Reconfiguring the biomedical dominance of pain: time for alternative perspectives from health promotion?

Strategies to reduce the burden of persistent pain in society are rooted in a biomedical paradigm. These strategies are located downstream, managing persistent pain once it has become a problem. Upstream activities that create social conditions to promote health and well-being are likely to help, yet health promotion discourse and research are lacking in pain literature. In this article, we argue that the subjective nature of pain has not sat comfortably with the objective nature of medical practice. We argue that the dominance of the biomedical paradigm, with a simplistic 'bottom-up' model of pain being an inevitable consequence of tissue damage, has been detrimental to the health and well-being of people living with persistent pain. Evidence from neuroscience suggests that bodily pain emerges as a perceptual inference based on a wide variety of contextual inputs to the brain. We argue that this supports community, societal and environmental solutions to facilitate whole-person care. We call for more salutogenic orientations to understand how people living with persistent pain can continue to flourish and function with good health. We suggest a need for 'upstream' solutions using community-based approaches to address cultural, environmental, economic and social determinants of health, guided by principles of equity, civil society and social justice. As a starting point, we recommend appraising the ways human society appreciates the aetiology, actions and solutions towards alleviating persistent pain.

Persistent pain is a major healthcare challenge. Most approaches to tackle pain involve medical treatments to relieve pain once it has become a problem. There has been little research into the role of activities that promote health and well-being on pain. We argue that there needs to be more research on how people living with persistent pain can continue to flourish and function with good health. We suggest that there needs to be more attention given to health promotion and community-based approaches to tackle persistent pain and that more research is needed on cultural, environmental, economic and social factors that influence pain.

Incorporating personal narratives in positive psychology interventions to manage chronic pain.

In this perspective paper, we argue for incorporating personal narratives in positive psychology interventions for chronic pain. Narratives refer to the telling and retelling of events. Narratives detail accounts of events and provide rich, in-depth information on human interactions, relationships, and perspectives. As such, narratives have been used to understand people's experiences with pain and pain coping mechanisms-as well as to facilitate therapeutic outcomes. Furthermore, narrative research has shown that narration can help restore and promote relief, calm, hope, self-awareness, and self-understanding in chronic pain sufferers. Positive psychology interventions have been successful in improving the lives of people living with chronic pain, but these psychology interventions do not typically incorporate personal narratives. Still, narrative, and positive psychology scholarship foci overlap, as both aim to enhance people's quality of life, happiness, and well-being, and to promote the understanding of psychosocial strengths and resources. In this article, we provide a rationale for incorporating personal narratives as an agentic form of positive psychology intervention. To that aim, we outline areas of convergence between positive psychology and narrative research and show how combining positive psychology exercises and narration can have additive benefits for pain sufferers. We also show how integrating narration in positive psychology intervention research can have advantages for healthcare research and policy.

A meta-analysis investigating the outcomes and correlation between heart rate variability biofeedback training on depressive symptoms and heart rate variability outcomes versus standard treatment in comorbid adult populations.

BACKGROUND AND AIM: Heart rate variability biofeedback (HRVB) has previously been used to ameliorate depressive symptoms but its uses for tackling depressive symptoms in an array of comorbid adult patients is less established. This meta-analysis aims to evaluate whether HRVB is a useful tool to reduce depressive symptoms and improve HRV relative to standard treatment in adult comorbid populations, while also attempting to establish the association between the two outcomes. METHODS: An extensive literature review was conducted using several databases including PubMed, Cinahl, Medline, Web of science and clinical.gov/UK register. A total of 149 studies were identified with 9 studies, totalling 428 participants were analysed using a random effects model. RESULTS: Depressive outcomes yielded a mean effect size g=0.478 (CI 95% 0.212, 0.743) with HRV outcomes, yielding a mean effect size of g=0.223 (95% CI 0.036 to 0.411). Total heterogeneity was non-significant for depressive outcomes (Q= 13.77, p=0.088 I^=42.86%) and HRV (Q= 1.598, p=0.991, I^=0.000%) which indicates that little variance existed for the included studies. CONCLUSIONS: In summary, the outcomes demonstrate that HRVB can improve both clinically relevant depressive symptoms and physiological HRV outcomes in various comorbid conditions in adult populations, while the correlation between the two was moderately negative, but non-significant.

Understanding chronic pain in the ubiquitous community: the role of open data.

The combined use of social media, open data, and Artificial Intelligence has the potential to support practitioners and empower patients/citizens living with persistent pain, both as local and online communities. Given the wide availability of digital technology today, both practitioners and interested individuals can be connected with virtual communities and can support each other from the comfort of their homes. Digital means may represent new avenues for exploring the complexity of the pain experience. Online interactions of patients, data on effective treatments, and data collected by wearable devices may represent an incredible source of psychological, sociological, and physiological pain-related information. Digital means might provide several solutions that enhance inclusiveness and motivate patients to share personal experiences, limiting the sense of isolation in both rural and metropolitan areas. Building on the consensus of the usefulness of social media in enhancing the understanding of persistent pain and related subjective experiences via online communities and networks, we provide relevant scenarios where the effectiveness and efficiency of healthcare delivery might be improved by the adoption of the digital technologies mentioned above and repeated subsequently. The aim of this perspective paper is to explore the potential of open data, social media, and Artificial Intelligence in improving the prevention and management of persistent pain by adopting innovative non-biomedical approaches.

How Does a Sport Psychological Intervention Help Professional Cyclists to Cope With Their Mental Health During the COVID-19 Lockdown?

All around the world in March, due to COVID-19, competitive sport calendars were suddenly canceled, jeopardizing the training programs of athletes. Moreover, in Italy, the government banned all non-essential travel across the entire country from the beginning of March. Consequently, Italian cyclists were banned from leaving their homes and therefore unable to perform their ordinary training activities. The Italian Association of Professional Cyclists (ACCPI) early on during that period noticed that several cyclists were experiencing a worrying decrease in their mental well-being and asked the authors to set up an online Sport Psychology Intervention (SPI) during lockdown to enhance the athletes' mental health. Through a number of unprecedented events and considerations, the aim of the current investigation was to assess the Italian cyclists' mental health during the lockdown and its changes after the SPI. We validated the Italian version of the Sport Mental Health Continuum Short Form (Sport MHC-SF)-presented in Study 1-and then applied it to a sample of Italian professional cyclists-presented in Study 2-prior to and after the SPI. To achieve these objectives, the reliability and construct validity of the Italian version of the Sport MHC-SF were tested in Study 1. RM-MANOVA tests were run to evaluate the effect of SPI on cyclists in Study 2. A total of 185 Italian athletes were involved in the validation of the MHC in Study 1 and 38 professional cyclists in Study 2. Results from Study 1 suggested a three-factor higher order model of Sport MHC-SF [Model fit: χ2(df) = 471.252 (252), p < 0.000; CFI = 0.951; RMSEA = 0.049; RMR= 0.048]. MCFA showed that the default model kept invariance among groups of athletes (i.e., female, male, individual, and team sports). Results from Study 2 highlighted that professional cyclists who followed the SPI were able to cope better with psychological stressors, showing improved well-being compared to the athletes that did not. No significant differences were found for emotional and social well-being. The present multi-study paper contributes to the theoretical field with a validated measure of Sport MHC-SF translated in the Italian language and culture. It also provides practical implications related to cases of reduced mental health due to injury, illness, or similar situations of home confinement in the future.

Baring all: The impact of the hospital gown on patient well-being.

Objectives The importance of personalized and dignified care is increasingly being recognized in health care policy and practice. Despite the known impact of clothing on social identity and self-expression, the impact of hospital clothing on patient well-being has been widely overlooked. Patients are often required to wear hospital clothing, commonly a backless gown, during medical procedures and surgeries. The impact of wearing patient clothing on well-being, during this time of vulnerability, was explored. Design A sequential multi-method approach consisting of two studies. Methods Two studies were carried out to consider the impact of the hospital gown on well-being among adults with and without chronic health conditions. The first study consisted of conducting in-depth, semi-structured interviews (n = 10) with adults living with a lifelong chronic health condition (congenital heart disease). The second study was a cross-sectional online survey exploring adults' views (n = 928) and experiences of wearing the hospital gown. Results Qualitative analysis identified the following master themes: (1) symbolic embodiment of the 'sick' role, (2) relinquishing control to medical professionals, and (3) emotional and physical vulnerability. Quantitative analysis of the online survey data indicated that adults often reported wearing the hospital gown despite a lack of medical necessity. Its design was considered to be not fit for purpose and lacking in dignity. Conclusions The implications of these findings for health policy and practice are discussed, emphasizing the importance of challenging cultural norms in health care since dehumanizing aspects of care, as symbolically represented by the hospital gown, may adversely impact on patient well-being. Statement of contribution What is already known Getting dressed is a form of self-expression, which contributes to the construction of social identity, yet few studies have explored the impact of wearing hospital clothing on patient well-being. The few studies on hospital clothing that exist suggest it is predominantly associated with feeling depersonalized, stigmatized, and devitalized, being in the 'patient role', low status, and a lack of control and privacy. However, previous studies include a variety of hospital clothing including pyjamas (Edvardsson, 2009) and dressing gowns (Topo & Iltanen-Tähkävuori, 2010), whereas in the United Kingdom, a 'one-size-fits-all' backless gown, held together with ties at the back, is most commonly used. What this study adds This study furthers understanding about the lived experience of wearing hospital clothing for people living with a chronic health condition (congenital heart disease) and without. Wearing hospital clothing (most commonly the hospital gown) was associated with symbolic embodiment of the 'sick' role, relinquishing control to medical professionals, and emotional and physical vulnerability for people living with a chronic health condition. Findings from a wider sample, drawn from the general population, suggest that the hospital gown is often being used despite a lack of medical necessity often leaving patients feeling exposed, self-conscious, vulnerable, uncomfortable, cold, embarrassed, and disempowered. These findings are exacerbated for people living with a long-term health condition and women. Together, these studies suggest that the current design of the hospital gown is not fit for purpose and impacts negatively on patient well-being.

Flow theory - goal orientation theory: positive experience is related to athlete's goal orientation.

The main purpose of this study was to examine the relationship between flow experience and goal orientation theory, as well as, the differences in flow experience based on the orthogonal model of goal orientation theory. Two hundred and seventy eight athletes completed the Task and Ego Orientation Sport Questionnaire based on how they usually feel. The challenge and skills ratings were completed 1 h before the competition, based on how they felt at the exact time of answering. In the following, the Flow State Scale-2 was completed up to 30 min after the competition they just participated, along with the challenge-skill ratings, based on how athletes felt during the competition. The results indicated that the athletes' task orientation may be an important factor for attaining flow in competitive sport, feeling more skillful and estimating the upcoming competition as challenging, while low ego and low task oriented athletes lack these elements, which are important for them to get into flow. Additionally, not the level of task and ego orientation per se, but the balance between athletes' goal orientation preferences seems important for the formation of flow experience, indicating that high task - high ego and high task - low ego athletes are experiencing the most positive mental state.