Marc-Henri Louis, Valéry Legrain, Vladimir Aron, Lieve Filbrich, Séverine Henrard, Olivier Barbier, Xavier Libouton, Dominique Mouraux, Julien Lambert, Anne Berquin
Background
Complex regional pain syndrome (CRPS) is a debilitating condition characterised by significant heterogeneity. Early diagnosis is critical, but limited data exists on the condition's early stages. This study aimed to characterise (very) early CRPS patients and explore potential subgroups to enhance understanding of its mechanisms.
Methods
A total of 113 early CRPS patients were recruited, with 89 undergoing physical assessments. Data included demographic information, work-related factors, CRPS history and clinical features, body perception disturbances, quantitative sensory testing (QST), and a visuospatial attention task.
Results
QST identified deficits in detecting thermal and mechanical stimuli, alongside increased sensitivity to thermal and blunt pressure painful stimuli. Participants reported body perception disturbances similar to those of persistent CRPS. Visuospatial biases were observed in two subgroups of patients. Latent class analysis (LCA) of 85 participants, based on five clinical parameters, identified four profiles: Mild, Moderate, Body Representation Disturbance (BRD), and Pressure Allodynia CRPS. The Mild and Moderate profiles were associated with higher-intensity trauma, with the latter showing worse outcomes. BRD and Pressure Allodynia CRPS followed mild trauma but exhibited the poorest outcomes. BRD CRPS displayed significant body perception disturbances, while Pressure Allodynia CRPS presented the highest sensitivity to pressure and psychosocial risk of chronification. Neither condition duration nor skin temperature effectively distinguished subgroups.
Conclusions
These findings emphasise the heterogeneity within (very) early CRPS patients and support the absence of a minimum required duration prior to the CRPS diagnosis. Central/systemic mechanisms may play critical roles in severe cases.
Significance
This study identifies distinct (very) early CRPS profiles, suggesting different pathophysiological mechanisms and challenging traditional classifications. It paves the way for improved diagnosis and tailored treatments.
{"title":"Early CRPS Is a Heterogeneous Condition: Results From a Latent Class Analysis","authors":"Marc-Henri Louis, Valéry Legrain, Vladimir Aron, Lieve Filbrich, Séverine Henrard, Olivier Barbier, Xavier Libouton, Dominique Mouraux, Julien Lambert, Anne Berquin","doi":"10.1002/ejp.4785","DOIUrl":"10.1002/ejp.4785","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Complex regional pain syndrome (CRPS) is a debilitating condition characterised by significant heterogeneity. Early diagnosis is critical, but limited data exists on the condition's early stages. This study aimed to characterise (very) early CRPS patients and explore potential subgroups to enhance understanding of its mechanisms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 113 early CRPS patients were recruited, with 89 undergoing physical assessments. Data included demographic information, work-related factors, CRPS history and clinical features, body perception disturbances, quantitative sensory testing (QST), and a visuospatial attention task.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>QST identified deficits in detecting thermal and mechanical stimuli, alongside increased sensitivity to thermal and blunt pressure painful stimuli. Participants reported body perception disturbances similar to those of persistent CRPS. Visuospatial biases were observed in two subgroups of patients. Latent class analysis (LCA) of 85 participants, based on five clinical parameters, identified four profiles: <i>Mild</i>, <i>Moderate</i>, <i>Body Representation Disturbance</i> (BRD), and <i>Pressure Allodynia</i> CRPS. The <i>Mild</i> and <i>Moderate</i> profiles were associated with higher-intensity trauma, with the latter showing worse outcomes. <i>BRD</i> and <i>Pressure Allodynia</i> CRPS followed mild trauma but exhibited the poorest outcomes. BRD CRPS displayed significant body perception disturbances, while Pressure Allodynia CRPS presented the highest sensitivity to pressure and psychosocial risk of chronification. Neither condition duration nor skin temperature effectively distinguished subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings emphasise the heterogeneity within (very) early CRPS patients and support the absence of a minimum required duration prior to the CRPS diagnosis. Central/systemic mechanisms may play critical roles in severe cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This study identifies distinct (very) early CRPS profiles, suggesting different pathophysiological mechanisms and challenging traditional classifications. It paves the way for improved diagnosis and tailored treatments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristy Themelis, Jenna L. Gillett, Paige Karadag, Martin D. Cheatle, Mark A. Ilgen, Shyam Balasubramanian, Swaran P. Singh, Nicole K. Y. Tang
Background
Mental defeat is considered a potential risk factor for suicidal thoughts and behaviours in chronic pain. This study evaluated the role of mental defeat in predicting future suicide risk and examined whether depression influences this relationship.
Methods
A total of 340 participants with chronic pain completed questionnaires at two time points, 12 months apart. Data collected included sociodemographic and pain characteristics, mental defeat, psychosocial risk factors including depression and health-related variables. Weighted univariate and multivariable analyses assessed the link between mental defeat and suicide risk, with a moderation analysis testing the role of depression.
Results
Higher levels of mental defeat and depression were linked to increased suicide risk at 12 months. Depression significantly amplified the effect of mental defeat on suicide risk, particularly in individuals with higher depression levels (B = 0.06, SE = 0.01, t = 6.21, p < 0.001) compared with moderate (B = 0.05, SE = 0.01, t = 5.20, p < 0.001) or low levels of depression (B = 0.04, SE = 0.01, t = 2.83, p = 0.004), indicating a dose–response relationship.
Conclusions
Mental defeat is a significant risk factor for suicide in chronic pain, with depression intensifying this risk. Addressing both mental defeat and depression simultaneously in treatment may help reduce suicide risk in these patients.
Significance
This study strengthens the evidence linking mental defeat with heightened suicide risk in chronic pain. By providing prospective data, it clarifies the temporality of this relationship. Given that suicide risk doubles in chronic pain patients, whereby comorbid depression is common, these findings have crucial clinical implications. Both mental defeat and depression are modifiable. Addressing them together in treatment may help reduce suicide risk in this population.
背景：心理失败被认为是慢性疼痛患者产生自杀念头和行为的潜在危险因素。这项研究评估了心理失败在预测未来自杀风险方面的作用，并研究了抑郁症是否会影响这种关系。方法：340名慢性疼痛患者分别在相隔12个月的两个时间点完成问卷调查。收集的数据包括社会人口学和疼痛特征、心理失败、包括抑郁和健康相关变量在内的社会心理风险因素。加权单变量和多变量分析评估了心理失败和自杀风险之间的联系，并进行了适度分析，测试了抑郁的作用。结果：在12个月内，心理挫败和抑郁程度越高，自杀风险越高。抑郁症显著放大了心理失败对自杀风险的影响，特别是在抑郁水平较高的个体中（B = 0.06, SE = 0.01, t = 6.21, p）结论：心理失败是慢性疼痛患者自杀的重要危险因素，抑郁症加剧了这种风险。在治疗中同时处理精神挫败和抑郁可能有助于降低这些患者的自杀风险。意义：本研究强化了慢性疼痛患者心理失败与自杀风险增高之间的联系。通过提供前瞻性数据，它澄清了这种关系的暂时性。考虑到慢性疼痛患者的自杀风险增加一倍，而伴随抑郁的患者很常见，这些发现具有重要的临床意义。精神上的失败和抑郁都是可以改变的。在治疗中同时解决这些问题可能有助于降低这一人群的自杀风险。
{"title":"Mental Defeat Predicts Increased Suicide Risk in Chronic Pain: A 12-Month Prospective Study","authors":"Kristy Themelis, Jenna L. Gillett, Paige Karadag, Martin D. Cheatle, Mark A. Ilgen, Shyam Balasubramanian, Swaran P. Singh, Nicole K. Y. Tang","doi":"10.1002/ejp.4779","DOIUrl":"10.1002/ejp.4779","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mental defeat is considered a potential risk factor for suicidal thoughts and behaviours in chronic pain. This study evaluated the role of mental defeat in predicting future suicide risk and examined whether depression influences this relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 340 participants with chronic pain completed questionnaires at two time points, 12 months apart. Data collected included sociodemographic and pain characteristics, mental defeat, psychosocial risk factors including depression and health-related variables. Weighted univariate and multivariable analyses assessed the link between mental defeat and suicide risk, with a moderation analysis testing the role of depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher levels of mental defeat and depression were linked to increased suicide risk at 12 months. Depression significantly amplified the effect of mental defeat on suicide risk, particularly in individuals with higher depression levels (<i>B</i> = 0.06, SE = 0.01, <i>t</i> = 6.21, <i>p</i> < 0.001) compared with moderate (<i>B</i> = 0.05, SE = 0.01, <i>t</i> = 5.20, <i>p</i> < 0.001) or low levels of depression (<i>B</i> = 0.04, SE = 0.01, <i>t</i> = 2.83, <i>p</i> = 0.004), indicating a dose–response relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Mental defeat is a significant risk factor for suicide in chronic pain, with depression intensifying this risk. Addressing both mental defeat and depression simultaneously in treatment may help reduce suicide risk in these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This study strengthens the evidence linking mental defeat with heightened suicide risk in chronic pain. By providing prospective data, it clarifies the temporality of this relationship. Given that suicide risk doubles in chronic pain patients, whereby comorbid depression is common, these findings have crucial clinical implications. Both mental defeat and depression are modifiable. Addressing them together in treatment may help reduce suicide risk in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David Casanova-Rodríguez, Antonio Ranchal-Sánchez, Rodrigo Bertoletti Rodríguez, Jose Manuel Jurado-Castro
Background and Objective
Fibromyalgia is a condition characterised by disabling levels of pain of varying intensity. Aerobic exercise may play a role in reducing pain in these patients. The aim of this review is to assess the dose of aerobic exercise needed, based on the frequency, intensity, type, time, volume and progression (FITT-VP) model, to obtain clinically relevant reductions in pain.
Databases and Data Treatment
A systematic review and meta-analysis of randomised clinical trials was conducted in the Web of Science (WoS), PEDro, PubMed and Scopus databases, the search having been conducted between July and October of 2023. Risk of bias was assessed with the Cochrane Risk of Bias assessment tool 2.
Results
Seventeen studies were included. The risk of bias varied, with six studies showing low risk; five, some concerns; and six, high risk. Aerobic exercise interventions were analysed using the FITT-VP model. Frequency ranged from 1 to 10 times per week, intensity varied from light to vigorous, and the types of exercise included music-based exercise, interval training, pool-based exercise, stationary cycling, swimming and walking. The intervention durations ranged from 3 to 24 weeks, with session lengths ranging from 10 to 45 min. Most of the studies presented significant differences, favouring aerobic exercise (MD −0.49; CI [−0.90, −0.08; p = 0.02]), with moderate to low heterogeneity in subgroup analyses.
Conclusions
The study findings underscore the efficacy of aerobic exercise in alleviating pain among fibromyalgia patients, advocating for tailored exercise dosing to optimise adherence and outcomes.
Significance Statement
Individuals with fibromyalgia should engage in aerobic exercises two to three times weekly, for twenty-five to forty minutes in each session, aiming for more than a hundred minutes per week. They should start at low intensity, gradually increasing to higher intensities over six to twelve weeks, for optimal pain management. Exercise types should be selected in collaboration with the patient and based on personal preferences and accessibility, such as walking, and swimming, to ensure long-term adherence to the regimen.
{"title":"Aerobic Exercise Prescription for Pain Reduction in Fibromyalgia: A Systematic Review and Meta-Analysis","authors":"David Casanova-Rodríguez, Antonio Ranchal-Sánchez, Rodrigo Bertoletti Rodríguez, Jose Manuel Jurado-Castro","doi":"10.1002/ejp.4783","DOIUrl":"10.1002/ejp.4783","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Fibromyalgia is a condition characterised by disabling levels of pain of varying intensity. Aerobic exercise may play a role in reducing pain in these patients. The aim of this review is to assess the dose of aerobic exercise needed, based on the frequency, intensity, type, time, volume and progression (FITT-VP) model, to obtain clinically relevant reductions in pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Databases and Data Treatment</h3>\u0000 \u0000 <p>A systematic review and meta-analysis of randomised clinical trials was conducted in the Web of Science (WoS), PEDro, PubMed and Scopus databases, the search having been conducted between July and October of 2023. Risk of bias was assessed with the Cochrane Risk of Bias assessment tool 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen studies were included. The risk of bias varied, with six studies showing low risk; five, some concerns; and six, high risk. Aerobic exercise interventions were analysed using the FITT-VP model. Frequency ranged from 1 to 10 times per week, intensity varied from light to vigorous, and the types of exercise included music-based exercise, interval training, pool-based exercise, stationary cycling, swimming and walking. The intervention durations ranged from 3 to 24 weeks, with session lengths ranging from 10 to 45 min. Most of the studies presented significant differences, favouring aerobic exercise (MD −0.49; CI [−0.90, −0.08; <i>p</i> = 0.02]), with moderate to low heterogeneity in subgroup analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The study findings underscore the efficacy of aerobic exercise in alleviating pain among fibromyalgia patients, advocating for tailored exercise dosing to optimise adherence and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Individuals with fibromyalgia should engage in aerobic exercises two to three times weekly, for twenty-five to forty minutes in each session, aiming for more than a hundred minutes per week. They should start at low intensity, gradually increasing to higher intensities over six to twelve weeks, for optimal pain management. Exercise types should be selected in collaboration with the patient and based on personal preferences and accessibility, such as walking, and swimming, to ensure long-term adherence to the regimen.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ilse H. van de Wijgert, Kris C. P. Vissers, Maaike G. E. Fenten, Akkie Rood, Regina L. M. van Boekel, Miranda L. van Hooff
Background
After lumbar spine surgery, a Core Outcome Set (COS) for acute pain is essential to ensure that the most meaningful outcomes are monitored consistently in the perioperative period. The aim of the present study was to consent on a COS for assessing the efficacy of acute pain management for patients undergoing lumbar spinal surgery.
Method
A modified Delphi procedure was conducted among a national (Dutch) expert panel. External endorsement of the final COS was conducted among an international panel of anaesthesiologists and the Dutch chronic pain patient association.
Results
A panel of 35 experts representing 10 stakeholder groups, including orthopaedic surgeons, anaesthesiologists, patient representatives, physician assistants, researchers, a neurosurgeon, nurses, and a psychologist, took part in the Delphi procedure. Five outcome domains reached consensus for inclusion in this COS. This COS contains the following domains: pain intensity, analgesic use, early mobilisation, length of stay, and adverse events. Of an international panel of 27 key opinion leaders, 77% agreed on the final COS. The patient association also consented to the final COS.
Conclusions
A COS to evaluate acute pain treatment after lumbar surgery is proposed after national Delphi consensus rounds and (international) external endorsement. Future research should focus on determining suitable measurement instruments, assessing feasibility, validation, and implementation of the COS in daily clinical practice and research.
Significance
This research proposes a clinically relevant spine-specific core outcome set (COS) of domains focusing on the acute postoperative phase (until 30 days). This is the first COS for evaluation of acute pain after lumbar spine surgery.
{"title":"Development of a Core Outcome Set of Domains to Evaluate Acute Pain Treatment After Lumbar Spine Surgery: A Modified Delphi Study","authors":"Ilse H. van de Wijgert, Kris C. P. Vissers, Maaike G. E. Fenten, Akkie Rood, Regina L. M. van Boekel, Miranda L. van Hooff","doi":"10.1002/ejp.4784","DOIUrl":"10.1002/ejp.4784","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>After lumbar spine surgery, a Core Outcome Set (COS) for acute pain is essential to ensure that the most meaningful outcomes are monitored consistently in the perioperative period. The aim of the present study was to consent on a COS for assessing the efficacy of acute pain management for patients undergoing lumbar spinal surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A modified Delphi procedure was conducted among a national (Dutch) expert panel. External endorsement of the final COS was conducted among an international panel of anaesthesiologists and the Dutch chronic pain patient association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A panel of 35 experts representing 10 stakeholder groups, including orthopaedic surgeons, anaesthesiologists, patient representatives, physician assistants, researchers, a neurosurgeon, nurses, and a psychologist, took part in the Delphi procedure. Five outcome domains reached consensus for inclusion in this COS. This COS contains the following domains: pain intensity, analgesic use, early mobilisation, length of stay, and adverse events. Of an international panel of 27 key opinion leaders, 77% agreed on the final COS. The patient association also consented to the final COS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A COS to evaluate acute pain treatment after lumbar surgery is proposed after national Delphi consensus rounds and (international) external endorsement. Future research should focus on determining suitable measurement instruments, assessing feasibility, validation, and implementation of the COS in daily clinical practice and research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This research proposes a clinically relevant spine-specific core outcome set (COS) of domains focusing on the acute postoperative phase (until 30 days). This is the first COS for evaluation of acute pain after lumbar spine surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert van der Noord, Roland R. Reezigt, Davy Paap, Henrica R. Schiphorst Preuper, Michiel F. Reneman
Background
The internet is increasingly used as a primary source of information for patients with musculoskeletal pain. Private physiotherapy practices provide informative content on low back pain (LBP) and neck pain (NP) on their websites, but the extent to which this information is biopsychosocial, guidelines-consistent, and fear-inducing is unknown. The aim of this study was to analyse the information on websites of private physiotherapy practices in the Netherlands about LBP and NP regarding consistency with the guidelines and the biopsychosocial model and to explore the use of fear-inducing language.
Methods
The content of all existing Dutch private physiotherapy practice websites was examined in a cross sectional study design. Content analysis was based on predetermined criteria of the biopsychosocial model and evidence-based guidelines. Descriptive statistics were applied.
Results
After removing duplicates and sites without information, 834 (10%) of 8707 websites remained. Information about LBP was found on 449 (54%) websites and 295 (35%) websites informed about NP. A majority of websites (LBP: n = 287, 64%; NP: n = 174, 59%) were biomedically oriented. Treatment advice was given 1855 times on n = 560 (67%) websites. Most of the recommended interventions were inconsistent with or not mentioned in the guidelines. Fear-inducing language was provided n = 1624 (69%) times.
Conclusions
The majority of the information on the Dutch private physiotherapy websites was biomedical and not in line with the current guidelines and fear-inducing.
Significance
This study revealed that the majority of private physiotherapy practice websites that provide information on LBP and NP are inconsistent with the biopsychosocial model and current guidelines. This information has a negative impact on patients' knowledge, attitudes, beliefs, and expectations, potentially affecting treatment outcomes. Consequently, most physiotherapy practice websites are unreliable sources of information on LBP and NP for patients. There is an urgent need to implement strategies to make websites reliable and helpful sources of information.
背景：互联网越来越多地被用作肌肉骨骼疼痛患者的主要信息来源。私人物理治疗实践在他们的网站上提供有关腰痛（LBP）和颈痛（NP）的信息，但这些信息在多大程度上是生物心理社会，指南一致性和恐惧诱导是未知的。本研究的目的是分析荷兰私人物理治疗网站上关于LBP和NP与指南和生物心理社会模型的一致性的信息，并探讨恐惧诱导语言的使用。方法：采用横断面研究设计对所有现有荷兰私人物理治疗实践网站的内容进行检查。内容分析基于生物心理社会模型和循证指南的预定标准。采用描述性统计。结果：剔除重复和无信息网站后，8707个网站中保留834个（10%）。在449个（54%）网站和295个（35%）网站上发现了LBP的信息。大多数网站(LBP: n = 287，占64%；NP: n = 174, 59%)为生物医学取向。在n = 560（67%）个网站上给出了1855次治疗建议。大多数推荐的干预措施与指南不一致或未提及。诱导恐惧的语言提供n = 1624次（69%）。结论：荷兰私人物理治疗网站上的信息大部分是生物医学信息，不符合现行指南，引起恐惧。意义：本研究揭示了大多数提供LBP和NP信息的私人物理治疗实践网站与生物心理社会模型和现行指南不一致。这些信息对患者的知识、态度、信念和期望产生负面影响，可能影响治疗结果。因此，大多数物理治疗实践网站是不可靠的LBP和NP患者的信息来源。迫切需要实施战略，使网站成为可靠和有用的信息来源。
{"title":"Unhelpful Information About Low Back and Neck Pain on Physiotherapist's Websites","authors":"Robert van der Noord, Roland R. Reezigt, Davy Paap, Henrica R. Schiphorst Preuper, Michiel F. Reneman","doi":"10.1002/ejp.4782","DOIUrl":"10.1002/ejp.4782","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The internet is increasingly used as a primary source of information for patients with musculoskeletal pain. Private physiotherapy practices provide informative content on low back pain (LBP) and neck pain (NP) on their websites, but the extent to which this information is biopsychosocial, guidelines-consistent, and fear-inducing is unknown. The aim of this study was to analyse the information on websites of private physiotherapy practices in the Netherlands about LBP and NP regarding consistency with the guidelines and the biopsychosocial model and to explore the use of fear-inducing language.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The content of all existing Dutch private physiotherapy practice websites was examined in a cross sectional study design. Content analysis was based on predetermined criteria of the biopsychosocial model and evidence-based guidelines. Descriptive statistics were applied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After removing duplicates and sites without information, 834 (10%) of 8707 websites remained. Information about LBP was found on 449 (54%) websites and 295 (35%) websites informed about NP. A majority of websites (LBP: <i>n</i> = 287, 64%; NP: <i>n</i> = 174, 59%) were biomedically oriented. Treatment advice was given 1855 times on <i>n</i> = 560 (67%) websites. Most of the recommended interventions were inconsistent with or not mentioned in the guidelines. Fear-inducing language was provided <i>n</i> = 1624 (69%) times.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The majority of the information on the Dutch private physiotherapy websites was biomedical and not in line with the current guidelines and fear-inducing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This study revealed that the majority of private physiotherapy practice websites that provide information on LBP and NP are inconsistent with the biopsychosocial model and current guidelines. This information has a negative impact on patients' knowledge, attitudes, beliefs, and expectations, potentially affecting treatment outcomes. Consequently, most physiotherapy practice websites are unreliable sources of information on LBP and NP for patients. There is an urgent need to implement strategies to make websites reliable and helpful sources of information.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yann Seznec, Joy Thomas, Pelletier Jean Baptiste, Benjamin Buhot, Philippe Convers, Roland Peyron, François Vassal
Background
Preliminary studies on epidural motor cortex stimulation (eMCS) for the treatment of drug-resistant neuropathic pain have supported the extension to novel stimulation waveforms, in particular burstDR. However, only a low level of evidence is available. The aim of this retrospective observational study was to compare the analgesic efficacy of burstDR versus tonic eMCS.
Methods
Patients suffering from unilateral, drug-resistant neuropathic pain were selected for eMCS. During the trial phase, burstDR and tonic waveforms were successively applied for three consecutive months in a double-blinded fashion and in a random order. The primary outcome criterion was the percentage of pain relief (%PR) at 3 and 6 months. The secondary outcome criterion was the proportion of patients reporting a superior %PR with the burstDR waveform.
Results
Thirteen patients were included. The averaged %PR was 75.4% ± 18.6% after burstDR eMCS and 61.1% ± 28.6% after tonic eMCS (p = 0.21). Nine patients preferred the burstDR waveform for chronic eMCS (p = 0.16), and six of them were able to decrease or withdraw their analgesic drug intake. No adverse side effect was encountered in relation to burstDR eMCS.
Conclusions
BurstDR eMCS seems at least as effective as tonic eMCS for the treatment of drug-resistant neuropathic pain and shows a similar safety profile. Although the precise mechanisms of action remain to be fully elucidated, adequate matching between the oscillatory rhythm in the motor cortex and that of the burstDR waveform may increase synaptic efficacy, thus enhancing the functional connectivity of the motor cortex with remote brain networks involved in pain modulation.
Significance Statement
In the present paper, we provide for the first time a double-blinded study comparing burstDR versus tonic eMCS for the treatment of intractable, drug-resistant neuropathic pain. Our results show that burstDR eMCS is a promising option in a population of patients especially difficult to treat, and support the ongoing move toward new stimulation waveforms able to more efficiently activate the brain networks involved in pain modulation.
背景：硬膜外运动皮层刺激（eMCS）治疗耐药神经性疼痛的初步研究支持了新刺激波形的扩展，特别是burst - dr。然而，只有低水平的证据可用。本回顾性观察性研究的目的是比较突发性dr与强直性eMCS的镇痛效果。方法：选择单侧耐药神经性疼痛患者进行eMCS。在试验阶段，以双盲和随机顺序连续三个月连续应用爆发dr和强直波形。主要结局标准是3个月和6个月时疼痛缓解百分比（%PR）。次要结果标准是报告具有burstDR波形的高%PR的患者比例。结果：纳入13例患者。burst - dr eMCS组平均%PR为75.4%±18.6%，tonic eMCS组平均%PR为61.1%±28.6% （p = 0.21）。9例患者首选burstDR波形治疗慢性eMCS (p = 0.16)，其中6例患者能够减少或停用镇痛药物。没有遇到与爆裂dr eMCS相关的不良副作用。结论：在治疗耐药神经性疼痛方面，BurstDR eMCS似乎至少与强直性eMCS一样有效，并且显示出相似的安全性。虽然确切的作用机制仍有待完全阐明，但运动皮层的振荡节律与脉冲dr波形之间的充分匹配可能会增加突触的效力，从而增强运动皮层与参与疼痛调节的远程脑网络的功能连通性。意义声明：在这篇论文中，我们首次提供了一项双盲研究，比较了爆裂dr和强直eMCS治疗难治性、耐药神经性疼痛的效果。我们的研究结果表明，对于那些特别难以治疗的患者来说，burst - dr eMCS是一个很有前途的选择，并且支持正在进行的能够更有效地激活参与疼痛调节的大脑网络的新刺激波形。
{"title":"A Double-Blind Comparative Study of burstDR Versus Tonic Epidural Motor Cortex Stimulation for the Treatment of Intractable Neuropathic Pain","authors":"Yann Seznec, Joy Thomas, Pelletier Jean Baptiste, Benjamin Buhot, Philippe Convers, Roland Peyron, François Vassal","doi":"10.1002/ejp.4778","DOIUrl":"10.1002/ejp.4778","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preliminary studies on epidural motor cortex stimulation (eMCS) for the treatment of drug-resistant neuropathic pain have supported the extension to novel stimulation waveforms, in particular burstDR. However, only a low level of evidence is available. The aim of this retrospective observational study was to compare the analgesic efficacy of burstDR versus tonic eMCS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients suffering from unilateral, drug-resistant neuropathic pain were selected for eMCS. During the trial phase, burstDR and tonic waveforms were successively applied for three consecutive months in a double-blinded fashion and in a random order. The primary outcome criterion was the percentage of pain relief (%PR) at 3 and 6 months. The secondary outcome criterion was the proportion of patients reporting a superior %PR with the burstDR waveform.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen patients were included. The averaged %PR was 75.4% ± 18.6% after burstDR eMCS and 61.1% ± 28.6% after tonic eMCS (<i>p</i> = 0.21). Nine patients preferred the burstDR waveform for chronic eMCS (<i>p</i> = 0.16), and six of them were able to decrease or withdraw their analgesic drug intake. No adverse side effect was encountered in relation to burstDR eMCS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BurstDR eMCS seems at least as effective as tonic eMCS for the treatment of drug-resistant neuropathic pain and shows a similar safety profile. Although the precise mechanisms of action remain to be fully elucidated, adequate matching between the oscillatory rhythm in the motor cortex and that of the burstDR waveform may increase synaptic efficacy, thus enhancing the functional connectivity of the motor cortex with remote brain networks involved in pain modulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>In the present paper, we provide for the first time a double-blinded study comparing burstDR versus tonic eMCS for the treatment of intractable, drug-resistant neuropathic pain. Our results show that burstDR eMCS is a promising option in a population of patients especially difficult to treat, and support the ongoing move toward new stimulation waveforms able to more efficiently activate the brain networks involved in pain modulation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Umut Islam Tayboga, Yucel Olgun, Osman Hakan Gunduz, Savas Sencan
Background
Cervical radiculopathy is caused by dysfunction of nerve roots in the cervical spine. While many studies have assessed the effectiveness of interlaminar epidural steroid injection (ILESI) and stabilisation exercises separately for this condition, our study aims to evaluate the impact of different stabilisation exercise programmes following ILESI on treatment outcomes in radiculopathy patients.
Methods
Sixty-two patients with cervical radiculopathy were randomised into three groups: cervical ILESI-only (CO), neck stabilisation group (NSG) and scapular stabilisation group (SSG). The CO group received only ILESI, while NSG and SSG underwent stabilisation exercises following ILESI. Outcomes were assessed using the Numerical Rating Scale (NRS) for neck and arm pain, the Neck Disability Index (NDI) for functionality and the Short Form-12 (SF-12) for quality of life at baseline, 1 and 3 months posttreatment.
Results
When NRS, NDI and SF-12 parameters were analysed in all groups, a statistically significant improvement was observed in the 1st and 3rd months compared to the pretreatment period. While the improvement in SF-12 physical parameters was significant in SSG and NSG in the 1st month compared to the pretreatment period, no significant difference was found in the CO group in the posttreatment periods. When the 1st and 3rd month results were analysed in NSG, a greater improvement was observed in terms of NRSNECK parameter in both evaluations compared to the other groups.
Conclusions
Stabilisation exercise programme, especially neck stabilisation, should be included after ILESI treatment due to positive effects on treatment outcomes.
Significance
To the best of our knowledge, our study is the first to investigate the effect of a stabilisation exercise programme after ILESI on treatment outcomes in patients with radiculopathy due to cervical disc herniation. It is a valuable study in terms of its prospective design, its specific and homogeneous patient population and its results. Our study will help clinicians when prescribing exercise programmes for these patients.
{"title":"Are Stabilisation Exercises Effective After Epidural Steroid Injection in Patients With Cervical Radiculopathy? A Prospective Randomised Controlled Trial","authors":"Umut Islam Tayboga, Yucel Olgun, Osman Hakan Gunduz, Savas Sencan","doi":"10.1002/ejp.4777","DOIUrl":"10.1002/ejp.4777","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cervical radiculopathy is caused by dysfunction of nerve roots in the cervical spine. While many studies have assessed the effectiveness of interlaminar epidural steroid injection (ILESI) and stabilisation exercises separately for this condition, our study aims to evaluate the impact of different stabilisation exercise programmes following ILESI on treatment outcomes in radiculopathy patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty-two patients with cervical radiculopathy were randomised into three groups: cervical ILESI-only (CO), neck stabilisation group (NSG) and scapular stabilisation group (SSG). The CO group received only ILESI, while NSG and SSG underwent stabilisation exercises following ILESI. Outcomes were assessed using the Numerical Rating Scale (NRS) for neck and arm pain, the Neck Disability Index (NDI) for functionality and the Short Form-12 (SF-12) for quality of life at baseline, 1 and 3 months posttreatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>When NRS, NDI and SF-12 parameters were analysed in all groups, a statistically significant improvement was observed in the 1st and 3rd months compared to the pretreatment period. While the improvement in SF-12 physical parameters was significant in SSG and NSG in the 1st month compared to the pretreatment period, no significant difference was found in the CO group in the posttreatment periods. When the 1st and 3rd month results were analysed in NSG, a greater improvement was observed in terms of NRS<sub>NECK</sub> parameter in both evaluations compared to the other groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Stabilisation exercise programme, especially neck stabilisation, should be included after ILESI treatment due to positive effects on treatment outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>To the best of our knowledge, our study is the first to investigate the effect of a stabilisation exercise programme after ILESI on treatment outcomes in patients with radiculopathy due to cervical disc herniation. It is a valuable study in terms of its prospective design, its specific and homogeneous patient population and its results. Our study will help clinicians when prescribing exercise programmes for these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>NCT05307211</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amani Lavefjord, Felicia T. A. Sundström, Dane Chia, Fara Tabrizi, Monica Buhrman, Lance M. McCracken
Background
The Multidimensional Psychological Flexibility Inventory (MPFI) is a measure of all facets of psychological flexibility and inflexibility, potentially important processes of change in psychological treatment for chronic pain. In some contexts, it can be considered too long. The aim of this study was, therefore, to validate a short form MPFI (MPFI-24P) in a chronic pain sample.
Methods
Adults with chronic pain were recruited online (N = 404) for a cross-sectional survey study. They first completed pain background questions and the MPFI. For examining convergent construct validity and explained variance in pain-related outcomes, participants also completed the Brief Pain Inventory (BPI) Pain Interference Scale, the Work and Social Adjustment Scale (WSAS) and the Patient Health Questionnaire (PHQ-9), a depression measure. Data were collected on two occasions, 2 weeks apart. Item response theory (IRT) and confirmatory factor analysis (CFA) were used for selecting the best-performing items.
Results
IRT parameters were overall adequate, and hierarchical CFA demonstrated a good model fit. Network analysis of the MPFI items indicated that, in general, items intended to measure the same facets were substantially interconnected, more so for the inflexibility items. Temporal stability was adequate, and internal consistency was good. The MPFI-24P correlated with pain interference, work and social adjustment and depression, with the inflexibility scale better predicting these outcomes. The MPFI-24P correlated strongly with the full-length MPFI.
Conclusions
The MPFI-24P for chronic pain is generally valid and reliable, especially the inflexibility scale. It performs similarly to the full-length MPFI.
Significance
This paper contributes with a measure that is both feasible to use in clinical practice and research, while being able to measure all facets of psychological flexibility and inflexibility—psychological processes of change that are important to evaluate in psychological treatment of chronic pain in order to better individualize treatment.
{"title":"Comprehensive and Efficient Assessment of Psychological Flexibility in the Context of Chronic Pain","authors":"Amani Lavefjord, Felicia T. A. Sundström, Dane Chia, Fara Tabrizi, Monica Buhrman, Lance M. McCracken","doi":"10.1002/ejp.4781","DOIUrl":"10.1002/ejp.4781","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Multidimensional Psychological Flexibility Inventory (MPFI) is a measure of all facets of psychological flexibility and inflexibility, potentially important processes of change in psychological treatment for chronic pain. In some contexts, it can be considered too long. The aim of this study was, therefore, to validate a short form MPFI (MPFI-24P) in a chronic pain sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults with chronic pain were recruited online (<i>N</i> = 404) for a cross-sectional survey study. They first completed pain background questions and the MPFI. For examining convergent construct validity and explained variance in pain-related outcomes, participants also completed the Brief Pain Inventory (BPI) Pain Interference Scale, the Work and Social Adjustment Scale (WSAS) and the Patient Health Questionnaire (PHQ-9), a depression measure. Data were collected on two occasions, 2 weeks apart. Item response theory (IRT) and confirmatory factor analysis (CFA) were used for selecting the best-performing items.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>IRT parameters were overall adequate, and hierarchical CFA demonstrated a good model fit. Network analysis of the MPFI items indicated that, in general, items intended to measure the same facets were substantially interconnected, more so for the inflexibility items. Temporal stability was adequate, and internal consistency was good. The MPFI-24P correlated with pain interference, work and social adjustment and depression, with the inflexibility scale better predicting these outcomes. The MPFI-24P correlated strongly with the full-length MPFI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The MPFI-24P for chronic pain is generally valid and reliable, especially the inflexibility scale. It performs similarly to the full-length MPFI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This paper contributes with a measure that is both feasible to use in clinical practice and research, while being able to measure all facets of psychological flexibility and inflexibility—psychological processes of change that are important to evaluate in psychological treatment of chronic pain in order to better individualize treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ferdinand Bastiaens, Miranda L. van Hooff, Ivar J. Bruaset, Els van den Eede, Natasja J. G. Maandag, Erkan Kurt, Monique C. M. Schel-Huisman, Jessica T. Wegener, Kris C. P. Vissers
<div> <section> <h3> Background</h3> <p>In recent years, delayed elective care and growing waiting lists increasingly resulted in postponed surgeries for patients with chronic back and leg pain.</p> </section> <section> <h3> Objective</h3> <p>To develop, implement, and evaluate the feasibility of a triage tool for patients with chronic back and/or leg pain to identify those eligible for referral to spinal cord stimulation (SCS) consultation.</p> </section> <section> <h3> Methods</h3> <p>A triage tool was developed, based on Dutch SCS guidelines, literature review and expert panel consultation. The triage process was detected and implemented in collaboration with a multidisciplinary team, prior to first orthopaedic consultation. Feasibility, reliability and predictive accuracy were analysed as part of the evaluation of the triage tool.</p> </section> <section> <h3> Results</h3> <p>The triage indicators included: Pain location (leg/mixed), DN4 > 3, pain duration ≥ 3 months, leg pain ≥ back pain and NPRS leg pain ≥ 5. The triage tool was applied on patients on the orthopaedic waiting list, followed by a full orthopaedic review if they were not excluded. A total of 1025 orthopaedic patients with chronic back and leg pain were assessed with the triage tool. The triage tool was evaluated as feasible (mean System Usability Score 74.2 [SD 11.5]), reliable (inter-rater reliability [Fleiss' Kappa 0.79], intra-rater reliability [Cohen's Kappa 0.89]) and accurate (sensitivity [100%], specificity [98.8%], positive predictive value [40%] and negative predictive value [100%]).</p> </section> <section> <h3> Conclusion</h3> <p>Early triage of potential SCS candidates potentially supports rapid and appropriate care allocation, shortens waiting list time and improves clinical outcomes. Future research should explore strategies to optimise the tool's performance in identifying patients most likely to benefit from SCS therapy.</p> </section> <section> <h3> Significance</h3> <p>A novel triage tool was developed to identify patients with chronic back and leg pain for an early referral to SCS. This tool, evaluated for feasibility, reliability, and predictive accuracy, shows promise in reducing waiting times and improving patient selection. It can be a prelude to the further development of decision support for SCS and an acceleration in the care process for SCS candidat
{"title":"Development and Feasibility Study of a Triage Tool for Early Referral to Spinal Cord Stimulation for Patients With Chronic Low Back and Leg Pain","authors":"Ferdinand Bastiaens, Miranda L. van Hooff, Ivar J. Bruaset, Els van den Eede, Natasja J. G. Maandag, Erkan Kurt, Monique C. M. Schel-Huisman, Jessica T. Wegener, Kris C. P. Vissers","doi":"10.1002/ejp.4780","DOIUrl":"10.1002/ejp.4780","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In recent years, delayed elective care and growing waiting lists increasingly resulted in postponed surgeries for patients with chronic back and leg pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To develop, implement, and evaluate the feasibility of a triage tool for patients with chronic back and/or leg pain to identify those eligible for referral to spinal cord stimulation (SCS) consultation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A triage tool was developed, based on Dutch SCS guidelines, literature review and expert panel consultation. The triage process was detected and implemented in collaboration with a multidisciplinary team, prior to first orthopaedic consultation. Feasibility, reliability and predictive accuracy were analysed as part of the evaluation of the triage tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The triage indicators included: Pain location (leg/mixed), DN4 > 3, pain duration ≥ 3 months, leg pain ≥ back pain and NPRS leg pain ≥ 5. The triage tool was applied on patients on the orthopaedic waiting list, followed by a full orthopaedic review if they were not excluded. A total of 1025 orthopaedic patients with chronic back and leg pain were assessed with the triage tool. The triage tool was evaluated as feasible (mean System Usability Score 74.2 [SD 11.5]), reliable (inter-rater reliability [Fleiss' Kappa 0.79], intra-rater reliability [Cohen's Kappa 0.89]) and accurate (sensitivity [100%], specificity [98.8%], positive predictive value [40%] and negative predictive value [100%]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Early triage of potential SCS candidates potentially supports rapid and appropriate care allocation, shortens waiting list time and improves clinical outcomes. Future research should explore strategies to optimise the tool's performance in identifying patients most likely to benefit from SCS therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>A novel triage tool was developed to identify patients with chronic back and leg pain for an early referral to SCS. This tool, evaluated for feasibility, reliability, and predictive accuracy, shows promise in reducing waiting times and improving patient selection. It can be a prelude to the further development of decision support for SCS and an acceleration in the care process for SCS candidat","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.4780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katarina Rukavina, Juliet Staunton, Pavlos Zinzalias, Magdalena Krbot Skoric, Karolina Poplawska-Domaszewicz, Antonio Pisani, Kirsty Bannister, K Ray Chaudhuri
<div> <section> <h3> Background</h3> <p>Parkinson's disease (PD) is the second most common neurodegenerative disease. Over two thirds of People with Parkinson's (PwP) live with chronic PD-related pain, but its successful management remains an unmet need. Unrevealing links between pain and other motor and non-motor symptoms (NMS) of PD may accelerate delivery of much needed precision pain medicine approaches for PwP.</p> </section> <section> <h3> Methods</h3> <p>An exploratory, cross-sectional analysis of the prospective, observational, multicentre, international study ‘<i>The Non-motor International Longitudinal, Real-Life Study in PD - NILS</i>’.</p> </section> <section> <h3> Results</h3> <p>In 109 PwP (41.3% women, age 64.29 ± 9.80 years, disease duration 5.50 (2.44–10.89) years, H&Y stage 2 (1–4), levodopa equivalent daily dose 575.00 (315.00–1004.00) mg), strong correlations were noted between the total burden of PD-related pain and the total NMS burden (<i>r</i><sub>s</sub> = 0.641) and moderate with disturbances of sleep/fatigue (<i>r</i><sub>s</sub> = 0.483), cognitive issues (<i>r</i><sub>s</sub> = 0.445), motor complications (<i>r</i><sub>s</sub> = 0.421), anxiety (<i>r</i><sub>s</sub> = 0.441) and depression (<i>r</i><sub>s</sub> = 0.451). In a multivariate linear regression analysis, motor complications (<i>B</i> = 2.063, 95% CI for B 1.152–2.974, <i>p</i> < 0.001), sleep disturbances/fatigue (<i>B</i> = 0.392, 95% CI for <i>B</i> 0.064–0.720, <i>p</i> = 0.020) and anxiety (<i>B</i> = 0.912, 95% CI for <i>B</i> 0.165–1.659, <i>p</i> = 0.017) significantly impacted the overall burden of pain.</p> </section> <section> <h3> Conclusions</h3> <p>In PwP, PD-related pain is significantly impacted by motor complications, anxiety and sleep disturbances. A personalized, tailored approach to management of pain in PwP need to accurately identify and tackle all its interrelated symptoms. Whether successful management of motor complications, anxiety and sleep disturbances may contribute to pain relief in PwP for specified cohorts needs to be a focus of future randomized controlled clinical trials.</p> </section> <section> <h3> Significance statement</h3> <p>This explorative analysis identifies the frequent overlap of chronic pain, motor complications, sleep disturbances and anxiety in Parkinson's disease and could help advance the development of precise and effective pain management strategies tailored to the needs of People with Parkinson's.</
{"title":"Pain in Parkinson's disease is impacted by motor complications, anxiety and sleep disturbances","authors":"Katarina Rukavina, Juliet Staunton, Pavlos Zinzalias, Magdalena Krbot Skoric, Karolina Poplawska-Domaszewicz, Antonio Pisani, Kirsty Bannister, K Ray Chaudhuri","doi":"10.1002/ejp.4765","DOIUrl":"https://doi.org/10.1002/ejp.4765","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Parkinson's disease (PD) is the second most common neurodegenerative disease. Over two thirds of People with Parkinson's (PwP) live with chronic PD-related pain, but its successful management remains an unmet need. Unrevealing links between pain and other motor and non-motor symptoms (NMS) of PD may accelerate delivery of much needed precision pain medicine approaches for PwP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An exploratory, cross-sectional analysis of the prospective, observational, multicentre, international study ‘<i>The Non-motor International Longitudinal, Real-Life Study in PD - NILS</i>’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 109 PwP (41.3% women, age 64.29 ± 9.80 years, disease duration 5.50 (2.44–10.89) years, H&Y stage 2 (1–4), levodopa equivalent daily dose 575.00 (315.00–1004.00) mg), strong correlations were noted between the total burden of PD-related pain and the total NMS burden (<i>r</i><sub>s</sub> = 0.641) and moderate with disturbances of sleep/fatigue (<i>r</i><sub>s</sub> = 0.483), cognitive issues (<i>r</i><sub>s</sub> = 0.445), motor complications (<i>r</i><sub>s</sub> = 0.421), anxiety (<i>r</i><sub>s</sub> = 0.441) and depression (<i>r</i><sub>s</sub> = 0.451). In a multivariate linear regression analysis, motor complications (<i>B</i> = 2.063, 95% CI for B 1.152–2.974, <i>p</i> < 0.001), sleep disturbances/fatigue (<i>B</i> = 0.392, 95% CI for <i>B</i> 0.064–0.720, <i>p</i> = 0.020) and anxiety (<i>B</i> = 0.912, 95% CI for <i>B</i> 0.165–1.659, <i>p</i> = 0.017) significantly impacted the overall burden of pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In PwP, PD-related pain is significantly impacted by motor complications, anxiety and sleep disturbances. A personalized, tailored approach to management of pain in PwP need to accurately identify and tackle all its interrelated symptoms. Whether successful management of motor complications, anxiety and sleep disturbances may contribute to pain relief in PwP for specified cohorts needs to be a focus of future randomized controlled clinical trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance statement</h3>\u0000 \u0000 <p>This explorative analysis identifies the frequent overlap of chronic pain, motor complications, sleep disturbances and anxiety in Parkinson's disease and could help advance the development of precise and effective pain management strategies tailored to the needs of People with Parkinson's.</","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.4765","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143120435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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