Phenotyping of chronic pain in breast cancer survivors: an original study using the cancer pain phenotyping (CANPPHE) Network multidisciplinary international guidelines.

PURPOSE: The primary aim of this cross-sectional study is to examine the prevalence of pain phenotypes in breast cancer survivors (BCS). A secondary aim entails examining whether health related quality of life differs between the main pain phenotypes in BCS. METHODS: BCS who experienced chronic pain were asked to complete the numeric pain rating scale for pain, Margolis pain diagram, and short form 36 (SF-36). Following administration of questionnaires and quantitative sensory examinations were applied. To determine the prevalence of the predominant type of pain, a recently proposed classification system by the Cancer Pain Phenotyping (CANPPHE) Network was used. RESULTS: Of the 86 female participants, 19 (22.09%) had dominant neuropathic pain, 18 (20.93%) had dominant nociceptive pain and 14 (16.28%) had dominant nociplastic pain. 35 participants (40.70%) were classified as having mixed pain. One-way ANOVA revealed a significant difference between the four pain groups for the SF-36 general health (F = 3.205, p = 0.027), social functioning (F = 4.093, p = 0.009), and pain (F = 3.603, p = 0.017) subscale scores. CONCLUSION: This study found that pain in BCS was mostly of mixed phenotype, followed by predominantly neuropathic and nociplastic pain. Furthermore, it was found that, compared to BCS with predominant neuropathic and nociceptive pain, BCS with predominant nociplastic pain have lower health related quality of life in the areas of bodily pain and social functioning.

Towards precision pain medicine for pain after cancer: the Cancer Pain Phenotyping Network multidisciplinary international guidelines for pain phenotyping using nociplastic pain criteria.

Pain after cancer remains underestimated and undertreated. Precision medicine is a recent concept that refers to the ability to classify patients into subgroups that differ in their susceptibility to, biology, or prognosis of a particular disease, or in their response to a specific treatment, and thus to tailor treatment to the individual patient characteristics. Applying this to pain after cancer, the ability to classify post-cancer pain into the three major pain phenotypes (i.e. nociceptive, neuropathic, and nociplastic pain) and tailor pain treatment accordingly, is an emerging issue. This is especially relevant because available evidence suggests that nociplastic pain is present in an important subgroup of those patients experiencing post-cancer pain. The 2021 International Association for the Study of Pain (IASP) clinical criteria and grading system for nociplastic pain account for the need to identify and correctly classify patients according to the pain phenotype early in their treatment. These criteria are an important step towards precision pain medicine with great potential for the field of clinical oncology. Within this framework, the Cancer Pain Phenotyping (CANPPHE) Network, an international and interdisciplinary group of oncology clinicians and researchers from seven countries, applied the 2021 IASP clinical criteria for nociplastic pain to the growing population of those experiencing post-cancer pain. A manual is provided to allow clinicians to differentiate between predominant nociceptive, neuropathic, or nociplastic pain after cancer. A seven-step diagnostic approach is presented and illustrated using cases to enhance understanding and encourage effective implementation of this approach in clinical practice.

The effectiveness of specific exercise types on cardiopulmonary functions in patients with ankylosing spondylitis: a systematic review.

The aim of this review was to assess the effectiveness of specific exercise types on pulmonary functions, aerobic and functional capacity in patients with ankylosing spondylitis (AS). A systematic search of Cochrane Database of Systematic Review, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, AMED, EMBASE (OVID) was conducted in January 2016. The outcome measures were spirometric measurements, chest expansion, 6 minute walk distance (6MWD), pVO2, Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The search strategy was applied with limitation of date and language and this initial electronic search resulted in 143 relevant studies. After duplicates were removed, the titles and abstracts of 52 articles were screened. Of these, 14 full-text articles met initial criteria and were retrieved for review, with eight studies meeting final inclusion criteria. Both specific and conventional exercise groups showed significant improvements in BASDAI and BASFI scores (p < 0.05) in patients with AS, although there was no significant difference between two exercise groups. As for pulmonary functions, the specific exercise groups have greater improvements than conventional group in spirometric measurement, chest expansion (p < 0.05). However, there was no significant difference between specific conventional exercise types in 6MWD (p > 0.05). Specific exercises are an effective adjuvant therapy to enhance cardiopulmonary functions in patients with AS; therefore, it is assumed that in addition to the medical treatments, specific exercise therapy might reduce the cardiopulmonary complications related with AS.

The validity and reliability of the Turkish version of the Fear of Pain Questionnaire for Children-Short Form (FOPQC-SF) in children and adolescents with juvenile idiopathic arthritis.

OBJECTIVE: The aim of this study was to investigate the validity and reliability of the Turkish version of the Fear of Pain Questionnaire for Children-Short Form (FOPQC-SF) in children/adolescents with juvenile idiopathic arthritis (JIA). METHODS: To evaluate validity of FOPQC-SF, 70 children/adolescents with JIA were included. Data were collected using Pediatric Quality Of Life Inventory 3.0. Module Arthritis (PedsQL), Childhood Health Assessment Questionnaire (CHAQ) and Juvenile Arthritis Disease Activity Score (JADAS).To determine the reliability of the FOPQC-SF, test-retest was performed at one-week intervals on participants who had not made any changes to their pharmacological treatment and had not received any additional treatment. RESULTS: With factor restrictions, items of Turkish version of FOPQC-SF were found acceptable for a 2-factor structure (fear:4 items; avoidance:6 items)(RMSEA = 0.058, GFI = 0.890, X2 = 40.667 X2/df = 1.196). With no restrictions, items of Turkish version of FOPQC-SF were found to be excellent for a 3-factor structure (fear:3 items; avoidance:4 items; other:3 items) (RMSEA = 0.036, GFI = 0.909, X2 = 34.465, X2/df = 1.077).The Cronbach's alpha value of Turkish version of FOPQC-SF total was 0.865 (good). The intraclass correlation coefficient (ICC2,1) was 0.865 (very high). Fear and avoidance subscales and total score of Turkish version of FOPQC-SF had low to moderate correlation with CHAQ-disability index, CHAQ-pain, CHAQ-global evaluation, JADAS, PedsQL-child total, PedsQL-parent total (r:-0.283/-0.452)(p < 0.05). Other subscale of Turkish version of FOPQC-SF had low to moderate correlation with CHAQ-disability index, CHAQ-pain, PedsQL-parent total (r:0.286/0.318) (p < 0.05). CONCLUSION: The Turkish version of FOPQC-SF was found to be clinically valid and reliable in children and adolescents with JIA.

Efficacy of adding pain neuroscience education to a multimodal treatment in fibromyalgia: A systematic review and meta-analysis.

The aim of this study was to investigate whether adding pain neuroscience education (PNE) to a multimodal approach has additional benefits in patients with fibromyalgia (FM). The methodology of this study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The methods and strategies applied in the study were registered in PROSPERO (CRD42021272246). A systematic search with related search terms in the PubMed, Ebsco (Academic Search Ultimate), Cochrane Library, Physiotherapy Evidence Database (PEDro), Medline (Ebsco), Cinahl (Ebsco), Scopus and Web of Science was conducted up to June 2021. Statistical analysis was performed with Comprehensive Meta-Analysis (CMA) software Version 3 (CMA V3, Biostat Inc) comparing before and after values of mean ± standard deviation (SD) data in both groups. The primary outcome of interest was severity of FM (Fibromyalgia Impact Questionnaire), whereas secondary outcomes were pain intensity (visual analog scale, numeric pain rating scale), catastrophizing (Pain Catastrophizing Scale), depression (Hospital Anxiety and Depression Scale [HADS]) and anxiety (HADS). The initial search strategy based on the range and language yielded 274 relevant studies and 4 of these studies met the final eligibility criteria for this study. A total of 612 patients were enrolled in the included studies. The meta-analysis showed that PNE groups were statistically more effective than the interventions applied in the control groups on severity of FM (standard mean difference [SMD] = -1.051; 95% CI = -1.309, -0.793; P < .000), pain intensity (SMD = -1.049; 95% CI = -1.400, -0.698; P < .000), catastrophizing (SMD = -0.893; 95% CI = -1.437, -0.348; P = .001), depression (SMD = -0.686; 95% CI = -0.849, -0.523; P < .000) and anxiety (SMD = -0.711; 95% CI = -0.869, -0.552; P < .000). This review demonstrates that adding PNE to a multimodal treatment including exercise therapy might be an effective approach for improving functional status, pain-related symptoms, anxiety and depression for patients with FM. There is a need for further studies, especially on the optimum duration and dosage of PNE sessions in FM.

Do Pilates exercises improve balance in patients with multiple sclerosis? A systematic review and meta-analysis.

INTRODUCTION AND PURPOSE: Balance problems are common in people with multiple sclerosis (MS). Pilates can also be treatment strategy for people with MS, but there is inadequate evidence to support or refute the efficacy of Pilates, especially on balance in MS patients. The aim of this study was to conduct a systematic review and meta-analysis to determine the effects of Pilates exercises on balance in people with MS. METHODS: We conducted a literature search of the Cochrane Library, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, OVID, Science Direct, and Scopus databases using the following search terms: multiple sclerosis, Pilates, core stability, balance, equilibrium, postural control. All content from the date of database inception to March 2021 was included in the search. RESULTS: The initial search strategy based on date range and language yielded 246 relevant records and eight of them were about both Pilates and MS. According to this evaluation, we found the significant advantage of Pilates on balance in patients with MS, when compared to the control group in the Berg Balance Scale (SMD=1.017; 95% CI=-0.040, 1.994; p = 0.041), Activities-Specific Balance Confidence Scale (SMD=0.604; 95% CI=-0.078, 1.130; p = 0.024), Timed Up and Go Test (SMD=0.944; 95% CI=-0.022, 1.867; p = 0.045). But in the Functional Reach Test (SMD=1.846; 95% CI=-0.080, 3.772; p = 0.060), we did not found any difference between groups. CONCLUSIONS: Pilates exercises might be an optional method for improving balance in MS patients, however, we need further robust studies to prove whether it is more effective than other physiotherapy interventions.

The effectiveness of pain neuroscience education combined with manual therapy and home exercise for chronic low back pain: A single-blind randomized controlled trial.

Objectives The aim of this study was to investigate the short- and mid-term effects of pain neuroscience education (PNE) combined with manual therapy (MT) and a home exercise program (HEP) on pain intensity, back performance, disability, and kinesiophobia in patients with chronic low back pain (CLBP). Methods: This study was designed as a prospective, randomized, controlled, single-blind study in which 69 participants were randomly assigned to three groups. Participants in Group 1 received PNE, MT, and the HEP, while Group 2 received MT and the HEP. Participants in the control group did the HEP only. All interventions lasted 4 weeks. The participants' pain intensity, disability, low back performance, and kinesiophobia were assessed. All assessments were executed before intervention, at 4 weeks, and at 12 weeks post-intervention by the same blinded physiotherapist. A mixed model for repeated measures was used for each outcome measure. Results: Analysis of pain level (p < .05), back performance (p < .05), disability (p < .05) and kinesiophobia (p < .05) revealed significant time, group, and time-by-group interaction effects. The participants in Group 1 exhibited greater improvement in terms of pain intensity and kinesiophobia compared to the participants in Group 2 and the control group. Level of disability was significantly decreased in both Group 1 and Group 2 compared to the control group. Conclusion: This study suggests that a multimodal treatment program combining PNE, MT, and HEP is an effective method for improving back performance and reducing pain, disability, and kinesiophobia in the short (4 weeks) and midterm (12 weeks).

Relationship between shoulder ultrasound findings and disease activity in patients with rheumatoid arthritis: A pilot study.

Objectives: The aim of this study was to investigate whether shoulder ultrasound (US) findings were associated with disease activity and pain level in rheumatoid arthritis (RA) patients. Patients and methods: Between April 2019 and November 2019, a total of 60 shoulders of 30 female patients with RA (mean age: 53.8±12.0 years; range, 30 to 65 years) were included. The patients were questioned about shoulder pain and their Disease Activity Score-28 (DAS28) was estimated. After clinical examination with shoulder impingement tests, both shoulders were evaluated by US. Results: Of 60 shoulders examined by shoulder US, the most common shoulder pathology was supraspinatus tendinopathy (n=33, 55%). The prevalence of subdeltoid bursitis on US was significantly higher in the group with moderate disease activity, compared to the group with low disease activity (p<0.05). There were no significant differences in the physical examination findings of patients with low and moderate disease activity. In terms of US findings, subscapularis tendinopathy, glenohumeral joint and acromioclavicular joint degeneration, and subacromial bursitis were more common in shoulders with a history of pain, compared to non-painful shoulders. Conclusion: Shoulder US may be useful for demonstrating shoulder involvement in patients with RA, independent of the presence of shoulder pain.

Turkish version of health care providers' pain and impairment relationship scale: Reliability and validity.

PURPOSE: To develop the Turkish version of the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS-TR) by conducting the linguistic and cultural adaptation and to examine the psychometric properties and reliability of the adapted version. METHODS: A double back-translation procedure was used to translate the questionnaire. Participants received an online survey package with the HC-PAIRS-TR, the Turkish version of Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT-TR), and Turkish Version of the Tampa Scale for Kinesiophobia (TSK-TR). Cronbach's alpha coefficient and item analysis were used to evaluate internal consistency. Intraclass correlation coefficient (ICC) was used to determine the test-retest reliability. Confirmatory factor analysis (CFA) and Rasch Analysis were performed. RESULTS: The study was conducted with 153 physiotherapists practicing in Turkey. Cronbach's alpha was 0.81. Test-retest reliability was high (ICC = 0.85, p < 0.001), the standard error of measurement was 4.96 (0.94% of mean), and minimal detectable change was 13.75 (26.06% of mean). HC-PAIRS-TR scores correlated significantly with scores for the biomedical factor of the PABS-PT-TR (r = 0.52, p = 0.00), biopsychosocial factor of PABS-PT-TR (r = 0.32, p = 0.00), and TSK-TR (r = 0.52, p = 0.00). According to CFA and Rasch Analysis, the 12 items version of HC-PAIRS-TR fits the one-factor model excellently. CONCLUSION: The HC-PAIRS-TR appears to be a reliable and valid questionnaire to measure Turkish physiotherapists' beliefs and attitudes about the relationship between low back pain and impairment. Future studies might be planned to validate this questionnaire for other health care providers.

Pain neuroscience education combined with usual treatment for fibromyalgia syndrome: A randomized controlled trial.

AIM: The aim of this study was to investigate the effectiveness of pain neuroscience education (PNE) in addition to usual treatment in patients with fibromyalgia syndrome. METHODS: Forty patients were randomized into 2 groups. The experimental group underwent PNE sessions over 6 weeks in addition to pharmacological treatment, and the control group was given only pharmacological treatment. The primary outcome measure was functional status and the secondary outcome measures were widespread pain pressure threshold and kinesiophobia level. All assessments were conducted before the intervention and at the end of the 6th and 12th weeks by the same blinded researcher. RESULTS: The intervention group had significantly greater improvement than the control group in terms of the mean total scores in the Fibromyalgia Impact Questionnaire (P = .001) and the Tampa Scale of Kinesiophobia (P = .001) with large effect sizes. The intervention group also had significantly greater improvement in the pain pressure threshold values of the cervical (P = .040), thoracic (P = .001), lumbar (P < .001), elbow (P = .005) and calf (P = .006) regions with moderate-to-large effect sizes. CONCLUSION: This study showed that the addition of 6-week PNE sessions to pharmacological treatment was successful in improving functional status, widespread pain pressure threshold, and level of kinesiophobia in patients with fibromyalgia syndrome during a 12-week follow-up period.

Preoperative pain neurophysiology education for lumbar radiculopathy: A randomized-controlled trial.

OBJECTIVES: This study aims to investigate the postoperative short-term effectiveness of preoperative pain neurophysiology education on pain severity, kinesiophobia, and disability in patients undergoing lumbar surgery for radiculopathy. PATIENTS AND METHODS: Between April 2019 and August 2019, a total of 41 patients (22 males, 19 females; mean age 52.1±9.5 years; range, 37 to 64 years) scheduled for lumbar radiculopathy surgery were randomized to receive either preoperative routine education only (control group, n=20) or a 70-min pain neurophysiology education in addition to preoperative routine education (intervention group, n=21). The patients were evaluated for the following outcomes prior to surgery (baseline) and at 12 weeks after surgery: low back pain and leg pain using Numeric Pain Rating Scale, disability using Oswestry Disability Index), and kinesiophobia using Tampa Scale for Kinesiophobia. RESULTS: There were no statistically significant differences in low back pain (p=0.121), leg pain (p=0.142), and the length of stay hospital (p=0.110) between the groups. However, the interaction effects of intervention group were superior to control group regarding disability (p=0.042) and kinesiophobia (p<0.001). CONCLUSION: The addition of pain neurophysiology education to routine education following lumbar radiculopathy surgery yields significant improvements for disability and kinesiophobia, although no additional benefits is seen regarding the pain severity and length of stay in hospital in the short-term.

Does pain neuroscience education improve pain knowledge, beliefs and attitudes in undergraduate physiotherapy students?

BACKGROUND: To evaluate the effect of a brief pain neuroscience education (PNE) session on physiotherapy students' knowledge of pain and their beliefs and attitudes about the treatment of patients with chronic low back pain. METHODS: This study was a single-center, cross-sectional study including 205 physiotherapy undergraduate students. The participants completed the Neurophysiology of Pain Questionnaire (NPQ) and Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). They then received a 70-min neuroscience education session covering the mechanisms and biopsychosocial aspects of chronic low back pain. The questionnaires were readministered immediately after the educational session and at 6 months posteducation. RESULTS: Our analysis included data from 156 participants (mean age: 20.9 ± 2.51, 69.8% women) who completed the questionnaires pre-, post-, and 6 months after the educational session. To assess the effect of the education on the scores of the questionnaires, a repeated-measures ANOVA was conducted. There was a significant interaction observed for NPQ over time (p = 0.00; η 2  = 0.654), for PABS-PT factor 1(p < 0.001; η2 = 0.50) and for PABS-PT factor 2 over time (p = 0.02; η 2  = 0.04) CONCLUSION: This study showed that a 70-min session of PNE improves the level of pain knowledge in undergraduate physiotherapy students and influences their beliefs and attitudes concerning chronic low back pain. These findings suggest that adding PNE to the curricula of physiotherapy and rehabilitation programs may be beneficial.

Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future.

Recently, the International Association for the Study of Pain (IASP) released clinical criteria and a grading system for nociplastic pain affecting the musculoskeletal system. These criteria replaced the 2014 clinical criteria for predominant central sensitization (CS) pain and accounted for clinicians' need to identify (early) and correctly classify patients having chronic pain according to the pain phenotype. Still, clinicians and researchers can become confused by the multitude of terms and the variety of clinical criteria available. Therefore, this paper aims at (1) providing an overview of what preceded the IASP criteria for nociplastic pain ('the past'); (2) explaining the new IASP criteria for nociplastic pain in comparison with the 2014 clinical criteria for predominant CS pain ('the present'); and (3) highlighting key areas for future implementation and research work in this area ('the future'). It is explained that the 2021 IASP clinical criteria for nociplastic pain are in line with the 2014 clinical criteria for predominant CS pain but are more robust, comprehensive, better developed and hold more potential. Therefore, the 2021 IASP clinical criteria for nociplastic pain are important steps towards precision pain medicine, yet studies examining the clinimetric and psychometric properties of the criteria are urgently needed.

Does taping in addition to physiotherapy improve the outcomes in subacromial impingement syndrome? A systematic review.

BACKGROUND: Taping is used with or without other interventions for many purposes, especially to manage pain and improve functional activity in patients with shoulder pain. OBJECTIVES: The aim of this review was to determine whether any taping technique in addition to physiotherapy care is more effective than physiotherapy care alone in patients with shoulder impingement syndrome. METHODS: A systematic search of Cochrane Database of Systematic Review, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, AMED, EMBASE (OVID), The Kinesio Kinesio® Taping Method, Kinesio® Tex Tape UK and International websites ( www.kinesiotaping.co.uk ; www.kinesiotaping.com ) was conducted to June 2015. The outcome measures were pain, disability, range of motion and muscle strength. As data were not suitable for meta-analysis, narrative synthesis were applied. RESULTS: Three randomized controlled trials and one controlled trial (135 patients) were included. The results were conflicting and weak on the effectiveness of taping as an adjunct therapy for improvement of pain, disability, range of motion and muscle strength. CONCLUSION: Clinical taping in addition to physiotherapy interventions (e.g. exercise, electrotherapy, and manual therapy) might be an optional modality for managing patients with shoulder impingement syndrome, especially for the initial stage of the treatment; however, we need further robust, placebo controlled and consistent studies to prove whether it is more effective than physiotherapy interventions without taping.