Effects of Lockdown Restrictions and Impact of Anxiety and Depression Symptoms in People With Chronic Pain During the Covid-19 Pandemic: A 13-Wave Longitudinal Study.

In early 2020, countries across the world imposed lockdown restrictions to curb the spread of the Covid-19 coronavirus. Lockdown conditions, including social and physical distancing measures and recommended self-isolation for clinically vulnerable groups, were proposed to disproportionately affect those living with chronic pain, who already report reduced access to social support and increased isolation. Yet, empirical evidence from longitudinal studies tracking the effects of prolonged and fluctuating lockdown conditions, and potential psychological factors mediating the effects of such restrictions on outcomes in chronic pain populations, is lacking. Accordingly, in the present 13-wave longitudinal study, we surveyed pain intensity, pain interference, and tiredness in people with chronic pain over the course of 11 months of the Covid-19 pandemic (April 2020-March 2021). Of N = 431 participants at baseline, average completion rate was ∼50% of time points, and all available data points were included in linear mixed models. We examined the impact of varying levels of lockdown restrictions on these outcomes and investigated whether psychological distress levels mediated effects. We found that a full national lockdown was related to greater pain intensity, and these effects were partially mediated by depressive symptoms. No effects of lockdown level were found for pain interference and tiredness, which were instead predicted by higher levels of depression, anxiety, pain catastrophising, and reduced exercise. Our findings are relevant for improving patient care in current and future crises. Offering remote management options for low mood could be particularly beneficial for this vulnerable population in the event of future implementation of lockdown restrictions. PERSPECTIVE: This longitudinal study demonstrates the impact of Covid-19 lockdown restrictions on people with chronic pain. Findings suggest a complex interaction of psychosocial factors that impacted various aspects of pain experience in patients, which offer the potential to inform clinical strategies for remote medicine and future crises.

A single bout of breast milk expression does not increase resting metabolic rate.

INTRODUCTION: Breastfeeding women have elevated resting metabolic rate (RMR); however, whether a single bout of lactation increases RMR is unknown. This study aimed to determine if a single bout of lactation acutely increased RMR. METHODS: Twenty-two lactating women (age: 31 ± 0.9 year, body mass index: 27.3 ± 1.2 kg/m2 ) were recruited. RMR was assessed at baseline and at 1- and 2-h following breast milk expression. RESULTS: RMR was unchanged in lactating women following a single bout of lactation (baseline: 1437 ± 39; 1 h: 1425 ± 37 2 h: 1440 ± 31 kcal/day) (p > .05). RMR was not correlated to daily milk produced (r = 0.05, p > .05), but was correlated to body mass (r = 0.74, p < .001), fat-free mass (kg) (r = 0.61, p < .01), and fat mass (kg) (r = 0.71, p < .01). CONCLUSION: RMR in lactating women appears to be more related to body mass or composition in the postpartum period rather than lactation.

Short-term removal of exercise impairs glycemic control in older adults: A randomized trial.

Postprandial glycemia (PPG) predicts cardiovascular disease, and short-term physical inactivity increases PPG in young, active adults. Whether this occurs in older, active adults who may be more prone to bouts of inactivity is unknown. This study determined if postprandial interstitial glucose (PPIG) was impaired in active older adults following the removal of exercise for 3 days (NOEX) compared to active young adults. In this randomized, crossover study, 11 older (69.1 ± 1.9 years) and 9 young (32.8 ± 1.8 years) habitually active (≥90 min/week of exercise) adults completed 3-days of NOEX and 3-days of normal habitual exercise (EX), separated by ≥1 week. Diet was standardized across phases. Glycemic control (3-day average) was assessed via continuous glucose monitoring during both phases. Significant main effects of age and phase were detected (p < 0.05), but no interaction was found for steps/day (p > 0.05) (old EX: 6283 ± 607, old NOEX: 2380 ± 382 and young EX: 8798 ± 623, young NOEX: 4075 ± 516 steps/day). Significant main effects of age (p = 0.002) and time (p < 0.001) existed for 1-h PPIG, but no effect of phase or interactions was found (p > 0.05). Significant main effects (p < 0.05) of age (old: 114 ± 1 mg/dl, young: 106 ± 1 mg/dl), phase (NOEX: 112 ± 1 mg/dl, EX: 108 ± 1 mg/dl), and time (0 min: 100 ± 2, 30 min: 118 ± 2, 60 min: 116 ± 2, 90 min: 111 ± 2, 120 min: 108 ± 2 mg/dl) in 2-h PPIG were detected, but no interaction was found (p > 0.05). However, only significant main effects of phase (NOEX: 14 ± 1 and EX:12 ± 1, p > 0.05) were found for 24-h blood glucose standard deviation. Older adults appear to have impaired glycemic control compared to young adults and exercise removal impairs glycemic control in both populations. Yet, the impairment in glycemic control with exercise removal is not different between old and young adults.

The association of moderate-to-vigorous and light-intensity physical activity on static balance in middle-aged and older-aged adults.

BACKGROUND: Falls are the leading cause of injury among adults ≥ 65 years of age. Participation in physical activity (PA) is associated with improved balance, though it is impact in the middle-age population is not well understood. AIM: The purpose of the current study was to examine the influence of PA intensity on static balance in middle-aged and older aged individuals. METHODS: Included were middle-aged adults (40-64 years) and older adults (≥ 65 years) from the 2003-2004 years of the National Health and Nutrition Evaluation Survey. Light physical activity (LPA) and moderate-vigorous physical activity (MVPA) were collected via accelerometer and static balance via the Romberg Test of Standing Balance. RESULTS: No significant odds ratio relationship was found between MVPA or LPA and having good static balance in the middle-aged population; 1.04 (95% CI 0.95, 1.13) p = 0.427 and 1.05 (95% CI 0.97, 1.14) p = 0.182, respectively. Whereas, in older adults, every 60-min increase in LPA was significantly associated with 28% higher odds of good balance (95% CI 1.15, 1.41; p < 0.001), and every 10-min increase in MVPA with 25% higher odds of good balance (95% CI 1.08, 1.45; p = 0.006). DISCUSSION: LPA and MVPA were not associated with good static balance in middle-aged adults, but in older adults LPA was significantly associated with good static balance. CONCLUSION: A significant relationship is found between age and fall risk, which is a major concern in the aging population.

Development of an interdisciplinary specialist facial pain management programme.

Aims: This article aims to describe the development of a specialist chronic facial pain (CFP) management programme within an already well-established pain management service, including the content from a multidisciplinary perspective, and present preliminary descriptive 6-month outcomes from patients who have attended the programme. Methods: Authors used their clinical experience of working with people who have a diagnosis of CFP. They researched available literature, liaised with CFP support organisations and visited an existing UK-based CFP programme. Programme content was designed based on findings. The roles of pain interdisciplinary team members involved in delivering the programme are described, as well as a brief description of the structure of the programme and programme sessions provided by each discipline. Results: Clinical outcomes from programme participants were collected at assessment, end of treatment and 6 months post-treatment, which measured relevant outcomes for a pain management programme (PMP). Outcomes from 36 participants at both end of programme and 6 months following completion of programme demonstrate promising improvements. Qualitative data from patient satisfaction questionnaires completed at the end of programme suggest that providing a CFP-specific programme was beneficial for participants, with the main critique being that the programme sessions should be longer than 45 minutes. Conclusion: Attending a CFP-specific programme demonstrated positive 6-month changes in relevant outcome measures for people with CFP. With a small sample size, there is a need for further research into the effectiveness. It would also be beneficial to compare outcomes from the usual PMP treatment with people who have CFP, with outcomes from a CFP-specific programme.

The association of physical activity on homocysteine in pregnant women.

INTRODUCTION: Women with high levels of physical activity have improved pregnancy, labor, and delivery outcomes related to cardiovascular health. Hyperhomocysteinemia, which predicts cardiovascular disease risk, is associated with maternal vascular complications during pregnancy, such as placental abruption and preeclampsia. However, studies are lacking on whether physical activity impacts homocysteine in pregnant women, pointing to a potential mechanism behind the improved cardiovascular health in women who exercise during pregnancy. The purpose of this study was to examine if women with high levels of physical activity have lower levels of homocysteine compared to women with low levels of physical activity. METHODS: This study was a secondary analysis using data from the 2003 to 2006 National Health and Nutrition Examination Survey. A total of 257 pregnant women were included. Physical activity was assessed objectively over seven days with accelerometers. High and low groups based on moderate-to-vigorous physical activity (MVPA) and steps/day were defined. Homocysteine and related laboratory biomarkers (vitamin B12, folate, pyridoxal 5'-phosphate) were assessed through blood draws. Data assembly was performed using SAS and analysis via SPSS Complex Samples. RESULTS: Only an estimated 17.7 ± 4.7% of women met guidelines to achieve at least 150 min per week of MVPA. Plasma homocysteine was not different between pregnant women with high and low levels of moderate-to-vigorous physical activity (4.39 ± 0.21 and 4.44 ± 0.17 µmol/L; p > .05) or between those with high and low levels of steps (3.95 ± 0.26 and 4.62 ± 0.27 µmol/L; p > .05) when the data was split into two quantiles by the median. These results were similar when using log-transformed values for homocysteine to normalize the distribution of data. Pregnant women in the group of the high steps tended to have higher vitamin B12, folate, and pyridoxal 5'-phosphate than those in the group of the low steps. Sensitivity analyses revealed that homocysteine was not different between the upper 25% (4.04 ± 0.22 µmol/L) and lower 25% (4.17 ± 0.26 µmol/L) MVPA (p = .716) but that it was statistically higher in the low (<5000 steps/day) (4.99 ± 0.20 µmol/L) steps/day group compared to high (>7500 steps/day) steps/day (3.99 ± 0.23 µmol/L) (p = .003) after excluding individuals with hypertension and thyroid/kidney issues. CONCLUSION: Maternal steps/day, but not MVPA, appear to be associated with homocysteine (albeit weakly) in the present study after excluding potential factors which impact homocysteine. The volume of physical activity appears to be an important indicator as this difference was not revealed until the physical activity was more distinctly separated.

Measurement of Post-Exercise Response of Local Arterial Parameters Using an Adjustable Microfluidic Tactile Sensor.

In this work, we demonstrate an adjustable microfluidic tactile sensor for measurement of post-exercise response of local arterial parameters. The sensor entailed a polydimethylsiloxane (PDMS) microstructure embedded with a 5×1 resistive transducer array. The pulse signal in an artery deflected the microstructure and registered as a resistance change by the transducer aligned at the artery. PDMS layers of different thicknesses were added to adjust the microstructure thickness for achieving good sensor-artery conformity at the radial artery (RA) and the carotid artery (CA). Pulse signals of nine (n=9) young healthy male subjects were measured at-rest and at different times post-exercise, and a medical instrument was used to simultaneously measure their blood pressure and heart rate. Vibration-model-based analysis was conducted on a measured pulse signal to estimate local arterial parameters: elasticity, viscosity, and radius. The arterial elasticity and viscosity increased, and the arterial radius decreased at the two arteries 1min post-exercise, relative to at-rest. The changes in pulse pressure (PP) and mean blood pressure (MAP) between at-rest and 1min post-exercise were not correlated with that of heart rate and arterial parameters. After the large 1min post-exercise response, the arterial parameters and PP all went back to their at-rest values over time post-exercise.Clinical Relevance- The study results show the potential application of an affordable, user-friendly device for a more comprehensive arterial health assessment.

Adverse effects of COVID-19-related lockdown on pain, physical activity and psychological well-being in people with chronic pain.

Countries across the world imposed lockdown restrictions during the COVID-19 pandemic. It has been proposed that lockdown conditions, including social and physical distancing measures, may disproportionately impact those living with chronic pain and require rapid adaptation to treatment and care strategies. Using an online methodology, we investigated how lockdown restrictions in the United Kingdom impacted individuals with chronic pain (N = 431) relative to a healthy control group (N = 88). Data were collected during the most stringent period of lockdown in the United Kingdom (mid-April to early-May 2020). In accordance with the fear-avoidance model, we hypothesised lockdown-related increases in pain and psychological distress, which would be mediated by levels of pain catastrophising. Responses indicated that people with chronic pain perceived increased pain severity, compared to their estimation of typical pain levels prior to lockdown (p < .001). They were also more adversely affected by lockdown conditions compared to pain-free individuals, demonstrating greater self-perceived increases in anxiety and depressed mood, increased loneliness and reduced levels of physical exercise (p ⩽ .001). Hierarchical regression analysis revealed that pain catastrophising was an important factor relating to the extent of self-perceived increases in pain severity during lockdown (ß = .27, p < .001) and also mediated the relationship between decreased mood and pain. Perceived decreases in levels of physical exercise also related to perceptions of increased pain (ß = .15, p < .001). Interestingly, levels of pain intensity (measured at two time points at pre and during lockdown) in a subgroup (N = 85) did not demonstrate a significant change. However, individuals in this subgroup still reported self-perceived pain increases during lockdown, which were also predicted by baseline levels of pain catastrophising. Overall, the findings indicate that people with chronic pain suffer adverse effects of lockdown including self-perceived increases in their pain. Remote pain management provision to target reduction of pain catastrophising and increase health behaviours including physical activity could be beneficial for this vulnerable population.

A Consideration of the Psychological Aspects to Managing Patients with Painful Diabetic Neuropathy: An Insight into Pain Management Services at a Tertiary Centre in the UK.

Painful diabetic neuropathy (pDN) is characterised by both sensory and affective disturbances, suggesting a complex bidirectional relationship of neuropathic pain and mood disorders. Data on pDN indicate that neuropathic pain reduces quality of life, including mood and physical and social functioning. Depression and pain coping strategies such as catastrophising and social support predict pain severity. There is a significant and reciprocal relationship between depressed mood and increased pain. The key features of assessing people with neuropathic pain in relation to psychological aspects of their health are discussed in the context of management in a tertiary pain management centre (The Walton Centre, Liverpool, UK) including cognitive behavioural interventions amongst others to improve the quality of life in patients with pDN. We consider psychological issues as a factor influencing treatment and outcome in patients with pDN.

Exploring the impact of pain management programme attendance on complex regional pain syndrome (CRPS) patients' decision making regarding immunosuppressant treatment to manage their chronic pain condition.

Objectives Complex regional pain syndrome (CRPS) is a rare chronic pain condition for which no curative treatment exists. Patients in tertiary centres are often required to make decisions about treatment options. This study was conducted to explore how prior attendance of a pain management program might alter patients' decision making processes. Methods This qualitative study uses focus groups to gather patient views on an immunosuppressant drug treatment (mycophenolate) for the management of CRPS. Participants were allocated to one of three focus groups based on their treatment journey; Group 1 (n=3) were involved in a recent mycophenolate drug trial; Group 2 (n=5) were neither involved in the trial nor attended a Pain Management Programme (PMP); Group 3 (n=6) were not involved in the trial but had attended a PMP. Outcomes were considered within the framework of Leventhal's Common Sense Model (CSM) in relation to the decision making process. Results Thematic analysis identified differing themes for each group. Group 1: (1) Medication as a positive form of treatment, (2) The trial/drug and (3) Pacing. Group 2: (1) Medication as form of treatment, (2) Other forms of support/treatment and (3) Side effects of mycophenolate. Group 3: (1) Varied view of medication, (2) Consideration of other forms of support and (3) Side effects. Conclusions Attendance on a PMP might provide patients with skills to better manage uncertainty when faced with various treatment options. Leventhal's model goes some way to explaining this. The specific importance of, and benefit from understanding pacing when commencing an effective drug treatment for chronic pain became apparent.

The Effects of Caffeine Mouth Rinsing on Exercise Performance: A Systematic Review.

Caffeine ingestion can improve performance across a variety of exercise modalities but can also elicit negative side effects in some individuals. Thus, there is a growing interest in the use of caffeine mouth rinse solutions to improve sport and exercise performance while minimizing caffeine's potentially adverse effects. Mouth rinse protocols involve swilling a solution within the oral cavity for a short time (e.g., 5-10 s) before expectorating it to avoid systemic absorption. This is believed to improve performance via activation of taste receptors and stimulation of the central nervous system. Although reviews of the literature indicate that carbohydrate mouth rinsing can improve exercise performance in some situations, there has been no attempt to systematically review the available literature on caffeine mouth rinsing and its effects on exercise performance. To fill this gap, a systematic literature search of three databases (PubMed, SPORTDiscus, and Web of Science) was conducted by two independent reviewers. The search resulted in 11 randomized crossover studies that were appraised and reviewed. Three studies found significant positive effects of caffeine mouth rinsing on exercise performance, whereas the remaining eight found no improvements or only suggestive benefits. The mixed results may be due to heterogeneity in the methods across studies, interindividual differences in bitter tasting, and differences in the concentrations of caffeine solutions. Future studies should evaluate how manipulating the concentration of caffeine solutions, habitual caffeine intake, and genetic modifiers of bitter taste influence the efficacy of caffeine mouth rinsing as an ergogenic strategy.

The context of litigation in evaluating physical and psychological outcomes from pain management programmes.

OBJECTIVES: There has been extensive research in evaluating chronic pain in the context of litigation while considering the implications that it can have on healthcare outcomes and rehabilitation progress. The aim of this article is to present retrospective observational data about the levels of disability and distress reported by patients with ongoing litigation at the start and following a UK-based multi-disciplinary pain management programme (PMP) when compared with those without litigation. METHOD: Between June 2014 and September 2017, 859 patients attended and completed a 16-day PMP at a tertiary-level National Health Service (UK) pain clinic. Patients were split into two groups: (1) litigation (n = 110) and (2) non-litigation (n = 749). As a part of the assessment procedure, the patients were given a battery of psychological and physical measures to complete over two time points. RESULTS: Patients with litigation are statistically significantly more distressed at assessment but make comparable clinically meaningful change in PMP intervention when compared with a non-litigation sample. A very small proportion of the variance in depression scores post-treatment is accounted for by the context of litigation (0.5%), which may be accounted for by employment status. There was no effect of litigation on physical outcome post-intervention. DISCUSSION: This article concludes that it is not appropriate to merely assume that the context of litigation results in limited positive psychological and physical outcomes post-PMP. There are some limitations to the clinical sample presented in respect to the conclusions.

Growing pains: understanding the needs of emerging adults with chronic pain.

BACKGROUND: Emerging adulthood (18-30 years), in the Western world, is often a time of identity development and exploration, focusing on areas of work, relationships and education. Individuals with chronic illnesses, such as chronic pain, may be more vulnerable to facing challenges during this time. This study aims to investigate the needs of young adults (YAs) attending a tertiary level National Health Service (NHS) Pain Management Programme (PMP) Service in the United Kingdom; exploring how these needs may translate on to clinical assessment and the delivery of rehabilitation interventions. METHOD: This is a descriptive qualitative study influenced by phenomenological approaches. YA with a diagnosis of chronic pain were recruited and assigned to one of four focus groups facilitated by a clinical psychologist and occupational therapist. A semi-structured interview guide was used to help facilitate the group discussion. RESULTS: Qualitative analysis identified four key themes in understanding the needs of YAs with chronic pain: (1) thwarted opportunities, (2) peer separation, (3) perceived illness validity in the context of age and (4) dependency/parental enmeshment. CONCLUSIONS: The emerging adulthood literature provides a valuable framework for examining a normal developmental trajectory and highlights the relevance of age-related processes in YAs with chronic pain. The idealisation of opportunity and the role of perception in this developmental phase both appear relevant. It is significant that emotional stability is not yet established in emerging adulthood and links to unhelpful management strategies that may be differentiated from older populations are identified.

The development and delivery of a female chronic pelvic pain management programme: a specialised interdisciplinary approach.

CONTEXT/BACKGROUND: Chronic pelvic pain (CPP) is a physically and psychologically debilitating condition. European Association of Urology (EAU) Guidelines (2013) and Royal College of Obstetricians and Gynaecologists (RCOG) guidelines (2012) place strong emphasis upon multi-speciality assessment and liaison, as well as interdisciplinary assessment and intervention in reference to the management of CPP. OBJECTIVES: The aim was to introduce and describe the development and delivery of an interdisciplinary pain management programme (PMP), at a Specialised Pain Management Centre in Liverpool, United Kingdom, for women diagnosed with CPP. METHOD: The format and content of the CPP PMP at The Walton Centre, Liverpool, is described and the preliminary results from the CPP PMP are presented. RESULTS: Preliminary data suggest that outcomes on the specialised CPP PMP indicate that patients are able to make clinically important change across a range of outcome measures. Moreover, these results compare favourably to the established PMP for generalised chronic pain when comparing clinically significant outcomes with the Walton Centre's (a tertiary-level pain management centre) 2013 PMP Audit document. Patients attending the CPP PMP positively appraised the PMP and felt it was useful and supportive to be in a group dedicated to CPP. CONCLUSIONS: This article presents some preliminary results that suggest there is value in delivering a specialised multidisciplinary PMP for this group. There is a clear need for further clinical research into the effectiveness of similar interventions for CPP, including the early identification of those CPP patients who may benefit from both multi-specialty and interdisciplinary management.