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1.
Spine (Phila Pa 1976) ; 46(19): 1344-1353, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34517404

RESUMO

STUDY DESIGN: RAND/UCLA Appropriateness Method (RUAM) applied to chiropractic manipulation for patients with chronic low-back pain (CLBP) and chronic neck pain (CNP). OBJECTIVE: Determine the rate of appropriate care provided by US chiropractors. SUMMARY OF BACKGROUND DATA: Spinal manipulation has been shown effective for CLBP and CNP but may not be appropriate for all patients with these conditions. METHODS: Ratings of the appropriateness of spinal and cervical manipulation previously developed by two RUAM expert panels were applied to data abstracted from random samples of patient charts from chiropractors in six US regions to determine the appropriateness of manipulation for each patient. RESULTS: Of 125 chiropractors sampled, 89 provided charts that could be abstracted. Of the 2128 charts received, 1054 were abstracted. Charts received but not abstracted included 460 that were unusable (e.g., illegible), and 555 did not have CLBP or CNP. Across the abstracted charts 72% had CLBP, 57% had CNP, and 29% had both; 84% of patients with CLBP and 86% with CNP received manipulation. Patients with CLBP who had minor neurologic findings, sciatic nerve irritation, or no joint dysfunction were significantly less likely to receive manipulation. Patients with CNP who had substantial trauma etiology, no joint dysfunction, or no radiographs were significantly less likely to receive manipulation. Most manipulation for CLBP (64%) was appropriate and most manipulation for CNP (93%) was for patients where appropriateness was uncertain or equivocal. The proportions of patients receiving inappropriate manipulation for either condition were low (1%-3%) as were the numbers of patients presenting to these chiropractors for which manipulation was inappropriate. CONCLUSION: Chiropractors in this US sample tend to provide manipulation to very few patients with CLBP or CNP for which it is inappropriate. However, more research is needed to determine which patients with CNP benefit from manipulation.Level of Evidence: 4.


Assuntos
Quiroprática , Dor Crônica , Dor Lombar , Manipulação Quiroprática , Manipulação da Coluna , Dor Crônica/diagnóstico , Dor Crônica/terapia , Humanos , Dor Lombar/diagnóstico , Dor Lombar/terapia , Cervicalgia/diagnóstico , Cervicalgia/terapia
2.
Artigo em Alemão | MEDLINE | ID: mdl-34507384

RESUMO

The number of non-surgical patients in the hospital setting with pain due to medical conditions or comorbidities and/or invasive procedures or treatments is high. Compared to perioperative pain management, the portion of patients and/or conditions that require more than an approach focused on pharmacological treatment of nociceptive pain is considerably higher. Rather, treatment often requires the differentiated use of co-analgesics, non-pharmacological treatments, physiotherapy, occupational therapy, psychological assessment and interventsions and educational approaches, ideally in the form of closely coordinated interdisciplinary treatment. The assessment and treatment of acute and especially chronic pain should follow the biopsychosocial concept of pain, especially if risk factors for chronification have been identified, if patients receive high-dose therapy with analgesics or have preexisting a chronic pain disorder.


Assuntos
Dor Crônica , Manejo da Dor , Analgésicos/uso terapêutico , Dor Crônica/terapia , Humanos , Pacientes Internados , Medição da Dor
3.
Trials ; 22(1): 586, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479613

RESUMO

BACKGROUND: Non-specific chronic neck pain (NCNP) is a common musculoskeletal disorder which has caused a huge economic burden due to its expensive health costs and high re-occurrence rate. Yijinjing and Tuina are widely used for non-specific chronic neck pain in China. But there is little scientific evidence to evaluate their efficacy for NCNP. The aim of this research is to compare the efficacy of Yijinjng combined with Tuina versus Tuina for patients with NCNP. METHODS/DESIGN: A randomized controlled trial in which 102 patients with non-specific chronic neck pain will be recruited and randomly allocated to either the Tuina group or the Yijinjng combined with Tuina group in a 1:1 ratio. The interventions for both groups will be carried out three times a week for 8 weeks. The patients in the two groups will receive follow-up 1 month after the intervention. The primary outcome will be the changes in the visual analog scale (VAS). Secondary outcomes will be measured by the Neck Disability Index (NDI), Self-Rating Anxiety Scale (SAS), and Tissue Hardness and Active Range of Motion (AROM). The data will be analyzed at the baseline, 4 weeks during the intervention, at the end of the intervention, and 1 month after the intervention. The significance level sets as 5%. The safety of interventions will be evaluated after each treatment session. DISCUSSION: The purpose of this trial is to determine whether Yijinjing combined with Tuina is not inferior to Tuina for patients with NCNP. This study will provide clinicians and stakeholders much-needed knowledge for a complementary and alternative therapy for patients with non-specific chronic neck pain. TRIAL REGISTRATION: ChiCTR registry (ChiCTR) 2000036805 . Registered on August 25, 2020.


Assuntos
Dor Crônica , Cervicalgia , Dor Crônica/diagnóstico , Dor Crônica/terapia , Humanos , Cervicalgia/diagnóstico , Cervicalgia/terapia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Resultado do Tratamento
4.
Artigo em Inglês | MEDLINE | ID: mdl-34444389

RESUMO

The INYBI is an instrument used to release the suboccipital myofascial area. There is scarce evidence of its efficacy. A randomized controlled, double-blinded, longitudinal and prospective trial was performed. Ninety-six subjects (aged 29.47 ± 5.16 years) (70 women) with chronic neck pain were randomly assigned to the manual suboccipital inhibition technique (MSIT), instrumental suboccipital inhibition (INYBI) or the INYBI plus upper cervical manipulation technique (INYBI + UCMT) groups and received two sessions with a week interval between them. The Neck Disability Index was used before the first intervention and two weeks after the second intervention. Pre- and post-measurements were taken on both intervention days for pressure pain threshold of the upper trapezius and suboccipital muscles, self-perceived pain and cervical range of motion. In spite of a significant general improvement in time that was found for the three groups for all of the outcome measurements (p < 0.05 in all cases), no between-groups differences were found (p > 0.05 in all cases), with the exception of self-perceived pain for left rotation (p = 0.024), with the MSIT group showing the lower improvement. However, the higher degree of within-group improvements was found for the INYBI + UCMT group. It was concluded that the myofascial release therapy in the suboccipital area is effective in patients with chronic neck pain, either through a manual application or by means of the INYBI tool. Moreover, the addition of craniocervical manipulation achieved the higher within-group improvements, but with no statistical significance.


Assuntos
Dor Crônica , Manipulação da Coluna , Dor Crônica/terapia , Feminino , Humanos , Cervicalgia/terapia , Estudos Prospectivos , Amplitude de Movimento Articular
5.
J Transl Med ; 19(1): 357, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407840

RESUMO

BACKGROUND: The prevalence of chronic pain conditions is growing. Low back pain was the primary cause of disability worldwide out of 156 conditions assessed between 1990 and 2016, according to the Global Burden of Disease Study. Conventional medical approaches have failed to identify effective and long-lasting approaches for the management of chronic pain, and often fail to consider the multiple domains that influence overall health and can contribute to the pain experience. Leading international organizations that focus on pain research have stated the importance of considering these other domains within holistic and multidisciplinary frameworks for treating pain. While the research behind the theoretical link between these domains and chronic pain outcomes has expanded greatly over the last decade, there have been few practical and feasible methods to implement this type of care in normal clinical practice. METHODS: The purpose of this manuscript is to describe an implementation protocol that is being used to deliver a complex holistic health intervention at multiple sites within a large government health system, as part of a larger multisite trial for patients with chronic low back pain. The Move to Health program developed by the US Army Medical Command was tailored for specific application to patients with low back pain and begins by providing an empirical link between eight different health domains (that include physical, emotional, social, and psychological constructs) and chronic low back pain. Through a six-step process, a health coach leverages motivational interviewing and information from a personal health inventory to guide the patient through a series of conversations about behavioral lifestyle choices. The patient chooses which domains they want to prioritize, and the health coach helps implement the plan with the use of SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goals and a series of resources for every domain, triaged from self-management to specialist referral. DISCUSSION: Complex interventions described in clinical trials are often challenging to implement because they lack sufficient details. Implementation protocols can improve the ability to properly deliver trial interventions into regular clinical practice with increased fidelity. TRIAL REGISTRATION: Implementation of this intervention protocol was developed for a clinical trial that was registered a priori (clinicaltrials.gov #NCT04172038).


Assuntos
Dor Crônica , Dor Lombar , Dor Crônica/terapia , Humanos , Dor Lombar/terapia
6.
J Int Med Res ; 49(8): 3000605211038457, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34459276

RESUMO

OBJECTIVE: In this analysis, we examined differences between rechargeable and non-rechargeable spinal cord stimulation (SCS) devices in patients with pain. METHODS: We conducted a retrospective, longitudinal claims data analysis using a German research database comprising 5 million statutory insured patients (2012-2017). Outcomes of demographics, patient pathways, and health care resource utilization (HCRU) in patients with initial SCS were collected. RESULTS: Of 150 patients in the database, 73 (49%) received a rechargeable device and 77 (51%) a non-rechargeable device. The average age was 62.5 years (51% female and 49% male patients). A significant decrease over a 3-year follow-up was observed in analgesic prescriptions (-18%), number of patient visits to a physician, and number of patients who were hospitalized. HCRU-related figures for patients with non-rechargeable neurostimulators increased in the last follow-up year whereas the group receiving rechargeable neurostimulators showed a steady decrease. CONCLUSIONS: SCS seems to be an effective way for patients with chronic pain to decrease pain and improve quality of life. Rechargeable devices seem to be superior to non-rechargeable devices owing to greater longevity and were found to be associated with continuous reduction of pain diagnoses, hospitalization, physician visits, and use of pain medication in our study.


Assuntos
Dor Crônica , Estimulação da Medula Espinal , Dor Crônica/terapia , Análise de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos
7.
Rev Neurol (Paris) ; 177(7): 838-842, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34384626

RESUMO

Spinal cord stimulation (SCS) is used for more than 40years to treat localized chronic medically refractory neuropathic pain involving limb(s) and trunk. The most frequent indications remain complex regional pain syndrome (CRPS) failed back surgery syndrome (FBSS), and peripheral neuropathy. Stimulation-induced paresthesias, perceived by the patient, prevent blinded evaluation and increase the placebo effect, decreasing the credibility of the tonic SCS efficacy. Retrospective studies reported that about 50% of the patients are improved more than 50% at short-term, but long-term improvement is less. Several comparative randomized trials (RCT) are now available. In CRPS, a RCT demonstrated the superiority of SCS plus physiotherapy compared to physiotherapy alone. In FBSS, two RCTs have shown that SCS was superior to reoperation and conventional medical treatment, (CMM) respectively. New stimulation waveforms, namely burst, high frequency (10KHz) stimulation and close-loop SCS, have been proposed recently to avoid the perception of paresthesias and/or increase the pain relief. RCTs in FBSS have suggested that these new SCS modalities were as least as efficient than conventional tonic SCS and perhaps slightly superior. Two RCTs confirmed SCS efficacy in painful diabetic neuropathy in comparison with CMM. Complications are frequent (hardware dysfunction or migration, superficial infection) but exceptionally serious. Consequently, the risk/benefit ratio is favorable to SCS, considering that chronic pain patients undergoing this procedure are usually resistant to all the other therapies.


Assuntos
Dor Crônica , Síndrome Pós-Laminectomia , Neuralgia , Estimulação da Medula Espinal , Dor Crônica/terapia , Síndrome Pós-Laminectomia/terapia , Humanos , Neuralgia/terapia , Estudos Retrospectivos , Medula Espinal , Resultado do Tratamento
8.
Rev Neurol (Paris) ; 177(7): 843-848, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34384628

RESUMO

Neuropathic pain is frequent in the general population, with 7 to 10% of adults presenting with chronic neuropathic pain. To date, the gold standard to evaluate treatments is based on randomized controlled trials. Nonetheless, such design is run on a limited sample and for a limited period. Moreover, many treatments will never be compared directly in sufficiently large and representative populations. A way to overcome several of these limitations is to use real-world data. Indeed, the International Association for the Study of Pain (IASP) includes a special interest group focusing on pain registries and promoting the use of such approaches. In this short narrative review, several of the main chronic pain registries are presented. The strengths and weaknesses of this approach are presented. Indication bias is frequent in observational studies because the choice of treatment is generally influenced by the patients' characteristics. However, a propensity score can be computed to adjust for these differences. The use of propensity score is briefly explained. Some data specific to neuropathic pain are discussed.


Assuntos
Dor Crônica , Neuralgia , Adulto , Dor Crônica/epidemiologia , Dor Crônica/terapia , Humanos , Neuralgia/diagnóstico , Neuralgia/epidemiologia , Neuralgia/terapia , Sistema de Registros
9.
Pain ; 162(9): 2446-2455, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34448755

RESUMO

ABSTRACT: Psychosocial treatments for chronic pain produce favorable outcomes. However, we still do not know precisely by what mechanisms or techniques these outcomes are wrought. In secondary analyses of a 10-week group intervention study comparing the effects of literacy-adapted cognitive behavioral therapy (CBT) with literacy-adapted pain education (EDU) among patients with chronic pain, low-socioeconomic status, and low literacy, the Learning About My Pain trial, we examined whether pain catastrophizing was a mechanism specific to CBT. Participants (N = 168) completed mechanism and outcome measures weekly for the 10 weeks of group treatment. Analyses revealed that (1) pain catastrophizing was reduced similary across CBT and EDU; (2) lagged analyses indicated that previous week reductions in pain catastrophizing predicted next week reductions in pain intensity and pain interference; (3) cross-lagged analyses indicated that previous week reductions in pain intensity and interference predicted next week reductions in pain catastrophizing; and (4) the relationships between pain catastrophizing and pain intensity and interference were moderated by session progression such that these links were strong and significant in the first third of treatment, but weakened over time and became nonsignificant by the last third of treatment. Results suggest the existence of reciprocal influences whereby cognitive changes may produce outcome improvements and vice versa. At the same time, results from analyses of changes in slopes between pain catastrophizing and outcomes indicated that CBT and EDU were successful in decoupling pain catastrophizing and subsequent pain intensity and interference as treatment progressed. Results provide further insights into how psychosocial treatments for chronic pain may work.


Assuntos
Dor Crônica , Terapia Cognitivo-Comportamental , Catastrofização , Dor Crônica/terapia , Humanos , Resultado do Tratamento
10.
J Bodyw Mov Ther ; 27: 294-299, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391248

RESUMO

PURPOSE: To investigate the effects of Pilates exercise on improving health-related quality of life in people living with chronic low back pain. METHODS: This was a single-blind, randomised clinical trial. Thirty-nine physically active subjects aged between 30 and 70 years with nonspecific chronic low back pain for more than three months were recruited. The study employed a pretest-posttest design, with a 4 -, 8 -, and 26-week follow-up. For eight weeks, the intervention group participated in a group-supervised, mat-based Pilates program, while the control group received the usual pharmacologic and rehabilitation standard of care, including patient education on chronic low back pain. The primary outcome was self-perceived health status measured using the EQ-5D questionnaire in a structured form and a visual analogue scale. Secondary outcomes included intensity of pain and degree of disability. RESULTS: By the end of the 8-week Pilates program, the intervention group achieved a better health-related quality of life on the EQ-5D visual analogue score than the control group. In assessing the trends in each individual group regarding pain, the intervention group demonstrated an earlier pain reduction than the control group that lasted until the end of the trial. CONCLUSIONS: An 8-week supervised Pilates-based core exercise program is an effective therapeutic modality for improving self-perceived health status in patients with chronic low back pain. This finding could inform clinicians of better alternatives when they suggest exercise interventions for chronic low back pain.


Assuntos
Dor Crônica , Técnicas de Exercício e de Movimento , Dor Lombar , Pré-Escolar , Dor Crônica/terapia , Terapia por Exercício , Humanos , Dor Lombar/terapia , Projetos Piloto , Qualidade de Vida , Método Simples-Cego , Resultado do Tratamento
11.
J Bodyw Mov Ther ; 27: 647-653, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391301

RESUMO

BACKGROUND: Myofascial pain syndrome (MPS) is the most common form of muscle disorders. Traditional Thai massage (TM) and muscle energy (ME) technique have been used to treat patients with MPS for long time but head-to-head comparisons of these interventions have not been established. AIM: The aim of the current study was to compare the effects of TM and the ME technique on pain intensity (PI), pressure pain threshold (PPT), neck disability (ND), and neck flexion range of motion (NFROM) in patients with chronic neck pain associated with myofascial trigger points (MTrPs). DESIGN: A randomized, single-blinded clinical trial. SETTING: Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University. POPULATION: Forty-five patients with chronic neck pain associated with MTrPs were recruited. METHODS: The patients were randomly allocated to the TM, ME, or control groups, with each having eight treatment sessions over a period of two weeks. PI, PPT, ND, and NFROM were assessed before, immediately after the first treatment session, and one day after the last treatment session. RESULTS: Based on the results, both TM and the ME technique resulted in a significant improvement in all parameters (p < 0.05) compared to the control group. Additionally, no significant difference was observed between TM and the ME technique in all parameters. CONCLUSIONS: The application of TM or the ME technique can be a practical alternative approach for the treatment of chronic neck pain associated with MTrPs.


Assuntos
Dor Crônica , Síndromes da Dor Miofascial , Dor Crônica/terapia , Humanos , Massagem , Músculos , Síndromes da Dor Miofascial/terapia , Cervicalgia/terapia , Limiar da Dor , Tailândia , Resultado do Tratamento , Pontos-Gatilho
12.
Artigo em Inglês | MEDLINE | ID: mdl-34444594

RESUMO

BACKGROUND: Chronic neck pain is common in the adult general population. Although the etiology of chronic neck pain is under debate, it is clear that chronic neck pain is multifactorial, with both physical and psychosocial contributors. OBJECTIVE: To determine whether adding pain neuroscience education (PNE) to therapeutic exercises improved their pain-disability index, pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy in subjects with chronic nonspecific neck pain. METHODS: This study was a three-arm randomized control trial. Seventy-two patients with chronic nonspecific neck pain were allocated to three groups: therapeutic exercises alone (n = 24), combined (therapeutic exercises + PNE; (n = 24), and a control group (n = 24). Each program took place three times a week, lasting for six weeks. The disability index, pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy measured by the Neck Pain and Disability Scale (NPAD), Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ), and Pain Self-Efficacy Questionnaire (PSEQ), respectively. Participants were assessed before and after the six-week intervention, and there was no further follow-up. RESULTS: For the outcomes NPAD, PSC, and FABQ, combined intervention demonstrated more significant improvements than therapeutic exercises alone (p ≤ 0.05), whereas no differences were observed between the two intervention groups for PSEQ (p = 0.99). In addition, significant differences were favoring experimental groups versus control for all outcomes (p ≤ 0.001). CONCLUSION: Therapeutic exercises combined with pain neuroscience education reduced the pain-disability index, pain catastrophizing, and fear-avoidance beliefs more than therapeutic exercises alone in patients with chronic neck pain. For pain self-efficacy, there was no statistically significant difference between the two intervention groups; however, the combined group had a more significant effect than therapeutic exercises alone. Further studies with longer periods and follow-up are required.


Assuntos
Dor Crônica , Cervicalgia , Adulto , Catastrofização , Dor Crônica/terapia , Terapia por Exercício , Humanos , Cervicalgia/terapia , Medição da Dor
13.
Curr Opin Anaesthesiol ; 34(5): 634-640, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34435603

RESUMO

PURPOSE OF REVIEW: The introduction of ultrasound guidance in interventional pain management leads to the development of new interventional pain management techniques. Ultrasound-guided (UG) interventional pain management is rapidly developing and increasingly more commonly used, due to its many advantages over traditional radiologic imaging modalities. This review will summarize recent literature around novel interventional pain techniques with ultrasound guidance published over the last 18 months. RECENT FINDINGS: Many new interventional pain management methods have been described in the last few years in the literature. The use of ultrasonography in interventional pain management played a crucial role in these developments. This review includes newly described interventional methods in the literature. The review particularly focussed on the methods that are used to treat the pain in the hip, shoulder, knee, and lumbar area. These new techniques hold promise for significant improvements in the efficacy and safety of interventional pain management. SUMMARY: There have been many innovations in UG interventional procedures, however, some of them require more rigorous validation before their widespread use.


Assuntos
Dor Crônica , Dor Crônica/diagnóstico por imagem , Dor Crônica/terapia , Humanos , Manejo da Dor , Ultrassonografia , Ultrassonografia de Intervenção
14.
Complement Ther Clin Pract ; 44: 101439, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34246129

RESUMO

INTRODUCTION: Active treatments focused on improvement in motor function are postulated in chronic low back patients (CLBP). OBJECTIVE: to establish the acute effects of PNF exercise on the postural control strategy. METHODS: The sway of the body was tested before intervention in fifty-three CLBP patients and after that participants were randomly assigned into the intervention PNF group (n = 25). Mean velocity (VEL) and sample entropy (SEn), over the center of pressure in the mediolateral (ML) and anterior-posterior (AP) planes served to estimate the postural strategy and automaticity levels in the neuromuscular controller. Tandem and one-leg standing tests (OLST) with eyes open and eyes closed were used. RESULTS: Pain intensity decreased after the intervention. The VEL was no longer vision-dependent in both planes. The SEn decreased immediately after the exercise and either returned to or even exceeded the baseline values in the OLST ML plane. CONCLUSION: A single session of PNF exercise may have a beneficial effect on pain and postural control in CLBP patients. The statistically significant pain relief combined with newly acquired better control of posture may have encouraged the PNF group participants to a subconscious exploration of the stability area. Postural movements were more automatized in OLST in the delayed test.


Assuntos
Dor Crônica , Dor Lombar , Exercícios de Alongamento Muscular , Dor Crônica/terapia , Humanos , Dor Lombar/terapia , Equilíbrio Postural , Postura
15.
J Int Med Res ; 49(7): 3000605211027435, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34275375

RESUMO

OBJECTIVE: Interdisciplinary pain rehabilitation (IPR) usually employs a cognitive-behavioural therapeutic (CBT) approach. However, there is growing support for chronic pain treatments based on acceptance and commitment therapy (ACT). Most studies of ACT and CBT for chronic pain have evaluated their effects after psychological interventions, not after IPR. We compared the results of an ACT-based IPR programme with two CBT-based IPR programmes. METHODS: We used a retrospective multicentre pretest-posttest design with matched patient groups at three centres. Data were collected from the Swedish Quality Registry for Pain Rehabilitation before and after IPR participation. Participants completed the EQ-5D health-related quality of life questionnaire, the Chronic Pain Acceptance Questionnaire, (CPAQ) and the Hospital Anxiety and Depression Scale (HADS). Analyses were performed to compare the effects of the different interventions. RESULTS: Neither EQ-5D nor HADS depression scores were affected by the psychological approach used. The score changes on both CPAQ subscales (activity engagement and pain willingness) indicated significant improvements between admission and discharge at all centres. CONCLUSIONS: These findings indicate the effectiveness of using psychological approaches to manage chronic pain. Both CBT and ACT had a beneficial effect on most of the assessed health-related parameters.


Assuntos
Terapia de Aceitação e Compromisso , Dor Crônica , Terapia Cognitivo-Comportamental , Ansiedade/terapia , Dor Crônica/terapia , Depressão/terapia , Humanos , Qualidade de Vida , Estudos Retrospectivos , Suécia
16.
Trials ; 22(1): 486, 2021 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-34303381

RESUMO

BACKGROUND: Critically ill patients with COVID-19 are an especially susceptible population to develop post-intensive care syndrome (PICS) due to acute respiratory distress syndrome (ARDS). Patients can suffer acute severe pain and may have long-term mental, cognitive, and functional health deterioration after discharge. However, few controlled trials are evaluating interventions for the prevention and treatment of PICS. The study hypothesis is that a specific care program based on early therapeutic education and psychological intervention improves the quality of life of patients at risk of developing PICS and chronic pain after COVID-19. The primary objective is to determine whether the program is superior to standard-of-care on health-related quality of life at 6 months after hospital discharge. The secondary objectives are to determine whether the intervention is superior to standard-of-care on health-related quality of life, incidence of chronic pain and degree of functional limitation, incidence of anxiety, depression, and post-traumatic stress syndrome at 3 and 6 months after hospital discharge. METHODS: The PAINCOVID trial is a unicentric randomized, controlled, patient-blinded superiority trial with two parallel groups. The primary endpoint is the health-related quality of life at 6 months after hospital discharge, and randomization will be performed with a 1:1 allocation ratio. This paper details the methodology and statistical analysis plan of the trial and was submitted before outcome data were available. The estimated sample size is 84 patients, 42 for each arm. Assuming a lost to follow-up rate of 20%, a sample size of 102 patients is necessary (51 for each arm). DISCUSSION: This is the first randomized clinical trial assessing the effectiveness of an early care therapeutic education, and psychological intervention program for the management of PICS and chronic pain after COVID-19. The intervention will serve as proof of the need to implement early care programs at an early stage, having an incalculable impact given the current scenario of the pandemic. TRIAL REGISTRATION: This study is being conducted in accordance with the tenets of the Helsinki Declaration and has been approved by the authors' institutional review board Comité Ético de Investigación Clínica del Hospital Clínic de Barcelona (approval number: HCB/2020/0549) and was registered on May 9, 2020, at clinicaltrials.gov ( NCT04394169 ).


Assuntos
COVID-19 , Dor Crônica , Dor Crônica/diagnóstico , Dor Crônica/terapia , Estado Terminal , Humanos , Intervenção Psicossocial , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Resultado do Tratamento
17.
Artigo em Inglês | MEDLINE | ID: mdl-34209604

RESUMO

The prevalence of chronic pain in Spain is 15%. The objective of this study was to evaluate the efficacy of mindfulness-based cognitive therapy on patients with chronic pain. A quasi-experimental design of repeated measures pre- and post-test (N = 57) was carried out at three hospitals from the province of Alicante. Self-reported assessment measurements of pain intensity, anxiety-depression symptoms, perception of health status, interference of pain on sleep, self-efficacy in pain, acceptance, and mindfulness attitude were included. The T-test indicates significant differences in intensity of present pain, mental quality of life, and depression (medium effect sizes), as well as in self-efficacy: total score, symptom management and pain control (medium effect sizes), sleep disturbances and quantity of sleep (large effect sizes). MBCT is effective in reducing many symptoms in patients with chronic pain, although its maintenance needs to be further investigated.


Assuntos
Dor Crônica , Terapia Cognitivo-Comportamental , Atenção Plena , Dor Crônica/terapia , Humanos , Qualidade de Vida , Espanha , Resultado do Tratamento
18.
Life Sci ; 282: 119805, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34237313

RESUMO

AIMS: Widespread pain and headache are common in Gulf War Illness with suboptimal treatments available. We tested the efficacy of non-invasive, transcutaneous vagal nerve stimulation (nVNS) for relief of widespread pain and migraine in Gulf War Veterans with GWI. MAIN METHODS: A 10-week double-blind, randomized controlled trial of nVNS used the gammaCore (ElectroCore, Inc.) compared to sham stimulation with the same device followed by a 10-week open-label follow up with active nVNS. The primary outcome was a numerical pain rating at the end of the blinded period. Secondary outcomes included physical function, migraine frequency and severity, and impression of change during the blinded and open-label periods. Two-factor MANOVA models tested for significant differences between groups from baseline to end of the blinded period and during the open-label period. KEY FINDINGS: Among 27 participants enrolled and issued a nVNS device, there was a slight improvement in pain ratings from baseline to the end of the blinded phase [6.18 (±0.82) vs. 5.05 (±2.3); p = 0.040] which did not differ between active and sham nVNS. Physical function was also slightly improved overall without group differences. There were no significant changes in migraine frequency or severity during the blinded period. Twenty participants started in the open-label phase; no statistically significant changes in pain, physical function, migraine measures, or impression of change were noted during this phase. SIGNIFICANCE: Veterans with GWI actively treated with nVNS reported no improvement in either widespread pain or migraine frequency or severity relative to Veterans with GWI who received sham nVNS.


Assuntos
Dor Crônica/terapia , Síndrome do Golfo Pérsico/terapia , Estimulação do Nervo Vago/métodos , Adulto , Dor Crônica/etiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Golfo Pérsico/complicações , Resultado do Tratamento , Estimulação do Nervo Vago/efeitos adversos , Estimulação do Nervo Vago/instrumentação , Veteranos
19.
J Oral Rehabil ; 48(10): 1118-1128, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34273180

RESUMO

BACKGROUND: Aims of the study were to: Implement supported self-management for chronic primary oro-facial pain in a clinical setting. Evaluate its impact on consultation rates, pain severity, interference with life and patient experience. METHODS: Sixty-six patients with chronic primary oro-facial pain received the intervention at a facial pain clinic at Leeds Dental Institute, UK. Brief Pain Inventory (BPI) scores measured pain severity and interference with life before and after the intervention. Process mining outlined patient care pathways. Monthly consultation rates measured 12 months before and after the intervention were used to evaluate burden on healthcare services and economic impact. Patient feedback was assessed via Patient and Public involvement discussion groups. RESULTS: Mean BPI scores significantly improved after intervention-from 5.70 (SD 1.89) to 3.78 (SD 2.34) (p < .001); mean pain interference score reduced from 19.95 (SD 9.41) to 12.05 (SD 9.64) (p < .001). Average monthly consultations significantly (p = .001) reduced from 0.42/month before the intervention to 0.16/month after the intervention. Economic assessment showed cost savings of £293 per patient per year. Process mining showed high rates of service usage with 31 patients also attending 51 other specialist services between them. Patient and Public Involvement discussion groups with 5 patients identified that the intervention was a 'constant companion' and should be implemented at the outset in the care pathway. CONCLUSION: Supported self-management for chronic primary oro-facial pain has a positive impact on health outcomes (physical functioning, pain intensity and patient experience), as well as service usage and healthcare costs when implemented in a secondary care clinical setting. Reconfiguring current care pathways to upscale early implementation of such interventions should be a priority for future testing.


Assuntos
Dor Crônica , Autogestão , Transtornos da Articulação Temporomandibular , Dor Crônica/terapia , Face , Dor Facial/terapia , Humanos , Transtornos da Articulação Temporomandibular/terapia
20.
BMJ Open ; 11(7): e046025, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34244262

RESUMO

INTRODUCTION: Chronic, non-cancer, axial or radicular spinal pain is a common condition associated with considerable socioeconomic burden. Clinicians frequently offer patients various interventional procedures for the treatment of chronic spine pain; however, the comparative effectiveness and safety of available procedures remains uncertain. METHODS: We will conduct a systematic review of randomised controlled trials that explores the effectiveness and harms of interventional procedures for the management of axial or radicular, chronic, non-cancer, spine pain. We will identify eligible studies through a systematic search of Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science from inception without language restrictions. Eligible trials will: (1) enrol primarily adult patients (≥18 years old) with axial or radicular, chronic, non-cancer, spine pain, (2) randomise patients to different, currently available, interventional procedures or to an interventional procedure and a placebo/sham procedure or usual care, and (3) measure outcomes at least 1 month after randomisation.Pairs of reviewers will independently screen articles identified through searches and extract information and assess risk of bias of eligible trials. We will use a modified Cochrane instrument to evaluate risk of bias. We will use frequentist random-effects network meta-analyses to assess the relative effects of interventional procedures, and five a priori hypotheses to explore between studies subgroup effects. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in evidence for each outcome, including direct, indirect and network estimates. ETHICS AND DISSEMINATION: No research ethics approval is required for this systematic review, as no confidential patient data will be used. We will disseminate our findings through publication in a peer-reviewed journal and conference presentations, and our review will support development of a BMJ Rapid Recommendations providing contextualised clinical guidance based on this body of evidence. PROSPERO REGISTRATION NUMBER: CRD42020170667.


Assuntos
Dor Crônica , Dor Musculoesquelética , Adolescente , Adulto , Dor Crônica/terapia , Humanos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto
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