The effectiveness of a combined exercise and psychological treatment programme on measures of nervous system sensitisation in adults with chronic musculoskeletal pain - a systematic review and meta-analysis.

BACKGROUND: Quantitative sensory testing (QST) offers information regarding underlying mechanisms contributing to chronic pain (CP) in adults with musculoskeletal disorders. This review examined the use of QST measures in adults with CP following participation in a combined exercise and psychological intervention. METHODS: The review was conducted in accordance with the PRISMA guidelines. Five databases were searched from inception to November 2022. All study designs which evaluated the effects of a combined exercise and psychological treatment on measures of nervous system sensitivity in adults with chronic musculoskeletal pain were included. RESULTS: A total of 13 studies met the selection criteria, 10 of which were included in a meta-analysis. Local pressure pain thresholds were the most frequently used measure (n = 12 studies). Meta-analysis revealed statistically significantly improvements in favour of the combined exercise and psychological intervention group, compared to a control group, for local pressure pain threshold measures [SMD = 0.44, 95% CI 0.08-0.81, I2 = 84%], pain intensity scores [SMD=-0.89, 95% CI -1.66- -0.13, I2 = 94%] and the Central Sensitisation Inventory [SMD=-0.69, 95% CI -1.37- -0.02, I2 = 87%]. There were no significant differences found between groups for remote pressure pain thresholds, temporal summation or conditioned pain modulation. CONCLUSIONS: The results suggest that a combined exercise and psychological intervention may lead to greater improvements in local pressure pain threshold, pain intensity and Central Sensitisation Inventory scores when compared to a control intervention in adults with CP, however these findings must be interpreted with caution as a large degree of heterogeneity was present in these results (I2: 84-94%). Further large, longitudinal studies are required using standardised QST measurement procedures and patient reported outcome measures to explore changes in nervous system sensitisation. TRIAL REGISTRATION: This systematic review is registered with PROSPERO, ID Number CRD42022380464.

Pelvic organ prolapse: Women's experiences of Accessing Care & Recommendations for improvement.

Up to 50% of women will develop pelvic organ prolapse (POP) over their lifetime. Symptoms include pain, bulge, urinary, bowel and sexual symptoms affecting all aspects of a woman's life.Many women with POP symptoms present initially to primary care settings. Research has shown these interactions are often unsatisfactory, with women reporting their health care professional (HCP) trivialized their symptoms or appeared to have poor knowledge about pelvic floor dysfunction (PFD).Aim The aim of this qualitative study was to explore experiences of younger women seeking treatment for POP and their recommendations for improvements.Methods Ethics approval was obtained (LS-21-01-Carroll-Ful). Women with POP were recruited from an online support group (n = 930 members). Inclusion criteria: adult women, diagnosed with POP and aware of their POP stage. Following informed consent, a demographic questionnaire, interview questions and the Central Sensitization Inventory (CSI) were forwarded. Semi-structured zoom audio-recorded interviews were conducted. Thematic analysis was undertaken; transcripts coded, and themes identified.Results Fourteen women aged 32-41, parity 1-3, with POP Grade 1-3 participated. Many women reported HCPs as dismissive or not appreciative of the impact of their condition. Others described interactions with HCPs who they felt listened, understood the impact of their POP, gave simple explanations, a positive prognosis and outlined a realistic treatment plan.Current antenatal education, post-partum care and primary HCP screening for PFD were identified by women as deficient. Many highlighted delays in accessing specialist care for POP. Women made several recommendations for improvements to the current model of care.Conclusions Increased focus on person-centred care, particularly emotional support, information and education may improve younger women's experiences when seeking care for POP.

We Are All in This Together-Whole of Community Pain Science Education Campaigns to Promote Better Management of Persistent Pain.

Persistent pain is a major public health issue-estimated to affect a quarter of the world's population. Public understanding of persistent pain is based on outdated biomedical models, laden with misconceptions that are contrary to best evidence. This understanding is a barrier to effective pain management. Thus, there have been calls for public health-based interventions to address these misconceptions. Previous pain-focussed public education campaigns have targeted pain beliefs and behaviours that are thought to promote recovery, such as staying active. However, prevailing pain-related misconceptions render many of these approaches counter-intuitive, at best. Pain Science Education improves understanding of 'how pain works' and has been demonstrated to improve pain and disability outcomes. Extending Pain Science Education beyond the clinic to the wider community seems warranted. Learning from previous back pain-focussed and other public health educational campaigns could optimise the potential benefit of such a Pain Science Education campaign. Pain Science Education-grounded campaigns have been delivered in Australia and the UK and show promise, but robust evaluations are needed before any firm conclusions on their population impact can be made. Several challenges exist going forward. Not least is the need to ensure all stakeholders are involved in the development and implementation of Pain Science Education public messaging campaigns. Furthermore, it is crucial that campaigns are undertaken through a health equity lens, incorporating underrepresented communities to ensure that any intervention does not widen existing health inequalities associated with persistent pain. PERSPECTIVE: Public misconceptions about pain are a significant public health challenge and a viable intervention target to reduce the personal, social, and economic burden of persistent pain. Adaptation of Pain Science Education, which improves misconceptions in a clinical setting, into the public health setting seems a promising approach to explore.

Acceptability of the combined online interactive mindfulness and exercise programme (MOVE-Online) for adults with chronic pain - A qualitative study.

PURPOSE: The aim of this qualitative study was to utilise the recent Theoretical Framework of Acceptability (TFA) to explore participants' acceptability of the mindfulness and exercise interventions in the MOVE-Online pain management programme (PMP) and the programmes' online delivery method. METHODS: Online focus groups were carried out following the completion of the PMP. The data were analysed using template analysis in terms of the seven TFA constructs of acceptability [(i) Perceived Effectiveness, (ii) Affective Attitude, (iii) Self-Efficacy, (iv) Ethicality, (v) Burden, (vi) Opportunity Costs and (vii) Intervention Coherence]. RESULTS: Twenty-one participants took part in the focus groups. Five of the seven TFA constructs of acceptability were identified in the analysis. The participants perceived the intervention to have been effective at achieving the goals of the PMP (TFA construct: (i) Perceived Effectiveness), to have supported their emotional management ((ii) Affective Attitude), promoted long term self-directed engagement ((iii) Self-Efficacy), fostered a valued group environment ((iv) Ethicality) and the online delivery of the programme reduced the physical burden associated with participation at an in-person PMP ((v) Burden). CONCLUSION: The results of the study supports the utility of the TFA as a tool to explore the multi-dimensional construct of acceptability for the participants in the MOVE-Online programme.

This investigation contributes to the understanding of acceptability as a complex multidimensional construct and emphasises the importance of considering the multiple dimensions when evaluating participants interpretations of novel complex interventions.Results suggest that participants found a pain management programme delivered in a live, online, interactive format to be acceptable, and it may be useful for rehabilitation professionals as an option for chronic pain management.

Co-Design of a website for women with pelvic organ prolapse: A study protocol.

Background: Despite high reported prevalence of pelvic organ prolapse (POP), women report difficulties accessing evidence-based and reliable information about the condition. Many rely on social media and other popular and highly visible internet platforms which have been found to contain poor quality information that is difficult for the average patient to understand. The aim of the study is to co-design an information website for premenopausal women with POP. The website design will be based on the Website Developmental Model for the Healthcare Consumer (WDMHC) framework. Methods: A four phase process will be utilised as per the WDMHC framework: 1) User, task and environmental analysis; 2) Functional and representational analysis; 3) Cognitive walkthrough, keystroke level model, heuristic testing; 4) Content based testing, expert testing and user-based testing.Ethics approval has been obtained (LS-23-19-Carroll-Ful). Two groups of stakeholders will be recruited (i) patient group (ii) healthcare professional (HCP) group. Patient participants will be recruited from an online pelvic floor dysfunction (PFD) support group (n=950 members). A website designer and HCP stakeholders involved in the multidisciplinary team caring for women with POP will be invited to participate.Both groups will participate in separate co-design online workshops. Focus group workshops will be video-recorded, transcribed and imported into NVivo. Themes and subthemes will be developed.The website will be designed and disseminated to all participants for feedback. Cognitive walkthrough and heuristic testing will be undertaken. Following this, necessary modifications will be made to the website. Participants will then complete a modified System Usability Scale (SUS) and the eHealth Impact Questionnaire, while five HCPs will complete the DISCERN instrument. Conclusion: This study will inform the design and testing of an information website for women with POP. The website design and content will be informed by patient and HCP stakeholder voices and the health literacy literature.

Proof of concept of prehabilitation: a combination of education and behavioural change, to promote physical activity in people with fibromyalgia.

OBJECTIVES: To establish proof of concept of a prehabilitation intervention, a combination of education and behavioural change, preceding a physical activity programme in people with fibromyalgia (FM). SETTINGS: Open-label, feasibility clinical trial. PARTICIPANTS: Eleven people with FM (10 women). INTERVENTIONS: The prehabilitation intervention consisted of 4 weeks, 1 weekly session (~1 to 1.5 hours), aimed to increase self-efficacy and understand why and how to engage in a gentle and self-paced physical activity programme (6 weeks of walking with telephone support). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was the acceptability and credibility of the intervention by means of the Credibility/Expectancy Questionnaire. Secondary outcomes comprised scales to measure FM severity, specific symptoms and sedentary behaviour. An exit interview was conducted to identify the strengths and weaknesses and barriers to the intervention. RESULTS: One participant dropped out due to finding the walking programme excessively stressful. Participants expected the intervention would improve their symptoms by 22%-38% but resulted in 5%-26% improvements. Participants would be confident in recommending this intervention to a friend who experiences similar problems. The interviews suggested that the fluctuation of symptoms should be considered as an outcome and that the prehabilitation intervention should accomodate these fluctuation. Additional suggestions were to incorporate initial interviews (patient-centred approach), to tailor the programmes to individuals' priorities and to offer a variety of physical activity programmes to improve motivation. CONCLUSIONS: This feasibility study demonstrated that our novel approach is acceptable to people with FM. Future interventions should pay attention to flexibility, symptoms fluctuation and patients support. TRIAL REGISTRATION NUMBER: NCT03764397.

Biopsychosocial profile of women with pelvic organ prolapse: A systematic review.

Female pelvic organ prolapse is a common condition associated with significant impact on women's lives from a biopsychosocial perspective. The aim of this systematic review is to identify, appraise and summarize the biopsychosocial profile of women with pelvic organ prolapse. Searches were completed from inception to October 2022 from PubMed, Web of Science, EMBASE, CINAHL, Cochrane, PsycINFO and PEDro using a search string and in line with the Preferred Reporting Information for Systematic reviews and Meta-Analyses protocol. English language studies (randomized controlled trials, cohort studies, case-control studies, qualitative research) investigating female pelvic organ prolapse and using a validated patient-reported outcome measure and validated pelvic organ prolapse objective measurement were examined. Two reviewers independently screened titles, abstracts and full articles for eligibility. Data extraction included participant characteristics, pelvic organ prolapse grading and outcome measures. Risk of bias was assessed using the appropriate Joanna Briggs Institute Tool. Baseline mean score for each questionnaire or questionnaire domain in each category was presented in tertiles (low, moderate and high impact) to allow simple classification of impact. Of 8341 articles identified, 18 were included (n = 2075 women, age range = 22-85 years, parity range = 0-10). One objective outcome measure graded pelvic organ prolapse: Pelvic Organ Prolapse Quantification measurement. Eleven validated patient-reported outcome measures were utilized; two pelvic organ prolapse-specific (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, Pelvic Organ Prolapse Quality of Life Questionnaire), the remainder pelvic health (International Consultation on Incontinence Questionnaire-Vaginal Symptoms, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, Pelvic Floor Distress Inventory-20, Incontinence Impact Questionnaire-7, Female Sexual Function Index, Urinary Distress Inventory-6, Kings Health Questionnaire, Pelvic Floor Impact Questionnaire-7) or general health questionnaires (Short Form-36). Patient-reported outcome measures included in the review reported moderate levels of pain with sexual intercourse and low levels of bodily pain. Pelvic organ prolapse had a low to moderate impact in sleep/energy and quality of life and sexual function domains. Its impact on physical symptoms and general health perception domains was low. Patient-reported outcome measures results for physical functioning varied from low to high impact. More impact was demonstrated when using pelvic organ prolapse-specific patient-reported outcome measures. There are opportunities for improvement in the use of patient-reported outcome measures in clinical research which would facilitate increased understanding of the biopsychosocial profile of women with pelvic organ prolapse.

Mindfulness Combined With Exercise Online (MOVE) Compared With a Self-management Guide for Adults With Chronic Pain: A Feasibility Randomized Controlled Trial.

OBJECTIVE: Limited studies exist combining mindfulness-based stress reduction (MBSR) and exercise in a pain management programme (PMP), with none thus far delivering a combined intervention as an online PMP. This study aimed to explore the acceptability and feasibility of a combined MBSR and exercise online PMP for adults with chronic pain and to examine the feasibility of conducting a randomized controlled trial (RCT) comparing MBSR and exercise delivered online with an online self-management guide. MATERIALS AND METHODS: A feasibility RCT was conducted with participants randomized into the MOVE group (8-wk MBSR and exercise live online) or the self-management (SM) group (8-wk online self-management guide). Primary outcomes included recruitment, attrition, intervention adherence, and satisfaction. Participants wore a Fitbit watch during the study and completed patient-reported outcome measures at baseline, postintervention, and 12-week follow-up. RESULTS: Ninety-six participants were randomized and 80 (83.3%) completed the interventions. Higher mean satisfaction (Client Satisfaction Questionnaire-8) was reported in the MOVE group 26.2 (±5.5) than the SM group 19.4 (±5.6). The Patient Global Impression of Change scale showed favourable changes in both groups; 65.1% of the MOVE group, 42.3% of the SM group reporting improvement. Seventy-three participants (76.3%) adhered to wearing the Fitbit for 8 weeks. Comparable improvements postintervention and at a 12-week follow-up were noted within both groups for Brief Pain Inventory, Pain Self-Efficacy Questionnaire, Pain Disability Index, Pain Catastrophising Scale, Fear Avoidance Belief Questionnaire and Short Form-36 Health Survey. DISCUSSION: The findings suggest both interventions explored are acceptable and feasible. A fully powered RCT examining the effectiveness of MBSR combined with exercise, delivered live online is warranted.

Musculoskeletal Pain: Current and Future Directions of Physical Therapy Practice.

Musculoskeletal (MSK) pain is 1 of the most common problems managed by clinicians in MSK care. This article reviews current frameworks for the assessment and management of MSK pain within evidence-based physical therapy practice. Key considerations related to the biopsychosocial model of pain, evidence-based practice, assessment, treatment, physical activity/movement behavior, risk stratification, communication as well as patient education and self-management skills within physical therapy and physical and rehabilitation medicine are addressed. The future direction of MSK pain management is also discussed, including strategies to promote evidence-based practice, behavior change, social prescribing, and the use of technologies.

Comprehensive assessment and classification of upper and lower limb pain in athletes: a scoping review.

BACKGROUND: Upper and lower limb (peripheral) pain is prevalent in athletes. Contemporary research prioritises multidimensional pain assessment and classification. This study aims to review comprehensive athlete pain assessment practices against the reference standard (International Olympic Committee, IOC Athlete Pain framework), identifying trends and highlighting gaps. METHODS AND ANALYSIS: Six databases were searched using a comprehensive search strategy. This review followed the Joanna Briggs Institute standardised methodology for scoping reviews and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Title and abstract, full-text screening and data charting were completed by two independent reviewers. INCLUSION CRITERIA: Original research, systematic reviews and clinical practice guidelines reporting assessment or classification of pain in athletes of any age with chronic or acute peripheral pain in English on human participants from database inception. RESULTS: 470 studies with 175 different pain assessment tools were mapped against the IOC Athlete Pain Framework. Papers included tools from neurophysiological (470/100%), biomechanical (425/90%), affective (103/22%), cognitive (59/13%) and socioenvironmental (182/39%) domains. Pain classification was included in 108 studies (23%). 4 studies (0.85%) defined pain. Athletes with physical disability were included in 13 (3%) studies and no studies included athletes with intellectual disabilities. Socioeconomic factors were addressed in 29 (6%) studies. DISCUSSION: Neurophysiological and biomechanical domains are frequently addressed. Affective, socioenvironmental and cognitive tools are under-represented. Potential tools for use by researchers and clinicians are highlighted. Defining and classifying pain and determining predominant pain mechanisms is needed in both research and clinical practice. More work on underrepresented populations is needed. CONCLUSION: This review informs researchers and clinicians working with athletes in pain how pain assessment and classification is currently conducted and highlights future priorities.

Migraine in university students: A systematic review and meta-analysis.

BACKGROUND: Migraine is a complex, neurobiological disorder usually presenting as a unilateral, moderate to severe headache accompanied by sensory disturbances. Migraine prevalence has risen globally, affecting 14% of individuals and 16% of students and carries many negative impacts in both cohorts. With no recent meta-analysis of global migraine prevalence or associated factors in students, this systematic review and meta-analysis were conducted. DATABASES AND DATA TREATMENT: The review was registered with PROSPERO (CRD42020167927). Electronic databases (n = 12) were searched for cross-sectional studies (1988 to August 2021, IHS criteria). Ninety-two articles were meta-analysed and 103 were narratively reviewed. The risk of bias was assessed using an established tool. RESULTS: The risk of bias ranged from low to moderate. Migraine pooled prevalence (R-Studio) was demonstrated at 19% (95% CI, 16%-22%, p < 0.001, I^2 98%): females 23% (95% CI, 19%-27%, p < 0.001), males 12% (95% CI, 9%-15%, p < 0.001). Gender (p < 0.0001), geographical region (p = 0.01), migraine types (p = 0.0002) and prevalence timeframes (p = 0.02) may be influencing the substantial heterogeneity. Migraine triggers were primarily behavioural and environmental and treatments were predominantly pharmaceutical. Impacts ranged from academic performance impairment to psychological co-morbidities. CONCLUSIONS: This study offers the most comprehensive overview of migraine prevalence and associated factors in university students. Migraine prevalence in university students has increased and has many negative effects. Enhancing migraine recognition and management at university may have positive implications for an improved educational experience, as well as for the burden migraine currently incurs, both in university and beyond. SIGNIFICANCE: This global systematic review and meta-analysis of 92 studies and narrative review of 103 studies provide the most comprehensive synthesis to date of migraine prevalence and associated factors in university students. Pooled prevalence has increased to 19%. The significant heterogeneity demonstrated is influenced by gender, geographical region, migraine type and prevalence timeframes. Students manage migraines primarily with pharmaceuticals. Further studies conducted in low and middle-income countries, following headache protocols and reporting frequency of treatment-seeking and medication usage are warranted.

Multidimensional pain profiling in people living with obesity and attending weight management services: a protocol for a longitudinal cohort study.

INTRODUCTION: Pain is prevalent in people living with overweight and obesity. Obesity is associated with increased self-reported pain intensity and pain-related disability, reductions in physical functioning and poorer psychological well-being. People living with obesity tend to respond less well to pain treatments or management compared with people living without obesity. Mechanisms linking obesity and pain are complex and may include contributions from and interactions between physiological, behavioural, psychological, sociocultural, biomechanical and genetic factors. Our aim is to study the multidimensional pain profiles of people living with obesity, over time, in an attempt to better understand the relationship between obesity and pain. METHODS AND ANALYSIS: This longitudinal observational cohort study will recruit (n=216) people living with obesity and who are newly attending three weight management services in Ireland. Participants will complete questionnaires that assess their multidimensional biopsychosocial pain experience at baseline and at 3, 6, 12 and 18 months post-recruitment. Quantitative analyses will characterise the multidimensional pain experiences and trajectories of the cohort as a whole and in defined subgroups. ETHICS AND DISSEMINATION: The study protocol has been approved by the Ethics and Medical Research Committee of St Vincent's Healthcare Group, Dublin, Ireland (reference no: RS21-059) and the University College Dublin Human Research Ethics Committee (reference no: LS-E-22-41-Hinwood-Smart). Findings will be disseminated through peer-reviewed journals, conference presentations, public and patient advocacy groups, and social media. STUDY REGISTRATION: Open Science Framework Registration DOI: https://doi.org/10.17605/OSF.IO/QCWUE.

eHealth interventions to support self-management: Perceptions and experiences of people with musculoskeletal disorders and physiotherapists - 'eHealth: It's TIME': A qualitative study.

BACKGROUND: There is increasing interest in the potential role of eHealth interventions to support self-management in people with musculoskeletal disorders (MSDs). The COVID-19 pandemic appears to have been a significant catalyst for the implementation of eHealth modalities into routine practice, providing a unique opportunity for real-world evaluation of this underutilized method of delivering physiotherapy. OBJECTIVE: To explore the perceptions of eHealth-mediated supported self-management from the perspective of people with MSDs and physiotherapists who work in this clinical area. METHODS: A qualitative interpretive descriptive approach was used. Semi-structured telephone interviews with 13 musculoskeletal physiotherapists and 13 people with musculoskeletal disorders were undertaken. Transcripts were analyzed using reflexive thematic analysis. RESULTS: Three main themes were identified: 1) Flexibility within a blended care model; 2) eHealth as a facilitator of self-management support; and 3) Technology: Getting it right. Participants expressed concerns about assessment and diagnosis, establishing a therapeutic relationship and felt eHealth should be reserved for follow-up purposes. There was a consistent view expressed that eHealth could facilitate aspects of self-management support. A lack of resources and suboptimal user experience remains a challenge. CONCLUSIONS: eHealth-mediated self-management support interventions were broadly acceptably, predominately as a follow-up option.

Combined online interactive mindfulness and exercise programme (MOVE-Online) compared with a self-management guide for adults with chronic pain: protocol for a randomised controlled feasibility trial.

INTRODUCTION: Online pain management programmes (PMP) have growing evidence as effective interventions for individuals with chronic pain (CP). Mindfulness-based stress reduction (MBSR) is a psychological intervention proven to be effective in the management of CP. There is also a large body of evidence for the efficacy of exercise in the management of CP however, there are limited studies combining both these interventions and none to date delivering a combined intervention in the form of an online PMP. This study aims to explore the acceptability and feasibility of delivering a combined MBSR and exercise online PMP for adults with CP, and will examine the feasibility of conducting a randomised controlled trial of a combined MBSR and exercise online programme compared with an online self-management guide. METHODS AND ANALYSIS: A parallel-group, feasibility randomised controlled trial (RCT) will be conducted among participants in Ireland, which will include an embedded qualitative study. Seventy-five participants will complete an online consent form and be individually randomised to one of two groups. Group A will participate in live online MBSR and supervised exercise sessions (2 hours MBSR, 1 hour exercise) once a week for 8 weeks. Group B will receive access to an 8-week online self-management guide, released biweekly and containing eight self-directed modules. Analyses of the feasibility study will be descriptive and will address the outcomes relating to the feasibility and acceptability of the interventions and procedures of the study including recruitment and eligibility, data collection methods, intervention adherence, engagement and attrition rates, intervention acceptability and participants' subjective perceptions of the programmes. Comparisons of clinical treatment effects, using validated patient-reported outcome measures will be explored descriptively to consider the viability of investigating a combined online MBSR and exercise intervention in a future fully powered RCT. ETHICS AND DISSEMINATION: This study was approved by the Mater Misericordiae University Hospital Institutional Review Board (1/378/2124) and the University College Dublin Human Research Ethics Committee (LS-20-76-Deegan-Doody). Informed consent will be obtained from each participant prior to randomisation. The results of this feasibility study will be published in peer-reviewed academic journals and presented at national and international conferences. TRIAL REGISTRATION: NCT04899622.

The Efficacy, Adverse Events, and Withdrawal Rates of the Pharmacological Management of Chronic Spinal Cord Injury Pain: A Systematic Review and Meta-Analysis.

OBJECTIVE: To establish the efficacy of medications, incidence of adverse events (AEs), and withdrawal rates associated with the pharmacological management of chronic spinal cord injury pain. METHODOLOGY: PubMed, MEDLINE, Embase, CINAHL, Web of Science, CENTRAL, and PsycINFO were searched (November 2017) and updated (January 2020). Two independent review authors screened and identified papers for inclusion. RESULTS: Twenty-one studies met inclusion requirements for efficacy analysis and 17 for AE and withdrawal rate analysis; no additional papers were included from the updated 2020 search. Treatments were divided into six categories: anticonvulsants (n = 6), antidepressants (n = 3), analgesics (n = 8), anti-spasticity medications (n = 2), cannabinoids (n = 1), and other (n = 2). Trials of anticonvulsants, antidepressants, and cannabinoids included long-term follow-up trials (2 weeks to 4 months), and trials of analgesics and anti-spasticity medications, among others, were short-term trials (0-2 days). Effectiveness for neuropathic pain was found for pregabalin (3/3 studies) and lidocaine (2/3 studies). Studies using ketamine also reported effectiveness (2/2), but the quality of these papers was rated as poor. The most frequently reported AEs included dizziness, dry mouth, nausea, and constipation. Pregabalin was associated with a higher risk of somnolence (risk ratio [RR] 3.15, 95% confidence interval [CI]: 2.00-4.98) and dizziness (RR 2.9, 95% CI: 1.58-5.30). Ketamine was associated with a higher risk of reduced vision (RR 9.00, 95% CI: 0.05-146.11), dizziness (RR 8.33, 95% CI: 1.73-40.10), and somnolence (RR 7.00, 95% CI: 1.73-40.1). Withdrawal rates ranged from 18.4% for antidepressants to 0-30% for anticonvulsants, 0-10% for anti-spasticity medications, 0-48% for analgesics, 28.6% for cannabinoids, and 0-22.2% for other medications. CONCLUSION: Pregabalin was found to be effective for neuropathic pain vs placebo. Cannabinoids were ineffective for neuropathic pain. AEs are a common cause for withdrawal. The nature of AEs was poorly reported, and AE reporting should be improved in future randomized controlled trials.

Does changing weight change pain? Retrospective data analysis from a national multidisciplinary weight management service.

BACKGROUND: Musculoskeletal (MSK) pain is common in obese populations. Multidisciplinary Tier 3 weight management services (WMS) are effective in reducing weight; however, MSK pain as an outcome is not routinely reported post-WMS interventions. METHODS: Following ethical approval this retrospective design study using anonymized data from a national WMS established changes in anthropometric and pain prevalence and intensity scores as well as establishing variables predictive of achieving clinically significant changes (CSC) in pain scores. RESULTS: Of the 806 patients registered to the WMS (January 2011-February 2015), 59% (n = 476; CI = 56-62) attended their reassessments at 6 months. The overall mean age was 45.1 ± 12 years and 62% (n = 294) were female. At baseline 70% (n = 281; CI = 65-75) reported low back pain (LBP) and 59% (n = 234; CI = 54-64) had knee pain. At reassessment 37.3% (n = 177) of patients lost ≥5% body weight, 58.7% (n = 279) were weight stable (5% weight loss or gain) and 4.0% (n = 19) gained ≥5% body weight. Low back and knee pain prevalence reduced significantly for those who lost ≥5% body weight. Variables predictive of a CSC in LBP numerical rating scale (NRS) score included a higher baseline NRS score, weighing more, and rating losing weight as being important (p < 0.05). Higher baseline NRS and being younger resulted in higher odds of a CSC in knee pain NRS (p < 0.05). CONCLUSIONS: Overall this WMS was effective for clinical weight loss. For those who lost most weight prevalence of knee and LBP reduced. Imbedding pain management strategies within WMS's may provide a more holistic approach to obesity management. SIGNIFICANCE: Weight loss can reduce musculoskeletal pain, particularly for those who lose more weight. Imbedding pain management strategies within these services may provide a more holistic approach to obesity management.

An internet-delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: A randomized controlled trial.

BACKGROUND: Chronic pain is common after spinal cord injury (SCI) and dedicated SCI cognitive behavioural therapy pain management programmes (CBT-PMPs) have a growing evidence base to support their uptake clinically. The development of internet-delivered treatment options may overcome barriers to the access and uptake of centre-based programmes. This study examines such an approach on quality of lie (QoL), pain, mood and sleep. METHODS: Adults with SCI pain (>3 months) were recruited and randomly assigned to the intervention or control group. The intervention comprised a six module CBT-PMP delivered once weekly. A blinded assessor determined changes in self-reported outcome measures post-intervention and at 3 months. Linear mixed models and effect sizes based on changes between groups were reported. Significance was set p < 0.05. RESULTS: The recruitment rate was 32% (intervention n = 35, control n = 34), and the drop-out rate at 3 months was 26%. On average, participants accessed three (SD 2.1) of six modules. While no difference in QoL was reported, a significant group*time interaction was found for NRS of current pain (χ2  = 8.22, p = 0.016), worst pain (χ2  = 11.20, p = 0.004), and Brief Pain Inventory (interference) (χ2  = 6.924, p = 0.031). Moderate to large effect sizes favouring the intervention were demonstrated at each time point for the pain metrics (Cohen's d: 0.38-0.84). At 3-month follow-up, 48% of the intervention group rated themselves improved or very much improved (p < 0.05). CONCLUSIONS: This study demonstrates the potential of an internet-delivered SCI specific CBT-PMP in reporting significant statistical and clinical benefit in pain intensity and interference. Strategies to improve engagement are needed.

The impact of health literacy on health outcomes in individuals with chronic pain: a cross-sectional study.

OBJECTIVE: To establish if health literacy (HL) is linked to poorer outcomes and behaviours in patients with chronic pain. DESIGN: A prospective cross-sectional observational study. SETTING: Multidisciplinary out-patient pain clinics in three university teaching hospitals. PATIENTS: New patients (n=131) referred to the pain clinic with a history of chronic pain (>12 weeks). METHODS: A questionnaire was distributed to chronic pain patients attending their first appointment. Those eligible for inclusion were newly referred patients who had pain lasting longer than three months. The questionnaire comprised the following sections: demographics, chronic pain status and disease-related knowledge, quality of life (SF-36), beliefs (Beliefs About Pain Control Questionnaire), and a validated HL tool (Newest Vital Sign). RESULTS: Of the 131 participants recruited, 54% had inadequate HL. The group was subsequently stratified according to HL level. In bivariate analysis, inadequate HL was associated with older age (p<0.001), being unemployed or retired (p=0.005), less education (p<0.001), lower income, increased comorbidities (p=0.038), being less likely to utilise allied health services (p=0.001), poorer disease-related knowledge (p=0.002), and poorer beliefs about pain (p<0.05). In multivariate analysis, disease-related knowledge (OR 2.5, 95%CI 1.0 to 6.3, p=0.05) and beliefs about pain (B=-2.3, S.E=0.9, p=0.01) remained independently associated with HL. CONCLUSION: Inadequate HL is prevalent in chronic pain patients, and may impact on the development of certain characteristics necessary for effective self-management.

An investigation of healthcare utilization and its association with levels of health literacy in individuals with chronic pain.

OBJECTIVE: Chronic pain patients are frequent and recurrent users of health services, which may have an impact on levels of health literacy (HL). Therefore, the aim of the present study was to investigate associations between healthcare utilization and varying levels of HL in individuals with and without chronic pain. METHODS: A cross-sectional questionnaire was distributed in three pain clinics in Dublin, Ireland, comprising a demographic section, a validated HL assessment tool (Newest Vital Sign) and self-reported healthcare utilization in the previous year (i.e., general practitioner [GP] visits, accident and emergency room attendance, hospital services and allied health services). Patients with chronic pain, and a control group (no pain) were recruited. RESULTS: Overall, 262 participants were recruited: those with chronic pain (n = 131) and controls (n = 131). Those in the chronic pain group were more likely to be female (p = 0.004), have less education (p = 0.01), be unable to work (p < 0.001), have a lower monthly income (p = 0.001), be more likely to have a medical card (i.e., free access to public health services) (p = 0.002) and have a greater number of comorbidities (p < 0.0001). Although bivariate analyses demonstrated increased healthcare utilization in chronic pain patients (i.e., GP visits, hospital services and allied therapies; p < 0.05), there was no difference in HL levels between groups in multivariate analysis (chronic pain: 54%, n = 71; control group 49%, n = 64; p = 0.39). Higher educational attainment, greater levels of income and being younger remained independently associated with higher levels of HL. CONCLUSIONS: Further research is needed to understand the nature of how HL is acquired, both from individual and organizational perspectives. Once this has been established, it may facilitate the development or advancement of current HL-sensitive management strategies.