Pain neuroscience education and physical exercise for patients with chronic spinal pain in primary healthcare: a randomised trial protocol.

BACKGROUND: Chronic musculoskeletal pain affects more than 20% of the population, and the prevalence is increasing, causing suffering, loss of quality of life, disability, and an enormous expenditure on healthcare resources. The most common location for chronic pain is the spine. Many of the treatments used are mainly passive (pharmacological and invasive) and poor outcomes. The treatments currently applied in the public health system do not comply with the recommendations of the main clinical practice guidelines, which suggest the use of educational measures and physical exercise as the first-line treatment. A protocol based on active coping strategies is described, which will be evaluated through a clinical trial and which could facilitate the transfer of the recommendations of the clinical practice guidelines to a primary care setting. METHODS: Randomised and multicentre clinical trials, which will be carried out in 10 Primary Care centres. The trial will compare the effect of a Pain Neuroscience Education program (six sessions, 10 h) and group physical exercise (18 sessions program carried out in six weeks, 18 h), with usual care physiotherapy treatment. Group physical exercise incorporates dual tasks, gaming, and reinforcement of contents of the educational program. The aim is to assess the effect of the intervention on quality of life, as well as on pain, disability, catastrophism, kinesiophobia, central sensitisation, and drug use. The outcome variables will be measured at the beginning of the intervention, after the intervention (week 11), at six months, and a year. DISCUSSION: Therapeutic interventions based on active coping strategies are essential for the treatment of chronic pain and the sustainability of the Public Health System. Demonstrating whether group interventions have an effect size is essential for optimising resources in such a prevalent problem. TRIAL REGISTRATION: NCT03654235 "Retrospectively registered" 31 August 2018.

Reductions in kinesiophobia and distress after pain neuroscience education and exercise lead to favourable outcomes: a secondary mediation analysis of a randomized controlled trial in primary care.

ABSTRACT: Pain neuroscience education combined with exercise (PNE + exercise) is an effective treatment for patients with chronic spinal pain. Yet, however, little is known about its underlying therapeutic mechanisms. Thus, this study aimed to provide the first insights by performing a novel mediation analysis approach in a published randomized controlled trial in primary care where PNE + exercise was compared with standard physiotherapy. Four mediators (catastrophizing, kinesiophobia, central sensitization-related distress, and pain intensity) measured at postintervention and 3 outcomes (disability, health-related quality of life, and pain medication intake) measured at 6-month follow-up were included into the analysis. The postintervention measure of each outcome was also introduced as a competing candidate mediator in each respective model. In addition, we repeated the analysis by including all pairwise mediator-mediator interactions to allow the effect of each mediator to differ based on the other mediators' values. Postintervention improvements in disability, medication intake, and health-related quality of life strongly mediated PNE + exercise effects on each of these outcomes at 6-month follow-up, respectively. Reductions in disability and medication intake were also mediated by reductions in kinesiophobia and central sensitization-related distress. Reductions in kinesiophobia also mediated gains in the quality of life. Changes in catastrophizing and pain intensity did not mediate improvements in any outcome. The mediation analyses with mediator-mediator interactions suggested a potential effect modification rather than causal independence among the mediators. The current results, therefore, support the PNE framework to some extent as well as highlight the need for implementing the recent approaches for mediation analysis to accommodate dependencies among the mediators.

COVID-19 Pandemic Control Measures and Their Impact on University Students and Family Members in a Central Region of Spain.

The first waves of the COVID-19 pandemic were times of great change in the lives of university students and their families in Spain. The aim of this study was to explore the psychosocial aspects and preventive measures carried out during the COVID-19 pandemic by students and family members of the nursing degree students of the University of Valladolid (Spain). The number of people surveyed was 877, by means of an ad hoc questionnaire. Relationships between variables were established by means of the Chi-square test and Student's t-test. In addition, multivariate logistic regression was generated. The significance level used was 0.05. Students and family members maintained preventive measures= such as hand washing, correct use of masks =in closed places, avoiding crowds and maintaining social distance, but at low rates (close to 20% in all cases). Regarding psychosocial aspects, 41.07% of the participants suffered from anxiety and loneliness, while 5.2% needed to take drugs to reduce anxiety or sleep and 66.07% were dependent on technology. Suicidal behavior is related to stress, anxiety, loneliness, poor family relationships, psychotropic drug use and technology abuse. The pandemic has caused life changes in university students and their families at the psychosocial level, generating high figures of suicidal ideation regardless of age. Preventive measures adopted to control the pandemic have not been followed for the most part.

Effects of a Family Caregiver Care Programme in Musculoskeletal Pain and Disability in the Shoulder-Neck Region-A Randomised Clinical Trial.

Life expectancy in Spain has increased and older people need more health care to improve their quality of life. The high demands of the population sometimes collapse health services, making them insufficient to cover their needs, which leads to the development of "non-professional caregivers". These caregivers have suffered musculoskeletal injuries of the cervical spine and shoulders and should be guided and assessed on ergonomics, biomechanics, or kinesiotherapy. However, there are no interventions to help them care for themselves. This study presents the application of a physical exercise programme to prevent these disorders in women caregivers of dependent patients. It consists of a randomised controlled clinical trial with two groups: both received a family caregiver care programme, and the intervention group also received a physical therapeutic exercise programme for 12 weeks. A total of 62 caregivers completed the study, who were mostly daughters or wives of dependents. Of these, 70.97% presented a "moderate" pain intensity and a cervical disability of 13.72 ± 7.64 points in the NDI questionnaire in the initial evaluation. In the intervention group of caregivers, there was a significant decrease in the pain intensity and a significant increase (p < 0.05) in all cervical joint amplitude movements. Caregivers present a high prevalence of musculoskeletal disorders. The physical exercise programme was effective in reducing the intensity of pain, lumbar disability, and cervical disability of the family caregivers.

Musculoskeletal Pain in Family Caregivers: Does a Therapeutic Physical Program in Primary Care Work? A Randomized Controlled Trial.

Background: Family caregivers play a crucial role in the overall healthcare system and in our society. The elderly population is significantly increasing, which creates a high demand for family caregivers. Few studies have investigated the impact of caregiving on musculoskeletal pain or proposed an active approach for dealing with it. Objectives: To determine and characterize musculoskeletal pain in female family caregivers (FFCs) and assess the effects of adding a therapeutic exercise program to a family caregiver care program (FCCP) on the quality of life, physical conditions, and psychological well-being of FFCs. Methods: A multicenter randomized controlled clinical trial was conducted with 68 FFCs recruited in two public healthcare areas. The intervention and control groups received the same conventional FCCP for 6 h across 4 sessions. The intervention group received an additional 36 sessions of physical therapeutic exercise (PTE) program over 12 weeks. Results: All caregivers reported having pain in particular locations. Lower back pain and neck pain were the locations most frequently cited, with a prevalence of 69.4% and 56.7%, respectively. In total, 80% of participants presented moderate pain intensity. The intervention group showed a significant decrease in the intensity of the pain (p < 0.001), as well as in anxiety, depression, subjective burden perception (p < 0.01), and quality-of-life variables, including MCS (mental component summary) (p < 0.05) and PCS (physical component summary) (p < 0.001). Conclusions: A PTE program improved the musculoskeletal pain of FFCs in a clinically relevant way. The caregivers who improved the most were those who initially presented the most intense pain, had the greatest levels of disability, and had the lowest quality of life.

Effectiveness of a Physical Therapeutic Exercise Programme for Caregivers of Dependent Patients: A Pragmatic Randomised Controlled Trial from Spanish Primary Care.

Female family caregivers (FFCs) constitute one of the basic supports of socio-health care for dependence in developed countries. The care provided by FFCs may impact their physical and mental health, negatively affecting their quality of life. In order to alleviate the consequences of providing care on FFCs, the Spanish Public Health System has developed the family caregiver care programme (FCCP) to be applied in primary care (PC) centres. The effectiveness of this programme is limited. To date, the addition of a physical therapeutic exercise (PTE) programme to FCCP has not been evaluated. A randomised multicentre clinical trial was carried out in two PC centres of the Spanish Public Health System. In total, 68 FFCs were recruited. The experimental group (EG) performed the usual FCCP (4 sessions, 6 h) added to a PTE programme (36 sessions in 12 weeks) whereas the control group performed the usual FCCP performed in PC. The experimental treatment improved quality of life (d = 1.17 in physical component summary), subjective burden (d = 2.38), anxiety (d = 1.52), depression (d = 1.37) and health-related physical condition (d = 2.44 in endurance). Differences between the groups (p < 0.05) were clinically relevant in favour of the EG. The experimental treatment generates high levels of satisfaction.

Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial.

Chronic musculoskeletal pain affects more than 20% of the population, leading to high health care overload and huge spending. The prevalence is increasing and negatively affects both physical and mental health, being one of the leading causes of disability. The most common location is the spine. Most treatments used in the Public Health Services are passive (pharmacological and invasive) and do not comply with current clinical guidelines, which recommend treating pain in primary care (PC) with education and exercise as the first-line treatments. A randomized multicentre clinical trial has been carried out in 12 PC centres. The experimental group (EG) conducted a program of pain neuroscience education (6 sessions, 10 h) and group physical exercise with playful, dual-tasking, and socialization-promoting components (18 sessions in 6 weeks, 18 h), and the control group performed the usual physiotherapy care performed in PC. The experimental treatment improved quality of life (d = 1.8 in physical component summary), catastrophism (d = 1.7), kinesiophobia (d = 1.8), central sensitization (d = 1.4), disability (d = 1.4), pain intensity (d = 3.3), and pressure pain thresholds (d = 2). Differences between the groups (p < 0.001) were clinically relevant in favour of the EG. Improvements post-intervention (week 11) were maintained at six months. The experimental treatment generates high levels of satisfaction.

Musculoskeletal Pain and Non-Classroom Teaching in Times of the COVID-19 Pandemic: Analysis of the Impact on Students from Two Spanish Universities.

The lockdown, due to the coronavirus, has led to a change in lifestyle and physical activity in Spanish university students. The objective of this study was to analyze the prevalence of musculoskeletal pain and changes in physical activity and self-perceived stress in the student bodies of two Spanish Universities during the lockdown. A cross-sectional study was carried out in a sample of 1198 students (70.6% women). The main instruments used for measuring were the Standardized Kuorinka Modified Nordic Questionnaire and the Perceived stress scale (the questionnaire regarding the practice of physical activity). A reduction in the prevalence of musculoskeletal pain (p < 0.001) was identified in the sample of men and women, an increase (12.5%) in the frequency of carrying out physical activity from moderate to frequent, and the preference for strength training (15.1%), especially among women, was identified. All of this may be taken into account by health institutions when implementing measures to encourage physical activity in both suitable amounts and types, which improves the quality of life of the students.