Non-pharmacological Pain Management Research Articles

Impact of COVID-19 pandemic on nonpharmacological pain management trials in military and veteran healthcare settings: an evaluation informed by implementation science.

The coronavirus disease (COVID-19) pandemic disrupted healthcare and clinical research, including a suite of 11 pragmatic clinical trials (PCTs), across clinics within the Department of Veterans Affairs (VA) and the Department of Defense (DOD). These PCTs were designed to evaluate an array of nonpharmacological treatments and models of care for treatment of patients with pain and co-occurring conditions. The aims of the study are to (a) describe modifications to PCTs and interventions to address the evolving pandemic and (b) describe the application of implementation science methods for evaluation of those PCT modifications. The project used a two-phase, sequential, mixed-methods design. In Phase I, we captured PCT disruptions and modifications via a Research Electronic Data Capture questionnaire, using Periodic Reflections methods as a guide. In Phase II, we utilized the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) taxonomy to develop a focus group interview guide and checklist that would provide more in-depth data than Phase I. Data were analyzed using directed content analysis. Phase I revealed that all PCTs made between two and six trial modifications. Phase II, FRAME-guided analyses showed that the key goals for modifying interventions were increasing treatment feasibility and decreasing patient exposure to COVID-19, while preserving intervention core elements. Context (format) modifications led eight PCTs to modify parts of the interventions for virtual delivery. Content modifications added elements to enhance patient safety; tailored interventions for virtual delivery (counseling, exercise, mindfulness); and modified interventions involving manual therapies. Implementation science methods identified near-real-time disruptions and modifications to PCTs focused on pain management in veteran and military healthcare settings.

Abstract 4360: Opioid, non-opioid, and non-pharmacological pain management in patients with a history of cancer

Abstract Background Pain is highly prevalent among individuals with cancer. Consequently, adequate and equitable pain management are hallmarks of quality cancer care. Unfortunately, up to one-third of patients with cancer consider their pain symptoms poorly managed. Objective To characterize clinical and sociodemographic factors associated with opioid, non-opioid, and non-pharmacological pain management among individuals with a history of cancer. Methods We used the 2018 to 2020 full-year consolidated data files of the Medical Expenditure Panel Survey (MEPS), linked to the medical conditions, prescribed medicines, outpatient visits and office-based medical provider visits files. We estimated adjusted relative risk (aRR) of receipt of opioid, non-opioid, and non-pharmacological pain management (acupuncture, chiropractor, and massage/occupational/physical therapy), based on clinical (cancer site, comorbidities, depression status) and sociodemographic (race, sex, age, marital status, education, insurance, income, English speaking ability) factors, accounting for complex survey design in quasi-Poisson regression models. Results The study cohort was composed of 7,035 individuals with cancer, with 19.2% (0.65%; weighted proportions (standard error) receiving opioids, 51.09% (0.9%) receiving non-opioids, and 20.56% (0.75%) receiving non-pharmacological pain management. In our final models, compared to Other cancers, patients with bladder cancer were more likely to receive opioids (aRR 1.52; 95% CI 1.06, 2.17), while those with lung cancer were less likely to receive non-pharmacological pain management (aRR 0.46; 95% CI 0.25, 0.84). Also, depression was associated with increased risk of both opioid (aRR 1.26; 95% CI 1.09, 1.46) and non-opioid (aRR 1.26; 95% CI 1.18, 1.34), but not non-pharmacological pain management. There were no statistically significant differences in risk of opioid prescription between Black vs. White patients with cancer; however, Asian patients were significantly less likely to receive opioids (aRR 0.18; 95% CI 0.05, 0.67) as were patients who did not speak English well (aRR 0.22; 95% CI 0.11, 0.43). Female patients with cancer were significantly more likely to receive non-opioids (aRR 1.21; 95% CI 1.12, 2.31) and non-pharmacological pain management (aRR 1.49; 95% CI 1.27, 1.75) than males. Conclusions There are clinical and sociodemographic factors associated with opioid, non-opioid, and non-pharmacological pain management among individuals with cancer, and those who are depressed are at highest risk for opioid prescription, while those who cannot speak English well are less likely to receive opioids. For equitable pain care in patients with cancer, it is important that barriers associated with pain management are eliminated. Citation Format: Oyomoare L. Osazuwa-Peters, Justin M. Barnes, Eric Adjei Boakye, Trinitia Y. Cannon, Tammara L. Watts, Tomi Akinyemiju, Nosayaba Osazuwa-Peters. Opioid, non-opioid, and non-pharmacological pain management in patients with a history of cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4360.

Trends in Pain Medication Use in Patients With Type 2 Diabetes: NHANES 2005–2018

The aim of this research was to compare pain medication use trends among adults with and without type 2 diabetes in the US. This cross-sectional study used data of adults with and without (type 2) diabetes from the National Health and Nutrition Examination Survey waves 2005–2018. Use of pain medication including opioids, prescription nonsteroidal anti-inflammatory drugs, gabapentinoids, serotonin norepinephrine reuptake inhibitors, skeletal muscle relaxants, and headache treatment agents was compared by diabetes status and within select social determinants of health and clinical factors. Adults with type 2 diabetes were twice as likely to be prescribed pain medications compared to those without a diabetes diagnosis (16.2% vs 8.6%). Females and those with a history of smoking or arthritis were more likely to be on pain medications. Opioid use was the most prevalent regardless of diabetes status, and use was twice as high among those with diabetes (10.8% vs 5.5%). Patients with type 2 diabetes in the US are twice as likely to be prescribed pain medications overall as well as opioids compared with those without diabetes. Clinical guideline recommendations are necessary to find pharmacologic and nonpharmacologic nociceptive pain management specific for patients with diabetes.

Virtual reality increases pressure pain threshold and lowers anxiety in children compared with control and non-immersive control-A randomized, crossover trial.

Virtual reality (VR) is a promising non-pharmacological pain intervention because it may not only distract but also modulate pain by immersing the user in a three-dimensional 360° alternate reality. In children, VR has been reported to reduce clinical pain and anxiety during medical procedures. However, the effect of immersive VR on pain and anxiety remains to be investigated in randomized controlled trials (RCT). The aim of the present crossover RCT was to assess the effect of VR on pressure pain threshold (PPT) and anxiety level measured with the modified Yale Preoperative Anxiety Scale (mYPAS) in children in a controlled experimental setting. Seventy-two children (mean age 10.2 (6-14) years) were randomized to 24 sequences of four interventions (immersive VR Game, immersive VR video, tablet: 2D video and control: small talk). Outcome measures PPT, mYPAS and heart rate were assessed before and after each intervention. PPT increased significantly during VR game (PPTdiff): 136 kPa (CI 112; 161), p < 0.0001 and VR Video (PPTdiff): 122 kPa (CI 91; 153), p < 0.0001. Also, anxiety levels significantly decreased during both VR game (mYPASdiff: -7 points (-8 to -5), p < 0.0001) and VR video (mYPASdiff: -6 points (CI -7; -4), p < 0.0001). VR had a marked beneficial effect on PPT and anxiety compared with the control interventions: 2D video and small talk. Thus, immersive VR had a distinct modulatory effect on pain and anxiety in a well-controlled experimental setting. Immersive VR was effective and feasible in children and can act as a valid tool for non-pharmacological pain and anxiety management. Paediatric immersive VR seems to be beneficial although well-controlled studies are pending. We investigated whether immersive VR can modulate children's threshold for pain and anxiety level in an experimental well-controlled setting. We document a modulatory pain threshold increase and anxiety level decrease compared with extensive control conditions. Paediatric immersive VR is effective, feasible and valid for non-pharmacological pain and anxiety management. All efforts to reach the goal that no child should experience pain or anxiety when exposed to medical procedures.

A Study to Assess the Effectiveness of Lamaze Method in terms of Labour Pain Perception, Anxiety and Progress of Labour among Primi Mothers in active first stage of Labour

Background: Natural childbirth is a beautiful experience. Women dream of the perfect birth with less pain. But severe pain is a phenomenon embedded in the very nature of human existence. Though experiencing pain during labour is a universal feature of childbirth, the degree of pain perception can be reduced using many simple, effective, low cost non-pharmacological methods which also helps in improving labour progress and patient satisfaction. The concept of painless child birth gave rise to many scientific discoveries and research findings. Among that Lamaze method is one, which prepares mother for child birth and to tackle Labour pain. Objective: The objective of this study are to evaluate the effectiveness of Lamaze method in terms of pain perception, anxiety and progress of labour among primi mothers in first stage of labour admitted at Christian fellowship Hospital, Oddanchatram. Method: The research design used for the study was quasi experimental nonequivalent control group posttest only design. The sample size was 60 samples. Out of which 30 were in experimental group and 30 were in control group. The Samples were selected by using Non probability purposive sampling technique. Primi mothers at their term was selected and was given antenatal teaching on “Normal labor process and non-pharmacological labour pain management” in antenatal OPD for about 30 minutes. The same primi mothers who attended teaching were selected for experimental group during their labour period. During the first hour of active first stage of labour Lamaze intervention of visual stimuli was provided by showing natural sceneries during each contraction for the second hour auditory stimuli was provided by making the mother to listen to light music by using ear phone. During the 3rd hour of active first stage of labour abdominal effleurage stroke was done during each painful contractions. Followed by that hot water bag application on the sacral region was provided and was continued till delivery. Primi gravid mothers who did not undergo Lamaze teaching and interventions were selected for control group. Posttest was done on both experimental and control group after four hours of active stage of labor to assess the level of labor pain perception, the level of anxiety and progress of labor by using Universal pain assessment scale, modified Max Hamilton anxiety rating scale and Labor progress assessment scale. The level of satisfaction on Lamaze method among experimental group was assessed by using Likert scale on satisfaction of Lamaze method. Total time taken to perform posttest in both groups was 30 minutes. The gathered data were analyzed by using descriptive and inferential statistics. Results: Results: Independent “t” value for level of pain perception was 16.08(table value=2.001) which was significant at P&lt;0.05 level. The independent “t” value for level of anxiety was 5.08(table value=2.001) which was significant at P&lt;0.05 level. The independent “t” value for progress of labour was 9.86 (table value=2.001) which was significant at P&lt;0.05 level. Regarding the level of satisfaction on Lamaze method of experimental group all 30(100%) primi mothers were adequately satisfied. There was no significant association existing between pain perception, anxiety and progress of labour with demographic variables such as age, education, occupation, monthly income and residence except for pain perception and demographic variables such as religion (χ2 = 45.44) and family type (χ2 = 4.33) among experimental group. The study findings revealed that Lamaze method was effective in reducing labor pain perception, anxiety and promote labour progress among primi mothers in active first stage of labour.

Factors Affecting Pain in Hemodialysis and Non-pharmacological Management.

Pain is a frequent problem among hemodialysis patients, mostly caused by painful procedures, acute complications of hemodialysis, and painful syndromes, such as musculoskeletal and neuropathic syndromes. Pain can frequently lead to sleep disturbances, reduced adherence to hemodialysis treatment, frequent hospital admissions, decreased quality of life, and high mortality rates. Non-pharmacological management of pain in the hemodialysis population includes aerobic and resistance exercises, music therapy, and cognitive behavioral therapy. The present review focuses on the factors affecting pain in hemodialysis and its non-pharmacological management, offering important information to renal professionals.

Dexmedetomidine: An Alternative to Pain Treatment in Neonatology.

Infants might be exposed to pain during their admissions in the neonatal intensive care unit [NICU], both from their underlying conditions and several invasive procedures required during their stay. Considering the particularities of this population, recognition and adequate management of pain continues to be a challenge for neonatologists and investigators. Diverse therapies are available for treatment, including non-pharmacological pain management measures and pharmacological agents (sucrose, opioids, midazolam, acetaminophen, topical agents…) and research continues. In recent years one of the most promising drugs for analgesia has been dexmedetomidine, an alpha-2 adrenergic receptor agonist. It has shown a promising efficacy and safety profile as it produces anxiolysis, sedation and analgesia without respiratory depression. Moreover, studies have shown a neuroprotective role in animal models which could be beneficial to neonatal population, especially in preterm newborns. Side effects of this therapy are mainly cardiovascular, but in most studies published, those were not severe and did not require specific therapeutic measures for their resolution. The main objective of this article is to summarize the existing literature on neonatal pain management strategies available and review the efficacy of dexmedetomidine as a new therapy with increasing use in the NICU.

Practices and Challenges of Pain Management During First Stage of Labour Among Midwives in University of Medical Sciences Teaching Hospital Complex, Akure

Most women perceive labour pain and childbirth as the most severe and agonizing event in a woman’s life. Midwives play critical role in supporting women through the painful birthing process, to the desired favourable outcomes for mother and baby. The primary objective of this study is to evaluate the practices and challenges of pain management during the initial stage of labour among midwives at the University of Medical Sciences Teaching Hospital Complex in Akure. From July to October 2021, a facility-based descriptive cross-sectional study was conducted with 72 midwives employed at the University of Medical Sciences Teaching Hospital Complex in Akure. The first stage of labour pain management practices and challenges were evaluated among the study participants using a questionnaire. SPSS (version 23.0) was used in processing the data. In the first stage of labour, environmental pain management approach was shown to be the most used (95.4%), followed by psychospiritual pain management approach (91%); while the least employed was the pharmacological approach (63.4%). Effectiveness of the approaches were perceived to be in the following order: psychospiritual, environmental, physical, pharmacological and social. Lack of resources (84.7%) and understaffing (33.3%) were cited as part of the challenges associated with pain management. It is important for the government to provide adequate staff, equipment and conducive birthing environments; while the midwives continually educate patients on available non-pharmacological and pharmacological labour pain management approaches during their prenatal care visits, to enhance their self-efficacy and cooperation in labour.

The Effect of a Non-Pharmacological Multicomponent Pain Management Program on Pain Intensity and Quality of Life in Community-Dwelling Elderly Men With Chronic Musculoskeletal Pain

Background and AimImproving the level of care for the elderly with musculoskeletal pain requires pharmacological and non-pharmacological pain control methods. This study aimed to investigate the effect of a non-pharmacological pain management intervention on pain intensity and quality of life in community-dwelling older men with musculoskeletal pain who were referred to comprehensive healthcare centers in the city of Ilam, Iran. Materials and MethodsA quasi-experimental study with pre and post-test design was performed on 65 older men with chronic musculoskeletal pain. The samples were selected regarding inclusion criteria as available and randomly assigned to either the control (usual care) or the experimental group (educational intervention plus physical exercises). Baseline characteristics of participants, the Visual Analogue Scale, and the CASP-19 Quality of Life were used to collect data. Data were analyzed by SPSS software using the ANCOVA, independent and paired t-test, and chi-square test at the statistically significant level of 5 %. ResultsAccording to the findings, there was a significant difference between the experimental and control groups in terms of quality of life (p < .05) and pain intensity (p < .05) after the intervention. No relevant differences were found between groups regarding demographic characteristics at baseline. ConclusionsA six-week physical activity and education program for community-dwelling older men with chronic musculoskeletal pain could improve quality of life and decrease pain intensity after a one-month follow-up compared with usual care. Therefore, it seems necessary to consider pain management programs in the elderly care program and familiarize health care professionals with these pain control methods.

Period Pain among Female University Students in Jeddah City, Saudi Arabia: Cross-Sectional Study

Background: The aim of this study is to assess female college students’ behavior in Jeddah, Saudi Arabia toward menstrual pain (dysmenorrhea) and their knowledge regarding the proper use of over-the-counter pain medications. Methods: A cross-sectional survey-based study that assessed 300 healthy females. The major points in the questionnaire were symptoms experienced during menstruation, pharmacological and nonpharmacological pain management, effects of participants’ menstrual periods on daily activity, locations of pain, menstrual pain severity, and exercise activity. Results: From the 300 participants who participated in the survey, pain was experienced by 256 (85%) of participants. Among those 256, 46.1% felt the pain was severe. The most reported pain was in abdomen (89.2%) and back (70%). Most participants (81.2%) experienced pain during the first 3 days. As for the management method, 69.9% managed their pain by nonpharmacological and 66.8% by pharmacological agents. Approximately 43% reported to practice physical activity during menstruation. Conclusions: Dysmenorrhea is common among female college students and affects their daily activity. Many students are suffering from menstrual pain and treating it with different methods. Most participants are not aware of the proper usage of pain killers. Pharmacists and other health care personnel can instruct on how to use analgesics during menstruation.

Nonpharmacological pain management practices among nurses working in multiple centers in Saudi Arabia: A cross-sectional study

Objective: The aim of the study was to investigate the prevalence, and determinants, of nonpharmacological pain management practices among nurses in multiple settings. Materials and Methods: A cross-sectional examination was conducted involving 324 nurses from 16 hospitals in Hai’l, Saudi Arabia. Participants completed a self-reported survey utilizing established tools to assess the frequency of nonpharmacological pain management interventions utilization and identify associated barriers. Data analysis was performed using SPSS version 29.0. Results: Nonpharmacological pain management practices were found to be utilized “sometimes,” with a score of 2.89 ± 0.48. Commonly employed techniques included placing patients in comfortable positions and providing a tranquil environment. Gender was the sole demographic factor significantly affecting the use of these techniques (P &lt; 0.001), with female nurses demonstrating higher utilization. Barriers to implementation varied based on the hours of recent pain management education (P = 0.004), with prevalent barriers including nurse shortages, multiple responsibilities, heavy workloads, and nurse fatigue. Conclusion: The study reveals moderate utilization of nonpharmacological pain management approaches, primarily focusing on patient positioning and creating a calm environment. Female nurses exhibited higher adoption rates of these techniques. Barriers to implementation, such as nurse shortages and heavy workloads, were influenced by recent pain management education. Consequently, enhancing education and fostering supportive work environments are crucial for surmounting these barriers and promoting pain management awareness among nurses.

Non-Pharmacological Pain Management Practice and Associated Factors Among Nurses Working at Comprehensive Specialized Hospitals.

Non-pharmacological pain management practices are very important for the successful treatment of pain. It has an impact on the patient's quality of life and the family's financial situation owing to missed workdays, direct medical expenses, and incapacity from pain. Therefore, this study is intended to assess non-pharmacological pain management practice and associated factors among nurses working at comprehensive specialized hospitals in northwest, Ethiopia. Institution-based cross-sectional study design was employed from May 30 to June 30, 2022. A stratified random sampling technique was used to select 322 study participants. A binary logistic regression model was used to identify factors associated with non-pharmacological pain management practice. Variables with a P-value less than .25 in the bi-variable analysis were entered into the multivariable logistic regression analysis and a P-value of less than .05 was considered as having a statistically significant association. A total of 322 nurses participated, with a response rate of 98.8%. It was found that 48.1% (95% CI: 42.65, 53.62) of nurses had good practice in non-pharmacological pain management. Pain assessment tool availability (AOR = 1.68 [95% CI: 1.02, 2.75]) (P = .04), good pain assessment practice (AOR = 1.74 [95% CI: 1.03, 2.84]) (P = .03), favorable attitude (AOR = 1.71 [95% CI: 1.03, 2.95]) (P = .03), and age (26-35) (AOR = 4.46 [95% CI: 1.24, 16.18]) (P = .02) were factors significantly related to non-pharmacological pain management practice. According to this work, the prevalence of non-pharmacological pain management practices was found to be low. Good pain assessment practices, availability of pain assessment tools, favorable attitude, and age (26-35) years were significant factors of non-pharmacological pain management practice. Hospitals are better give training on non-pharmacological pain management methods for nurses as they are important to treat pain holistically, increase patient satisfaction, and are cost-effective.

Nonpharmacologic Pain Management for Patients in Ambulatory Extended Recovery After Minimally Invasive Gynecologic and Urologic Surgery.

To determine the effectiveness of an evidence-based postoperation nonpharmacologic pain management bundle for patients recovering from minimally invasive gynecologic and urologic surgeries. This study focused on patients recovering from minimally invasive gynecologic and urologic surgery at a comprehensive cancer center. The first cohort consisted of patients three months preimplementation (n = 96) and the second consisted of those three months postimplementation (n = 86). The project used a pre- and postintervention design and deployed the bundle as a nursing order. Nurses and patients were educated about the bundle and comprehensive postoperation pain management strategies. Postimplementation, the documented use of nonpharmacologic pain management interventions significantly increased and postoperation opioid use significantly decreased without negatively affecting pain scores or lengths of stay. Nonpharmacologic pain interventions can decrease the need for postoperation opioids, and ordering a bundle of interventions alongside analgesia is an effective way patients can manage pain.

Effectiveness of the “Photo-with-Movement Program” for Elders with Pain and their Carers: A Randomized Trial

1.1. Background and Objectives: The COVID-19 pandemic has imposed limitations on older adults with chronic pain concerning accessing adequate support. Consequently, they rely on assistance from caregivers, and the burden of caring deteriorates caregivers’ physical and psychological health. Thus, a dyadic non-pharmacological pain management program, Photo-with-Movement Program (PMP), that helps older adults relieve pain, lowers caregivers’ stress and improves their psychological well-being is necessary.

Intervention Fidelity in Pain Pragmatic Trials for Nonpharmacologic Pain Management: Nuanced Considerations for Determining PRECIS-2 Flexibility in Delivery and Adherence

Nonpharmacological treatments are considered first-line pain management strategies, but they remain clinically underused. For years, pain-focused pragmatic clinical trials (PCTs) have generated evidence for the enhanced use of nonpharmacological interventions in routine clinical settings to help overcome implementation barriers. The Pragmatic Explanatory Continuum Indicator Summary (PRECIS-2) framework describes the degree of pragmatism across 9 key domains. Among these, “flexibility in delivery” and “flexibility in adherence,” address a key goal of pragmatic research by tailoring approaches to settings in which people receive routine care. However, to maintain scientific and ethical rigor, PCTs must ensure that flexibility features do not compromise delivery of interventions as designed, such that the results are ethically and scientifically sound. Key principles of achieving this balance include clear definitions of intervention core components, intervention monitoring and documentation that is sufficient but not overly burdensome, provider training that meets the demands of delivering an intervention in real-world settings, and use of an ethical lens to recognize and avoid potential trial futility when necessary and appropriate. PerspectiveThis article presents nuances to be considered when applying the PRECIS-2 framework to describe pragmatic clinical trials. Trials must ensure that patient-centered treatment flexibility does not compromise delivery of interventions as designed, such that measurement and analysis of treatment effects is reliable.

Virtual interprofessional team care planning and communication for chronic pain management: An educational model

Ideal patient care involves interprofessional collaboration and therefore emphasizes the importance of communicating how roles and responsibilities differ to create a team environment critical for providing optimal patient care. In light of the ongoing opioid epidemic associated with chronic pain, this interprofessional simulation focused on utilizing an interprofessional team approach to recognize the biopsychosocial and pharmacologic aspects of chronic pain management through creation of a patient-centered care plan using a virtual platform. Virtual IPE events can be performed by institutions with limited access to other healthcare disciplines for remote learning opportunities and can be adapted to develop comprehensive strategies to evaluate effectiveness of learning interventions among varied disciplines. Participants from the Schools of Medicine, Nursing, Pharmacy, and Health Related Professions, including occupational and physical therapy, participated in the virtual simulation event. The format was chosen to adhere to current COVID-19 safety guidelines and facilitate easier scheduling between disciplines. The event included individual pre-work through an online learning management system leading to a 2-h virtual simulation event. Interprofessional Education Collaborative, or IPEC developed competencies focused on communication and teamwork to establish activity objectives. International Association for the Study of Pain, or IASP, pain curriculum outlines provided additional objectives and guided presented information on best practice approaches for interprofessional pain management. Objectives were evaluated through peer team feedback, peer discipline feedback, and assessment of the comprehensive team care plan that consisted of pharmacologic and nonpharmacologic pain management strategies. Programmatic review demonstrated students were able to have effective communication that led to a holistic patient care plan at the end of this activity.

A remote group-mediated daylong physical activity intervention for older adults with chronic pain: Results of the MORPH-II randomized pilot trial.

Chronic pain is a debilitating condition that affects many older adults who often have limited access to non-pharmacological pain management strategies. One potentially effective and novel lifestyle medicine for chronic pain involves increasing physical activity through frequent movement across the day, thereby also decreasing the presence of extended sedentary bouts. The MORPH-II pilot randomized controlled refinement trial iterated on the MORPH trial, which was a first-of-its-kind group-mediated daylong physical activity (DPA) intervention for older adults with chronic pain rooted in social cognitive and self-determination theories and supported by an mHealth toolset designed to foster social connection and awareness of physical activity patterns. MORPH-II was delivered fully remotely via videoconference software and supported by a technology kit comprising an iPad, activity monitor, and wireless weight scale. It was also implemented a refined coaching model designed to help participants better understand their own patterns of activity. A total of 44 participants were randomized to receive the 12-week group-mediated DPA intervention or to a low-contact control. Qualitative interviews suggest the program was well-received by participants and that participants developed an understanding of how patterns of physical activity related to their pain symptoms. Participants also highlighted several additional areas for refinement related to the coaching model and feedback provided within the mHealth app. Analyses of covariance, controlling for baseline values, revealed a small effect (η 2 = 0.01) on pain intensity favoring the intervention condition, though both groups improved during the study period. There was a large effect favoring the intervention condition on ActivPAL-assessed average daily steps (η 2 = 0.23) and postural shifts (η 2 = 0.24). Control participants spent less time in short sedentary bouts (η 2 = 0.09), and there was a small effect (η 2 = 0.02) indicating intervention participants spent less time in extended sedentary bouts. Finally, relative to control, intervention participants demonstrated a moderate improvement in autonomy satisfaction (η 2 = 0.05), relatedness frustration (η 2 = 0.05), and competence frustration (η 2 = 0.06), and a large magnitude improvement in competence satisfaction (η 2 = 0.22). These findings indicate that the MORPH-II intervention was feasible and acceptable, and may positively impact steps, postural breaks, and several key domains of basic psychological needs detailed in self-determination theory.

Multidisciplinary and Nonpharmacological Management of Pain in Temporomandibular Disorders (TMDs).

Temporomandibular joint dysfunction (TMD) is not a single diagnosis, but a term covering a group of conditions that involve pain and dysfunction of the masticatory muscles within the temporomandibular joint (TMJ) and associated structures. It is a set of disease entities comprising various ailments and clinical symptoms. One of the most distressing symptoms for TMD patients is pain. Pain is subjective and always unpleasant. The VAS (visual analogue scale) was used in this research. The aim of this study was to assess the influence of physical stimuli, namely extremely low frequency magnetic field (ELF-MF) and LED light, on the experience of pain caused by increased tension in the masticatory muscles in adults. Out of 150 people examined, 104 were enrolled in the study after meeting the eligibility criteria. The study group was divided into 4 subgroups. Each subgroup received physical therapy treatment using a different physical stimulus. The effects of four therapeutic modalities were compared. In terms of VAS scores, pain attenuation was observed in all subgroups. The study confirmed the analgesic effect of the selected physical therapy methods. The authors focused on the analysis of the results obtained for each subgroup, comparing the effects of individual modalities on pain intensity (according to VAS scores). After the treatment, pain relief was observed in each of the studied subgroups. Treatment using ELF-MF and ELF-MF in combination with LED light in the course of TMD brings about a significant improvement in the subjective pain experience expressed in VAS pain scores. The use of selected physical stimuli and their beneficial effect on pain symptoms during mandibular movements has important implications for patients' daily life and work. Incorporation of therapeutic methods can help enhance patient satisfaction and comfort during manual TMJ therapy and lengthy dental procedures.

Provider beliefs about the ideal design of an opioid deprescribing and substitution intervention for older adults.

Opportunities exist to meaningfully reduce suboptimal prescription opioid use among older adults. Deprescribing is one possible approach to reducing suboptimal use. Appropriate interventions should outline how to carefully taper opioids, closely monitor adverse events, substitute viable alternative and affordable nonopioid pain treatments, and initiate medications for opioid use disorder to properly manage use disorders, as needed. We sought to document and understand provider perceptions to begin developing effective and safe opioid deprescribing interventions. We conducted 3 semistructured focus groups that covered topics such as participant perspectives on opioid deprescribing in older adults, how to design an ideal intervention, and how to identify potential barriers or facilitators in implementing an intervention. Focus group transcripts were double coded and qualitatively analyzed to identify overarching themes. Healthcare providers (n = 17), including physicians, pharmacists, nurses, social workers, and administrative staff, participated in 3 focus groups. We identified 4 key themes: (1) involve pharmacists in deprescribing and empower them as leaders of an opioid deprescribing service; (2) ensure tight integration and close collaboration throughout the deprescribing process from the inpatient to outpatient settings; (3) more expansive inclusion criteria than age alone; and (4) provision of access to alternative pharmacological and nonpharmacological pain management modalities to patients. Our findings, which highlight various healthcare provider beliefs about opioid deprescribing interventions, are expected to serve as a framework for other organizations to develop and implement interventions. Future studies should incorporate patients' and family caregivers' perspectives.

Effect of slow stroke back massage nursing (SSBMN) cutaneus stimulus on pain intensity on sweet food crawings (Arai Pinang) suffering low back pain (LBP)

Low back pain is the most common complaint. About 90% of the causes of LBP are mechanical factors. The normal anatomic structure of the body when used excessively or previously experienced trauma can cause stress or strain on muscles, tendons and ligaments. Actually the pain is minimized by using a back massage. AHCPR (Agency for Health Care Policy and Research) guidelines for non-pharmacological acute pain management are suitable interventions. Non-pharmacological interventions that can be done to treat pain are cutaneous stimulation, distraction, relaxation, guided imagination and hypnosis. This study aims to determine the effect of slow stroke back massage cutaneous stimulus on pain intensity in Ladu snack craftsmen (aria pinang) who suffer from low back pain in Pariaman City. The research design used is a quasi experiment. The number of samples is 14 respondents with purposive sampling technique. The independent variable was slow stroke back massage cutaneous stimulus while the dependent variable was pain intensity. This study used the Wilcoxon signed runk test.