Prevalence of neck pain and its associated factors in Africa: a systematic review and meta-analysis protocol.

INTRODUCTION: Neck pain is one of the most prevalent musculoskeletal pain conditions with multifactorial impact including pain, disability and reduced quality of life. To the best of our knowledge, no systematic review and meta-analysis is available to provide reliable data on the pooled prevalence of neck pain and its associated factors in Africa. Thus, the objective of this study is to describe a protocol for a systematic review and meta-analysis on the prevalence of neck pain and its associated factors in Africa. METHODS: This systematic review protocol has been designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). A systematic search will be conducted among six key electronic databases including PubMed/MEDLINE, Scopus, African Journals Online, EMBASE, CINAHL and Web of Science, from inception onwards. Population-based cross-sectional studies reporting prevalence of neck pain in the African continent will be included. The primary outcome will be the prevalence of neck pain, whereas the secondary outcomes will be the factors associated with neck pain prevalence. Two independent reviewers will screen the titles/abstracts and relevant full-text articles of potentially relevant studies. Data from eligible studies will be extracted using a customised data extraction form. The risk of bias and methodological quality of the included studies will be assessed using the Newcastle-Ottawa Scale and critical appraisal tool, respectively. A narrative synthesis will be used to summarise the prevalence estimates of neck pain and associated factors. However, if feasible, random-effects meta-analysis will be conducted with Revman V.5.4 software. Additionally, subgroup, sensitivity and publication bias analyses will be conducted. DISCUSSION: This will be the first systematic review and meta-analysis to systematically identify and synthesise available literature on the prevalence of neck pain and its associated factors in Africa. The results of this review may assist health professionals and policymakers to plan and implement evidence-based strategies that will lessen the burden of neck pain. ETHICS AND DISSEMINATION: Data from previously published studies will be collected and analysed and hence ethical approval will not be sought for this study. The results of this review will be disseminated through publication in a peer-reviewed academic journal and presentation at relevant academic conferences. PROSPERO REGISTRATION NUMBER: CRD42021273585.

Effectiveness of Hands-Off Therapy in the Management of Primary Headache: A Systematic Review and Meta-Analysis.

A number of hands-off therapies have been widely reported and are used in the management of headache. This systematic review and meta-analysis aimed to assess evidence supporting these therapies on selected headache outcomes. A systematic literature search for randomized clinical trials reporting on the effects of hands-off therapies for headache was performed in two electronic databases; PubMed and Web of Science (PROSPERO: CRD42018093559). Risk of bias was assessed using the Cochrane risk of bias tool. Meta-analysis was performed using Review Manager v5.4. Thirty-five studies, including 3,403 patients with migraine, tension-type or chronic headaches were included in the review. Methodological quality of the studies ranged from poor to good. Result-synthesis revealed weak to moderate evidence for aerobic exercises, relaxation training and pain education for reducing disability. Other hands-off interventions were either weak or limited in evidence. Meta-analysis of 22 studies indicated that the effect of hands-off therapies significantly differed from one another for pain intensity, disability and quality of life (p < 0.05). Relaxation training, aerobic and active/stretching exercises had significant effect on pain intensity and disability (p < 0.05). To conclude, few hands-off therapies were effective on selected headache outcomes. Evidence to support other hands-off therapies is limited by paucity of studies.

Pilot study on the effects of a culturally-sensitive and standard pain neuroscience education for Hausa-speaking patients with chronic neck pain.

PURPOSE: To pilot feasibility and assess preliminary effectiveness of standard and culture-sensitive Pain Neuroscience Education (PNE) among Hausa-speaking patients with Chronic Neck Pain (CNP). METHODS: Adverts (online & clinic-based) were used to recruit Hausa-speaking patients with nonspecific CNP in Kano, Nigeria. Selected participants were randomized to culture-sensitive PNE (CSPNE), standard PNE (PNE), or control groups. Each group received bi-weekly sessions of exercise therapy for 6 weeks. Two sessions of PNE plus a home-based session were administered before exercise therapy in the PNE groups. Primary (pain-intensity and disability) and secondary (pain-knowledge, pain catastrophizing, and quality of life) outcomes were measured. The study was pre-registered (PACTR201902788269426). RESULTS: Fifty-three (out of 64) participants met the inclusion criteria. The majority of them were recruited through radio adverts (83%). Interventions were successfully administered and data collection was completed for the participants. About 15% and 17% drop-out rate was recorded before intervention (post-randomization) and during follow-up, respectively. Main results indicated that significant within-group improvements in disability and pain knowledge scores were found in favor of the PNE groups. CONCLUSION: Culture-sensitive and standard PNE plus exercise therapy are feasible for Hausa patients with CNP, and current findings indicate support for reducing disability and increasing pain knowledge among them.Implications for rehabilitationBoth standard PNE and culture-sensitive PNE are feasible for administration as interventions for Hausa-speaking patients with CNP.Radio adverts may be necessary for patients recruitment in addition to specialists' referrals.Culturally sensitive PNE materials may be more desirable as an intervention option due to the low literacy level among the Hausa population.

Religious Beliefs and Attitudes in Relation to Pain, Pain-Related Beliefs, Function, and Coping in Chronic Musculoskeletal Pain: A Systematic Review.

BACKGROUND: The biopsychosocial-spiritual model recognizes the impact of religious factors in modulating the experience of pain. Religious beliefs are factors that can influence perceptions, emotions, and behavior, all of which have important implications on health, pain experience, and treatment outcomes. OBJECTIVES: The aim of the present study was to identify if and how religious beliefs and attitudes can influence pain intensity, pain interference, pain-related beliefs and cognitions, emotions, and coping among patients with chronic musculoskeletal pain. STUDY DESIGN: Systematic review. METHODS: This systematic review was conducted and reported, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). An electronic search was conducted in 4 online databases (PubMed, Embase, Web of science, and PsychArticles) and complemented with a hand search (PROSPERO registry: CRD42020161289). Two reviewers independently performed eligibility screening, risk of bias assessment, and data extraction. The risk of bias of the included studies was assessed using the Newcastle Ottawa Scale. RESULTS: Nine cross-sectional studies and one case-control study were included in the review. The methodological quality of the included studies ranged from low to high. The results gathered regarding the association between religiosity and pain intensity, disability, or pain interference were found to be conflicting. Limited evidence suggests that religiosity is positively associated with worse pain-related beliefs and cognitions, worse pain-related emotion, and better pain acceptance. There is insufficient data available to support the claim that religiosity is negatively associated with physical functioning and pain-related self-efficacy in people with chronic musculoskeletal pain. LIMITATIONS: The number of included studies was small, with a low level of evidence, and a possible risk of bias. CONCLUSION: This systematic review shows low evidence and conflicting results for the presence of associations between religiosity and different pain domains such as pain intensity, disability, and pain-related cognitions or emotions in people with chronic musculoskeletal pain.

Development of culturally sensitive pain neuroscience education materials for Hausa-speaking patients with chronic spinal pain: A modified Delphi study.

This study aimed to develop culturally sensitive pain neuroscience education (PNE) materials for Hausa speaking patients with chronic spinal pain (CSP). PNE is a program of teaching patients about pain that has gained considerable attention in research and is increasingly used during physical therapy for patients with chronic pain. It helps in decreasing pain, disability, fear-avoidance, pain catastrophization, movement restriction, and health care utilization among patients with chronic pain. However, existing PNE materials and their application are limited to few languages and cultural inclinations. Due to the variations in pain perceptions, beliefs, and related outcomes among different population groups, culture-sensitive PNE materials addressing these outcomes are warranted. A focus-group discussion comprising 4 experts was used to adapt and develop preliminary PNE materials. Thereafter, an internet-based 3-round modified Delphi-study involving 22 experts ensued. Experts' consensus/recommendations concerning the content were used in modifying the PNE materials. Consensus was predefined as ≥75% level of (dis)agreement. Eighteen experts completed the Delphi rounds. Nineteen, 18 and 18 experts participated in rounds 1, 2 and 3 respectively, representing 86%, 94% and 100% participation rate respectively. Consensus agreement was reached in every round and content of the materials, including drawings, examples, figures and metaphors were adapted following the experts' suggestions. We therefore concluded that, culture-sensitive PNE materials for Hausa speaking patients with CSP were successfully produced. The present study also provides a direction for further research whereby the effects of culturally-sensitive PNE materials can be piloted among Hausa speaking patients with CSP.

Culture-sensitive and standard pain neuroscience education improves pain, disability, and pain cognitions in first-generation Turkish migrants with chronic low back pain: a pilot randomized controlled trial.

Purpose: To compare the effectiveness of culture-sensitive and standard pain neuroscience education (PNE) on pain knowledge, pain intensity, disability, and pain cognitions in first-generation Turkish migrants with chronic low back pain (CLBP).Methods: Twenty-nine Turkish first-generation migrants with CLBP were randomly assigned to the culture-sensitive (n = 15) or standard PNE (n = 14) groups. Primary (pain knowledge, pain intensity, and disability) and secondary outcomes (pain beliefs, catastrophization, and fear of movement) were evaluated at baseline, immediately after the second session of PNE (week 1), and after 4 weeks.Results: There was a significant main effect of time in pain knowledge (p < .001), pain intensity (p = .03), disability (p = .002), organic and psychological pain beliefs (p = .002, p = .01), catastrophization (p = .002), and fear of movement (p = .02). However, no significant difference was found between groups in terms of all outcome measures (p > .05).Conclusions: Both PNE programs resulted in improvements in knowledge of pain, pain intensity, perceived disability, and pain cognitions. Nevertheless, the superiority of the culture-sensitive PNE approach could not be proved. Therefore, maybe migrants who are living in the host country for longer length of time do not need culturally adapted therapies due to cultural integration, while these adaptations might be essential for the recent migrants or the autochthonous population in Turkey. Further research is required to investigate the effects of culture-sensitive PNE alone or in combination with physiotherapy interventions in recent migrants or Turkish natives with CLBP.

Views and experiences of discharged COVID-19 patients in Kano, Nigeria: a qualitative study.

INTRODUCTION: COVID-19 has spread globally, thereby contributing to substantial hospitalisation rates and morbidity. However, little or no information is available on the experiences of patients with COVID-19 in an African-setting. The study aimed to explore the experiences of patients with COVID-19. METHODS: semi-structured interviews were conducted via telephone with eleven individuals who were managed and discharged due to COVID-19. A descriptive phenomenological approach to qualitative research was employed and participants were mainly asked about their experiences before, during and after hospitalisation for COVID-19. Data were analysed using thematic analysis. RESULTS: patients' viewpoints were suggestive of community and secondary transmission of COIVD-19 in the study area. A few participants experienced severe symptoms. Most participants tend to resign their condition to fate; while some displayed unfounded conspiracy theories. Nevertheless, precautionary measures to prevent infection were largely observed. COVID-19 also negatively affected activities of daily living of the participants. Furthermore, the participants were generally satisfied with quality of care provided. However, areas of patients' education, isolation centre set-up and caregiver-patient interaction needed further improvements. Lastly, experience of fear and stigma during post-hospitalisation were common. CONCLUSION: COVID-19 impacted negatively on the lives of the studied population. However, their experience during hospitalisation was generally positive.

Development of culturally sensitive Pain Neuroscience Education for first-generation Turkish patients with chronic pain: A modified Delphi study.

BACKGROUND: Pain Neuroscience Education (PNE) has been recognized as an efficacious approach for chronic pain, but evidence for these findings have mainly been gathered in Caucasian patient populations. In recent years, it has been proposed that the treatment of pain and patient information materials should be culturally sensitive for different ethnic populations and cultures since cultural variations in pain beliefs and cognitions. OBJECTIVES: To culturally adapt PNE material for first-generation Turkish patients with chronic pain. DESIGN: A modified Delphi study with three consecutive rounds. METHOD: A total of 10 participants (8 experts and 2 first-generation Turkish patients with chronic pain) were recruited for this study. Three online questionnaire rounds were conducted to synthesize the perspectives and to reach agreement on the suggested PNE materials. RESULTS: Results on multiple-choice questions from the first round revealed that the compatibility of the visual information and the clarity of the message obtained lower scores. Examples, visual information (illustrations, pictures), and metaphors in the teaching materials and the home education leaflet were revised based on suggestions in Rounds 1 and 2. In Round 3, respondents reached an acceptable agreement level for the clinical usefulness of the PNE teaching materials and the home education material. CONCLUSIONS: Culturally sensitive PNE materials were produced for first-generation Turkish patients. Since the results of the present study only reveal perspectives of the experts, further validation of education materials may be required before they are recommended for Turkish patients in clinical practices.

Are Pain Beliefs, Cognitions, and Behaviors Influenced by Race, Ethnicity, and Culture in Patients with Chronic Musculoskeletal Pain: A Systematic Review.

BACKGROUND: Chronic pain has been considered as a biopsychosocial condition in which cognitive and emotional factors as well as biological factors significantly affect perception of pain. Race, ethnicity and culture have a crucial impact on illness beliefs, health care preferences, help-seeking behaviors, and acceptance of medical interventions. OBJECTIVES: The aim of the present study was to systematically review the current evidence regarding the racial, ethnic and cultural alterations and differences in pain beliefs, cognitions, and behaviors in patients with chronic musculoskeletal pain (MSKP). STUDY DESIGN: Systematic review. METHODS: This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines (PRISMA). PubMed and Web of Science were searched. A first screening was conducted based on title and abstract of the articles. In the second screening, full-texts of the remaining articles were evaluated for the fulfilment of the inclusion criteria. The risk of bias was assessed with the modified Newcastle-Ottawa Scale. RESULTS: A total of 11 articles were included. The methodological quality of the included studies ranged from low to moderate. There is moderate evidence that African-Americans use more praying, hoping, and emotion-focused coping strategies than Caucasians. There is also preliminary evidence regarding the differences in some coping strategies such as distraction, catastrophizing, and problem-focused solving between African-Americans and Caucasians. Preliminary evidence exists regarding the differences in pain coping strategies between the US and Portugal; the US and Singapore; and among 4 French-speaking countries. It is found that Spanish patients with fibromyalgia (FM) have more negative illness perceptions than Dutch patients. There is preliminary evidence that Caucasians have higher self-efficacy than African-Americans. There is also preliminary evidence that New Zealanders have more internal health expectancies than patients from the US. Preliminary evidence is demonstrated that Caucasians with rheumatoid arthritis (RA) have more positive control beliefs than African-Americans. Lastly, there is preliminary evidence that patients from the US believe that they are more disabled, while Singaporeans interpret the pain more by a traditional biomedical perspective. LIMITATIONS: Only 11 articles were included. The small number of articles, wide range of assessment methods, and substantial risk of bias in the included studies led the investigator to draw conclusions cautiously. CONCLUSION: Preliminary to moderate evidence shows the differences in coping strategies, illness perceptions, self-efficacy, fear avoidance beliefs, locus of control, and pain attitudes in different populations. Further prospective and longitudinal studies using standard definitions for race, ethnicity or culture and valid questionnaires for each population are warranted to explore the racial, ethnic and cultural discrepancies in pain beliefs, cognitions, and behaviours. KEY WORDS: Chronic pain, musculoskeletal pain, pain beliefs, pain cognitions, pain behaviors, race, ethnicity, culture.

Central Poststroke Pain: Its Profile among Stroke Survivors in Kano, Nigeria.

BACKGROUND: Central poststroke pain (CPSP) caused by sensory dysfunction of central origin is a disabling condition that significantly affects the quality of life of stroke patients. AIM: The aim of this study is to determine the clinical profiles and pattern of CPSP among stroke patients in Kano, Nigeria. METHODS: The study was a cross-sectional design involving stroke survivors who were ≥18 years old and with no significant cognitive impairment approved by the Research Ethics Committee of Aminu Kano Teaching Hospital. Participants were assessed using diagnostic criteria form, the douleur neuropathique 4 questions (DN4 questionnaire), and Leeds assessment of neuropathic symptoms and signs (LANNS). RESULTS: A total of 120 stroke patients participated in the study, in which 6 (5%) were diagnosed with CPSP occurring within the first 3 months in 50% of the participants. The pain characteristics were mainly moderate (83.3%), burning (62.5%), and continuously experienced (66.7%). The frequently affected parts were extremities or occurring as hemisyndrome. CONCLUSION: Prevalence of CPSP following stroke is low. The clinical features are variable and can occur at a varied time and different intensities and locations. However, it majorly occurs within the first few months post stroke.