A Feasibility Study of Pain Neuroscience Education and Exercise for Community-Dwelling Older Adults With Chronic Pain.

BACKGROUND AND PURPOSE: Pain prevalence in older adults is high and greatly impacts their functioning. The primary aim of this study was to determine the feasibility of an intervention consisting of pain neuroscience education (PNE) plus exercise for community-dwelling older adults attending primary care, by assessing recruitment rates (inclusion, refusal, and exclusion rates), adverse events, and acceptability of the intervention. Secondary aims were to establish suitable procedures for delivering the intervention and assess the feasibility of data collection for psychosocial and physical functioning. METHODS: A mixed-methods feasibility study with 2 groups was conducted. One group received 8 weekly 75-minute sessions of PNE plus exercise (PNE+E) and the other received usual care (UC), which consisted of appointments with the general practitioner. Inclusion, refusal, exclusion, and retention rates, dropouts, and adverse events were assessed. The Brief Pain Inventory, the Pain Catastrophizing Scale, the Tampa Scale, the Geriatric Depression Scale, the World Health Organization Disability Assessment Schedule, the 4-meter walk gait speed test and the 5 times sit-to-stand tests were used for assessment. A focus group interview was conducted with participants from the PNE+E group. Descriptive statistics were used for quantitative data and thematic analysis for qualitative data. RESULTS AND DISCUSSION: Of 61 participants recruited, 33 (PNE+E = 22; UC = 11) entered the study, and 24 completed the intervention (PNE+E = 15; UC = 9). The inclusion rate was 54%, the refusal rate was 21%, the exclusion rate was 35%, the dropout rate was 32% in the PNE+E and 18% in the UC, and the retention rate was 68% in the PNE+E group and 82% in the UC group. No adverse events were reported and the intervention was well accepted by participants. Data collection for the clinical outcomes was feasible and results suggested higher improvements in the PNE+E group than in the UC group. CONCLUSION: PNE+E is possible to implement, safe, and well accepted by community-dwelling older adults independent of their education level. This study informs future studies on practical and methodological strategies that should be considered when designing a PNE+E intervention for older adults, such as adapting the language of the PNE to participants, using relatable metaphors, and encouraging written and exercise homework.

Pain Neuroscience Education and Exercise for Neck Pain: A Focus Group Study on Adolescents' Views.

PURPOSE: To explore the views of adolescents with chronic idiopathic neck pain toward an intervention consisting of pain neuroscience education and exercise administered in the school setting. METHODS: Four focus group interviews were conducted with 21 adolescents with chronic idiopathic neck pain who participated in a 4-week intervention consisting of pain neuroscience education and exercise. The interviews were transcribed verbatim and analyzed using content analysis. RESULTS: Two main themes emerged: the perceived relevance of acquired knowledge and the perceived adequacy of the intervention. CONCLUSION: An intervention consisting of pain neuroscience education and exercise administered in the school setting is well accepted and considered relevant and appropriate by adolescents with chronic idiopathic neck pain.

Musculoskeletal Multisite Pain and Patterns of Association After Adjusting for Sleep, Physical Activity, and Screen Time in Adolescents.

STUDY DESIGN: Cross-sectional. OBJECTIVE: This study aims to describe how pain at multiple body sites is associated after controlling for other predictive factors such as age, sex, sleeping hours, time spent in physical activity, and time spent in screening based activities in adolescents aged 13 to 19 years. SUMMARY OF BACKGROUND DATA: The prevalence of multisite pain in adolescents is high, but studies investigating the patterns of association between painful body sites are scarce. METHODS: Pain for the last 3 months was assessed using Nordic Musculoskeletal Questionnaire. In addition, data on time spent in moderate and vigorous physical activity, sleeping, and in screen based activities were also assessed. RESULTS: In univariable analysis of associations, there is a significant association between most painful body sites (odds ratio [OR\ between 1.52 and 3.73, P < 0.05). After controlling for age, sex, physical activity, sleep and screen time, most of the previous associations remain significant (OR between 1.50 and 3.07, P < 0.05). CONCLUSION: This study's results seem to suggest that pain at one body site is more important in determining multiple painful body sites than demographic or lifestyle factors. Longitudinal studies exploring the association and chronology of multisite pain are needed. LEVEL OF EVIDENCE: 3.

The effects of pain neuroscience education and exercise on pain, muscle endurance, catastrophizing and anxiety in adolescents with chronic idiopathic neck pain: a school-based pilot, randomized and controlled study.

PURPOSE: To compare the effectiveness of pain neuroscience education (PNE) and neck/shoulder exercises with no intervention in adolescents with chronic idiopathic neck pain (CINP). METHODS: Forty-three adolescents with CINP were randomly allocated to receive PNE and shoulder/neck exercises (n = 21) or no intervention (n = 22). Data on pain intensity, neck flexor and extensor muscles endurance, scapular stabilizers endurance, pain catastrophizing, anxiety, and knowledge of pain neurophysiology were collected. Measurements were taken before and after the intervention. RESULTS: All participants completed the study. Analysis using ANCOVA revealed a significant increase in the neck extensors endurance capacity (adjusted mean ± SE change = + 47.5 ± 13.5 s versus +14.2 ± 13.1 s) and knowledge of pain neurophysiology (adjusted mean ± SE change = + 9.8 ± 3.2 versus -0.6 ± 0.6) in the group receiving the intervention. A higher mean decrease in pain intensity, pain catastrophizing and anxiety and a higher mean increase in the scapular stabilizers endurance capacity were also found in the intervention group, but differences did not reach statistical significance. CONCLUSIONS: Results suggest a potential benefit of PNE and exercise for adolescents with CINP. Further studies with larger sample sizes are needed.

Chronic pain in high school students is associated with physical activity and sleeping hours but not with screen time.

Background Existing studies on the association between physical activity (PA), screen based time and sleeping show conflicting results. Objective This study investigates the association between chronic pain at different body regions and self-reported PA, screen based time and sleeping hours in high school students. Subjects A total of 969 students aged 13-19 years old. Methods Participants completed a questionnaire on chronic pain, time spent in moderate and vigorous PA, screen based time watching televivsion (TV)/digital versatile discs (DVD), playing, using mobile phones and computers and sleeping hours. Univariate and multivariate associations between pain and PA, screen based time and sleeping hours were investigated. Results In the univariate model time spent in moderate and vigorous PA, in screen based activities and sleeping were associated with pain in at least one body site. In the multivariate model, screen based activities were not associated with pain; sleeping 7 h or less and increased time in moderate PA were associated with pain at almost all body sites [odds ratio (OR) between 2.69-3.66 and 1.06-1.10, respectively]. Conclusion Time spent in PA and sleeping increased the risk of chronic pain in almost all body regions and might confound the association between screen based time and pain.

Pain, pain intensity and pain disability in high school students are differently associated with physical activity, screening hours and sleep.

BACKGROUND: Studies exploring the association between physical activity, screen time and sleep and pain usually focus on a limited number of painful body sites. Nevertheless, pain at different body sites is likely to be of different nature. Therefore, this study aims to explore and compare the association between time spent in self-reported physical activity, in screen based activities and sleeping and i) pain presence in the last 7-days for 9 different body sites; ii) pain intensity at 9 different body sites and iii) global disability. METHODS: Nine hundred sixty nine students completed a questionnaire on pain, time spent in moderate and vigorous physical activity, screen based time watching TV/DVD, playing, using mobile phones and computers and sleeping hours. Univariate and multivariate associations between pain presence, pain intensity and disability and physical activity, screen based time and sleeping hours were investigated. RESULTS: Pain presence: sleeping remained in the multivariable model for the neck, mid back, wrists, knees and ankles/feet (OR 1.17 to 2.11); moderate physical activity remained in the multivariate model for the neck, shoulders, wrists, hips and ankles/feet (OR 1.06 to 1.08); vigorous physical activity remained in the multivariate model for mid back, knees and ankles/feet (OR 1.05 to 1.09) and screen time remained in the multivariate model for the low back (OR = 2.34. Pain intensity: screen time and moderate physical activity remained in the multivariable model for pain intensity at the neck, mid back, low back, shoulder, knees and ankles/feet (Rp2 0.02 to 0.04) and at the wrists (Rp2 = 0.04), respectively. Disability showed no association with sleeping, screen time or physical activity. CONCLUSIONS: This study suggests both similarities and differences in the patterns of association between time spent in physical activity, sleeping and in screen based activities and pain presence at 8 different body sites. In addition, they also suggest that the factors associated with the presence of pain, pain intensity and pain associated disability are different.