stratifications. Patients and methodsThe work included 513 medical students from Kafrelsheikh University. The 2010 and 2016 American College of Rheumatology (ACR) fibromyalgia classification criteria were used to determine the presence of FMS. The chronic pain grade questionnaire was used to assess pain severity and impact on daily activities, recreational, social and family activities, and ability to work. ResultsThe students were 296 females (57.7 %) and 217 males (42.3 %). 64 (12.5 %) fulfilled the 2010 criteria (F:M 2.8:1) (p = 0.015). The frequency of female affection was 15.9 % (47/296) compared to 7.83 % (17/217) in male. 37 (7.2 %) fulfilled 2016 criteria and only six cases (9.3 %) were known to have FMS. The frequency of FMS in students of the first 3 years (basic science) and the following 3 years (clinical) was 14.1 % and 9.5 %, respectively. Considering the chronic pain grade, there was a significant difference (p < 0.0001) in all pain items, daily recreational, social, family activities, and ability to work between those with and without FMS. 213 (41.5 %) had knowledge about FMS and the source of their information was from social media (39.4 %), their academic study (26.8 %), web pages (25.4 %) and friends (8.5 %). ConclusionFibromyalgia is highly frequent among medical students, especially females of basic years with a high impact on recreational, social, family activities, and ability to work. Medical students should be considered a “high-risk” group for FMS and should be educated about it and managed accordingly.

Life-course socioeconomic circumstances in acute, chronic and disabling pain among young employees: a double suffering.

Pain is known to be socioeconomically patterned and associated with disability. However, knowledge is scarce concerning life-course socioeconomic circumstances and pain among young adults. Our aim was to examine the associations of childhood and current socioeconomic circumstances with acute pain and chronic pain with low and high disability levels among young Finnish municipal employees. We analysed questionnaire data retrieved from the Young Helsinki Health Study (n=4683) covering 18-39-year-old employees of the City of Helsinki, Finland. We included multiple indicators of childhood and current socioeconomic circumstances and examined their associations with acute pain and with chronic pain with low and high disability levels. The level of chronic pain-related disability was assessed by the chronic pain grade questionnaire. Multinomial logistic regression analyses were conducted with stepwise adjustments for sociodemographic, socioeconomic and health-related covariates. Childhood and current socioeconomic disadvantage were associated with acute and chronic pain, particularly with chronic pain with high disability level. The strongest associations after adjustments for covariates remained between chronic pain with high disability level and low educational level (odds ratio (OR) 3.38, 95% confidence interval (CI) 2.18-5.24), manual occupation (OR 3.75, 95% CI 1.92-7.34) and experiencing frequent economic difficulties (OR 3.07, 95% CI 2.00-4.70). Pain is a common complaint that contributes to disability among young employees, particularly the most socioeconomically vulnerable. There is a socioeconomic gradient in both pain chronicity and the level of chronic pain-related disability. Life-course socioeconomic factors should be considered in pain-preventing strategies and in clinical practice.

RENaBack: low back pain patients in rehabilitation—study protocol for a multicenter, randomized controlled trial

BackgroundMillions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country.MethodsThe aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program.The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG).DiscussionAn improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers.Trial registrationDRKS, DRKS00020373. Registered on 15 April 2020

707High levels of back disability,but not back pain,are associated with reduced physical activity in women

Abstract Background Although clinical guidelines recommend physical activity for low back pain (LBP), our understanding of the physical activity undertaken by people with LBP is limited. We examined the amounts, intensities and types of physical activity performed by community-based women with different levels of pain and disability. Methods 542 women were invited to participate. Physical activity was measured using the International Physical Activity Questionnaire, and LBP and disability were assessed using the Chronic Pain Grade Questionnaire. Participants were categorised into no/low or high pain intensity and disability groups. Results Women with high levels of back disability performed half the total physical activity of those with no/low levels of back disability (MET(hours/week): median(95%CI)=27.3(13.2-41.4) vs. 53.9(44.9-62.8),p=0.002), including less moderate (17.5(10.4-24.7) vs. 32.1(26.8-37.4),p&amp;lt;0.001) and domestic and gardening activity (14.4(7.2- 21.7) vs. 23.5(19.0-28.0), p = 0.02). Moreover, fewer women with high disability participated in vigorous (3(8.11%) vs. 134(32.0%),OR(95%CI)=0.17(0.04-0.75),p=0.02) and leisure activities (17(45.9%) vs. 294(70.2%),OR(95% CI)=0.44(0.21-0.94),p=0.03) compared to those with no/low disability. There were no differences in physical activity between women with no/low and high pain intensity (all p &amp;gt; 0.05). Conclusions High levels of back disability, but not back pain intensity, were associated with reduced physical activity, including less total activity, moderate and vigorous intense activity, and discretionary activity. Key messages These findings highlight the impact of high levels of disability on physical activity. Further work is needed to determine whether targeting these types and intensities of physical activity will help in reducing back disability.

Self-reported Fear, Psychological Inflexibility and Opioid Dose in Relation to Pain

Within the past two decades, research on the treatment of chronic pain with opioid medication has attempted to understand the complex relationship between psychological factors, subjective pain experience, and prescription opioid use. Specifically, fear and psychological inflexibility factors have been explored in relation to both pain sensation and opioid dose. The current study aims to explore and enhance the understandings of brief, subjective self-report measures of fear in relation to opioid dose, subjective fear, self-reported pain, and psychological inflexibility processes. This study examined whether (1) a quadratic relationship would exist between pain scores and opioid dose; (2) individuals with higher opioid dosages would have higher psychological inflexibility scores and subjective fear of pain scores; (3) subjective fear scores, in concert with psychological inflexibility pain measures, would be predictive of pain scores, and (4) subjective fear scores would positively correlate to psychological inflexibility pain measures. The final sample consisted of 202 respondents of an online survey for chronic pain. Survey measures included the Chronic Pain Grade questionnaire (CPG), the Psychological Inflexibility in Pain Scale (PIPS), Subjective Fear of Pain when in Low Pain (FlowP), and when in No Pain (FnoP). Opioid dosage for each participant was converted to the standardized Morphine Milligram Equivalent (MME). A significant quadratic relationship between the CPG and MME was found (p=0.016). MME scores were <i>ns</i> in relation to Subjective Fear of Pain scores or PIPS. FlowP and FnoP, however, did predict overall pain scores for participants (p<0.001). Overall pain scores also showed a positive moderate relationship with overall PIPS scores (r(200)=0.673, p<0.001). FlowP and PIPS together explained 45.7% of the variance of pain scores (F(2,199) = 83.640, p=0.003, R=0.676, R²=0.457) with FnoP and PIPS explaining slightly less at 44.8% (F(2,187)=76.002, p<0.001, R=0.670, R²=0.448). FlowP, however, showed slightly stronger correlations to overall PIPS scores (r(200)=0.648, p<0.001) when compared to FnoP (r(188)=0.589, p<0.001). These findings support previous research indicating a quadratic relationship between pain and opioid dose. Higher pain scores were correlated to higher scores on PIPS and subjective fear of pain questions. Of benefit, the subjective fear of pain questions showed some minor predictability when used as a two-question predictor of pain. Our results not only support previous research underlying the relationship between opioid dose and pain but expand on insight into the use of short-form, fear-related questions to predict psychometrics such as psychological inflexibility and pain sensation.

Rumination-Focused Cognitive-Behavioral Therapy for Chronic Low Back Pain: A Randomized Controlled Trial.

Background: Chronic pain remains or reappears for more than 3 to 6 months, and it is influencing 20% of the global population. The pain catastrophizing affects pain intensity and psychological conditions of patients with chronic pain. Rumination-focused cognitive-behavioral therapy (RFCBT) targets rumination as the key component of pain catastrophizing. The aim of this study was to determine the effectiveness of RFCBT on depression, anxiety, and pain severity of individuals with chronic low back pain (LBP). Materials and Methods: In a randomized controlled trial, 30 patients aged between 20-55 years with diagnosed chronic LBP were chosen by convenience sampling and randomly allocated into intervention and control groups. All patients used their prescribed medications for pain management, but the intervention group received 12 weekly sessions of RFCBT, which was manualized psychotherapy to change unconstructive rumination to constructive rumination. Depression Anxiety and Stress scale-21 and chronic pain grade questionnaire were administered as pre-tests and re-administered after 3 and 6 months as post-test and follow-up assessments, respectively. Results: RFCBT significantly reduced depression (F1=23.01, P=0.001), anxiety (F1=25.7, P=0.001) and pain severity (F1=7.17, P=0.012) in patients with chronic LBP. Conclusion: RFCBT may offer benefits for treating patients with chronic low back pain when added to their usual pharmacological treatment. This benefit may be the result of targeting rumination as the key element of pain catastrophizing.

Personalized Treatment Suggestions: The Validity and Applicability of the Risk-Prevention-Index Social in Low Back Pain Exercise Treatments.

Background: The back pain screening tool Risk-Prevention-Index Social (RPI-S) identifies the individual psychosocial risk for low back pain chronification and supports the allocation of patients at risk in additional multidisciplinary treatments. The study objectives were to evaluate (1) the prognostic validity of the RPI-S for a 6-month time frame and (2) the clinical benefit of the RPI-S. Methods: In a multicenter single-blind 3-armed randomized controlled trial, n = 660 persons (age 18–65 years) were randomly assigned to a twelve-week uni- or multidisciplinary exercise intervention or control group. Psychosocial risk was assessed by the RPI-S domain social environment (RPI-SSE) and the outcome pain by the Chronic Pain Grade Questionnaire (baseline M1, 12-weeks M4, 24-weeks M5). Prognostic validity was quantified by the root mean squared error (RMSE) within the control group. The clinical benefit of RPI-SSE was calculated by repeated measures ANOVA in intervention groups. Results: A subsample of n = 274 participants (mean = 38.0 years, SD 13.1) was analyzed, of which 30% were classified at risk in their psychosocial profile. The half-year prognostic validity was good (RMSE for disability of 9.04 at M4 and of 9.73 at M5; RMSE for pain intensity of 12.45 at M4 and of 14.49 at M5). People at risk showed significantly stronger reduction in pain disability and intensity at M4/M5, if participating in a multidisciplinary exercise treatment. Subjects at no risk showed a smaller reduction in pain disability in both interventions and no group differences for pain intensity. Regarding disability due to pain, around 41% of the sample would gain an unfitted treatment without the back pain screening. Conclusion: The RPI-SSE prognostic validity demonstrated good applicability and a clinical benefit confirmed by a clear advantage of an individualized treatment possibility.

Active video games for knee osteoarthritis improve mobility but not WOMAC score: A randomized controlled trial.

Active video games (AVGs) have become popular and have been investigated for their therapeutic purposes. However, the effect of AVGs on patients with knee osteoarthritis (OA) remains uncertain. We aimed to compare the effects of AVGs with those of traditional therapeutic exercise on patients with knee OA. This was a prospective single-blind, randomized controlled trial. Participants (n=80) with knee OA were allocated to the AVGs group (n=40) or therapeutic exercise group (n=40). Both groups received treatment 3 times a week for 4 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and secondary outcome measures were the World Health Organization Quality of Life-Brief Vision, Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, physical functional performance (including time for 10-m walking and for ascending and descending stairs), Biodex Stability System, Chronic Pain Grade Questionnaire, and Work Ability Index. The patients were evaluated at baseline, 2 and 4 weeks after treatment, and 1 and 3 months after treatment completion. Both groups showed significant time effect in the pain subcategory of the WOMAC (P=0.047). However, we found no significant group×time interaction effect between the groups at any follow-up assessments for pain (P=0.066), stiffness (P=0.284), or physical function (P=0.179) for the WOMAC. Among the secondary outcomes, we found significant group×time effects favoring the AVG group in dynamic balance (P=0.020), and physical functional performance including 10-m walking time (P=0.002) and stair ascent time (P=0.005), and the physical domain of health (P=0.032). Therapeutic exercises and playing AVGs similarly improved the pain of patients with knee OA; however, playing AVGs improved dynamic balance, physical functional performance, and physical health more than therapeutic exercises did.

Feasibility and long-term efficacy of a proactive health program in the treatment of chronic back pain: a randomized controlled trial

BackgroundTo facilitate access to evidence-based care for back pain, a German private medical insurance offered a health program proactively to their members. Feasibility and long-term efficacy of this approach were evaluated.MethodsUsing Zelen’s design, adult members of the health insurance with chronic back pain according to billing data were randomized to the intervention (IG) or the control group (CG). Participants allocated to the IG were invited to participate in the comprehensive health program comprising medical exercise therapy and life style coaching, and those allocated to the CG to a longitudinal back pain survey. Primary outcomes were back pain severity (Korff’s Chronic Pain Grade Questionnaire) as well as health-related quality of life (SF-12) assessed by identical online questionnaires at baseline and 2-year follow-up in both study arms. In addition to analyses of covariance, a subgroup analysis explored the heterogeneity of treatment effects among different risks of back pain chronification (STarT Back Tool).ResultsOut of 3462 persons selected, randomized and thereafter contacted, 552 agreed to participate. At the 24-month follow-up, data on 189 of 258 (73.3%) of the IG were available, in the CG on 255 of 294 (86.7%). Significant, small beneficial effects were seen in primary outcomes: Compared to the CG, the IG reported less disability (1.6 vs 2.0; p = 0.025; d = 0.24) and scored better at the SF-12 physical health scale (43.3 vs 41.0; p < 0.007; d = 0.26). No effect was seen in back pain intensity and in the SF-12 mental health scale. Persons with medium or high risk of back pain chronification at baseline responded better to the health program in all primary outcomes than the subgroup with low risk at baseline.ConclusionsAfter 2 years, the proactive health program resulted in small positive long-term improvements. Using risk screening prior to inclusion in the health program might increase the percentage of participants deriving benefits from it.Trial registrationThe trial was registered at the German Clinical Trials Register under DRKS00015463 retrospectively (dated 4 Sept 2018).

Validity and Reliability of the Persian Version of the Chronic Pain Grade Questionnaire in Patients with Musculoskeletal Pain

Introduction: Chronic pain which is a pain that remains or repeats for more than 3 to 6 months affects one in every 10 people in the world. Rising direct and indirect costs of chronic pain show the importance of researches which help to find better ways of pain management. Testing the validity and reliability of pain measurement tools in different populations can help this kind of researches. The chronic pain grade questionnaire is devised by Vonkorff and his colleagues. This seven-item instrument gives a score which empowers chronic pain patients to be characterized into one of four hierarchical categories according to pain severity or interference. The goal of this research was to test the validity and reliability of the Persian version of the chronic pain grade questionnaire. Methods: As a cross-sectional study after downloading the questionnaire from the internet and translating from English to Persian by researchers and backward translation by a native researcher, it was answered by 204 patients with musculoskeletal pain. These patients were referred to the physical medicine and rehabilitation clinic in Modarres Hospital and were registered using convenience sampling method. Patients were aged between 18 and 87; suffering from musculoskeletal pain (including primary and secondary pains) for at least the last 6 months. Fifty patients were reevaluated after two weeks. Results: As a result of testing reliability, Cronbach’s alpha was 0.89 and the Guttman split-half coefficient was around 0.82 and Test re-test coefficient using Spearman’s correlation coefficient was 0.89. Only a single component was extracted for the questionnaire, as a result of factor analysis. This component defines 59.8% of the variance. Conclusions: In summary, construct validity and reliability of the Persian version of the chronic pain grade questionnaire are approved, therefore it would be applicable to people with musculoskeletal pain in the Iranian population.

The effect of treatment regimens on salivary cortisol levels in patients with chronic musculoskeletal disorders

BackgroundIncreased levels of circulating cortisol have been associated with pain severity in patients with chronic musculoskeletal disorders (CMD). Little is known about the potential association between pain management and salivary cortisol alterations in CPM patients treated with different regimens. ObjectivesThis prospective feasibility study aimed to determine the effect of two treatment regimens in comparison with sham therapy on pain intensity and disability and salivary cortisol concentration (SCC) in patients with CMD. MethodsThirty patients were randomly assigned to 3 groups of 10: two experimental groups (A and B) and a control group (C). The experimental groups followed physiotherapy treatment (A) or acupuncture (B), while the control group (C) followed a sham therapy for 10 sessions. Pain data were collected using the Chronic Pain Grade (CPG) questionnaire and SCC was measured by enzyme-linked immunosorbent assay at pre- and posttreatment. ResultsRepeated-measures analysis of variance showed that patients treated with acupuncture experienced greater decreases in pain intensity/pain disability (P < 0.05) than the physiotherapy and sham therapy groups. No statistical differences were found between the three groups for the SCC outcome variable. Bonferroni adjustments showed that the mean values of SCC were significantly decreased at posttreatment (P < 0.05) across the three groups. ConclusionThere was a significant decrease in both pain and cortisol outcomes at posttreatment in patients with CMD. Because of the limitations of this study, we cannot draw conclusions regarding whether the lower SCC could be an indication of pain reduction in patients with CMD.

Psychological pain responses in athletes and non-athletes with low back pain: Avoidance and endurance matter.

Dysfunctional psychological pain responses, namely fear-avoidance (FAR), including catastrophizing and helplessness, as well as endurance-related responses (ER), including thought suppression and overactivity, have been shown to be risk factors for persistent low back pain (LBP). Literature suggests that athletes may differ from non-athletes regarding psychological responses to pain. This study set out to compare FAR and ER between athletes and non-athletes with LBP. It was hypothesized that athletes would report less frequent FAR and more frequent ER, and that both FAR and ER are associated with LBP intensity and disability. The 173 athletes and 93 non-athletes cross-sectionally reported how frequently they employ FAR and ER on the Avoidance-Endurance Questionnaire (AEQ), as well as LBP intensity and disability on the Chronic Pain Grade Questionnaire (CPGS). MANOVA was applied to compare FAR and ER between athletes and non-athletes. Hierarchical multiple linear regression models were used to determine the unique associations between FAR and ER with LBP intensity and disability. Athletes reported lower frequencies of behavioural avoidance than non-athletes, but no other FAR variables differed between the groups. Frequencies of ER did not differ between athletes and non-athletes. Regression analysis indicated substantial associations of FAR with LBP intensity, as well as of FAR and ER with disability in athletes and non-athletes. The results of the present study suggest that athletes and non-athletes with LBP differ regarding behavioural avoidance, but overall, differences regarding pain responses are marginal. FAR and ER are both reported in athletes and non-athletes and contribute to disability in both groups. Athletes train to endure pain in the course of athletic socialization, at least in the context of exercise. However, there is sparsity of knowledge about psychological pain responses in athletes with low back pain and whether they differ from those in non-athletes. The results of this comparative study suggest that endurance responses are more frequent than avoidance responses among athletes and non-athletesalike. However, both types of responses seem relevant to clinical pain management in athletes as well as non-athletes.

Quality of life and its predictors in Thai patients following multiple trauma

Purpose The purpose of this paper is to describe the quality of life (QOL) and to examine factors predicting the QOL among the demographic characteristics, injury severity, effect on work, pain intensity, disability point, coping and resilience factors, in Thai patients following multiple injuries. Design/methodology/approach A cross-sectional research design was used. A total of multiple 106 trauma patients were obtained by simple random sampling. The patients were between 18 and 59 years of age, and had visited an outpatient clinic at one of three randomly selected tertiary hospitals in Metropolitan Bangkok, Thailand. Dependent variable was QOL measured by Trauma Outcome Profile (TOP) questionnaire. Independent variables were demographic and illness-related factors collected from patients’ medical records, coping measured by the Jalowiec Coping Scale, pain measured by the Chronic Pain Grade questionnaire (CPGQ) and resilience measured by the Connor-Davidson Resilience Scale (CD-RISC-10). Data were analyzed using descriptive statistics and multiple regression analysis. Findings Except for satisfaction, the other nine dimensions of the QOL in patients following traumatic injuries were poor. Pain intensity was the most influential factor predicting the QOL, but the patient’s resilience, emotional coping and disability points were also able to predict the QOL. Originality/value The TOP, CPGQ and CD-RISC-10 were translated into Thai and used in the current study for the first time. The results of the study revealed that the pain intensity, and the patient’s resilience and coping influenced the QOL more than other factors, such as the demographic data and injury severity.

Association of obesity, physical performance and mental health status with low back pain: a prospective cohort study

Purpose: While obesity, physical performance and mental health are associated with low back pain (LBP), our understanding of the inter-relationship between these factors is limited. This study examined the associations of 1) obesity and physical performance with LBP; and 2) obesity and mental health status with LBP in community-based adults. Methods: A total of 5058 participants (56% women) of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) were assessed at baseline (1999-2000) for obesity (BMI >30 kg/m2), physical performance using the physical health component summary (PCS) score of Short Form 36 (SF-36) and mental health using the mental health component summary (MCS) score of the SF-36. At follow-up (2013-2014) LBP was assessed using the Chronic Pain Grade Questionnaire. Based on the presence of obesity and significantly impaired physical performance (defined as the lowest 25% of PCS score), participants were categorised into the following groups: (i) no obesity and normal physical performance; (ii) obesity and normal physical performance; (iii) no obesity and impaired physical performance and (iv) obesity and impaired physical performance. Similarly, based on the presence of obesity and significantly impaired mental health (defined as the lowest 25% of MCS score), participants were categorised into the following groups: (i) no obesity and normal mental health; (ii) obesity and normal mental health; (iii) no obesity and impaired mental health and (iv) obesity and impaired mental health. Binary logistic regressions were used to estimate the odds ratio for LBP intensity associated with obesity and physical performance; and obesity and mental health. All the analyses were adjusted for age, smoking, socioeconomic status, physical activity and mental component score. Results: 20% of participants reported high intensity LBP, of whom 60% were women. Using women with neither obesity nor significantly impaired physical performance as the reference group, women with both obesity and significantly impaired physical performance had a higher prevalence of high intensity LBP (OR 4.69, 95% CI 3.35- 6.58) compared with those with significantly impaired physical performance alone (OR 2.81, 95% CI 2.12- 3.73) or obesity alone (OR 1.55, 95% CI 1.17- 2.05). In men, those with obesity and significantly impaired physical performance had a higher prevalence of high intensity LBP (OR 4.38, 95% CI 2.78-6.90) compared to significantly impaired physical performance alone (OR 2.45, 95% CI 1.76-3.42). Using women with neither obesity nor impaired mental health as the reference group, women with both obesity and impaired mental health had a higher risk of high intensity LBP (OR 3.08, 95% CI 2.15-4.40) compared to those with significantly impaired mental health only (OR 1.93, 95% CI 1.5- 2.48) or obesity only (OR 1.59, 95% CI 1.20- 2.09). In men, the risk of high intensity LBP was similar in those with obesity and significantly impaired mental health (OR 1.73, 95% CI 1.08- 2.77) and those with significantly impaired mental health alone (OR 1.53, 95% CI 1.13-2.07). Conclusions: Our findings suggest that, along with targeting obesity, strategies aiming to improve physical performance and mental health have the potential to reduce the burden of LBP in community-based adults, particularly in women.

The association of adverse childhood experiences and of resilience with chronic noncancer pain in the German adult population - A cross-sectional survey.

Adverse childhood experiences (ACE) might predispose to and resilience might protect against chronic noncancer pain (CNCP). We studied whether ACE are positively associated with CNCP, whether resilience was negatively associated with CNCP and whether resilience buffered a potential association of ACE with CNCP. A cross-sectional survey (N=2,425) representative for the adult German general population was conducted in 2013. The following questionnaires were used: Chronic Pain Grade Questionnaire for CNCP stages; Childhood Trauma Screener for ACE; Brief Resilient Coping Scale for resilience; Patient Health Questionnaire 4 for psychological symptom burden; Giessen Subjective Complaints List for somatic symptom burden. To test the association of ACE and resilience with CNCP stages, logistic regression analyses including sociodemographic variables and psychological and somatic symptom burden as possible confounders were calculated. No statistically significant associations between any CNCP and disabling CNCP respectively with physical, emotional, and sexual abuse; emotional and physical neglect if compared to no chronic pain were found in uni- and multivariate analyses. There was a small effect of combined ACE and a small attenuating effect of resilience on any and disabling CNCP in univariate, but not in multivariate analysis. Large associations were found between age>65years with any CNCP (OR 6.51 [95% confidence interval 3.38 to 12.51)] and disabling CNCP (OR 9.33 [95% confidence interval 2.39 to 36.41]), respectively, if compared to no pain. There was no pain-proneness by single and combined ACE for and no protection by resilience for any and for disabling CNCP in the general adult German population. There is no pain-proneness due to adverse childhood experiences for any and disabling chronic noncancer pain. Resilience does not protect against any and disabling chronic noncancer pain. Older age is the strongest predictor of any and disabling chronic noncancer pain.

Vitamin D supplementation may improve back pain disability in vitamin D deficient and overweight or obese adults

Back pain is currently the greatest cause of disability worldwide, and there are very limited therapeutic options available. Vitamin D deficiency and obesity are both risk factors for back pain. The few randomised controlled trials examining the effects of vitamin D supplementation on back pain have methodological limitations and largely include non-vitamin D deficient participants. Thus, the aim of this study was to determine whether vitamin D supplementation improves back pain symptoms in vitamin D deficient and overweight or obese, otherwise healthy adults. Sixty-five overweight or obese adults (BMI ≥ 25 kg/m2) with vitamin D deficiency (25-hydroxyvitamin D [25(OH)D] concentrations ≤50 nmol/L) were randomised to a bolus oral dose of 100,000 IU followed by 4000 IU cholecalciferol/day or matching placebo for 16 weeks. We measured 25(OH)D concentrations (chemiluminescent immunoassays) and self-reported back pain (Chronic Pain Grade Questionnaire) before and after the intervention. Lifestyle habits including sun exposure, physical activity, and diet were collected using questionnaires. Fifty-four participants completed the study, of which 49 had complete data for back pain and were included in the present analyses (31 M/18 F; mean ± SD age: 31.8 ± 8.9 years; BMI: 31.1 ± 4.5 kg/m2). After the 16-week intervention, 25(OH)D levels increased significantly with vitamin D supplementation compared with placebo (55.7 ± 20.9 versus 3.9 ± 14.4 nmol/L, respectively, p < 0.001). There were no significant differences between vitamin D and placebo groups in change in back pain intensity or disability scores (all p > 0.05). However, in those with 25(OH)D concentrations <30 nmol/L at baseline (n = 20), there was a significantly greater reduction in back pain disability scores in the vitamin D group compared with placebo, after adjusting for important covariates known to affect vitamin D status and/or back pain (b [95%CI] = -11.6 [-22.4, -0.8], p = 0.04). Our findings suggest that vitamin D supplementation in overweight or obese and markedly vitamin D deficient adults (25(OH)D <30 nmol/L) may improve back pain disability. Although treating severe vitamin D deficiency is recommended for optimising bone health, this study suggests it may also improve back pain. Hence, testing for vitamin D deficiency in those with back pain who are overweight or obese may be warranted.