Pain Beliefs Research Articles

Postoperative Patients in Jordan: Pain Prevalence, Characteristics, Beliefs, and Satisfaction

BackgroundUnrelieved postoperative pain contributes to soaring medical costs and poor quality of life. Whilst much has been written about postoperative pain prevalence in the literature, few empirical studies have explored pain care in Middle Eastern countries. AimsThis study aimed to determine pain prevalence, its characteristics, beliefs and satisfaction among postoperative patients in Jordan. DesignThis is a descriptive survey design. SettingsThis study was conducted in a 200-bed Jordanian public hospital located in the southern province of Jordan. ParticipantsA convenient sample of 143 surgical patients was selected. MethodsData were collected by the American Pain Society Patient Outcomes questionnaire, Brief Pain Inventory scale and beliefs towards pain scale. Data were analyzed using SPSS version 21. ResultsPain prevalence following surgery during the first 24 hours was 87%. The overall Mean of satisfaction of all participants was moderate (66.6%). The analysis found that the greatest interference of pain was with activity (Mean ± SD = 6.27 ± 3.30). The belief “people get addicted to pain medicine easily” was the most common misunderstanding (Mean ± SD = 3.48 ± 1.71). Male participants had worse average pain experience but were more satisfied with pain management than females (ps = .012, .017, respectively). Participants aged 30 or more had better pain management experience and satisfaction than those aged under 30 (p = .021). ConclusionsThe study revealed high pain prevalence among surgical patients that remains undertreated. If patients’ postoperative environment is to be a “Pain Free Zone”, nurses’ training programs and the application of various screening tools in the postoperative context taking into account the role of gender and culture are urgently needed.

The Role of Spirituality in Pain, Function, and Coping in Individuals with Chronic Pain.

Chronic pain is a multidimensional experience associated with psychosocial (e.g., pain-related beliefs and pain coping responses) and spiritual factors. Spirituality is a universal aspect of the human experience that has been hypothesized to impact pain experience via its effects on pain, physical/psychological function, resilience and pain-related beliefs, and pain coping responses. However, research evaluating the associations between measures of spirituality and measures of pain and function in individuals with chronic pain is limited. This study seeks to address this limitation. Participants were 62 Portuguese adults with chronic musculoskeletal pain. Participants completed measures of spirituality, pain intensity, physical and psychological function, and pain coping responses. Spirituality as hope and a positive perspective toward life was positively and moderately associated with better psychological function and coping responses of ignoring pain sensations and coping self-statements. Spirituality as a search for meaning and sense of purpose was positively and moderately associated with the coping response of task persistence. These findings suggest the possibility that spirituality may be a useful resource for facilitating psychological adjustment, potentially promoting the use of some adaptive pain coping responses.

Placebo and nocebo effects and operant pain-related avoidance learning.

Research on learning in placebo and nocebo has relied predominantly on Pavlovian conditioning procedures. Operant learning procedures may more accurately model learning in real-life situations in which placebo and nocebo effects occur. To investigate the development and persistence of placebo and nocebo effects using an operant avoidance learning task. Pain-free participants (n = 58) could learn to avoid pain by performing movements that differed in difficulty and intensity of painful stimulation. Participants performed movements in 2 contexts. In the high cost of avoidance context, pain stimulus intensity reduced with increasing movement difficulty. In the low cost of avoidance context, contingencies were reversed. Participants rated pain expectations and pain intensity. During test, movement difficulties were unchanged, but participants always received a medium-intensity pain stimulus. Placebo and nocebo effects were defined as lower/higher pain intensity ratings for trajectories that previously resulted in low/high-intensity compared with medium-intensity stimulation. As expected, participants acquired differential movement-pain expectations and differential movement choices. Testing with a medium-intensity pain stimulus quickly erased differences in movement choice across contexts, but differences in pain expectations were maintained. Pain modulation across context was in line with movement-pain expectations. However, we only observed placebo effects within the low cost of avoidance context and found no evidence of nocebo effects. Operant learning can change pain expectations, pain modulation, and pain-related avoidance behavior. Persisting pain expectations suggest that acquired pain beliefs may be resistant to disconfirmation, despite self-initiated experience with novel pain-movement contingencies.

(321) Physiotherapists’ Attitudes and Beliefs Towards Chronic Non-Specific Low Back Pain in Saudi Arabia

Chronic non-specific low back pain (CNSLBP) is one of the most widespread conditions affecting the population indiscriminately across the world. It is a considerable health problem and the main causes of disability and pain. It is a complex, multifactorial disorder and one of the most controversial conditions for clinicians, patients, and policy makers. Physiotherapists’ (PTs) attitudes and beliefs towards CNSLBP still unknown in Saudi Arabia (SA). The aim of this study was to identify PTs attitudes and beliefs towards NSLBP in SA. A cross sectional study was conducted using a convenience sample. An online survey was distributed from April to September 2018. Only participants working as physiotherapists in SA whether in clinical or academic settings were included. Data were collected regarding demographics, beliefs and attitudes towards NSLBP using the short form of Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). The short form of PABS-PT consisted of 19 items on a 6-point scale evaluating ‘biomedical’ and ‘biopsychosocial treatment orientation’ factors. Higher scores indicate a higher level of orientation. The data analysis was performed using IBM SPSS (v.24). A total of 299 PTs participated in this study. The majority of the participants were males (61.5%) and most of them had completed their bachelor's degree (54.5%). Most participants worked as a full time (79.9%) and more than half of them had experience less than 5 years (53.8%). The overall mean score for biomedical factor was 34.4 (SD 7.7) and overall mean score for biopsychosocial factor was 31.7 (SD 5.5). Overall mean score of both factors was mean 66.2 (SD 9.6). Among the 19 items of PABS-PT, the lowest three mean scores items were related to biopsychosocial orientation. Physiotherapists were found to have similar biomedical and biopsychosocial orientations in their attitudes and beliefs but both orientation scores were not high.

Are attitudes about pain related to coping strategies used by adolescents in the community?

Background and aims To better understand the associations between pain beliefs and pain coping strategies in a sample of community adolescents. Methods Four hundred and thirty-four adolescents were asked to complete measures of physical function, pain-related beliefs and use of pain coping strategies. A series of three hierarchical regression analyses were performed. Results Approach coping strategies demonstrated significant and positive associations with beliefs about the importance of solicitousness responding and control over pain. Problem-focused avoidance coping strategies evidenced a negative association with the belief of being disabled by pain, and a positive association with the importance of exercise. Emotion-focused avoidance coping strategies showed significant and positive associations with beliefs about being disabled by pain and that emotions affect pain, and negative associations with beliefs about control over pain and the appropriateness of pain medications. Conclusions The findings provide important new information regarding the potential role that beliefs could play as predictors of pain coping in adolescents living in the community. Prospective studies are needed to evaluate the possible causal role that beliefs play in decisions to use what pain coping strategy and under what circumstances. Implications The role that pain beliefs and coping strategies play in the adjustment to pain in adolescents in the community has both similarities to and differences with the role that these factors play in adolescent clinical populations. This information can guide the development of community-based treatment programs for adolescents with pain.

The Relationship Between Musculoskeletal Pain and Picky Eating: The Role of Negative Self-Labeling.

IntroductionPicky eating appears to be associated with poor health outcomes and thus it might have a role in musculoskeletal pain in adults. However, this relationship has not been investigated yet. The aim of the present study was to determine whether the number of musculoskeletal pain regions was associated with picky eating, which was characterized by food intake balance of familiar products or self-identification.MethodsA total of 4660 adult subjects were enrolled in this study. Picky eating was assessed in two ways; a countable score and self-identification of picky eating. For the countable score, the number of food items, which the subjects usually did not consume among a list of 11 familiar products was measured. Self-identification as a picky eater was defined through a single question. The presence of musculoskeletal pain; in the neck, low back, knee, back, or arm, within 2 months of the survey was also identified.ResultsOf all subjects, 2654 (56%) had musculoskeletal pain in at least one region. The prevalence of musculoskeletal pain in every region was seen as consistently higher in subjects who self-identified as picky eaters than those who were non-picky eaters. In multiple linear regression analysis, the number of pain regions was significantly associated with older age, females, self-identification as a picky eater, and low body weight, not but the countable score.ConclusionsThere may be an association between musculoskeletal pain and negative beliefs about one’s own eating behaviors.Electronic supplementary materialThe online version of this article (10.1007/s40122-019-0116-2) contains supplementary material, which is available to authorized users.

Causal mechanisms of a healthy lifestyle intervention for patients with musculoskeletal pain who are overweight or obese

Purpose: To assess the causal mechanisms of a healthy lifestyle intervention for patients with chronic low back pain and knee osteoarthritis, who are overweight or obese. Methods: We conducted causal mediation analyses of aggregated data from two randomized controlled trials (RCTs); which included 160 patients with chronic low back pain, and 120 patients with knee osteoarthritis. The intervention consisted of brief advice and referral to a six-month telephone-based healthy lifestyle coaching service. We used causal mediation to estimate the indirect, direct and path-specific effects of hypothesized mediators including: self-reported weight, diet, physical activity, and pain beliefs. Outcomes were pain intensity, disability, and quality of life (QoL). Results: The intervention did not reduce weight, improve diet or physical activity or change pain beliefs, and these mediators were not associated with the outcomes. Sensitivity analyses showed that our estimates were robust to the possible effects of unknown and unmeasured confounding. Conclusions: Our findings show that the intervention did not cause a meaningful change in the hypothesized mediators, and these mediators were not associated with patient-reported outcomes.

GLA:D\xae Back: implementation of group-based patient education integrated with exercises to support self-management of back pain - protocol for a hybrid effectiveness-implementation study

BackgroundReassuring patient education and exercise therapy are widely recommended interventions for back pain in clinical guidelines. However, many patients are offered non-guideline endorsed options, and strategies for effective implementation of guideline-based care have not yet been developed. This protocol outlines the evaluation of a strategy for nationwide implementation of standardised patient education and exercise therapy for people with persistent or recurrent back pain in a hybrid implementation-effectiveness design. The strategy and the evaluation were planned using the framework of the Behaviour Change Wheel.MethodsThe main activity of the implementation strategy is a two-days course for physiotherapists and chiropractors in delivering patient education and exercise therapy that is aimed at supporting patient self-management. This comes with ready-to-use patient education materials and exercise programs. The clinical intervention is a group-based program consisting of two sessions of patient education and 8 weeks of supervised exercises. The program uses a cognitive-behavioural approach and the aim of the exercise component is to restore the patient’s ability and confidence to move freely. The implementation process is evaluated in a dynamic process monitoring the penetration, adoption and fidelity of the clinical intervention. The clinical intervention and potential effect mechanisms will be evaluated at the patient-level using measures of knowledge, skills, beliefs, performance, self-efficacy and success in self-management. The education of clinicians will be evaluated via clinician-level outcomes, including the Pain Attitudes and Beliefs Scale, the Practitioner Confidence Scale, and the Determinants of Implementation Behaviour Questionnaire. Effects at a national level will be investigated via data from national registries of health care utilisation and sick-leave.DiscussionThis implementation-effectiveness study is designed to evaluate the process of implementing an evidence-based intervention for back pain. It will inform the development of strategies for implementing evidence-based care for musculoskeletal pain conditions, it will enhance the understanding of mechanisms for developing patient self-management skills, and it will demonstrate the outcomes that are achievable in everyday clinical practice.Trial registrationClinicalTrials.gov NCT03570463. Registered 27 June 2018.

Discriminative Validity of the Pain Attitudes and Beliefs Scale for Physical Therapists.

The Pain Attitudes and Beliefs Scale (PABS) for Physical Therapists aims to measure clinicians' biomedical and biopsychosocial treatment orientations regarding nonspecific low back pain. The objective of this study was to assess whether the PABS can differentiate between subgroups of physical therapists hypothesized to differ in treatment orientations. This study was a cross-sectional survey. The PABS was completed by 662 Norwegian physical therapists with a diversity of professional backgrounds. Twenty-four a priori hypotheses on expected differences in PABS scores were formulated. Sufficient discriminative ability was defined as a minimum of 75% confirmed hypotheses. Hypotheses on differences in scores were tested for the biomedical and biopsychosocial subscales separately as well as for combinations of the 2 subscales, representing responders with high biomedical and low biopsychosocial PABS scores and vice versa. Of the 24 hypotheses, only 15 (62.5%) were confirmed. Between-group differences concerning the separate subscales were small, varying from -0.63 to 1.70 scale points, representing values up to 6.0% of the total subscale ranges. Between-group differences were larger when combined subscales were used, varying from 1.80 to 6.70 points, representing values up to 25.1% of the total subscale ranges. Despite little spread in scores, 24% of respondents demonstrated extreme attitudes. The lack of convincing scientific evidence from previous research on differences in attitudes and beliefs between physical therapists was a limitation for the formulation of hypotheses. Discriminative validity of separate subscales of the PABS was not supported. Combining the 2 subscales into global treatment attitudes enabled better discrimination. Little spread in biomedical and biopsychosocial orientations explains why more than one-third of the hypotheses were not confirmed. Either Norwegian physical therapists are basically similar in their treatment orientation or the PABS is not able to detect any differences between them.

Development and proof of concept of a blended physiotherapeutic intervention for patients with non-specific low back pain

ObjectiveTo develop a blended physiotherapeutic intervention for patients with non-specific low back pain (e-Exercise LBP) and evaluate its proof of concept. DesignFocus groups with patients, physiotherapists, and eHealth and LBP experts were conducted to investigate values according to the development of e-Exercise LBP. Proof of concept was evaluated in a multicentre study. SettingDutch primary care physiotherapy practices (n=21 therapists). ParticipantsAdults with non-specific LBP (n=41). Interventione-Exercise LBP was developed based on clinical LBP guidelines and the focus groups, using the Center for eHealth Research Roadmap. Face-to-face physiotherapy sessions were integrated with a web application consisting of 12 information lessons, video-supported exercises and a physical activity module with the option to gradually increase individuals’ level of physical activity. The intervention could be tailored to patients’ risk of persistent disabling LBP, according to the STarT Back Screening Tool. Main outcome measuresFunctional disability, pain, physical activity, sedentary behaviour and fear-avoidance beliefs, measured at baseline and 12 weeks. ResultsAfter 12 weeks, improvements were found in functional disability [Quebec Back Pain Disability Scale: mean difference (MD) −12.2/100; 95% confidence interval (CI) 8.3 to 16.1], pain (Numeric Pain Rating Scale: MD −2.8/10; 95% CI 2.1 to 3.6), subjective physical activity (Short Questionnaire to Assess Health Enhancing Physical Activity: MD 11.5minutes/day; 95% CI −47.8 to 24.8) and objective sedentary behaviour (ActiGraph: MD −23.0minutes/day; 95% CI −8.9 to 55.0). Small improvements were found in objective physical activity and fear-avoidance beliefs. The option to gradually increase physical activity was activated for six patients (15%). On average, patients received seven face-to-face sessions alongside the web application. ConclusionsThe results of this study provide the first indication of the effectiveness of e-Exercise LBP, particularly for disability and pain among patients with LBP. Future studies will focus on end-user experiences and (cost-) effectiveness.

Childhood Trauma Predicts Cancer Treatment-Related Pain in Breast Cancer Survivors.

Childhood trauma has been linked to neuropathic pain in noncancer populations, but its relationship with cancer treatment-related neuropathic pain is unknown. This secondary data analysis of a prospective, longitudinal, observational study aimed to explore the relationship of childhood trauma experience with pain severity, pain interference, and neuropathic symptom severity (NSS) 12 months after surgery in women receiving treatment for stage 0 to III breast cancer. Women (N = 44) recruited from a comprehensive cancer center self-reported childhood trauma experience, pain severity, pain interference, NSS, co-occurring symptoms, and pain beliefs via questionnaires. Descriptive statistics were used to describe childhood trauma experience. Linear regression was used to model childhood trauma and other predictors on pain variables 12 months after surgery. Childhood trauma predicted pain severity and pain interference 12 months after surgery (P < .05), as did baseline pain severities and helplessness-pain catastrophizing. Age predicted only NSS. Together, the best models predicted 31.6% to 40.9% of the variance in pain severities at 12 months (P < .001). Childhood trauma exposure was a significant predictor of pain 12 months after breast cancer surgery and adjuvant treatment. Younger and helplessness-pain catastrophizing women are also at risk. Research is needed to identify preventive neuropathic pain interventions for high-risk women. Women receiving breast cancer treatment should proactively be assessed for childhood trauma history, possibly by using discreet previsit questionnaires. Childhood trauma survivors may be at high risk for poor pain outcomes and may benefit from tailored pain interventions.

Pain Beliefs and Perceptions and Their Relationship with Coping Strategies, Stress, Anxiety, and Depression in Patients with Cancer.

Objective:The current study was conducted aiming at the investigation of pain beliefs and perceptions and their relationship with coping strategies, stress, anxiety, and depression in patients with cancer.Materials and Methods:Study design: This was a descriptive-correlational and cross-sectional study. Data collection tools – Demographic questionnaire, Pain Beliefs and Perceptions Inventory, Pain Coping Strategies Questionnaire (Rosenstiel and Keefe), and Depression, Anxiety, and Stress Scale were used in this study. The dataset was analyzed using descriptive and infreretial statistics that included the chi-square and one-way ANOVA with software SPSS v.16 analysis.Results:Findings of the study indicated that the most common belief about pain in patients is pain permanence. In addition, the most commonly used strategies for coping pain in patients were praying/hoping (25.82 ± 7.86) and self-statements (22.3 ± 10.34). Results indicated that there is a significant difference between pain coping strategies and pain control (P = 0.02). No significant difference was observed between the pain beliefs and the coping strategies (P = 0.15). Depression and anxiety level of patients was estimated as moderate, and their stress was estimated as mild. It was specified that there is a significant difference between self-blame belief and depression of patients (P = 0.01).Conclusion:Understanding and identifying emotional-psychological variables in patients with chronic pains may provide a basis for implementing educational cognitive-behavioral programs for patients and the ground for increasing the ability to control the pain in nonpharmacological methods leading to promoting quality of life in these patients.

Repetitive transcranial magnetic stimulation in chronic tension-type headache: A pilot study.

Background & objectives:Tension-type headache (TTH) is the most common type of primary headache disorder. Its chronic form is often the most ignored and challenging to treat. Transcranial magnetic stimulation (TMS) is a novel technique in the treatment of chronic pain. The aim of this pilot study was to explore the effect of low-frequency repetitive TMS (rTMS) on pain status in chronic TTH (CTTH) by subjective and objective pain assessment.Methods:Patients (n=30) diagnosed with CTTH were randomized into rTMS (n=15) and placebo (n=15) groups in this study. Pre-intervention detailed history of patients was taken. Numerical Rating Scale (NRS) for Pain and questionnaires [Headache Impact Test-6 (HIT-6), McGill Pain Questionnaire, Pain Beliefs Questionnaire, Coping Strategies Questionnaire, State-Trait Anxiety Inventory Test, Hamilton Rating Scale for Depression and WHO-Quality of Life Questionnaire-Brief version] were filled, and objective assessments such as nociceptive flexion reflex (NFR) and conditioned pain modulation were done. The tests were repeated after 20 sessions (5 days/week). In the rTMS group, 1200 pulses in eight trains of 150 pulses each were given at 1Hz over the right dorsolateral prefrontal cortex (RDLPFC). In the placebo group, the rTMS coil was placed such that magnetic stimulation did not reach the cortex.Results:The NRS score decreased significantly (P<0.001) and NFR thresholds increased significantly (P=0.011) in the rTMS group when compared to placebo group.Interpretation & conclusions:Subjective improvements in the NRS, HIT-6, McGill Present Pain Intensity, trait of anxiety and psychological pain beliefs were observed. The increase in the thresholds of NFR served as an objective marker for improvement in pain status. Further studies need to be done to confirm our preliminary findings.

Fizyoterapi Öğrencilerinde Bel Ağrısı ile İlgili Tutum ve İnanışların İncelenmesi

Fizyoterapi Öğrencilerinde Bel Ağrısı ile İlgili Tutum ve İnanışların İncelenmesi

Effective Recovery and Control of Chronic Low Back Pain by using Rehabilitation Exercises Therapy

Exercise is a commonly recommended treatment for chronic low back pain due to its effectiveness in enhancing work and function. This study aims to review numerous crucial phases of the usefulness and safety of exercise in order to provide vital information for treating chronic low back pain. An online literature search of Medline was performed using “exercise,” “fitness,” “low back pain,” “backache” and “rehabilitation” as search words abstracts that identified using this method were carefully read, and relevant articles were considered for further analysis. Additional materials were gathered by sourcing relevant research articles. The articles were carefully examined for relevance. There is no evidence that exercise increases low back pain problems, particularly for people with acute, subacute or chronic low back pain. Current studies indicate that exercise has either a neutral effect or might reduce the risk of future back injuries to some extent. Exercise might be suggested for patients with chronic low back pain for three purposes. The first and most recognized purpose is to enhance or decrease deficiencies in back flexibility and strength and improve the performance of endurance activities. It is evident that this purpose can be achieved for most patients suffering from chronic low back pain. The second purpose of exercise is to decrease the severity of low back pain. Many studies reported an overall decrease in the intensity of low back pain ranging from 10% to 50% subsequent to exercise treatment. The third purpose of the exercise is to decrease low back pain–related incapacity by desensitizing worries and anxieties and changing pain attitudes and beliefs. The exercise mechanisms that can be employed to achieve the aforementioned purposes have been the subject of extensive study. The relevance of using exercise as a therapeutic method to decrease deficiencies in back flexibility and strength has been established. Several studies reported enhancements in global pain ratings subsequent to exercise programs. Exercise can also reduce the cognitive, behavioral, and disability effects of low back pain conditions.

Attitudes and beliefs about musculoskeletal pain and its association with pain neuroscience knowledge among physiotherapy students in Israel

BackgroundPhysiotherapy has a vital role in helping patients manage and overcome musculoskeletal pain. Healthcare providers’ beliefs about pain are associated with the beliefs of their patients. This study evaluated the attitudes, beliefs and level of pain neuroscience knowledge among Israeli Bachelor-level physiotherapy students.MethodsFirst-year (n = 29, before pain course), second-year (n = 28, immediately after pain course and before clinical placements), and fourth-year (n = 28, post-clinical placements) physiotherapy students completed the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS, range 15–105, lower scores indicate a more positive attitude) to assess pain attitudes and beliefs. The Neurophysiology of Pain Questionnaire (NPQ, range 0–19, higher scores indicate more pain-related knowledge) was also completed to measure pain neuroscience knowledge. Two separate one-way ANOVAs with post hoc analyses were used to compare HC-PAIRS and NPQ results between the three groups of students. Pearson correlations were determined between HC-PAIRS and NPQ.ResultsHC-PAIRS scores of the first-year students were significantly higher than those of second- and fourth-year students (p = 0.011, p < 0.001, respectively), with no difference between second- and fourth-year students; indicating that first-year students had less-positive attitudes toward the ability of individuals with musculoskeletal pain to function. Similarly, NPQ scores showed that first-year students differed from second- and fourth-year students (p < 0.001, p < 0.001, respectively). The HC-PAIRS and NPQ correlation among the fourth-year students yielded a moderately negative association (r = − 0.462, p = 0.01), indicating that pain neuroscience knowledge was associated with less belief that chronic pain justifies disability.ConclusionsA specific curriculum about pain during physiotherapy undergraduate education contributes to a more positive evidenced-based attitude to musculoskeletal pain and patient function. The association between pain neuroscience knowledge and positive attitudes and beliefs regarding pain were enhanced after clinical placements, demonstrating that learning improves when integrated into practice. Due to the impact of pain training and the expected benefits to patient care, health policy decision makers and educators should verify that the pain curriculum is current with the best research evidence. Future studies with larger samples that include students from other healthcare disciplines, including medicine are warranted.

GLA:D\xae Back group-based patient education integrated with exercises to support self-management of back pain\xa0- development, theories and scientific evidence\xa0-

BackgroundClinical guidelines recommend that people with back pain be given information and education about their back pain, advice to remain active and at work, and exercises to improve mobility and physical activity. Guidelines, however, rarely describe how this is best delivered. The aim of this paper is to present the development, theories, and underlying evidence for ‘GLA:D Back’ - a group education and exercise program that translates guideline recommendations into a clinician-delivered program for the promotion of self-management in people with persistent/recurrent back pain.MethodsGLA:D Back, which included a rationale and objectives for the program, theory and evidence for the interventions, and program materials, was developed using an iterative process. The content of patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements hypothesised to improve back pain beliefs and management skills. The program was tested on eight people with persistent back pain in a university clinic and 152 patients from nine primary care physiotherapy and chiropractic clinics. Following feedback from the clinicians and patients involved, the working version of the program was created.ResultsEducational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between the sum of demands and the individual’s capacity. These were operationalised in PowerPoint presentations with supporting text to aid clinicians in delivering two one-hour patient education lectures.The exercise program included 16 supervised one-hour sessions over 8 weeks, each comprising a warm-up section and eight types of exercises for general flexibility and strengthening of six different muscle groups at four levels of difficulty. The aims of the exercises were to improve overall back fitness and, at the same time, encourage patients to explore variations in movement by incorporating education content into the exercise sessions.ConclusionFrom current best evidence about prognostic factors in back pain and effective treatments for back pain, research and clinical experts developed a ready-to-use structured program - GLA:D® Back - to support self-management for people with persistent/recurrent back pain.

Translation and psychometric evaluation of the Hebrew version of the Health Care Providers' Pain and Impairment Relationship Scale.

Physiotherapists' different attitudes towards low back pain (LBP) are associated with patients' attitudes towards pain and with patients' disability. The Health Care Providers' Pain and Impairment Relationship Scale (HC-Pairs) is a self-administered instrument that assesses the attitudes and beliefs of health care professionals regarding LBP and the patient's daily function. The aims of this study are to translate, culturally adapt, and asses the psychometric properties of the Hebrew version of the HC-Pairs. The English version of the HC-Pairs was forward-backward translated, pretested, and reviewed by a panel of experts. Reliability was determined by computing Cronbach's α, and validity by exploring the correlations between the HC-Pairs' scores and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) scores. Confirmatory factor analysis was performed. A convenience sample of 277 physiotherapists was invited to fill the HC-Pairs and PABS-PT questionnaires and a sociodemographic questionnaire. The forward-backward translation process revealed minor discrepancies between the texts. After the pretest, the expert panel agreed on a final version. A sample of 241 physiotherapists completed the questionnaires (response rate of 87%; 241/277); 213 met the inclusion criteria. Factor analysis suggests that the Hebrew version of the scale fits the one-factor model. Cronbach's α was 0.81 after deletion of two items and indicated good internal consistency. The scores produced by the instrument showed a substantial correlation with those of the biomedical dimension of the PABS-PT, and poor correlation with the behavioural dimension, in the expected directions. The findings of the present study on the psychometric properties of the HC-Pairs are positive. Nevertheless, the Hebrew version of the HC-Pairs is still in a developmental stage. Further psychometric research is needed to assess the attitudes and beliefs of Hebrew-speaking physiotherapists, which have been shown to be associated with treatment orientations and work recommendations.

Are Pain Beliefs, Cognitions, and Behaviors Influenced by Race, Ethnicity, and Culture in Patients with Chronic Musculoskeletal Pain: A Systematic Review

Chronic pain has been considered as a biopsychosocial condition in which cognitive and emotional factors as well as biological factors significantly affect perception of pain. Race, ethnicity and culture have a crucial impact on illness beliefs, health care preferences, help-seeking behaviors, and acceptance of medical interventions. The aim of the present study was to systematically review the current evidence regarding the racial, ethnic and cultural alterations and differences in pain beliefs, cognitions, and behaviors in patients with chronic musculoskeletal pain (MSKP). Systematic review. This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines (PRISMA). PubMed and Web of Science were searched. A first screening was conducted based on title and abstract of the articles. In the second screening, full-texts of the remaining articles were evaluated for the fulfilment of the inclusion criteria. The risk of bias was assessed with the modified Newcastle-Ottawa Scale. A total of 11 articles were included. The methodological quality of the included studies ranged from low to moderate. There is moderate evidence that African-Americans use more praying, hoping, and emotion-focused coping strategies than Caucasians. There is also preliminary evidence regarding the differences in some coping strategies such as distraction, catastrophizing, and problem-focused solving between African-Americans and Caucasians. Preliminary evidence exists regarding the differences in pain coping strategies between the US and Portugal; the US and Singapore; and among 4 French-speaking countries. It is found that Spanish patients with fibromyalgia (FM) have more negative illness perceptions than Dutch patients. There is preliminary evidence that Caucasians have higher self-efficacy than African-Americans. There is also preliminary evidence that New Zealanders have more internal health expectancies than patients from the US. Preliminary evidence is demonstrated that Caucasians with rheumatoid arthritis (RA) have more positive control beliefs than African-Americans. Lastly, there is preliminary evidence that patients from the US believe that they are more disabled, while Singaporeans interpret the pain more by a traditional biomedical perspective. Only 11 articles were included. The small number of articles, wide range of assessment methods, and substantial risk of bias in the included studies led the investigator to draw conclusions cautiously. Preliminary to moderate evidence shows the differences in coping strategies, illness perceptions, self-efficacy, fear avoidance beliefs, locus of control, and pain attitudes in different populations. Further prospective and longitudinal studies using standard definitions for race, ethnicity or culture and valid questionnaires for each population are warranted to explore the racial, ethnic and cultural discrepancies in pain beliefs, cognitions, and behaviours. Chronic pain, musculoskeletal pain, pain beliefs, pain cognitions, pain behaviors, race, ethnicity, culture.

Development of culturally sensitive Pain Neuroscience Education for first-generation Turkish patients with chronic pain: A modified Delphi study

BackgroundPain Neuroscience Education (PNE) has been recognized as an efficacious approach for chronic pain, but evidence for these findings have mainly been gathered in Caucasian patient populations. In recent years, it has been proposed that the treatment of pain and patient information materials should be culturally sensitive for different ethnic populations and cultures since cultural variations in pain beliefs and cognitions. ObjectivesTo culturally adapt PNE material for first-generation Turkish patients with chronic pain. DesignA modified Delphi study with three consecutive rounds. MethodA total of 10 participants (8 experts and 2 first-generation Turkish patients with chronic pain) were recruited for this study. Three online questionnaire rounds were conducted to synthesize the perspectives and to reach agreement on the suggested PNE materials. ResultsResults on multiple-choice questions from the first round revealed that the compatibility of the visual information and the clarity of the message obtained lower scores. Examples, visual information (illustrations, pictures), and metaphors in the teaching materials and the home education leaflet were revised based on suggestions in Rounds 1 and 2. In Round 3, respondents reached an acceptable agreement level for the clinical usefulness of the PNE teaching materials and the home education material. ConclusionsCulturally sensitive PNE materials were produced for first-generation Turkish patients. Since the results of the present study only reveal perspectives of the experts, further validation of education materials may be required before they are recommended for Turkish patients in clinical practices.