European journal of pain : EJP
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A cognitive behavioural account of chronic low back pain (CLBP) proposes that the relationship between pain catastrophizing and functional disability is mediated by fear of movement/(re)injury. Several clinical studies already demonstrated the contribution of pain catastrophizing and fear of movement/(re)injury in the development and maintenance of CLBP. This study included people with low back pain (LBP) in the general population, and aimed to investigate whether fear of movement/(re)injury mediated the relationship between pain catastrophizing and functional disability, by examining several prerequisites for mediation. ⋯ However, pain catastrophizing was significantly related to fear of movement/(re)injury 6 months later, above and beyond other contributing variables such as fear of movement/(re)injury already present at baseline. On its turn, fear of movement/(re)injury was related to functional disability, in addition to pain intensity. Although this study leaves some indistinctness concerning the actual relationships between pain catastrophizing, fear of movement/(re)injury, and functional disability, it does provide some evidence for the contributing role of these factors in LBP in the general population.
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There is limited knowledge on prognostic factors for developing chronic low back pain (LBP) at an early stage of LBP. The objectives of this study were to investigate the clinical course of pain and disability, and prognostic factors for non-recovery after 1-year, in patients seeking help for the first time due to acute LBP. An inception cohort study included 123 patients with acute LBP lasting less than 3 weeks and consulting primary care for the first time. ⋯ The proportions with sickness absence due to LBP at 6, 9, and 12 months were 7%, 8%, and 9%, respectively. At 12 months, 17% of patients had not fully recovered. Multivariate logistic regression analyses showed that high scores on a psychosocial screening (acute low back pain screening questionnaire) and emotional distress (Hopkin's symptom check list) were significantly associated with non-recovery at 12 months, with odds ratios of 4.4 (95% confidence interval 1.1-17.4) and 3.3 (1.1-10.2), respectively.
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For chronic pain of unclear origin (idiopathic), pharmacological therapy is often insufficient. Psychological treatment strategies have been developed and evaluated for adults with chronic pain. However, few such studies are seen with youths, and to date there is limited empirical evidence regarding the effectiveness of psychological treatment for generalized musculoskeletal pain syndromes in adolescents. ⋯ Following treatment, and retained at 3- and 6-month follow-up, improvements in functional ability, school attendance, catastrophizing and pain (i.e., intensity and interference) were seen. The outcome of this pilot study indicates that exposure and acceptance can been useful in the rehabilitation of adolescents with chronic debilitating pain. Randomized controlled studies are needed to empirically evaluate the effectiveness of this approach.
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To assess the long-term efficacy of neurostimulation for treating refractory angina pectoris-like chest pain, we followed patients, treated with either transcutaneous electrical nerve stimulation (TENS) or spinal cord stimulation (SCS). ⋯ Neurostimulation techniques should thus be of widespread value for treating angina pectoris-like chest pain in patients who are refractory to medication.
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Fear of pain and avoidance are psychological factors of primary importance when assessing chronic musculoskeletal pain, which are often measured with the Fear-Avoidance Beliefs Questionnaire (FABQ). Both two- and three-subscale versions have been described. The aims of this study were: to assess the cognitive traits of musculoskeletal pain patients using a newly validated Greek version of the FABQ, and to further examine the construct validity and responsiveness of the measure. ⋯ Responsiveness of the 3-factor model was satisfactorily assessed as the ability to detect: (A) change in general - (paired t test, effect size); (B) clinically important change (paired t test, standardised effect size), and (C) real change in the concept being measured (ROC analysis). Construct validity of the FABQ was shown through the interaction with anxiety and depression, pain control and responsibility, psychological distress and pain intensity, and criterion-related validity through the association with another fear-avoidance measure (TSK). New aspects of responsiveness and construct validity were demonstrated for the FABQ, using a three-subscale validated Greek version.